State Law

KY. Rev. Statutes-Chapter 304-Subtitle 17A-Health Benefit Plans-Managed Care Plans

08/05/2023 Kentucky Section 304.17A-590

Participating provider directories


(1) An insurer that offers a managed care plan or a risk-bearing managed care plan shall notify an enrollee, in writing, of the availability, in a manner consistent with KRS 304.14-420 to 304.14-450, in writing, at the time of enrollment and thereafter upon request, and as new providers are contracted with by the plans, or as the directory may change, of a current participating provider directory providing information on a covered person’s access to primary care physicians and specialists, optometrists, chiropractors, and hospitals, including available participating physicians, optometrists, chiropractors, and hospitals, by provider category or specialty and by county. The directory shall include the following:

(a) Professional office addresses and telephone numbers for all participating providers;

(b) The benefits for each provider type;

(c) General information about the type of financial incentives between participating providers under contract with the insurer and other participating health care providers and facilities to which the participating providers refer their managed care patients; and

(d) Grievance procedures available under the plans for complaint resolutions.

In addition to making the information available in a printed document, an insurer may also make the information available in an accessible electronic format.

(2) The insurer shall promptly notify each covered person on the termination or withdrawal from the insurer’s provider network of the covered person’s designated primary care provider.

(3) The provisions of this section shall be implemented prior to any open enrollment period for which the effective date of coverage will be January 1, 1999, or for which the effective date shall commence after an open enrollment period, and shall continue for each open enrollment period thereafter.