Title 27, INSURANCE

Sec. 13. (a) The commission shall pay liabilities of members of the fund in accordance with rules established by the commission. (b) Payment from the fund for any liability covered under IC 34-13-3 (or IC 34-4-16.5 before its repeal) or for any other liability designated under ru…

Sec. 14. (a) In order to be eligible for payment under this chapter, a liability of a political subdivision must arise out of a claim based upon an act or omission that takes place while the political subdivision is a member of the fund. (b) The maximum amount payable from the fu…

Sec. 15. (a) A political subdivision may become a member of the fund by filing a written notice of its intent to become a member with the commission by the date exactly six (6) months before the expiration date of the liability insurance policy covering the political subdivision …

Sec. 16. (a) The governor shall appoint the initial members of the commission by May 1, 1986. (b) The commission shall adopt rules under IC 4-22-2 for the implementation of this chapter by October 1, 1986, and shall adopt other rules as required after that date. As added by P.L.1…

Sec. 17. (a) As used in this section: (1) "basic fund" refers to the political subdivision risk management fund established by this chapter; and (2) "catastrophic fund" refers to the political subdivision catastrophic liability fund established by IC 27-1-29.1. (b) Before July 1,…

Sec. 2. As used in this chapter, "fund" refers to the political subdivision risk management fund established by this chapter. As added by P.L.162-1986, SEC.1.

Sec. 28. (a) As used in this section, "fund" means the political subdivision risk management fund established by section 10 of this chapter. (b) Upon a determination by the commissioner that: (1) all members have withdrawn from the fund; and (2) all payments of liabilities of for…

Sec. 29. (a) Except as provided in subsection (b), this chapter expires when the insurance commissioner certifies to the executive director of the legislative services agency that: (1) the fund has no remaining members; (2) all payments of liabilities of former members of the fun…

Sec. 3. As used in this chapter, "liability" means an obligation arising from a claim for the payment of money in an amount established under IC 34-13-3 (or IC 34-4-16.5 before its repeal) or any other claim for which coverage is provided for members of the fund under rules adopt…

Sec. 4. As used in this chapter, "political subdivision" has the meaning set forth in IC 34-6-2.1-155. As added by P.L.162-1986, SEC.1. Amended by P.L.5-1988, SEC.143; P.L.1-1998, SEC.142; P.L.186-2025, SEC.145.

Sec. 5. (a) The Indiana political subdivision risk management commission is created as a separate body corporate and politic, constituting an instrumentality of the state for the public purposes set out in this chapter, but not a state agency. The commission is separate from the …

Sec. 6. The commission shall meet upon the call of the commissioner, who shall convene meetings as often as necessary to accomplish the purposes of this chapter. The commission may act: (1) through the vote of a majority of members at a meeting at which at least six (6) members a…

members of fund; reports Sec. 7. (a) The commission is granted all powers necessary, convenient, or appropriate to carry out and effectuate its public and corporate purposes under this chapter and IC 27-1-29.1 including, but not limited to, and except as otherwise restricted in t…

Sec. 8. (a) All expenses incurred by the commission in administering the fund under this chapter shall be paid from the fund. (b) All expenses incurred by the commission in administering the political subdivision catastrophic liability fund established by IC 27-1-29.1 shall be pa…

Sec. 9. (a) The commission shall purchase liability insurance for, or otherwise indemnify, its members against personal liability for acts and omissions arising out of their performance, in good faith, of their duties as members of the commission. (b) The state is not responsible…

Sec. 1. As used in this chapter, "Affordable Care Act" refers to the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152). As added by P.L.226-2023, SEC.21.

Sec. 2. As used in this chapter, "health maintenance organization" has the meaning set forth in IC 27-13-1-19. As added by P.L.226-2023, SEC.21.

Sec. 3. As used in this chapter, "insurer" has the meaning set forth in IC 27-1-2-3(x). As added by P.L.226-2023, SEC.21.

Sec. 4. As used in this chapter, "Marketplace plan" means: (1) a policy of accident and sickness insurance; (2) a health maintenance organization contract; or (3) an exclusive provider organization plan, point of service plan, preferred provider organization plan, or any other pl…

Sec. 5. As used in this chapter, "policy of accident and sickness insurance" means a policy or contract providing one (1) or more of the kinds of insurance described in Class 1(b) or 2(a) of IC 27-1-5-1. As added by P.L.226-2023, SEC.21.

Sec. 6. As used in this chapter, "qualified health plan" has the meaning set forth in Section 1301 of the Affordable Care Act, 42 U.S.C. 18021. As added by P.L.226-2023, SEC.21.

Sec. 7. (a) An insurer or health maintenance organization that provides coverage under a Marketplace plan shall provide to each individual covered under the Marketplace plan, not earlier than six (6) months and not later than two (2) months before the birthday on which the indivi…

Sec. 1. As used in this chapter, "accident and sickness insurance policy" has the meaning set forth in IC 27-8-28-1. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.

Sec. 10. As used in this chapter, "insured" has the meaning set forth in IC 27-8-28-8. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.

Sec. 11. As used in this chapter, "insurer" has the meaning set forth in IC 27-8-28-9. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.

Sec. 12. An insurer shall establish and maintain an external grievance procedure for the resolution of external grievances regarding the following: (1) The following determinations made by the insurer or an agent of the insurer regarding a service proposed by the treating health …

Sec. 13. (a) An external grievance procedure established under section 12 of this chapter must: (1) allow a covered individual, or a covered individual's representative, to file a written request with the insurer for an external grievance review of the insurer's (A) appeal resolu…

Sec. 14. (a) A covered individual who files an external grievance under this chapter: (1) shall not be subject to retaliation for exercising the covered individual's right to an external grievance under this chapter; (2) shall be permitted to utilize the assistance of other indiv…

Sec. 15. (a) An independent review organization shall: (1) for an expedited external grievance filed under section 13(a)(2)(A) of this chapter, within seventy-two (72) hours after the external grievance is filed; or (2) for a standard external grievance filed under section 13(a)(…

Sec. 15.5. Upon the request of a covered individual who is notified under section 15(d) of this chapter that the independent review organization has made a determination, the independent review organization shall provide to the covered individual all information reasonably necess…

Sec. 16. A determination made under section 15 of this chapter is binding on the insurer. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.

Sec. 17. (a) If, at any time during an external review performed under this chapter, the covered individual submits information to the insurer that is relevant to the insurer's resolution of the covered individual's appeal of a grievance decision under IC 27-8-28-17 and that was …

Sec. 18. This chapter does not add to or otherwise change the terms of coverage included in a policy, certificate, or contract under which a covered individual receives health care benefits under IC 27-8. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.

Sec. 19. (a) The department shall establish and maintain a process for annual certification of independent review organizations. (b) The department shall certify a number of independent review organizations determined by the department to be sufficient to fulfill the purposes of …

Sec. 2. As used in this chapter, "appeal" means the procedure described in IC 27-8-28-17. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.

Sec. 20. Except as provided in section 19(g) of this chapter, documents and other information created or received by the independent review organization or the medical review professional in connection with an external grievance review under this chapter: (1) are not public recor…

Sec. 21. (a) An insurer shall each year file with the commissioner a description of the grievance procedure established by the insurer under this chapter, including: (1) the total number of external grievances handled through the procedure during the preceding calendar year; (2) …

Sec. 22. (a) An independent review organization is immune from civil liability for actions taken in good faith in connection with an external review under this chapter. (b) The work product or determination, or both, of an independent review organization under this chapter are ad…

Sec. 23. If a covered individual has the right to an external review of a grievance under Medicare, the covered individual may not request an external review of the same grievance under this chapter. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.

Sec. 24. The department may adopt rules under IC 4-22-2 to implement this chapter. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.

Sec. 3. As used in this chapter, "commissioner" refers to the insurance commissioner appointed under IC 27-1-1-2. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.1-2002, SEC.117.

Sec. 4. As used in this chapter, "covered individual" has the meaning set forth in IC 27-8-28-3. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.

Sec. 5. As used in this chapter, "department" refers to the department of insurance. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.

Sec. 6. As used in this chapter, "external grievance" means the independent review under this chapter of a: (1) grievance filed under IC 27-8-28; or (2) denial of coverage based on a waiver described in IC 27-8-5-2.5(e) (expired July 1, 2007, and removed) or IC 27-8-5-19.2 (expir…

Sec. 7. As used in this chapter, "grievance" has the meaning set forth in IC 27-8-28-6. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.

Sec. 8. As used in this chapter, "grievance procedure" has the meaning set forth in IC 27-8-28-7. As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.