Title 27, INSURANCE

Sec. 10. (a) This section applies to a health provider contract in which at least one (1) of the parties is a health provider facility. (b) A health provider contract that: (1) requires the parties to commence negotiations to amend the terms of the contract if there is a change i…

Sec. 11. The department shall do the following: (1) Require health carriers to meet network adequacy standards that are no less stringent than the network adequacy standards established by the Centers for Medicare and Medicaid Services. (2) When assessing whether a health carrier…

Sec. 2. As used in this chapter, "health maintenance organization" means a person that undertakes to provide or arrange for the delivery of health care services to individuals on a prepaid basis, except for the individual's responsibility for copayments or deductibles. The term i…

Sec. 3. As used in this chapter, "health provider contract" means an agreement with a provider or a health provider facility relating to terms and conditions of reimbursement for health care services provided to an individual under: (1) an employee welfare benefit plan (as define…

Sec. 3.2. As used in this chapter, "health provider facility" means any of the following: (1) A hospital, as defined in IC 16-18-2-179(a). (2) A hospital system. (3) An affiliate of a hospital or hospital system. As added by P.L.198-2021, SEC.19.

Sec. 3.5. As used in this chapter, "hospital system" means: (1) a parent corporation of at least one (1) hospital and any entity affiliated with the parent corporation through ownership, governance, or membership; or (2) a hospital and any entity affiliated with the hospital thro…

Sec. 4. (a) As used in this chapter, "person" means an individual, an agency, a political subdivision, a partnership, a corporation, an association, or any other entity. (b) The term does not include a health care provider described in IC 16-18-2-163(a)(1), IC 16-18-2-163(a)(2), …

Sec. 5. As used in this chapter, "provider" means an individual or entity licensed or legally authorized to provide health care services. As added by P.L.197-2001, SEC.1.

Sec. 6. (a) Except as provided in subsection (b), a person may not require a provider, as a condition of entering into a health provider contract for the provision of health care services other than health care services to enrollees of a health maintenance organization, to provid…

Sec. 6.5. (a) As used in this section, "health plan" means any of the following that provides coverage for health care services: (1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1). However, the term does not include the coverages described in IC 27-8-5-2.…

Sec. 7. (a) This section applies to health provider contracts entered into or renewed after June 30, 2020. (b) A health provider contract, including a contract with a pharmacy benefit manager or a health facility, may not contain a provision that prohibits the disclosure of healt…

Sec. 7.5. (a) This section applies to a health provider contract entered into, amended, or renewed after June 30, 2025. (b) When a health carrier is in the process of negotiating a health provider contract with a health provider facility or provider, the health carrier must provi…

Sec. 8. (a) This section applies to a health provider contract entered into, amended, or renewed after June 30, 2025. (b) A health provider contract, including a contract with a pharmacy benefit manager, may not contain a provision that does any of the following: (1) Limits the a…

Sec. 9. (a) This section applies to health provider contracts entered into or renewed after June 30, 2024. (b) If a party to a health provider contract intends to terminate the contractual relationship with another party to the health provider contract, the terminating party must…

Sec. 1. As used in this chapter, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1, offered on an individual or group basis. As added by P.L.130-2020, SEC.14.

Sec. 2. A policy of accident and sickness insurance must provide coverage for treatment of: (1) pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS); and (2) pediatric acute-onset neuropsychiatric syndrome (PANS); including treatment w…

Sec. 3. The coverage required by this chapter may not be subject to annual or lifetime limitation, deductible, copayment, or coinsurance provisions that are more restrictive than the annual or lifetime limitation, deductible, copayment, or coinsurance provisions that apply genera…

Sec. 1. (a) A health maintenance organization shall allow each enrollee of the health maintenance organization to choose the enrollee's own primary care provider from a list of participating primary care providers within the health maintenance organization. (b) The list described…

Sec. 2. (a) Each health maintenance organization shall develop a system to allow an enrollee to use an appropriate participating provider to manage the enrollee's medical condition when the enrollee's primary care provider determines that the use of another appropriate participat…

Sec. 3. Beginning July 1, 1999, each health maintenance organization shall provide continuity of care and referral to appropriate participating providers when specialty care is warranted, including the following: (1) Enrollees have access to appropriate participating providers on…

Sec. 4. (a) Each health maintenance organization shall offer to each purchaser of a group contract or individual contract a point-of-service product to the extent permitted by IC 27-13-13-8. (b) Beginning July 1, 2001, a limited service health maintenance organization that provid…

Sec. 5. Each health maintenance organization shall allow an enrollee who has received a medical opinion from a participating provider to obtain a second medical opinion from an appropriate participating provider concerning the enrollee's medical condition at the enrollee's reques…