Kentucky insurance law and regulation
News that affects your health insurance and planning
December 1, 2019 – Lafayette General Healthcare Clinic will reopen in late 2020 to treat both Medicaid and private health insurance customers in an area underserved by primary medical providers.
November 3, 2019 – The Kentucky Department of Insurance is investigating whether a Kenton County company is selling health insurance policies online without a license. Freedom Benefits is aware that there is a line between reviewing insurance news and referring to a licensed insurance exchange vs actually selling online. We anticipate more of these investigations in the future. When in doubt, look up the name of the insurance company and the insurance exchange on the state insurance department web site.
June 16, 2019 – Status of alternative non-ACA health plans: Kentucky does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage and permits insurers to sell non-compliant transitional policies in the individual market. Kentucky does not limit the sale of short-term coverage more strictly than the federal government.
March 21, 2019 – In it’s fourth attempt, the Kentucky legislature certified professional midwives over the strong opposition from the Kentucky Hospital Association and the doctors’ lobby, the Kentucky Medical Association. The American College of Obstetricians and Gynecologists was neutral. The fact it that more baby deliveries in Kentucky will be at home in the future regardless of professional licensing or financial politics.
January 1, 2019 – More than half of the state’s residents questioned by Foundation for a Healthy Kentucky did not know that the Affordable Cate Act controlled some basic everyday health care rights like the ability to cover children up to age 26 and the ability to buy coverage after a pre-existing medical condition. Despite this, Kentucky residents now support the Affordable Care Act, also known as Obamacare, by more than a 10 percentage point margin. That’s a big change since 2012 when most residents opposed those federal requirements and legal protections.
The history of health care planning in Kentucky (Information is outdated and links may be expired)
10/20/2015 Kentucky Health Cooperative that provided coverage for 51,000 members will not offer coverage for 2016. Seven other commercial companies offer coverge alternatives. Some members are concerned that the options may be unaffordable. People with cancelled policies from the cooperative can get more information by calling the state Insurance Department at 800-595-6053.
2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
7/26/2013 Affordable Smart Term Life Insurance is now available to most Kentucky residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
12/14/2012 Kentucky is one of a minority of states that will run a health insurance exchange for individuals and small businesses that is not managed by the federal government. Consumer advocates who once viewed a state-run exchange as a positive are growing concerned that the state may not be fully committed to implementing all of the funding and features expected to be part of the federal health insurance exchanges that are expected to open in the fall of 2013.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Anthem Health Plans of Kentucky and Humana Health Plan are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
12/14/2011 An open enrollment period for child-only health insurance is established in January of 2012 and 2013 for all health insurance plans in Kentucky. Details are posted in this PDF order from the insurance commissioner.
11/7/2011 Kentucky opened its Children’s Health Insurance Program (CHIP) to the kids of low-income and part-time state employees, an option that was prohibited until the passage of the 2010 health-care law. The program is jointly financed by the state and the federal government to provide coverage to the uninsured children of families who earn too much to qualify for Medicaid but cannot afford private insurance.
3/10/2011 The Kentucky Department of Insurance issued clarification of the child-only insurance order. Despite the order and additional guidance, we expect that the state’s commercial insurance companies will continue to be unwilling to issue coverage until and unless loss due to litigation or enforcement by the State is an imminent. Because this enforcement process takes time, it is of little use to children who need coverage immediately. We suggest Kentucky Access or the Federal Pre-Existing Condition Insurance Plan as immediately available alternatives.
3/1/2011 Kentucky requested an exemption from the federal Minimum Loss Ratio rules in an attempt to make more affordable health insurance choices available to consumers. Due to failed attempts to legislate Minimum Loss Ratios and control insurance company profits in the 1990s, the health insurance companies that offer the nation’s most affordable health insurance plans do not do business in Kentucky. We do not have any indication at this time of whether the state’s effort will encourage any of the carriers listed on Freedom Benefits to expand coverage offerings in Kentucky.
2/7/2011 The state’s pre-existing condition insurance plan (PCIP) monthly premium rates (per person):
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods. PCIP applicants who are approved to participate in PCIP can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses. Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the amount the plan pays for your care. If you apply for PCIP coverage on the government Web site, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed. Note that your premium may increase if you age into a higher rate tier, or if PCIP adjusts its premiums to any changes in the commercial market.
1/19/2011 Child-only health insurance for children with significant medical problems will be available through an open enrollment period mandated by federal state law during the month of July. All children, regardless of medical condition, continue to be eligible for insurance when applying as a dependent on a parent’s policy and healthy children are eligible for child-only insurance at any time. When applying for child-only insurance for more than one child, make a separate application for each child. See additional information in this separate blog post.
12/16/2010 Kentucky Cabinet for Health and Family Service officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, the Cabinet for Health and Family Service said that it would: 1) Create an interagency working group, 2) Conduct background research and analysis on the uninsured and insured populations in Kentucky, 3) Survey health insurance carriers to determine current plan designs and premium levels in the market place, 4) Perform economic and actuarial modeling to project trends of newly insured’s and the impact of merging the individual and small group markets, and 5) Visit other States with existing Exchanges to obtain detailed information on the benefits and limitations of each Exchange.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Kentucky is now available at Freedom Benefits.