Title 27, INSURANCE

Sec. 1. As used in this chapter, "casualty and liability insurance" means the type of insurance described in IC 27-1-5-1, Class 2(h). As added by P.L.146-2015, SEC.33.

Sec. 2. As used in this chapter, "casualty insurance company" has the meaning set forth in IC 27-1-2-3(t). As added by P.L.146-2015, SEC.33.

Sec. 3. As used in this chapter, "group" means a group of individuals who: (1) have similar professional attributes; (2) belong to the group for purposes other than that of obtaining insurance; and (3) are eligible to purchase casualty and liability insurance. As added by P.L.146…

Sec. 4. As used in this chapter, "group tenant users liability insurance policy" means a policy of insurance that provides tenant users liability insurance to participating group members under one (1) master policy: (1) that is issued to a named insured; and (2) under which indiv…

Sec. 5. As used in this chapter, "tenant users liability insurance" means insurance that provides liability coverage for property damage or bodily injury to a third party caused by a vendor, exhibitor, or performer during a special event. As added by P.L.146-2015, SEC.33.

Sec. 6. An insurer that is authorized under IC 27-1-3-20 to: (1) transact business as a casualty insurance company; and (2) offer casualty and liability insurance; may provide a group tenant users liability insurance policy. As added by P.L.146-2015, SEC.33.

Sec. 0.5. (a) This chapter applies to the following: (1) A person who conducts medical claims review concerning health care services delivered to an enrollee in Indiana. (2) A person who acts as a claim review consultant concerning the: (A) appropriateness of; or (B) amount charg…

Sec. 1. (a) As used in this chapter, "claim review agent" means any entity performing medical claims review on behalf of an insurance company, a health maintenance organization, or another benefit program providing payment, reimbursement, or indemnification for health care costs …

Sec. 1.5. (a) As used in this chapter, "claim review consultant" means a person who: (1) makes a recommendation or provides consultation to: (A) an entity engaged in performing medical claims review; or (B) an insurance company, a health maintenance organization, or another benef…

Sec. 10. A provider, an enrollee, or an agent of a provider or enrollee who provides fraudulent or misleading information to a claim review agent is subject to the appropriate administrative, civil, and criminal penalties. As added by P.L.128-1992, SEC.2.

Sec. 11. (a) The compensation of a claim review agent for the performance of medical claims review may not be based on the amount by which claims are reduced for payment. (b) The compensation of a claim review consultant for making a recommendation or providing consultation conce…

review Sec. 12. (a) If the department believes that a claim review agent or claim review consultant has violated this chapter, the department shall notify the claim review agent or claim review consultant of the alleged violation. (b) The claim review agent or claim review consul…

Sec. 13. (a) This chapter does not require a claim review agent or claim review consultant to disclose information that is proprietary. (b) Any: (1) information concerning standards, criteria, or medical protocols used by a claim review agent in conducting medical claims review; …

Sec. 14. The department shall adopt rules under IC 4-22-2 necessary to carry out this chapter. As added by P.L.128-1992, SEC.2.

Sec. 2. As used in this chapter, "department" refers to the department of insurance. As added by P.L.128-1992, SEC.2.

Sec. 3. As used in this chapter, "enrollee" means an individual who has contracted for or who participates in coverage under an insurance policy, a health maintenance organization contract, or another benefit program providing payment, reimbursement, or indemnification for the co…

Sec. 4. (a) As used in this chapter, "medical claims review" means the determination of the reimbursement to be provided under the terms of an insurance policy, a health maintenance organization contract, or another benefit program providing payment, reimbursement, or indemnifica…

Sec. 4.5. As used in this chapter, "person" means an individual, a corporation, a limited liability company, a partnership, or an unincorporated association. As added by P.L.260-1995, SEC.3.

Sec. 5. (a) A claim review agent may not conduct medical claims review concerning health care services delivered to an enrollee in Indiana unless the claim review agent holds a certificate of registration issued by the department under this chapter. (b) To obtain a certificate of…

Sec. 5.2. (a) A person may not act as a claim review consultant concerning health care services delivered to an enrollee in Indiana unless the person holds a certificate of registration issued by the department under this chapter. (b) To obtain a certificate of registration under…

Sec. 6. (a) To remain in effect, a certificate of registration issued under this chapter must be renewed annually. To obtain the renewal of a certificate of registration, a claim review agent or a claim review consultant must submit an application to the commissioner. The applica…

Sec. 7. A claim review agent must satisfy the following minimum requirements: (1) Provide toll free telephone access at least forty (40) hours each week during normal business hours. (2) Maintain a telephone call recording system capable of accepting or recording incoming telepho…

Sec. 8. (a) An insurance company, a health maintenance organization, or another benefit program providing payment, reimbursement, or indemnification for health care costs that contracts with a claim review agent for medical claims review services shall maintain and make available…

Sec. 9. To provide documentation demonstrating that a claim review agent is capable of satisfying the requirement of section 7(6) of this chapter, the claim review agent must provide a signed statement of a provider employed by the claim review agent verifying that determinations…

Sec. 9.5. (a) As used in this section, "data base" means a data base that provides information concerning health care services or amounts charged for health care services. (b) If a claim review agent bases a medical claims review determination concerning a health care service pro…

Sec. 1. A parent company under this article: (1) shall locate its executive offices in Indiana; (2) shall employ at least five hundred (500) persons or a substantial percentage of its workforce in Indiana; (3) shall be organized under the laws of Indiana; and (4) may be: (A) a co…

Sec. 2. The commissioner may adopt rules under IC 4-22-2 necessary for the administration of this article. As added by P.L.94-1999, SEC.3.

Sec. 3. (a) The commissioner may, at the expense of a converting mutual that has: (1) filed an application under this article; (2) notified the commissioner of its intention to file an application under this article; or (3) adopted a resolution proposing a simple plan of conversi…

Sec. 4. If a converting mutual complies substantially and in good faith with this article with respect to any required notice to members and policyholders, its failure in any case to give the notice to any person entitled to notice does not: (1) impair the validity of actions tak…

Sec. 5. At any time before the effective date of the plan of conversion, the plan may be abandoned under provisions included in the plan of conversion filed under this article. As added by P.L.94-1999, SEC.3.

Sec. 6. After conversion, the name of the former mutual may not include the term "mutual". As added by P.L.94-1999, SEC.3.