900 Ky. Admin. Regs. 13:010

Current through Register Vol. 51, No. 5, November 1, 2024

Section 900 KAR 13:010 - Guaranteed Acceptance Program (GAP) reporting requirements

RELATES TO: KRS 304.17B-001, 304.17B-021(2), 304.17B-023

NECESSITY, FUNCTION, AND CONFORMITY: KRS 304.17B-031(1) requires the Office of Health Data and Analytics to promulgate administrative regulations necessary to carry out the provisions of KRS 304.17B-001 to 304.17B-031. KRS 304.17B-023 establishes reporting requirements for the Guaranteed Acceptance Program for a participating insurer and KRS 304.17B-021(2) establishes requirements for a supporting insurer to provide information to the office. This administrative regulation prescribes the form and the time schedule for submitting reports to the office.

Section 1. Definitions.

(1) "Earned premium" is defined by KRS 304.17B-001(8).

(2) "Guaranteed acceptance program" or "GAP" is defined by KRS 304.17B-001(11).

(3) "Guaranteed acceptance program participating insurer" is defined by KRS 304.17B-001(12).

(4) "Health benefit plan" is defined by KRS 304.17A-005(22).

(5) "Insurer" is defined by KRS 304.17A-005(29).

(6) "Office" is defined by KRS 304.17B-001(24).

(7) "Stop-loss carrier" is defined by KRS 304.17B-001(27).

(8) "Supporting insurer" is defined by KRS 304.17B-001(28).

Section 2. GAP Participating Insurer's Monthly Report. A GAP participating insurer shall submit a GAPERF-M-1 to the office within thirty (30) calendar days after the end of each calendar month.

Section 3. Supporting Insurer's and Stop-Loss Carrier's Quarterly Report. A supporting insurer and a stop-loss carrier shall submit a GAPQR-2 to the office within thirty (30) calendar days after the end of each calendar quarter.

Section 4. GAP Participating Insurer's Annual Report. A GAP participating insurer shall submit a GAPERF-A-1 to the office within forty-five (45) calendar days after the end of each calendar year.

Section 5. Certification. A GAP participating insurer shall complete and attach a GAPC-1 to the following reports at the time of the report's submission to the office:

(1) GAPERF-M-1; and

(2) GAPERF-A-1.

Section 6. Annual Earned Premium Verification.

(1) After the end of a calendar year, the office may request in writing that a supporting insurer verify the total earned premiums reported by the insurer for that calendar year.

(2) If an earned premium verification is requested pursuant to subsection (1) of this section, a supporting insurer shall submit the following documentation:

(a)

1. Confirmation that the reported health benefit plan or stop-loss earned premium amounts are correct; or

2. Corrections of reported health benefit plan or stop-loss earned premium amounts; and

(b) A GAPAFF-1.

Section 7. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) "Guaranteed Acceptance Program and Kentucky Access Affidavit", GAPAFF-1, 11/2021;

(b) "Guaranteed Acceptance Program (GAP) and Kentucky Access Data Certification Form", GAPC-1, 11/2021;

(c) "Annual Report for GAP Participating Insurers", GAPERF-A-1, 11/2021;

(d) "Monthly Report for GAP Participating Insurers", GAPERF-M-1, 11/2021; and

(e) "Supporting Insurer's and Stop-Loss Carrier's Quarterly Report", GAPQR-2, 11/2021.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Kentucky Office of Health Data and Analytics, Division of Health Benefit Exchange, 275 East Main Street 4WE, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m., or may be accessed at khbe.ky.gov.

900 KAR 13:010

49 Ky.R. 2348; eff. 7/20/2022.

STATUTORY AUTHORITY: KRS 304.17B-031(1)