February 10, 2015
On Jan. 21, 2015, Commissioner of Insurance Clark issued Advisory Opinion 2015-01. The opinion reminds self-insured non-ERISA plans that they are subject to the state's external review process. As a reminder, governmental and church plans are considered non-ERISA plans. Employers that sponsor a self-insured governmental or church plan in Kentucky should review their governing plan documents to make sure they are in compliance with the state's requirements.
Under state statute, a participant who has had a claim denied in whole or in part (called an “adverse benefit determination”) has the right to request an external review after the plan's internal appeals process has been exhausted. The request must be made within 60 days of the adverse benefit determination. The independent review organization must issue a decision with 21 days from receipt of information, with an expedited review available upon request for certain circumstances. The self-insured entity or their third party administrator must register with eServices in order to administer the review process.
Advisory Opinion 2015-01