Title 27, INSURANCE

Sec. 34. The commissioner, under IC 4-22-2, may adopt rules necessary to implement this chapter. As added by P.L.162-1988, SEC.2.

Sec. 4. As used in this chapter, "hazardous financial condition" means that, based on its present or reasonably anticipated financial condition, a risk retention group, although not yet financially impaired or insolvent, is unlikely to be able to: (1) meet obligations to policyho…

Sec. 5. As used in this chapter, "insurance" means primary insurance, excess insurance, reinsurance, surplus lines insurance, and any other arrangement for shifting and distributing risk that is determined to be insurance under the laws of Indiana. As added by P.L.162-1988, SEC.2…

Sec. 6. (a) As used in this chapter, "liability" means legal liability for damages (including costs of defense, legal costs and fees, and other claims expenses) because of injuries to other persons, damage to their property, or other damage or loss to other persons, resulting fro…

Sec. 7. As used in this chapter, "personal risk liability" means liability for damages because of injury to any person, damage to property, or other loss or damage resulting from any personal, familial, or household responsibilities or activities, rather than from responsibilitie…

Sec. 8. As used in this chapter, "plan of operation or feasibility study" means an analysis that presents the expected activities and results of a risk retention group including, at a minimum, the following: (1) Information sufficient to verify that the members of the risk retent…

Sec. 9. (a) As used in this chapter, "product liability" means liability for damages because of any personal injury, death, emotional harm, consequential economic damage, or property damage (including damages resulting from the loss of use of property) arising out of the manufact…

Sec. 0.1. The following amendments to this chapter apply as follows: (1) The addition of section 10 of this chapter by P.L.93-1995 applies to all small employer health insurance plans issued or renewed under IC 27-8-15, as amended by P.L.93-1995, after December 31, 1995. (2) The …

Sec. 0.5. (a) Except as provided in this section, the insurance operations of the association cease on the later of: (1) the date on which a health benefit exchange (as defined in IC 27-19-2-8) begins operating in Indiana; or (2) December 31, 2013. (b) A claim for payment under a…

Sec. 1. (a) The definitions in this section apply throughout this chapter. (b) "Association" means the Indiana comprehensive health insurance association established under section 2.1 of this chapter. (c) "Association policy" means a policy issued by the association that provides…

Sec. 10. Before January 1, 1996, the board of directors of the association shall establish eligibility guidelines for the issuance of an association policy under this chapter to prohibit an: (1) employer; (2) insurance producer; or (3) insurance broker; from placing in or referri…

Sec. 11.2. (a) Not more than ninety (90) days after the date of the version specified in IC 27-1-1.5 of a diagnostic or procedure code described in this subsection: (1) the association shall begin using the version specified in IC 27-1-1.5 of the: (A) Current Procedural Terminolo…

Sec. 2.1. (a) There is established a nonprofit legal entity to be referred to as the Indiana comprehensive health insurance association, which must assure that health insurance is made available throughout the year to each eligible Indiana resident applying to the association for…

Sec. 2.3. (a) A member shall, not later than October 31 of each year, certify an independently audited report to the: (1) association; (2) legislative council; and (3) department of insurance; of the amount of tax credits taken against assessments by the member under section 2.1 …

Sec. 2.4. (a) Beginning January 1, 2005, a member that, before January 1, 2005, has: (1) paid an assessment; and (2) not taken a credit against taxes; under section 2.1 of this chapter (as in effect December 31, 2004) is not entitled to claim or carry forward the unused tax credi…

Sec. 2.5. (a) A member shall comply with the association's plan of operation. (b) A member assessment under section 2.1 of this chapter is due not more than thirty (30) days after the member receives written notice of the assessment. A member that pays an assessment after the due…

Sec. 2.6. (a) If a: (1) member is aggrieved by an act of the association; or (2) health care provider is aggrieved by an act of the association with respect to reimbursement to the provider under an association policy; the member or health care provider shall, not more than ninet…

Sec. 3. (a) An association policy issued under this chapter may pay an amount for medically necessary eligible expenses related to the diagnosis or treatment of illness or injury that exceed the deductible and coinsurance amounts applicable under section 4 of this chapter. Paymen…

Sec. 3.2. Except as provided in section 3.6 of this chapter, a health care provider shall not bill an insured for any amount that exceeds: (1) the payment made by the association under the association policy for eligible expenses incurred by the insured; and (2) any copayment, de…

Sec. 3.5. (a) The association shall: (1) approve and implement chronic disease management and pharmaceutical management programs based on: (A) an analysis of the highest cost health care services covered under association policies; (B) a review of chronic disease management and p…

Sec. 3.6. (a) The association shall approve a mail order or Internet based pharmacy (as defined in IC 25-26-18-1) through which an insured may obtain prescription drugs covered under an association policy. (b) A prescription drug that is covered under an association policy is cov…

Sec. 4. (a) Subject to the limitation provided in subsection (c), an association policy offered in accordance with this chapter must impose a five hundred dollar ($500) deductible on a per person per policy year basis. The deductible must be applied to the first five hundred doll…

Sec. 5.1. (a) A person is not eligible for an association policy if the person is eligible for any of the coverage described in subdivisions (1) and (2). A person other than a federally eligible individual may not apply for an association policy unless the person has applied for:…

upon death of policyholder Sec. 6. (a) An association policy offered under this chapter must contain provisions under which the association is obligated to renew the contract until: (1) the date on which coverage terminates under section 5.1 of this chapter; or (2) the day on whi…

Sec. 7. The commissioner may adopt rules, under IC 4-22-2, that: (1) provide for disclosure by carriers of the availability of insurance coverage from the association; and (2) implement this chapter. As added by Acts 1981, P.L.249, SEC.1.

Sec. 8. Neither the participation by carriers or members in the association, the establishment of rates, forms, or procedures for coverages issued by the association, nor any joint or collective action required by this chapter shall be the basis of any legal action, civil, or cri…

Sec. 9. (a) The association may issue Medicare supplement policies to individuals who reside in Indiana. (b) A Medicare supplement policy issued under this section: (1) must be based on a model policy adopted by the commissioner under IC 27-8-13-10.1; and (2) must meet the standa…

Sec. 1. A health maintenance organization or limited service health maintenance organization shall establish and maintain a grievance procedure for the resolution of grievances initiated by enrollees and subscribers of the organization. The grievance procedure of a health mainten…

Sec. 11. A health maintenance organization may not take action against a provider solely on the basis that the provider represents an enrollee or subscriber in a grievance filed under this chapter. As added by P.L.191-1997, SEC.11.

Sec. 12. (a) Notwithstanding IC 27-13, the department shall approve the grievance and appeals procedures of a health maintenance organization if: (1) the health maintenance organization certifies in writing to the department of the health maintenance organization's compliance wit…

Sec. 13. The department may adopt rules under IC 4-22-2 to implement this chapter. As added by P.L.191-1997, SEC.13.

Sec. 2. The commissioner may examine the grievance procedures of health maintenance organizations and limited service health maintenance organizations. As added by P.L.26-1994, SEC.25.

Sec. 3. A health maintenance organization or limited service health maintenance organization shall maintain records regarding all grievances of enrollees that the organization has received since the examination by the commissioner of the grievance procedure of the organization th…

Sec. 4. (a) A health maintenance organization shall provide, at the request of the enrollee, subscriber, or legal representative of the enrollee or subscriber, and upon contract issuance, at each contract renewal, and with any notice of denial of a claim, timely, adequate, and ap…

Sec. 5. (a) An enrollee or a subscriber may file a grievance orally or in writing. (b) A health maintenance organization shall make available to enrollees and subscribers a toll free telephone number through which grievances may be filed. The toll free number must: (1) be staffed…

Sec. 6. (a) A health maintenance organization shall establish procedures to assist enrollees and subscribers in filing grievances. (b) An enrollee or subscriber may designate a representative to file a grievance for the enrollee or subscriber and to represent the enrollee or subs…

Sec. 7. (a) A health maintenance organization shall establish written policies and procedures for the timely resolution of grievances filed under this chapter. The policies and procedures must include the following: (1) An acknowledgment of the grievance, orally or in writing, to…

Sec. 8. (a) A health maintenance organization shall establish written policies and procedures for the timely resolution of appeals of grievance decisions. The procedures for registering and responding to oral and written appeals of grievance decisions must include the following: …

Sec. 1. (a) The sole purpose of any dividend preservation provision shall be to provide for reasonable policyholder dividend expectations on policies that provide for the distribution of policy dividends. (b) No dividend preservation provision in a plan under this article shall b…

Sec. 2. Any dividend preservation provision may be limited to participating individual life insurance policies and participating individual annuity contracts in force or considered to be in force by the plan of conversion on the effective date of the plan of conversion for which …

Sec. 1. The department may suspend or revoke a discount medical card program organization's registration or order compliance if the department finds any of the following: (1) The discount medical card program organization is not in compliance with this article. (2) The discount m…

Sec. 2. If the department has cause to believe that grounds for the suspension or revocation of a registration under this article exist, the department shall: (1) notify the discount medical card program organization in writing specifically stating the grounds for suspension or r…

Sec. 3. Upon the effective date of the surrender or revocation of a discount medical card program organization's registration, the discount medical card program organization shall conclude the discount medical card program organization's affairs transacted under the registration.…

Sec. 4. (a) If the department suspends the registration of a discount medical card program organization, the department must specify in the order of suspension the: (1) period during which the suspension is in effect; and (2) conditions that must be met by the discount medical ca…

Sec. 5. On the date that a discount medical card program organization receives notice from the department that the discount medical card program organization's registration is suspended, the discount medical card program organization shall: (1) cease to enroll new cardholders; (2…