Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO:
KRS
304.1-010,
304.12-020,
304.1-050,
304.3-270,
304.4-010,
304.14-120,
304.14-190,
304.17-380,
304.17A-005,
304.17A-095,
304.17A-096,
304.17C-010(5)
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
304.2-110(1) authorizes the
Commissioner of Insurance to promulgate reasonable administrative regulations
necessary for or as an aid to the effectuation of the Kentucky Insurance Code,
as defined by
KRS
304.1-010.
KRS
304.14-420 requires the commissioner to
promulgate administrative regulations to establish minimum standards for the
readability and intelligibility of insurance contracts. This administrative
regulation establishes rate and form filing procedures for health
insurers.
Section 1. Definitions.
(1) "Commissioner" means the Commissioner of
Insurance as defined by
KRS
304.1-050(1).
(2) "Department" means Department of
Insurance as defined by
KRS
304.1-050(2).
(3) "Filing entity" means a health insurer
authorized to transact business in Kentucky or an entity authorized by that
health insurer to submit filings on its behalf.
(4) "Health benefit plan" is defined by
KRS
304.17A-005(22).
(5) "Health policy form" or "form" means:
(a) Any application, policy, certificate,
contract, rider, or endorsement; and
(b) Includes advertising for long-term care,
short-term nursing, and Medicare Supplement products.
(6) "Limited health service benefit plan" is
defined by
KRS
304.17C-010(5).
Section 2. Filing Procedures.
(1) A health insurance rate and form filing
shall be accompanied by a Face Sheet and Verification Form, Form
HIPMC-F1.
(2) An individual health
insurance rate filing shall be accompanied by an Individual Health Forms
Actuarial Certification Form, Form HIPMC-R4.
(3) An insurer issuing, delivering, or
renewing a health benefit plan or a limited health service benefit plan shall
complete and attach to each plan filed a Health Summary Sheet - Form Filings,
Form HL-F11.
(4) Except for a
health benefit plan rate filing pursuant to
KRS
304.17A-095, a rate filing shall be
accompanied by a Rate Filing Information Form, Form HIPMC-R36.
(5) If a rate or form filing submitted by a
health insurer does not contain the information necessary to review the filing,
the department shall use an Additional Health Information Request Form, Form
HIPMC-F16, to request submittal of the incomplete information.
(6) Each form shall be identified by a unique
form number in the lower left-hand corner of the first page of the form. Other
numbers shall not appear in close proximity to the form number.
(7) Each submission shall be accompanied by a
submittal letter listing:
(a) All forms by
number with a brief description of each form; and
(b) All of the forms that will be submitted
together.
(8) If a form
is submitted with alternate pages or alternative benefits, the submittal letter
required by subsection (7) of this section shall:
(a) State under what conditions each
alternate page or alternative benefit may be used; and
(b) Identify by a unique form number each
alternate page or alternative benefit.
(9) If a filing entity files a form
containing variable text, the filing entity shall file an explanation of each
variation the health insurer proposes to use.
(10) Except for an insert page or alternate
page, each form shall contain the corporate name and address of the health
insurer.
(11) A form that contains
advertising or marketing material shall be filed separately from all other
forms.
(12) If a new form is
submitted, the filing entity shall identify the unique features of the
form.
(13) If a filing includes a
form which was previously disapproved by the department, the filing entity
shall assign the form a new form number.
Section 3. Filing Entity. A filing entity may
include in a filing multiple forms or documents pertaining to a single line of
insurance, filed together on a particular date.
Section 4. Date of Filing. Pursuant to
KRS
304.4-010(2), a fee payable
under the Kentucky Insurance Code shall be collected in advance, unless an
insurer is excluded from paying the fee in advance pursuant to
KRS
304.4-010(3). The period of
time in which the commissioner may approve or disapprove a filing shall not
commence, and the submission shall not be given a filing date, until the
following are received by the department:
(1)
The rate or form filing;
(2) The
appropriate fee pursuant to
806 KAR
4:010; and
(3) The form or letter of explanation
required by Sections 2 and 6 of this administrative regulation, as
appropriate.
Section 5.
Use of Forms and Rates.
(1) A form or rate
filing shall not be used in Kentucky until:
(a) The form or rate has been approved by the
department, which shall occur within the sixty (60) day timeframe identified in
KRS
304.14-120(2) except as
follows:
1. If the 60th day falls on a
weekend or holiday, the 60th day shall be the following business day;
and
2. If the commissioner grants
an extension of the sixty (60) day time period required for approval or
disapproval of a form or rate, and the insurer does not submit a corrected form
or rate or additional requested information at least five (5) days prior to the
expiration of the extended time period, the filing shall be disapproved;
and
(b) If a rate for
the form is required by
KRS
304.14-120 to be approved, the appropriate
rate schedule has been approved.
(2) A document subject to a filed-only
process, including advertisements and provider directories, shall be:
(a) Filed with the department; and
(b) Subject to review in accordance with
KRS
304.14-120.
Section 6. Form Revision. If a filing
includes a form that amends, replaces, or supplements a form which has been
previously filed, it shall be accompanied by a letter of explanation from the
filing entity which identifies:
(1) All
changes contained in the newly filed form;
(2) The form being replaced;
(3) The date the replaced form was:
(a) Approved;
(b) Disapproved;
(c) Withdrawn; or
(d) Submitted; and
(4) The effect the changes have upon the
policy or the rates applicable to the policy.
Section 7. Rate Revision and Annual Rate
Filings.
(1) The following shall be included
and properly completed in a filing for rate revision or annual rate filing:
(a) Signed actuarial memorandum, in
accordance with
806 KAR
17:070, Section 4;
(b) New rate sheet, in accordance with
806 KAR
17:070, Section 3; and
(c) Forms required by Section 4 of this
administrative regulation.
(2) An appropriate fee, shall be submitted
with each filing, pursuant to
806 KAR
4:010.
Section 8. Officer Signature. A change of
signature of the executing officer on a policy form shall not, because of this
change alone, require a new filing.
Section
9. Electronic Filings.
(1) A
health insurer may file a rate or form electronically through the National
Association of Insurance Commissioners' electronic system for rate and form
filings via the Web site
www.serff.com.
(2) An electronic filing as identified in
subsection (1) of this section shall be in lieu of a paper filing.
Section 10. Incorporation by
Reference.
(1) The following material is
incorporated by reference:
(a) Form HIPMC-F1,
"Face Sheet and Verification Form", 10/2021 edition;
(b) Form HL-F11, "Health Summary Sheet - Form
Filings", 07/2020 edition;
(c) Form
HIPMC-R4, "Individual Health Forms Actuarial Certification Form", 07/2020
edition;
(d) Form HIPMC-R36, "Rate
Filing Information Form", 07/2020 edition; and
(e) Form HIPMC-F16, "Additional Health
Information Request Form", 07/2020 edition.
(2) This material may be inspected, copied or
obtained, subject to applicable copyright law, at the Department of Insurance,
Mayo-Underwood Building, 500 Mero Street, Frankfort, Kentucky 40601, Monday
through Friday, 8 a.m. to 4:30 p.m. This material is also available on the
department's Web site at:
https://insurance.ky.gov/ppc/CHAPTER.aspx.
STATUTORY AUTHORITY:
KRS
304.2-110(1),
304.14-420
