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Kentucky - Compensation & Benefit Legislation

KENTUCKY - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

 

KENTUCKY - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of adopted children is included in state's newborn health care mandate. 5 days of hospital nursery care for well newborn is an employer option.

 

Preventive care for children: No.

 

(Kentucky Rev. Stat Ann. Sections 304.17A-140, 304.18-032, 304.18-033)

 

KENTUCKY - ALCOHOLISM & DRUG ABUSE:

Employer option (alcoholism treatment only).

 

Minimum yearly inpatient coverage: Emergency detoxification: 3 days at $40 per day; residential treatment: 10 days at $50 per day.

 

Minimum yearly outpatient: 10 visits at $10 per visit.

 

Minimum lifetime coverage: No statutory requirements.

 

(Kentucky Rev. Stat. Ann. Sections 304.18-130, 304.18-140)

 

CHAPTER 304 INSURANCE CODE

304.18-140 Treatment of alcoholism, required provisions, minimum benefits.

 

Group contracts providing major medical or outpatient care benefits issued pursuant to KRS 304. 18-130 for treatment of alcoholism shall require:

 

(1) That the patient be under the supervision of a physician licensed to practice in the Commonwealth or a professional designated by such physician, and who is a recognized staff member of a treatment facility licensed by the department or accredited by the Joint Commission on the Accreditation of Hospitals;

 

(2) That the patient receive appropriate emergency detoxification treatment, residential treatment and outpatient treatment at facilities licensed by the department or accredited by the Joint Commission on the Accreditation of Hospitals, for alcoholism treatment; and

 

(3) That the following minimum benefits per patient be provided:

(a) Emergency detoxification - 3 days, $40 per day

(b) Residential treatment - 10 days, $50 per day

(c) - Outpatient treatment - 10 visits, $10 per visit.

 

304.18-160 Alcoholism to be considered a disease.

Treatment for alcoholism in acute care hospitals licensed by the Commonwealth or accredited by the Joint Commission on Accreditation of Hospitals shall be treated by all health care carriers as any other disease entity covered by their contracts.

 

304.18-170 Alcoholism, definitions, requirements for treatment.

 

(1) All definitions relating to alcoholism and the treatment for alcoholism, as contained in KRS Chapter 222 and Kentucky Administrative Regulations promulgated therefrom, shall apply to KRS 304.18-130 to 304.18-170.

 

(2) All services rendered by a health care facility under KRS 304.18-130 to 304.18170 shall comply with the requirements for such services as contained in KRS Chapter 222 and Kentucky Administrative Regulations filed pursuant to KRS Chapter 13A.

 

Legislative Research Commission Note (10/5/90).

Pursuant to KRS 7.136(1), KRS Chapter 13A has been substituted for the prior reference to KRS Chapter 13 in this statute. The sections in KRS Chapter 13 were repealed by 1984 Ky. Acts ch. 417, Section 36 and KRS Chapter 13A was created in that same chapter of the 1984 Kentucky. Acts.

 

KENTUCKY - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: Certain Kentucky municipalities, including Lexington, require employers to count cafeteria plan payments as wages for purposes of local income taxes. For state Unemployment Insurance purposes, employee contributions are taxable if the employee can elect to receive a cash payment prior to retirement or termination of employment for age, sickness, or disability (whether or not the employee chooses the cash option). Payments to provide for medical and hospital expenses are taxable unless they are received under the worker's compensation law or are made at least six months after termination. Employee salary reductions for the purchase of group-term life insurance are not taxable.

 

KENTUCKY - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

KENTUCKY - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits (effective 1/1/87). Includes alternative provisions allowing secondary payer to pay less than 100 percent of total allowable expenses. Based on 1985 National Association of Insurance Commissioner Rules model. (Kentucky Admin. Regs. 18:030)

 

KENTUCKY - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

KENTUCKY - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

State has no statutory requirements.

 

KENTUCKY - GROUP HEALTH CODE ADDITIONS (MANDATED)

Alcoholism Treatment: Insurers must offer major medical or outpatient care to policyholders coverage for at least 3 days of emergency detoxification up to $40 per day, and 10 outpatient visits up to $10 per visit. (Kentucky Rev. Stat. Sections 304.18-130, 304.18-140.)

 

Breast Treatments: Health policies, including HMOs, which provide treatment for breast cancer by chemotherapy also must provide coverage by high dose chemotherapy with autologous bone marrow transplantation or stem cell transplantation. (H504, 1996) (Kentucky Rev. Stat. Sections 304.17, 38, 17A100-160.)

 

Coverage Continuation and Conversion: Group policies must provide continuation rights of up to 9 months and subsequent conversion rights for persons whose coverage terminates for themselves and their dependents and to spouses and dependents who cease to be eligible family members due to age, death of the insured, or dissolution of marriage. (Kentucky Rev. Stat. Section 304.18-110.)

 

Home Health Care: Insurers must offer individual policies that cover home health care of at least 60 visits per year. (Kentucky Rev. Stat. Section 304.17-313.)

 

Mammography Screening: Policies that cover mastectomy also must cover mammography screening as described. (Kentucky Rev. State. Sections 304.17-316, 304.18-098.)

 

Maternity Benefits: Health plans which provide maternity coverage must provide coverage for inpatient care for a mother and her newborn child for a minimum of 48 hours after a vaginal delivery and for a minimum of 96 hours after a Caesarean section. Exceptions to these inpatient time guidelines are acceptable for a mother and newborn child if an insurance plan authorizes an initial postpartum home visit which would include the collection of samples for hereditary and metabolic newborn screening or if the attending physician with the mother's approval authorizes a shorter inpatient stay. (H186, 1996) (Kentucky Rev. Stat. Section 304.17A.)

 

Mental Health: Insurers must offer coverage for inpatient and outpatient treatment to at least the same extent as for physical illness. (Kentucky Rev. Stat. Sections 304.17-318, 304.18-036, 304.38-193.)

 

Newborns: Policies providing family coverage must provide benefits for newborns from the moment of birth for injury or sickness, including treatment of medically diagnosed congenital defects and birth abnormalities. (Kentucky Rev. Stat. Sections 304.17-041, 304.18-032, 304.18-033.) Well-baby care: Insurers must offer policyholders with maternity benefits optional coverage of routine nursery care for well newly born children for up to five days in a hospital nursery. (Kentucky Rev. Stat. Sections 304.1, 304.7-185, 304-18,033.)

 

Policies for Small Employers: Any area development district may form a health care trust and negotiate with insurers to provide coverage to participating employers including basic inpatient hospital services of at least 14 days and at least 50 percent of related physician charges. Such contracts are exempt from additional benefits mandated in Section 304. (Kentucky Rev. Stat. Section 304.18-025.)

 

Providers: Dentists, optometrists, osteopaths, and chiropractors: Costs for services must be covered if the provider is licensed, the services is within the provider's scope of services, and the service is covered by the policy. (Kentucky Rev. Stat. Sections 304.18-095, 304.18-097.) Ambulatory surgical centers: Costs of services covered by the policy must be covered on the same basis as services rendered on an inpatient basis. (Kentucky Rev. State. Sections 304.17-317, 304.18-035.)

 

Temporomandibular Joint and Craniomandibular Jaw Disorders: Policies that cover treatment of skeletal disorders must cover such conditions. (Kentucky Rev. Stat. Sections 304.17-319, 304.18-0365.)

 

KENTUCKY - GROUP HEALTH FOR SMALL EMPLOYERS

None reported.

 

KENTUCKY - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: Yes, unless amount of insurance is less than $2,000 per life of any employee.

 

Percent of employees who must elect coverage (if employees pay part of premium): 75%.

 

Percent of employees who must be covered if employer pays all of premium: 100%.

 

Minimum number of employees in group plan: 10.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): 31.

 

Mandatory conversion: Yes.

 

Other provisions: Benefits for HIV infection may not be different from those for any other health condition.

 

(Kentucky Rev. Stat. Ann. Sections 304.-12-103, 304.-16-030, 304.-16-120, 304.-16-190)

 

KENTUCKY - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Lincoln's Birthday, Columbus Day (or 2nd Monday in October). Other: Days appointed by the President or Governor. If holiday falls on a Sunday, following Monday is a holiday. (Kentucky Rev. Stat. Ann. Sections 2.110, 2.120-2.140, 2.190)

 

KENTUCKY - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

KENTUCKY - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Violator is guilty of a class B misdemeanor. Employee can bring civil action within 90 days of discharge for lost wages, reinstatement and reasonable attorney fees. Damages shall not exceed lost wages.

 

Other Requirements: None reported. (Kentucky Rev. Stat. Ann. Sections 29A.160, 29A.990.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: State reports no statutory requirements.

 

Remedies and Penalties: State reports no statutory requirements.

 

Other Requirements: None reported.

 

KENTUCKY - LEAVES OF ABSENCE

Employers Subject to Leave Laws: All employers.

 

Criteria for Eligibility: State reports no statutory requirements.

 

Maximum length of leave: 6 weeks.

 

Paid Leave: State does not require paid leave.

 

Acceptable Reasons for Leave: Reception of an adopted child under age 7.

 

Employment Guarantees After Leave: State reports no statutory requirements.

 

Use of Vacation or other Time-off Benefits: State reports no statutory requirements.

 

Certification Required: State reports no statutory requirements.

 

Effect Of Leave on Other Benefits: State reports no statutory requirements.

 

Effect of Seniority Accrual During Leave: State reports no statutory requirements.

 

Minimum Requirements for Notification to Employer: Written notice is required.

 

Conditions for Denial of a Request For Leave: State reports no statutory requirements.

 

(Kentucky Rev. Stat. Ann. Section 337.015.)

 

See U.S. Federal Family and Medical Leave Act

 

KENTUCKY - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

KENTUCKY - MANDATED PROVIDERS

Optometrists, chiropractors, dentists, psychologists, podiatrists, and social workers. Mandatory coverage for osteopaths. (Kentucky Rev. Stat. Ann. Sections 304.18-0363, 304.18-095, 304.18-097)

 

KENTUCKY - MENTAL HEALTH CARE

Employer option.

 

Minimum yearly inpatient coverage: Policy must provide coverage that is no less than the coverage it provides for physical illness.

 

Minimum yearly outpatient coverage: Policy must provide coverage that is no less than the coverage it provides for physical illness.

 

Minimum lifetime coverage: No less than lifetime maximum for physical illness.

 

(Kentucky Rev. Stat. Ann. Section 304.18-036)

 

KENTUCKY - MINIMUM WAGE

Refer to the Federal minimum wage: $5.15 per hour (effective September 1, 1997).

 

Exemptions: Certain professionals, agriculture workers, domestics, and outside sales. Students, apprentices, and handicapped workers in special environments may be exempt by special certificate. (Kentucky Rev. Stat. Ann. Sections 337.010, 337.275)

 

See U.S. Minimum Wage

 

KENTUCKY - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: All new hires, rehires, and potential employees who refuse employment.

 

Exempt from reporting: Employees under age of 18 or those earning less than $300 per month.

 

Form(s) to file: W-4 or state form.

 

Filing deadline: Within 20 days of hire.

 

Employer information to be included: Name, address, and federal EIN.

 

Employee information to be included: Name, address, and SSN.

 

Penalty for failure to report: After two notices is assumed conspiracy resulting in $250 fine per month, per person until report is submitted.

 

(Kentucky Rev. Stat. Ann. Section 341.190)

 

KENTUCKY - NEWBORN CARE MANDATE

Mandated coverage. 5 days of hospital nursery care for well newborn is an employer option.

 

Preventive care for children: no. (Kentucky Rev. Stat Ann. Sections 304.17A-140, 304.18-032, 304.18-033)

 

KENTUCKY - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

KENTUCKY - PRE-EXISTING CONDITIONS:

CHAPTER 304 INSURANCE CODE

 

304.17A-110 Requirement of compliance with specified conditions regarding renewability and pre-existing conditions.

 

All health benefit plans issued or renewed on or after July 15, 1995, shall comply with the following provisions:

 

(1) All health benefit plans shall be renewable with respect to all eligible persons and dependents at the option of the policyholder or contract holder, except:

(a) For nonpayment of the required premiums by the policyholder or contract holder;

(b) For fraud or misrepresentation of the policyholder or contract holder;

(c) For intentional and abusive noncompliance with health benefit plan provisions;

(d) If the insurer ceases doing business in Kentucky and notice of the decision to cease to do business in Kentucky is provided to the department, and to either the policyholder or contract holder. Health benefit plans shall not be canceled by the insurer for one (1) year after the date of the notice required under this paragraph unless the business has been sold to another insurer. An insurer that ceases to do business in Kentucky shall not reenter Kentucky for a period of five (5) years from the date of the notice required under this paragraph.

 

(2) (a) pre-existing conditions provisions shall not exclude or limit coverage for a period beyond six (6) months, or twelve (12) months for health benefit plans issued after July 15, 1996, following the individual's effective date of coverage and may only relate to conditions which had, during the six (6) months, or twelve (12) months for health benefit plans issued after July 15, 1996, immediately preceding the effective date of coverage, manifested themselves in a manner that would cause an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment or for which medical advice, diagnosis, care, or treatment was recommended or received or as to a pregnancy existing on the effective date of coverage.

 

(3) Health care benefit plans shall not discriminate against any provider who is located within the geographic coverage area of the health benefit plan and is willing to meet the terms and conditions for participation established by the health benefit plan.

 

(4) No individually insured person shall be required to replace an individual policy with group coverage on becoming eligible for group coverage that is not provided by an employer. In a situation where a person holding individual coverage is offered or becomes eligible for group coverage not provided by an employer, the person holding the individual coverage shall have the option of remaining individually insured, as the policyholder may decide. This shall apply in any such situation that may arise through the Kentucky Health Purchasing Alliance, any other health purchasing alliance, an association, an affiliated group, the Kentucky state employee health insurance plan, or any other entity.

 

Effective: July I5, 1996

History: Amended 1996 Ky. Acts ch. 371, section 8, effective July 15, 1996. -- Created 1994 Ky. Acts ch. 512, section 54, effective July 15, 1994.

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

KENTUCKY - PROTECTED CLASSIFICATIONS

Age:  Yes, age 40 and over.

Race:  Yes.

Color:  Yes.

National Origin:  Yes.

Ancestry:  No specific law. State has expressed policy against discrimination.

Religion:  Yes.

Sex:  Yes.

Pregnancy: Yes.

Sexual Harassment: No specific law. State has expressed policy against discrimination.

 

(Ky. Rev. Stat. Ann. Sections 18A.140, 344.020-344.080.)

 

KENTUCKY - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

KENTUCKY - SHORT TERM DISABILITY CODE ADDITIONS

State does not require employer or employee participation in short term disability plans.

 

KENTUCKY - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Later of payday or 14 days.

Date due if employee resigns: Later of payday or 14 days.

Wages: Yes.

Vacation Pay: Yes.

Holiday: No.

Sick leave: No.

Severance: No. (Kentucky Rev. Stat. Ann. Sections 337.010, 337.055; OAG 91-73))

 

KENTUCKY - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: Yes.

 

(Kentucky Rev. Stat. Ann. Sections 341.125, 341.190, 341.270.)

 

KENTUCKY - VACATION PAY

See TERMINATION & SEVERANCE PAY (above)

 

KENTUCKY - VOTING TIME OFF

Employee can take sufficient time to vote without penalty if such time is not otherwise provided by employer. (Kentucky Rev. Stat. Ann. Sections 118.035, 121.310, 121.990.)

 

KENTUCKY - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employments, including corporate executives. Elective as to owner of business or partner. Worker may reject coverage voluntarily prior to injury.

 

Public Employers: Mandatory as to state and political sub-divisions, including elected and appointed state officials, employees of the General Assembly and volunteer ambulance, fire, and police personnel.

 

Exceptions: Domestic servants if employer employs fewer than 2, each regularly employed 40 hours a week; casual workers employed less than 20 consecutive work days; agricultural labor; worker for charitable or religious organization in return for aid or sustenance; and participant in car pool to and from work.

 

Special Coverage Provisions: Specifically covers newspaper carriers and members of volunteer ambulance service, fire, or police department. Voluntary as to excluded employments. (U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)