Kentucky Health Insurance (KY)

Kentucky (KY)
Individual Health Insurance Regulations

Learn more about Kentucky Individual Health Insurance

Kentucky does not require its individual health insurance policies to be guarantee issue. Because individual health plans are medically underwritten, health insurance companies may decline an application based upon a pre-existing medical condition or past health history. During the application process, the health insurance company has the option to decline you for coverage based on the information provided in your health insurance application, offer to provide you with health insurance that includes certain limitations on pre-existing health conditions or approve your application for full coverage. Benefits for each individual health insurance policy will vary according to the specific design plan marketed by each health insurance carrier. There is a 12 month exclusionary period allowable for pre-existing conditions with a 6 month look-back clause. For those that are coming onto an individual health plan from another qualified health plan, the insurance companies are required to give credit toward prior coverage. An insurance company may also charge a higher premium for persons that have health risk concerns, but this premium increase can't exceed 35% of the standard issue rate. Kentucky also has a set of standardized health plans that must be offered by all insurance companies selling individual health insurance in the state. This includes an indemnity plan, an HMO plan and a PPO plan.

Kentucky (KY)
Small Group Health Insurance Regulations

Defined as a group of employees with numbers between 2 and 50, small group health insurance in Kentucky is issued on a guarantee issue basis. Under guarantee issue regulations, no group may be declined coverage as a result of their current or past medical history. Under an employer-sponsored group health plan, employers may require eligible employees to incur a waiting period. Once determined eligible to join the plan, issuance of health insurance coverage is guaranteed and may not be denied or altered in any way due to your health status. Under Kentucky law, group health insurance carriers have a 6 month look back period and can recognize a 12 month exclusionary period for pre-existing conditions on all applicants who do not have prior creditable coverage. Credit for prior coverage is required so long as there is no break in coverage of more than 63 days. Rates are medically underwritten and, depending on the health status of the group, may vary plus or minus 35 percent of the indexed rate.

Kentucky COBRA and Continuation Coverage

Regardless of size, all employer groups in Kentucky are regulated by some form of COBRA benefits. Employers with 20 or more employees fall under federal COBRA regulations. Employers with less than 20 employees fall under Kansas mini-COBRA laws. To be eligible for mini-COBRA an individual must have had at least 3 months of prior plan coverage to be eligible and must elect such coverage within 31 days of the notice of eligibility being sent by the insurer. If proper notice is not give, the individual will have an additional 60 days to elect coverage, up until 90 days following termination. COBRA continuation coverage provides an additional 18 months of coverage under the employer-sponsored plan. Individual conversion plans are also available from many insurance companies that will allow you to convert your group health plan into personal coverage. The state high risk pool is an alternative option of coverage for individuals who have lost their coverage and have had 18 months of prior health insurance without a lapse of more than 63 days.

(Chapter 304 of the Kentucky Insurance Code provides employees of any employer group policy to be offered COBRA for 18 months as long as they have been insured under the group plan for at least 3 months.)

Additional Kentucky Resources

• Kentucky Access
  Kentucky Access is the state run high risk pool which allows individual health insurance policies to be sold to persons who are unable to obtain private health insurance due to past or current health status.
• Kentucky Children's Health Insurance Program (KCHIP)
  KCHIP is a state run health insurance program providing health insurance coverage to low income, uninsured children in Kentucky.
• Department for Medicaid Services
  The Kentucky Department for Medicaid Services administers the Medicaid program available to individuals or families who meet the specified criteria.

KY Medical Insurance Statistics

Total Population: 4,052,000
With Health Insurance: 3,539,000 / 87.3%
Without Health Insurance: 514,000 / 12.7%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of Kentucky residents without health insurance has decreased by 1.6% 2004.

Kentucky Office of Insurance
Phone: 800-595-6053
The Kentucky Office of Insurance regulates and monitor the insurance markets and protects the Kansas consumer through the enforcement of these regulations.

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