Title 27, INSURANCE

Sec. 7. As used in this chapter, "corrective order" means an order issued by the commissioner that specifies the corrective actions that the commissioner determines are required. As added by P.L.186-1996, SEC.1.

Sec. 8. As used in this chapter, "domestic insurer" means any: (1) insurance company; (2) health maintenance organization; (3) limited service health maintenance organization; or (4) fraternal benefit society; that is domiciled in Indiana. As added by P.L.186-1996, SEC.1. Amended…

Sec. 9. As used in this chapter, "foreign insurer" means the following: (1) An insurer that is: (A) licensed to do business in Indiana under IC 27-1-17; but (B) not a domestic insurer. (2) A health maintenance organization that: (A) is organized under the laws of a state other th…

Sec. 9.2. As used in this chapter, "fraternal benefit society" refers to a society (as defined in IC 27-11-1-11) that holds a certificate of authority issued under IC 27-11-4 or IC 27-11-8-5. As added by P.L.276-2013, SEC.19.

Sec. 9.3. As used in this chapter, "health insurer" means the following: (1) A health maintenance organization. (2) A limited service health maintenance organization. (3) An insurer that makes one (1) or more of the types of insurance described in Class 1(b) or Class 2(a) of IC 2…

Sec. 9.4. As used in this chapter, "health maintenance organization" has the meaning set forth in IC 27-13-1-19. As added by P.L.51-2002, SEC.4.

Sec. 9.6. As used in this chapter, "insurer" includes: (1) a health maintenance organization; (2) a limited service health maintenance organization; and (3) a fraternal benefit society. As added by P.L.51-2002, SEC.5. Amended by P.L.276-2013, SEC.21.

Sec. 9.8. As used in this chapter, "limited service health maintenance organization" has the meaning set forth in IC 27-13-34-4. As added by P.L.51-2002, SEC.6.

Sec. 1. (a) Each health maintenance organization shall appoint a medical director who has an unlimited license to practice medicine under IC 25-22.5 or an equivalent license issued by another state. (b) The medical director is responsible for oversight of treatment policies, prot…

Sec. 10. Each health maintenance organization shall demonstrate to the commissioner that the health maintenance organization has developed an access plan to meet the needs of the health maintenance organization's enrollees, including vulnerable and underserved enrollees and enrol…

Sec. 11. The health maintenance organization shall develop standards for continuity of care following enrollment, including sufficient information on how to access care within the health maintenance organization. As added by P.L.69-1998, SEC.14.

Sec. 12. (a) As used in this section, "nonparticipating provider" means a provider that has not entered into an agreement with a health maintenance organization to serve as a participating provider. (b) After September 30, 2009, if a health maintenance organization makes a paymen…

Sec. 2. Beginning July 1, 1999, each health maintenance organization shall include a sufficient number and type of primary care providers and other appropriate providers throughout the health maintenance organization's service area to: (1) meet the needs of; and (2) provide a cho…

Sec. 2.5. (a) A health maintenance organization may not discriminate against a provider acting within the scope of the provider's license or certification with respect to: (1) participation; (2) reimbursement; (3) indemnification; or (4) scope of care; solely on the basis of the …

Sec. 3. (a) The provisions of this section do not apply until July 1, 1999. (b) Each health maintenance organization shall demonstrate to the department that the health maintenance organization offers an adequate number of: (1) acute care hospital services; (2) primary care provi…

Sec. 4. Beginning July 1, 1999, primary care providers shall include licensed physicians who practice in one (1) or more of the following areas: (1) Family practice. (2) General practice. (3) Internal medicine. (4) As a woman's health care provider, in compliance with IC 27-8-24.…

Sec. 5. (a) The provisions of the section do not apply until July 1, 1999. (b) When an enrollee's primary care provider determines that the enrollee needs a particular health care service and the health maintenance organization determines that the type of health care service need…

Sec. 6. (a) A health maintenance organization shall include provisions in the health maintenance organization's contracts with providers to provide for continuation of care in the event that a provider's contract with the health maintenance organization is terminated, provided th…

Sec. 7. Each health maintenance organization shall provide the following: (1) Telephone access to the health maintenance organization during business hours to ensure enrollee access for routine care. (2) Twenty-four (24) hour telephone access to either: (A) a representative of th…

Sec. 8. (a) Each health maintenance organization shall establish guidelines for establishing reasonable periods of time within which an enrollee must be given an appointment with a participating provider, except as provided in section 9 of this chapter regarding emergency service…

Sec. 9. (a) As used in this section, "care obtained in an emergency" means, with respect to an enrollee, covered services that are: (1) furnished by a provider within the scope of the provider's license and as otherwise authorized under law; and (2) needed to evaluate or stabiliz…