Individual Kentucky Health Insurance Regulations: What You Need to Know

Because the state of Kentucky does not require individual health insurance plans to be guarantee issue, health insurance providers in Kentucky have the right to decline an application. When requests for coverage go through the medical underwriting process, the insurers will review the health history and identify any pre-existing medical condition. It is during this process that the medical insurance provider in Kentucky can either decline coverage based on the health history or offer a plan with limitations denying coverage on certain pre-existing conditions.

There are a variety of individual Kentucky health insurance plans available, and the benefits will vary from plan to plan depending on the insurer and type of policy. There are, however, a set of standardized health policies that must be offered by all insurers in Kentucky. These include plans like HMO, PPO and indemnity.

Insurance companies offering coverage in Kentucky are able to use a one-year period, excluding coverage of pre-existing conditions, and are allowed to review the consumer's health history in the 6 months prior to new coverage. If the consumer is coming directly from another qualified health policy, the insurers must provide credit based on the prior coverage. However, consumers with previous health problems can expect higher premiums even if they have had continuous coverage from another policy. The premium increase may not be more than 35% of the standard issue rate.

Small Group Kentucky Health Insurance Regulations and Guarantee Issue

In Kentucky, an employee group with two to 50 people qualifies for small group health insurance. Kentucky law states that small groups must receive coverage on a guarantee issue basis, meaning a group cannot be declined coverage due to health history or current medical conditions.

It is the employer's discretion whether or not he/she wants to mandate a waiting period for new employees joining the employer-sponsored group Kentucky health insurance plan. The law in Kentucky states that group health insurance carriers can review the employee's health history in the past six months and can also put into place a one-year exclusionary period for applicants with pre-existing conditions who did not have prior health insurance coverage.

Health insurance companies in Kentucky must offer credit for prior coverage if there was never a coverage break longer than 63 days. When the insurance company and the employer determine the employee is eligible to join the policy, the coverage is then guaranteed and they may not decide to decline coverage due to health issues. Still, the premium rates are a result of the medical underwriting process and may vary 35% higher or lower than the indexed rate based on the health status of the group.

Understanding Kentucky COBRA and Continuation Health Insurance Coverage

COBRA benefits regulate all employer groups in Kentucky, regardless of group size. While employer groups with 20 or more employees are a part of federal COBRA regulations, groups with less than 20 employees are part of the Kentucky mini-COBRA regulations.

Mini-COBRA provides health insurance coverage in Kentucky for an individual who has had a minimum of three months prior credible plan coverage. For a mini-COBRA applicant, there is also a rule that he/she must choose the coverage within 31 days from the time the insurer sends the eligibility notice. In the case that the insurer does not provide the required notice, the applicant will have another 60 days to choose coverage and up to 90 days following the termination from employment.

COBRA continuation coverage offers an additional 18 months of coverage under the plan that is employer-sponsored. Additionally, conversion plans for individuals are available through most insurers, allowing one to convert a group health policy into a personal coverage plan.

Yet another option for Kentucky employees is the state high risk pool designed for people who have lost coverage and had 18 months of previous health coverage with no lapse exceeding 63 days.

Arming yourself with information about Kentucky laws and health insurance coverage options is essential when choosing the right plan to meet your unique health insurance needs. By taking responsibility and knowing all of your options for healthcare, you are doing the most you can to protect your health as well as your financial future. Just fill in your zip code above to get you free health insurance quotes in Kentucky.