Kentucky Health Insurance Guide
Kentucky Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a Kentucky resident you have a variety of private health insurance plans to choose from including individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Kentucy State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Kentucky is not a guarantee issue state. That means private insurance companies are not required to sell you an individual health insurance policy if do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health, gender, age and lifestyle habits. If you are accepted, the insurer has the right to impose an exclusionary period up to 12 months for any pre-existing conditions. Kentucky also allows insurance companies to a 6-month look-back period. If you are considered a health risk, you can be charged a higher premium. Kentucky law prohibits health insurance companies from adding elimination riders to your policy. Credit for prior coverage is required by Kentucky state law for individuals coming from another qualified health care plan. Kentucky also require that all insurance companies selling individual health plans in the state offer a set of standardized plans that include indemnity, HMO and PPO plans.
Kentucky is a guarantee issue state for group health plans issued to small businesses. If your Kentucky health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. However, a 12-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of prior creditable coverage. Credit for creditable coverage is also required if there was no break in coverage of more than 63 days. Kentucky allows group health insurance issuers to medically underwrite policies to determine the premium they will charge the entire group, although the highest premium cannot be 35% more than the standard rate.
Kentucky is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status.
Kentucky Mandated Health Benefits
Kentucky laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism
- Ambulatory Surgery
- Autism
- Bone Marrow Transplants
- Bone Mass Measurement
- Breast Reconstruction
- Contraceptives
- Dental Anesthesia
- Diabetes Supplies and Self Management
- Emergency Services
- Hearing Aids
- Home Health Care
- Hospice Care
- Mammography
- Mastectomy
- Maternity Stays
- General and Parity Mental Health
- PKU/Formula
- TMJ Disorder
- Coverage for newborns under parent's policy
- Coverage for handicapped and continuation/dependents under their parent’s policy
- Coverage for continuation/employees
- Coverage for conversion to non-groups
Types Health Insurance Plans Available in Kentucky
The following major medical health insurance plans are generally available in Kentucky. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Kentucky
Kentucy Access
Kentucky has a state-sponsored program that enables health insurance companies to sell individual policies to eligible applicants who have been denied coverage due to a pre-existing condition or chronic illness. You must have lived in Kentucky for at least 12 months and meet other eligibility requirement, based on one of six different eligibility categories. Kentucky Access offers three different plans: a traditional fee for service plan and two PPO plans. Deductibles, coinsurance and maximum out-of-pocket limits vary per plan. Premiums are based on plan selection, age and sex, change yearly and are capped at 175% of the standard risk rate for similar individual coverage. Lifetime maximum benefits range from $2 million to unlimited. Enrollment is open. There is a 12-month waiting period for benefits on pre-existing conditions, however waivers are available based on how long your previous insurance was in effect and when it expired.
Kentucky Children’s Health Insurance Program
KCHIP is the state-sponsored program providing health insurance for resident uninsured children from low-income families, who under the age of 19 and do not qualify for Medicaid. Services and benefits are comprehensive and include doctor visits and well-child care, dental care, hospitalization, vision exams and glasses, psychiatric and mental health services, lab and x-rays, hearing services, prescription drugs, immunization, speech therapy and physical therapy. Coverage is provided through an HMO. Maximum monthly premium is $20. Modest co-payments are required for some services. There may be a 6-month waiting period under some circumstances, which can be waived under some conditions. Annual renewal is required.
Regulating Agency
The Kentucky Department of Insurance is responsible for regulating Kentucky’s health insurance industry.
Get access to Kentucky health insurance quotes from http://www.einsurance.com/health-insurance.
Kentucky Department of Insurance
PO Box 517
Frankfort, KY 40602-0517
(502) 564-3630 or (800) 595-6053
http://insurance.ky.gov
Kentucky Access
PO Box 33707
Indianapolis, IN 46203-0707
(866) 405-6145
http://www.kentuckyaccess.com/index.cfm
Kentucky Children’s Health Insurance Program
(877) KCHIP-18 ((877) 524-4718)
http://kidshealth.ky.gov/en
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/