| CHAPTER-2 | 806 KAR 2:088. | Verification of Risk Location Systems. | | Application for Verification of Risk Location System or Program, 11/2008Verification Data Manual 1/2009 |
| CHAPTER-2 | 806 KAR 2:095 | Accounting and reporting requirements for collecting local government premium tax. | | FORM LGPT 140FORM LGPT 141FORM LGPT 142 |
| CHAPTER-2 | 806 KAR 2:200 | In accordance with KRS 304.2-450, this administrative regulation establishes the operations of the Strengthen Kentucky Homes Program as well as the eligibility and grant procedures for applicants. | | (g) TB Eligibility and Compliance of Accessory Roof Structure (h) TB Requirements for Cement and Clay Hip and Ridge Tile Installed Over Asphalt Shingle Roof Cover(i) TB Foundation Requirements for FORTIFIED Home Eligibility (j) TB FORTIFIED Home Requirements for Homes with Excessive Gaps Between Wood Decking Boards(k) TB FORTIFIED Guidance on Leaf Guards and Gutters(l) 2025-FORTIFIED-Home-StandardForm AOC-1Form BDS-1 - Final (2)Form CCF-1Form HRForm Inv-1Form PSI-1 |
| CHAPTER-2 | 806 KAR 2:210 | In accordance with KRS 304.2-450, this administrative regulation establishes the eligibility requirements for contractors and evaluators to work with the Strengthen Kentucky Homes Program. | | FORTIFIED-Roofing-Contractor-Agreement_5-25-22FORTIFIED_Home_Evaluator-AgreementFORTIFIED_Home_Evaluator_HandbookFORTIFIED_Roof_Contractor_Handbook_2025 |
| CHAPTER-3 | 806 KAR 3:190 | Risk-based capital for insurers. | | "Risk-Based Capital Forecasting & Instructions, Life" (2011) |
| CHAPTER-3 | 806 KAR 3:210 | Privacy of consumer financial and health information. | | "Model Privacy Forms & General Instructions", May 2017PVCY-01, "Sample Clauses and Examples", (Edition 11/01) |
| CHAPTER-3 | 806 KAR 3:240 | Corporate governance annual disclosure | | "Corporate Governance Annual Disclosure", 07/19 |
| CHAPTER-5 | 806 KAR 5:025 | Credit for reinusrance. | | "Certificate of Certified Reinsurer," Form CR-1 (09/19)"Form CR-F" (09/19)"Form CR-S" (09/19)Form RJ-1 9-21 NEW"Certificate of Assuming Insurer," Form AR-1 December 95 |
| CHAPTER-6 | 806 KAR 6:010 | Valuation standards; audits. | | "1958 Commissioners Standard Ordinary Table of Mortality", 1958 "2001 Commissioner Standard Ordinary Male Composite Ultimate Mortality Table", 2001 |
| CHAPTER-6 | 806 KAR 6:060 | Reserve liabilities, cash surrender values, and nonforfeiture benefits for plans of life insurance with separate rates for smokers and nonsmokers. | | "1980 CSO Table (1980)" "Ten (10) Year Select Mortality Factors (1980)" "1980 CET Table (1980)" "1958 CSO Table (1958)" "1958 CET Table (1958)" |
| CHAPTER-6 | 806 KAR 6:075 | Valuation of life insurance policies. | | Select Mortality Factors Male and Female Smoker and Non Smoker 1998 Edition2001 CSO Mortality Table (2001) |
| CHAPTER-6 | 806 KAR 6:080 | Reserve standards for individual health insurance policies | | "Reserve Standards for Individual Health Insurance", 6/2020 |
| CHAPTER-6 | 806 KAR 6:100 | Actuarial opinion and memorandum. | | "Table of Reserves and Liabilities", 5/2009 |
| CHAPTER-6 | 806 KAR 6:120 | Recognition of preferred mortality tables for use in determining minimum reserve liabilities. | | 2001 CSO Mortality Table/2001 CSO Preferred Class Structure Mortality Table |
| CHAPTER-6 | 806 KAR 6:130 | Minimum standards for determining reserve liabilities and nonforfeiture values for preneed insurance. | | https://mort.soa.org/ |
| CHAPTER-8 | 806 KAR 8:010 | Valuation of assets on deposit. | | Form143 6 |
| CHAPTER-9 | 806 KAR 9:025 | Licensing Process. | | Form 8301 Individual Application CLEAN 9-21Form 8301-BE Bus Entity App CLEAN 9-21Form 8302-AP Appointment CLEAN 9-2021Form 8302-TE Termination CLEAN 9-2021Form 8303 CLEAN 9-21Form 8304-Exam Retake CLEAN 9-21Form 8305-BE Designation 9-21Form CE AFF 304 CLEAN 9-21Form CE PL 100Form CE PL 200Form KYP-01 Provider Approval CLEAN 9-21Form MLW 01 Military Request CLEAN 9-21NAIC CE Reciprocity Form 5-2019NAIC Recommended Guidelines for CE Online Courses 8 2019 |
| CHAPTER-9 | 806 KAR 9:030 | Adjuster licensing restrictions | | Form 8307 Request for Unlicensed Adjusters 5-2019 |
| CHAPTER-9 | 806 KAR 9:190 | Disclosure requirements for financial institutions authorized to engage in insurance agency activities. | | Form FI-02 Free Choice of Agent FI-03, "Financial Institution Disclosures", (8/2020 edition) |
| CHAPTER-9 | 806 KAR 9:360 | Pharmacy Benefit Manager License. | | PBM License Application 2021 CLEAN |
| CHAPTER-9 | 806 KAR 9:380 | Limited lines self-storage space insurance requirements | | Form Self-Service Storage Space Locations 2022 |
| CHAPTER-9 | 806 KAR 9:390 | Portable Electronic Retailer license | | Form PEI-Locations 22Form PEI_BE Portable Elect Retailer 2022 |
| CHAPTER-11 | 806 KAR 11:010 | Industrial insured, government entity insured, and exempt commercial policyholder. | | Form ECP-1 P&C Exempt Commercial Policyholder Affidavit 2000Form II-1 P & C Industrial Insured AffidavitGEI-1 P & C Government Entity Insured Affidavit |
| CHAPTER-12 | 806 KAR 12:010 | This administrative regulation clarifies the minimum standards for advertising as established in KRS 304.12-010 and 304.12-020. | | FORM 440 2021 |
| CHAPTER-12 | 806 KAR 12:060 | Health Insurance replacement. | | APPENDIX A NOTICE TO APPLICANT REGARDING REPLACEMENT OF HEALTH INSURANCE |
| CHAPTER-12 | 806 KAR 12:080 | Replacement of life insurance and annuity contracts | | "Office Form C, Important Notice: Replacement of Life Insurance or Annuities", April 2005"Office Form b, Notice Regarding Replacing Your Life Insurance Policy Or Annuity", April 2005"Office Form A, Important Notice: Replacement of Life Insurance or Annuities", April 2005 |
| CHAPTER-12 | 806 KAR 12:120 | Suitability in annuity transactions. | | Consumer Decision to Purchase an Annuity NOT Based on a Recommendation 12-120Consumer Refusal to Provide Information 12-120Insurance Agent Producer Disclosure For Annuities 12-120 |
| CHAPTER-12 | 806 KAR 12:140 | Life insurance illustrations. | | "Actuarial Standard of Practice No. 24, Compliance with the NAIC Life Insurance Illustrations Model Regulation", February 2007 |
| CHAPTER-12 | 806 KAR 12:170 | Life Insurance Disclosures | | "Life Insurance Buyer’s Guide, "National Association of Insurance Commissioners", 2018 |
| CHAPTER-12 | 806 KAR 12:180 | Military sales practices. | | Department of Defense Instruction Number 1344.07, Personal Commercial Solicitation on DoD Installations"Department of Defense Form 2885, Personal Commercial Solicitation Evaluation" |
| CHAPTER-13 | 806 KAR 13:130 | Experience modification factors for workers' compensation insurers. | | NAIC Buyers Guide Deferred Annuites 2013 |
| CHAPTER-13 | 806 KAR 13:150 | Property and casualty rate and rule filings. | | LC-1 P and C 2007LC-2 P and C 2007PC TD-1 Transmittal Document CLEANUniform Property & Casualty Product Coding Matrix Clean |
| CHAPTER-14 | 806 KAR 14:007 | Rate and form filing for health insurers. | | HIPMC-F1 2021HIPMC-F16HIPMC-R36HIPMC-R4HL-F11 |
| CHAPTER-15 | 806 KAR 15:050 | Reporting and general requirements for settlement providers and brokers. | | Form VOCLS6_Settlement Provider Cert FormLS7_Form 2020LifeSettlementGuide 2020ls1_031209 (1)ls2_031209 (1)ls3_031209 (1) |
| CHAPTER-15 | 806 KAR 15:090 | Notice of rights as an owner of a life insurance policy. | | Notice 126 2021 |
| CHAPTER-17 | 806 KAR 17:081 | Minimum standards for long-term care insurance policies | | "Disclosures and Language for Long-term Care Policies and Certificates, HIPMC-LTC10", 09/2008"Long-term Care Insurance Potential Rate Increase Disclosure Form, HIPMC-LTC-2", 09/2008"Notice to Applicant Regarding Replacement of Individual Accident and Sickness or Long-term Care Insurance, HIPMC-LTC-8", 09/2008"Long-term Care insurance replacement and lapse reporting form, HIPMC-LTC-11", 09/2008"Rescission Reporting Form for Long-term Care Policies, HIPMC-LTC-3", 09/2008"Long-term Care Insurance Personal Worksheet, HIPMC-LTC-1", 09/2008"Notice to Applicant Regarding Replacement of Accident and Sickness or Long-term Care Insurance, HIPMC-LTC-9", 09/2008"Claims Denial Reporting Form for Long-term Care Insurance, HIPMC-LTC-4", 09/01Things You Should Know Before You Buy Long-term Care Insurance, HIPMC-LTC-5", 09/2008"Long-term Care Insurance Suitability Letter, HIPMC-LTC-6", 09/2008"Outline of Coverage, HIPMC-LTC-7", 09/2008 |
| CHAPTER-17 | 806 KAR 17:083 | Kentucky long-term care partnership insurance program. | | "Important Information About Your Kentucky Long-Term Care Partnership Insurance, LTCPIP-1", 12/2008 |
| CHAPTER-17 | 806 KAR 17:085 | Minimum standards for short-term nursing home insurance policies. | | Outline of Coverage Template HIPMC-STN1 2021 |
| CHAPTER-17 | 806 KAR 17:100 | Certificate of filing for provider-sponsored networks. | | Form 996 8 |
| CHAPTER-17 | 806 KAR 17:160 | Creditable coverage for health insurance. | | Form HIPMC-CC1, "Certificate of Individual Health Plan Coverage", Kentucky Department of Insurance, January 2006 edition |
| CHAPTER-17 | 806 KAR 17:230 | Requirements regarding medical director’s signature on health care benefit denials. | | HIPMC-MD-1 2021 |
| CHAPTER-17 | 806 KAR 17:240 | Data reporting requirements. | | HIPMC-DR-1 9-21-21 |
| CHAPTER-17 | 806 KAR 17:270 | Telehealth claim forms and records. | | 2019ADADentalClaim Form_2019May |
| CHAPTER-17 | 806 KAR 17:270 | Telehealth claim forms and records | | ADA Form - J588, "Dental Claim Form" (1999 version 2000) |
| CHAPTER-17 | 806 KAR 17:270 | Telehealth claim forms and records. | | Sample 1500_2012_02 |
| CHAPTER-17 | 806 KAR 17:270 | Telehealth claim forms and records | | Form HCFA - 1500, "Health Insurance Claim Form" (12-90 Edition) |
| CHAPTER-17 | 806 KAR 17:280 | Registration, utilization review, and internal appeal. | | HIPMC-MD-1 Medical Director Form 1_1_2023-INTERACTIVE (1)HIPMC-STE-1 Step TherapyException Report 1-2023HIPMC-UR-1 Utilization Review Registration Application 1_1_2023-INTERACTIVEHIPMC-UR-2 Utilization Review Annual Report 1_1_2023-INTERACTIVE |
| CHAPTER-17 | 806 KAR 17:290 | Independent External Review Program. | | HIPMC-IRE-1 Application for Certificate of an Independent Review Entity 1_1_2023-INTERACTIVEHIPMC-IRE-2 Assignment of Independent Review Entity Form1_1_2023-INTERACTIVEHIPMC-IRE-3 External Review Decision Notification Form 1_1_2023-INTERACTIVEHIPMC-IRE-4 Annual Independent Review Entity Report Form 1_1_2023-INTERACTIVEHIPMC-IRE-5 Approval of an External Review Fee in Excess of 800 1_1_2023HIPMC-IRE-6 External Review Information Face Sheet 1_1_2023-INTERACTIVE |
| CHAPTER-17 | 806 KAR 17:300 | This administrative regulation establishes the filing requirements of provider agreements, subcontract agreements, and risk sharing arrangements. | | HIPMC R1 NEW 10-21 |
| CHAPTER-17 | 806 KAR 17:300 | Provider agreement and risk-sharing agreement filing requirements | | HIPMC R1 NEW 10-21 |
| CHAPTER-17 | 806 KAR 17:350 | Guaranteed Acceptance Program (GAP) reporting requirements | | Guaranteed Acceptance Program Electronic Report Format - Annual for GAP Participating Insurers, HIPMC-GAPERF-A-1 (12/00)Guaranteed Acceptance Program Electronic Report Format - Monthly for GAP Participating Insurers, HIPMC-GAPERF-M-1 (04/01)Guaranteed Acceptance Program (GAP) Data Certification Form, HIPMC-GAPC-1 (12/00)Guaranteed Acceptance Program Affidavit, HIPMC-GAPAFF-1 (06/01) |
| CHAPTER-17 | 806 KAR 17:360 | Prompt payment of claims. | | "Prompt Payment Reporting Manual, DIPRPPR1",7/2018 |
| CHAPTER-17 | 806 KAR 17:450 | Insurance purchasing outlet requirements. | | Health_j_HIPMC-IPO-4Quarterly_Financial"Insurance Purchasing Outlet Application for Registration," HIPMC-IPO-1, (7/02)"Annual Financial Statement of Insurance Purchasing Outlet," HIPMC-IPO-3, (9/02)"Annual Report on Operations of Insurance Purchasing Outlet," HIPMC-IPO-2, (9/02) |
| CHAPTER-17 | 806 KAR 17:480 | Uniform evaluation and reevaluation of providers. | | "Kentucky Application for Provider Evaluation and Reevaluation", Form KAPER-1 (11/2019) |
| CHAPTER-17 | 806 KAR 17:570 | Minimum standards for Medicare supplement insurance policies and certificates. | | "HL-MS-1", July 2009 edition"Plan Benefit Chart", April 2018"HL-MS-08", October 2009 edition"HL-MS-07", July 2009 edition"HL-MS-06", July 2009 edition"HL-MS-5", May 2018 edition"HL-MS-4", October 2009 edition"HL-MS-3", July 2009 edition"HL-MS-2", July 2009 edition |
| CHAPTER-17 | 806 KAR 17:575 | Pharmacy benefit managers. | | PBM External Annual Report PolicyPBMAnnualReportFinal2017 |
| CHAPTER-17 | 806 KAR 17:575 | Pharmacy benefit managers. | | "Pharmacy Benefit Manager Annual Report," June 2017 |
| CHAPTER-17 | 806 KAR 17:585 | Annual Report Mental Health Parity Nonquantitative Treatment Limitation Compliance | | NQTL Reporting Form 5.22 |
| CHAPTER-17 | 806 KAR 17:590 | Annual Report on Providers Prescribing Medication for Addiction Treatment | | Medical Claims SDR 10-21Pharmacy Claims SDR Rx 10-21 |
| CHAPTER-37 | 806 KAR 37:010 | Insurance holding company systems. | | "Form A Statement Regarding the Acquisition of Control of or Merger With a Domestic Insurer," October 2014"Form B Insurance Holding Company System Annual Registration Statement," August 2014 |
| CHAPTER-37 | 806 KAR 37:010 | Insurance holding company systems. | | "Form A Statement Regarding the Acquisition of Control of or Merger With a Domestic Insurer," October 2014 |
| CHAPTER-37 | 806 KAR 37:010 | Insurance holding company systems. | | "Form D Prior Notice of a Transaction," August 2014 |
| CHAPTER-37 | 806 KAR 37:010 | Insurance holding company systems. | | "Form C Summary of Changes to Registration Statement," August 2014"Form D Prior Notice of a Transaction," August 2014 |
| CHAPTER-37 | 806 KAR 37:010 | Insurance holding company systems. | | "Form C Summary of Changes to Registration Statement," August 2014 |
| CHAPTER-37 | 806 KAR 37:010 | Insurance holding company systems. | | "Form B Insurance Holding Company System Annual Registration Statement," August 2014 |
| CHAPTER-38 | 806 KAR 38:100 | Risk-based capital for health organizations. | | RBC Health Instructions CLEAN |
| CHAPTER-39 | 806 KAR 39:030 | Kentucky No-Fault Rejection Form. | | NFR KY 2022 CLEAN |
| CHAPTER-39 | 806 KAR 39:050 | Self-insurance. | | Application for Motor Vehicle Self-Insurance NEW |
| CHAPTER-40 | 806 KAR 40:020 | Charitable health care provider registration. | | 806 KAR 40 020 CHP2A 2020806 KAR 40 020 CHPB2 2020 |
| CHAPTER-46 | 806 KAR 46:040 | Forms for application and financial statements. | | "Form 101 - Trustee Confirmation of Receipt", 7/2020 "Form 995 - Application for Certificate of Filing As a Liability Self-Insurance Group", 7/2020 "Liability Self-Insurance Group Quarterly Statement (Blank)", 7/2020 "Liability Self-Insurance Group Annual Statement (Blank)", 7/2020. |
| CHAPTER-46 | 806 KAR 46:050 | Liability self-insurance group rate, underwriting and evidence of coverage filings. | | Form LSIG: S-1 P & C, "Filing Synopsis for Rates and or Rules", 7/2010Form LSIG: F-2 P & C, "Forms Index", 7/2010Form LSIG: LC-2 P & C, "Expense Constant Supplement", 7/2010Form LSIG: LC-1 P & C, "Calculation of Loss Cost Multiplier", 7/2010Form LSIG: S-2 P & C, "Filing Synopsis Form", 7/2010Form LSIG: F-1A P & C, "Face Sheet and Verification Form for Liability Self Insurance Groups", 7/2010;Form LSIG: EMA P & C, "E-mod Affidavit", 7/2010 |
| CHAPTER-47 | 806 KAR 47:010 | Fraud prevention. | | Uniform Suspected Insurance Fraud Reporting Form - 03-2019 - Clean |
| CHAPTER-49 | 806 KAR 49:020 | Captive insurer application requirements. | | Biographical Affidavit CI-501 (4/2001)Coverage, Limits and Reinsurance CI-105 (4/2001)Captive Application for Admission CI-103 (6/2020)Application for Authorization to Certify Loss Reserves and Loss Expense Reserves for Captives CI-110 (6/2020)Application for Authorization as an Independent Certified Public Accountant for Captive Insurance Business CI-120 (6/2020)Irrevocable Letter of Credit CI-130 (6/2020) |
| CHAPTER-52 | 806 KAR 52:010 | Forms for application, security deposits and financial statements. | | "Form 100 - Initial Application for Certificate of Filing As a Workers’ Compensation SelfInsured Group 7/2020 "Form 141 - Election Form for Designation of Custodian Bank for Safekeeping of Securities 7/2020"Form 142 - Letter of Credit 7/2020"Form 145 - Transaction Sheet for Securities Held Under Safekeeping with Designated Custodian Banks 7/2020"Form 147 - Deposit Calculation for Workers’ Compensation Self-Insured Groups 6/2020 "Form 826 - Safekeeping Agreement for Workers’ Compensation Self-Insured Groups 7/2020 "Form 102 - Trustee Confirmation of Receipt 7/2020 "Workers’ Compensation Self-Insured Group Quarterly Statement (Blank) 7/2020"Workers’ Compensation Self-Insured Group Annual Statement (Blank) 7/2020 |
| CHAPTER-52 | 806 KAR 52:030 | Workers’ compensation self-insured group rate, rule and form filings. | | WC SIG EMA PCWC SIG F-1A PCWC SIG F-2 PCWC SIG LC-1 PCWC SIG LC-2 PCWC SIG S-1 PCWC SIG S-2 PC |
