AN ACT relating to coverage for prostheses and orthoses.

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AN ACT relating to coverage for prostheses and orthoses. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
SECTION 1. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 3
IS CREATED TO READ AS FOLLOWS: 4
(1) As used in this section, "health benefit plan" has the same meaning as in KRS 5
304.17A-005, except for purposes of this section, the te rm includes student health 6
insurance offered by a Kentucky -licensed insurer under written contract with a 7
university or college whose students it proposes to insure. 8
(2) All health benefit plans shall provide coverage for prostheses and orthoses. 9
(3) The coverage required under this section: 10
(a) Shall, at a minimum, be equivalent to the coverage of, and payment for, 11
prostheses and orthoses provided for the aged and disabled under the 12
following, as amended: 13
1. 42 U.S.C. sec. 1395k; 14
2. 42 U.S.C. sec. 1395l; 15
3. 42 U.S.C. sec. 1395m; 16
4. 42 C.F.R. sec. 410.100; 17
5. 42 C.F.R. sec. 414.202; 18
6. 42 C.F.R. sec. 414.210; and 19
7. 42 C.F.R. sec. 414.228; 20
(b) To the extent not covered under paragraph (a) of this subsection, shall 21
include: 22
1. Subject to paragraph (e) of this subsection, coverage for any one (1) or 23
more prostheses and orthoses prescribed by an insured's health care 24
provider and determined by a licensed prosthetist or orthotist to be the 25
most appropriate model or models that adequately me et the medical 26
needs of the insured for purposes of each of the following: 27
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a. Completing activities of daily living; 1
b. Completing essential job-related activities; 2
c. Performing physical activities, including but not limited to 3
running, biking, swimming, and strength training; 4
d. Maximizing the insured's whole -body health, including lower 5
and upper limb function; or 6
e. Showering and bathing; 7
2. For any prosthesis or orthosis covered under this section, coverage 8
for: 9
a. All materials and components necessar y to use the prosthesis or 10
orthosis; 11
b. Instruction to the insured on using the prosthesis or orthosis; 12
and 13
c. The repair of the prosthesis or orthosis or any of its parts; and 14
3. a. Subject to subdivision b. of this subparagraph, coverage for the 15
replacement of a prosthesis or orthosis, or any of its parts, 16
covered under this section without regard to continuous use or 17
useful lifetime restrictions, if the prescribing health care 18
professional determines that a replacement or part is necessary 19
because of any of the following: 20
i. A change in the physiological condition of the patient; 21
ii. An irreparable change in the condition of the prosthesis or 22
orthosis or any of its parts; or 23
iii. The cost to repair the device or part would be more than 24
sixty percent (60%) of the cost of a replacement device or of 25
the part being replaced. 26
b. If a prosthesis or orthosis that is less than three (3) years old is 27
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being replaced, the insurer offering or providing the health 1
benefit plan may require confirmation of the need for a 2
replacement from the ordering health care professional; 3
(c) Shall not be subject to cost -sharing requirements that are applicable 4
only with respect to the coverage required under this section; 5
(d) May be subject to cost -sharing requirements if the require ments are 6
not more restrictive than the cost -sharing requirements for inpatient 7
physician and surgical services; 8
(e) May be subject to a limit of three (3) prostheses and orthoses per 9
affected limb within a three (3) year period; and 10
(f) Shall be considered habilitative or rehabilitative services and devices 11
for purposes of any federal requirements to provide coverage fo r 12
essential health benefits. 13
(4) (a) With respect to the coverage required under this section, a utilization review 14
decision rendered by an insurer or its private review agent shall: 15
1. Be made in a nondiscriminatory manner; and 16
2. Not deny coverage solely on the basis of the insured's actual or 17
perceived disability. 18
(b) An insurer or its private review agent shall provide a description of the 19
insured's rights under paragraph (a) of this subsection in: 20
1. The health benefit plan's evidence of coverage; and 21
2. Any denial letter relating to the coverage required under this section. 22
(5) If an insurer or its private review agent denies the coverage required under this 23
section based on medical necessity, the insurer or agent shall provide a denial 24
letter to the insured and the provider that: 25
(a) Is in writing; 26
(b) Explains why the claim does not meet medical necessity standards; and 27
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(c) Complies with any other applicable state and federal laws. 1
(6) (a) An insurer or administrator that utilizes a network to provide prostheses 2
and orthoses under a health benefit plan shall ensure that the network is 3
reasonably adequate and accessible with respect to the provision of 4
prostheses and orthoses required to be covered under this section. 5
(b) A reasonably adequate network, with respect to the provision of prostheses 6
and orthoses that are required to be covered under this section, shall, at a 7
minimum, offer an adequate number of accessible prosthetists or orthotists 8
in accordance with the requirements set forth for managed ca re plans in 9
KRS 304.17A-515. 10
(7) (a) By June 1 of each year, each insurer that offers or provides a health benefit 11
plan shall submit a report to the commissioner detailing the insurer's 12
experience with providing the coverage required under this section. 13
(b) The report required under paragraph (a) of this subsection shall: 14
1. Be in a form prescribed by the commissioner in an administrative 15
regulation promulgated in accordance with KRS Chapter 13A; and 16
2. With respect to the coverage required under this secti on, include the 17
following for the preceding plan year: 18
a. The number of claims received; and 19
b. The number of claims paid. 20
(c) By October 1 of each year, the commissioner shall submit a report to the 21
Legislative Research Commission, for referral to the Int erim Joint 22
Committee on Banking and Insurance, that provides the aggregated data of 23
the reports submitted under paragraph (b) of this subsection by plan year. 24
Section 2. KRS 164.2871 is amended to read as follows: 25
(1) The governing board of each state postsecondary educational institution is 26
authorized to purchase liability insurance for the protection of the individual 27
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members of the governing board, faculty, and staff of such institutions from liability 1
for acts and omi ssions committed in the course and scope of the individual's 2
employment or service. Each institution may purchase the type and amount of 3
liability coverage deemed to best serve the interest of such institution. 4
(2) All retirement annuity allowances accrued or accruing to any employee of a state 5
postsecondary educational institution through a retirement program sponsored by 6
the state postsecondary educational institution are hereby exempt from any state, 7
county, or municipal tax, and shall not be subject to execution, attachment, 8
garnishment, or any other process whatsoever, nor shall any assignment thereof be 9
enforceable in any court. Except retirement benefits accrued or accruing to any 10
employee of a state postsecondary educational institution through a ret irement 11
program sponsored by the state postsecondary educational institution on or after 12
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 13
provided in KRS 141.010 and 141.0215. 14
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 15
members of governing boards, faculty and staff of institutions of higher education 16
in this state shall not be construed to be a waiver of sovereign immunity or any 17
other immunity or privilege. 18
(4) The governing board of each state postsecondary education institution is authorized 19
to provide a self -insured employer group health plan to its employees, which plan 20
shall: 21
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 22
(b) Except a s provided in subsection (5) of this section, be exempt from 23
conformity with Subtitle 17A of KRS Chapter 304. 24
(5) A self-insured employer group health plan provided by the governing board of a 25
state postsecondary education institution to its employees shall comply with: 26
(a) KRS 304.17A-129; 27
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(b) KRS 304.17A-133; 1
(c) KRS 304.17A-145; 2
(d) KRS 304.17A-163 and 304.17A-1631; 3
(e) KRS 304.17A-261; 4
(f) KRS 304.17A-262; 5
(g) KRS 304.17A-264;[ and] 6
(h) KRS 304.17A-265; and 7
(i) Section 1 of this Act. 8
(6) (a) A self-insured employer group health plan provided by the governing board of 9
a state postsecondary education institution to its employees shall provide a 10
special enrollment period to pregnant women who are eligible for coverage in 11
accordance with the requirements set forth in KRS 304.17-182. 12
(b) The governing board of a state postsecondary education institution shall, at or 13
before the time an employee is initially offered the opportunity to enroll in the 14
plan or coverage, provide the employee a notice of the special e nrollment 15
rights under this subsection. 16
Section 3. KRS 18A.225 is amended to read as follows: 17
(1) (a) The term "employee" for purposes of this section means: 18
1. Any person, including an elected public official, who is re gularly 19
employed by any department, office, board, agency, or branch of state 20
government; or by a public postsecondary educational institution; or by 21
any city, urban -county, charter county, county, or consolidated local 22
government, whose legislative body has opted to participate in the state -23
sponsored health insurance program pursuant to KRS 79.080; and who 24
is either a contributing member to any one (1) of the retirement systems 25
administered by the state, including but not limited to the Kentucky 26
Retirement Systems, County Employees Retirement System, Kentucky 27
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Teachers' Retirement System, the Legislators' Retirement Plan, or the 1
Judicial Retirement Plan; or is receiving a contractual contribution from 2
the state toward a retirement plan; or, in the case of a public 3
postsecondary education institution, is an individual participating in an 4
optional retirement plan authorized by KRS 161.567; or is eligible to 5
participate in a retirement plan established by an employer who ceases 6
participating in the Kentucky Employees Retirement System pursuant to 7
KRS 61.522 whose employees participated in the health insurance plans 8
administered by the Personnel Cabinet prior to the employer's effective 9
cessation date in the Kentucky Employees Retirement System; 10
2. Any certified o r classified employee of a local board of education or a 11
public charter school as defined in KRS 160.1590; 12
3. Any elected member of a local board of education; 13
4. Any person who is a present or future recipient of a retirement 14
allowance from the Kentucky R etirement Systems, County Employees 15
Retirement System, Kentucky Teachers' Retirement System, the 16
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 17
Kentucky Community and Technical College System's optional 18
retirement plan authorized by KRS 161.567, except that a person who is 19
receiving a retirement allowance and who is age sixty -five (65) or older 20
shall not be included, with the exception of persons covered under KRS 21
61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 22
employed pursuant to subparagraph 1. of this paragraph; and 23
5. Any eligible dependents and beneficiaries of participating employees 24
and retirees who are entitled to participate in the state -sponsored health 25
insurance program; 26
(b) The term "health benefit plan" for the purposes of this section means a health 27
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benefit plan as defined in KRS 304.17A-005; 1
(c) The term "insurer" for the purposes of this section means an insurer as defined 2
in KRS 304.17A-005; and 3
(d) The term "managed care plan" for the purposes of this se ction means a 4
managed care plan as defined in KRS 304.17A-500. 5
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 6
recommendation of the secretary of the Personnel Cabinet, shall procure, in 7
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 8
from one (1) or more insurers authorized to d o business in this state, a group 9
health benefit plan that may include but not be limited to health maintenance 10
organization (HMO), preferred provider organization (PPO), point of service 11
(POS), and exclusive provider organization (EPO) benefit plans 12
encompassing all or any class or classes of employees. With the exception of 13
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 14
all employers of any class of employees or former employees shall enter into 15
a contract with the Personnel Cabinet prior to including that group in the state 16
health insurance group. The contracts shall include but not be limited to 17
designating the entity responsible for filing any federal forms, adoption of 18
policies required for proper plan administration, acceptanc e of the contractual 19
provisions with health insurance carriers or third -party administrators, and 20
adoption of the payment and reimbursement methods necessary for efficient 21
administration of the health insurance program. Health insurance coverage 22
provided to state employees under this section shall, at a minimum, contain 23
the same benefits as provided under Kentucky Kare Standard as of January 1, 24
1994, and shall include a mail -order drug option as provided in subsection 25
(13) of this section. All employees and other persons for whom the health care 26
coverage is provided or made available shall annually be given an option to 27
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elect health care coverage through a self -funded plan offered by the 1
Commonwealth or, if a self -funded plan is not available, from a list of 2
coverage options determined by the competitive bid process under the 3
provisions of KRS 45A.080, 45A.085, and 45A.090 and made available 4
during annual open enrollment. 5
(b) The policy or policies shall be approved by the commissioner of insurance 6
and may co ntain the provisions the commissioner of insurance approves, 7
whether or not otherwise permitted by the insurance laws. 8
(c) Any carrier bidding to offer health care coverage to employees shall agree to 9
provide coverage to all members of the state group, inc luding active 10
employees and retirees and their eligible covered dependents and 11
beneficiaries, within the county or counties specified in its bid. Except as 12
provided in subsection (20) of this section, any carrier bidding to offer health 13
care coverage to em ployees shall also agree to rate all employees as a single 14
entity, except for those retirees whose former employers insure their active 15
employees outside the state -sponsored health insurance program and as 16
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 17
(d) Any carrier bidding to offer health care coverage to employees shall agree to 18
provide enrollment, claims, and utilization data to the Commonwealth in a 19
format specified by the Personnel Cabinet with the understanding that the data 20
shall be owned by the Commonwealth; to provide data in an electronic form 21
and within a time frame specified by the Personnel Cabinet; and to be subject 22
to penalties for noncompliance with data reporting requirements as specified 23
by the Personnel Cabinet. The Per sonnel Cabinet shall take strict precautions 24
to protect the confidentiality of each individual employee; however, 25
confidentiality assertions shall not relieve a carrier from the requirement of 26
providing stipulated data to the Commonwealth. 27
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(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 1
for timely analysis of data received from carriers and, to the extent possible, 2
provide in the request -for-proposal specifics relating to data requirements, 3
electronic reporting, and penalti es for noncompliance. The Commonwealth 4
shall own the enrollment, claims, and utilization data provided by each carrier 5
and shall develop methods to protect the confidentiality of the individual. The 6
Personnel Cabinet shall include in the October annual rep ort submitted 7
pursuant to the provisions of KRS 18A.226 to the Governor, the General 8
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 9
financial stability of the program, which shall include but not be limited to 10
loss ratios, methods of risk adjustment, measurements of carrier quality of 11
service, prescription coverage and cost management, and statutorily required 12
mandates. If state self -insurance was available as a carrier option, the report 13
also shall provide a detailed financial ana lysis of the self -insurance fund 14
including but not limited to loss ratios, reserves, and reinsurance agreements. 15
(f) If any agency participating in the state -sponsored employee health insurance 16
program for its active employees terminates participation and there is a state 17
appropriation for the employer's contribution for active employees' health 18
insurance coverage, then neither the agency nor the employees shall receive 19
the state -funded contribution after termination from the state -sponsored 20
employee health insurance program. 21
(g) Any funds in flexible spending accounts that remain after all reimbursements 22
have been processed shall be transferred to the credit of the state -sponsored 23
health insurance plan's appropriation account. 24
(h) Each entity participating in the state-sponsored health insurance program shall 25
provide an amount at least equal to the state contribution rate for the employer 26
portion of the health insurance premium. For any participating entity that used 27
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the state payroll system, the employer co ntribution amount shall be equal to 1
but not greater than the state contribution rate. 2
(3) The premiums may be paid by the policyholder: 3
(a) Wholly from funds contributed by the employee, by payroll deduction or 4
otherwise; 5
(b) Wholly from funds contributed by any department, board, agency, public 6
postsecondary education institution, or branch of state, city, urban -county, 7
charter county, county, or consolidated local government; or 8
(c) Partly from each, except that any premium due for health care coverage or 9
dental coverage, if any, in excess of the premium amount contributed by any 10
department, board, agency, postsecondary education institution, or branch of 11
state, city, urban -county, charter county, county, or consolidated local 12
government for any other health care coverage shall be paid by the employee. 13
(4) If an employee moves his or her place of residence or employment out of the 14
service area of an insurer offering a managed health care plan, under which he or 15
she has elected coverage, into either the service area of another managed health care 16
plan or into an area of the Commonwealth not within a managed health care plan 17
service area, the employee shall be given an option, at the time of the move or 18
transfer, to change his or her coverage to another health benefit plan. 19
(5) No payment of premium by any department, board, agency, public postsecondary 20
educational institution, or branch of state, city, urban -county, charter county, 21
county, or consolidated local government shall constitute compensation to an 22
insured employee for the purposes of any statute fixing or limiting the 23
compensation of such an employee. Any premium or other expense incurred by any 24
department, board, agency, public postsecondary educational institution, or branch 25
of state, city, urban -county, charter county, county, or consolidated local 26
government shall be considered a proper cost of administration. 27
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(6) The policy or policies may contain the provisions with respect to the class or classes 1
of employees covered, amounts of insurance or cov erage for designated classes or 2
groups of employees, policy options, terms of eligibility, and continuation of 3
insurance or coverage after retirement. 4
(7) Group rates under this section shall be made available to the disabled child of an 5
employee regardless of the child's age if the entire premium for the disabled child's 6
coverage is paid by the state employee. A child shall be considered disabled if he or 7
she has been determined to be eligible for federal Social Security disability benefits. 8
(8) The health care contract or contracts for employees shall be entered into for a 9
period of not less than one (1) year. 10
(9) The secretary shall appoint thirty -two (32) persons to an Advisory Committee of 11
State Health Insurance Subscribers to advise the secretary or th e secretary's 12
designee regarding the state -sponsored health insurance program for employees. 13
The secretary shall appoint, from a list of names submitted by appointing 14
authorities, members representing school districts from each of the seven (7) 15
Supreme Court districts, members representing state government from each of the 16
seven (7) Supreme Court districts, two (2) members representing retirees under age 17
sixty-five (65), one (1) member representing local health departments, two (2) 18
members representing the Kentucky Teachers' Retirement System, and three (3) 19
members at large. The secretary shall also appoint two (2) members from a list of 20
five (5) names submitted by the Kentucky Education Association, two (2) members 21
from a list of five (5) names submitted by the largest state employee organization of 22
nonschool state employees, two (2) members from a list of five (5) names submitted 23
by the Kentucky Association of Counties, two (2) members from a list of five (5) 24
names submitted by the Kentucky League of Cities , and two (2) members from a 25
list of names consisting of five (5) names submitted by each state employee 26
organization that has two thousand (2,000) or more members on state payroll 27
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deduction. The advisory committee shall be appointed in January of each yea r and 1
shall meet quarterly. 2
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 3
provided to employees pursuant to this section shall not provide coverage for 4
obtaining or performing an abortion, nor shall any state funds be used for the 5
purpose of obtaining or performing an abortion on behalf of employees or their 6
dependents. 7
(11) Interruption of an established treatment regime with maintenance drugs shall be 8
grounds for an insured to appeal a formulary change through the established appeal 9
procedures approved by the Department of Insurance, if the physician supervising 10
the treatment certifies that the change is not in the best interests of the patient. 11
(12) Any employee who is eligible for and elects to participate in the state health 12
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 13
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 14
state health insurance contribution toward health care coverage as a r esult of any 15
other employment for which there is a public employer contribution. This does not 16
preclude a retiree and an active employee spouse from using both contributions to 17
the extent needed for purchase of one (1) state sponsored health insurance poli cy 18
for that plan year. 19
(13) (a) The policies of health insurance coverage procured under subsection (2) of 20
this section shall include a mail -order drug option for maintenance drugs for 21
state employees. Maintenance drugs may be dispensed by mail order in 22
accordance with Kentucky law. 23
(b) A health insurer shall not discriminate against any retail pharmacy located 24
within the geographic coverage area of the health benefit plan and that meets 25
the terms and conditions for participation established by the insurer, including 26
price, dispensing fee, and copay requirements of a mail -order option. The 27
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retail pharmacy shall not be required to dispense by mail. 1
(c) The mail -order option shall not permit the dispensing of a controlled 2
substance classified in Schedule II. 3
(14) The policy or policies provided to state employees or their dependents pursuant to 4
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 5
aid-related services for insured individuals under eighteen (18) years of age, subj ect 6
to a cap of one thousand four hundred dollars ($1,400) every thirty -six (36) months 7
pursuant to KRS 304.17A-132. 8
(15) Any policy provided to state employees or their dependents pursuant to this section 9
shall provide coverage for the diagnosis and treat ment of autism spectrum disorders 10
consistent with KRS 304.17A-142. 11
(16) Any policy provided to state employees or their dependents pursuant to this section 12
shall provide coverage for obtaining amino acid -based elemental formula pursuant 13
to KRS 304.17A-258. 14
(17) If a state employee's residence and place of employment are in the same county, 15
and if the hospital located within that county does not offer surgical services, 16
intensive care services, obstetrical services, level II neonatal services, diagnostic 17
cardiac c atheterization services, and magnetic resonance imaging services, the 18
employee may select a plan available in a contiguous county that does provide 19
those services, and the state contribution for the plan shall be the amount available 20
in the county where the plan selected is located. 21
(18) If a state employee's residence and place of employment are each located in 22
counties in which the hospitals do not offer surgical services, intensive care 23
services, obstetrical services, level II neonatal services, diagnost ic cardiac 24
catheterization services, and magnetic resonance imaging services, the employee 25
may select a plan available in a county contiguous to the county of residence that 26
does provide those services, and the state contribution for the plan shall be the 27
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amount available in the county where the plan selected is located. 1
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 2
in the best interests of the state group to allow any carrier bidding to offer health 3
care coverage u nder this section to submit bids that may vary county by county or 4
by larger geographic areas. 5
(20) Notwithstanding any other provision of this section, the bid for proposals for health 6
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 7
the statewide rating structure provided in calendar year 2003 and a bid scenario that 8
allows for a regional rating structure that allows carriers to submit bids that may 9
vary by region for a given product offering as described in this subsection: 10
(a) The regional rating bid scenario shall not include a request for bid on a 11
statewide option; 12
(b) The Personnel Cabinet shall divide the state into geographical regions which 13
shall be the same as the partnership regions designated by the Department for 14
Medicaid Services for purposes of the Kentucky Health Care Partnership 15
Program established pursuant to 907 KAR 1:705; 16
(c) The request for proposal shall require a carrier's bid to include every county 17
within the region or regions for which the bid is submitted and include but not 18
be restricted to a preferred provider organization (PPO) option; 19
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 20
carrier all of the counties included in its bid within the region. If the Personnel 21
Cabinet deems the bids submitted in accordance with this subsection to be in 22
the best interests of state employees in a region, the cabinet may award the 23
contract for that region to no more than two (2) carriers; and 24
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 25
other requirements or criteria in the request for proposal. 26
(21) Any fully insured health benefit plan or self -insured plan issued or renewed on or 27
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after July 12, 2006, to public employees pursuant to this s ection which provides 1
coverage for services rendered by a physician or osteopath duly licensed under KRS 2
Chapter 311 that are within the scope of practice of an optometrist duly licensed 3
under the provisions of KRS Chapter 320 shall provide the same paymen t of 4
coverage to optometrists as allowed for those services rendered by physicians or 5
osteopaths. 6
(22) Any fully insured health benefit plan or self -insured plan issued or renewed to 7
public employees pursuant to this section shall comply with: 8
(a) KRS 304.12-237; 9
(b) KRS 304.17A-270 and 304.17A-525; 10
(c) KRS 304.17A-600 to 304.17A-633; 11
(d) KRS 205.593; 12
(e) KRS 304.17A-700 to 304.17A-730; 13
(f) KRS 304.14-135; 14
(g) KRS 304.17A-580 and 304.17A-641; 15
(h) KRS 304.99-123; 16
(i) KRS 304.17A-138; 17
(j) KRS 304.17A-148; 18
(k) KRS 304.17A-163 and 304.17A-1631; 19
(l) KRS 304.17A-265; 20
(m) KRS 304.17A-261; 21
(n) KRS 304.17A-262; 22
(o) KRS 304.17A-145; 23
(p) KRS 304.17A-129; 24
(q) KRS 304.17A-133; 25
(r) KRS 304.17A-264;[ and] 26
(s) Section 1 of this Act; and 27
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(t) Administrative regulations promulgated pursuant to statutes listed in this 1
subsection. 2
(23) (a) Any fully insured health benefit plan or self-insured plan issued or renewed to 3
public employees pursuant to this section shall provide a special enrollment 4
period to pregnant women who are eligible for coverage in accordance with 5
the requirements set forth in KRS 304.17-182. 6
(b) The Department of Employee Insurance shall, at or before the time a public 7
employee is initially offered the opportunity to enroll in t he plan or coverage, 8
provide the employee a notice of the special enrollment rights under this 9
subsection. 10
Section 4. Sections 1, 2, and 3 of this Act apply to health benefit plans issued or 11
renewed on or after January 1, 2027. 12
Section 5. (1) Within 30 days of the effective date of this section, the 13
Department of Insurance shall submit the following to the federal Department of Health 14
and Human Services: 15
(a) The Department of Insurance' s determination as to whether any requirement 16
of Section 1 of this Act is in addition to the essential health benefits required under 17
federal law; and 18
(b) A request to confirm the determination submitted under paragraph (a) of this 19
subsection within 1 year from the date the determination was received. 20
(2) If the federal Department of Health and Human Services fails to respond to 21
the determination and request submitted under subsection (1) of this section within 1 year 22
from the date the determination was rec eived, the Department of Insurance shall consider 23
the determination submitted under subsection (1) as accepted by the federal department. 24
Section 6. Sections 1 to 4 of this Act take effect January 1, 2027. 25