Title 27, INSURANCE

Sec. 10.5. (a) As used in this chapter, "urgent care facility" means a freestanding health care facility that offers episodic, walk-in care for the treatment of acute, but not life threatening, health conditions. (b) The term does not include an emergency department of a hospital…

Sec. 11. (a) This section does not: (1) apply to an individual who is a Medicaid recipient; or (2) limit the authority of a legal representative of the patient. (b) An individual for whom a nonemergency health care service has been ordered, scheduled, or referred may request from…

Sec. 12. (a) If: (1) the individual who requests a good faith estimate from a provider facility under this chapter and has been verified as a covered individual with respect to a network plan; and (2) the provider facility from which the individual requests the good faith estimat…

Sec. 13. A provider facility may provide a good faith estimate to an individual under this chapter: (1) in a writing delivered to the individual; (2) by electronic mail; or (3) through a mobile application or other Internet web based method, if available; according to the prefere…

Sec. 14. (a) A good faith estimate provided by a provider facility to an individual under this chapter must: (1) provide a summary of the services and material items that the good faith estimate is based on; and (2) include a total figure that is a sum of the estimated prices ref…

Sec. 15. (a) Each provider must make diligent attempts to ensure that the patient is aware of the patient's right to request a good faith estimate under this chapter. The communication by a provider to the patient concerning the right to a good faith estimate must be conspicuous …

Sec. 16. If: (1) a provider facility receives a request for a good faith estimate under this chapter; and (2) the patient is eligible for Medicare coverage; the provider facility shall provide a good faith estimate to the patient within two (2) business days based on available Me…

Sec. 17. (a) If a provider facility fails or refuses: (1) to provide a good faith estimate as required by this chapter; or (2) to provide communication to a patient of information concerning the patient's right to a good faith estimate as required under section 15 of this chapter…

Sec. 18. The requirements of this chapter do not apply to a facility or practitioner that: (1) is required to comply with; and (2) is in compliance with; 45 CFR Part 149, Subparts E and G, as may be enforced and amended by the federal Department of Health and Human Services. As a…

Sec. 2. As used in this chapter, "good faith estimate" means a reasonable estimate of the price each provider anticipates charging for an episode of care for nonemergency health care services that: (1) is made by a provider under this chapter upon the request of the individual fo…

Sec. 3. (a) As used in this chapter, "health carrier" means an entity: (1) that is subject to IC 27 and the administrative rules adopted under IC 27; and (2) that enters into a contract to: (A) provide health care services; (B) deliver health care services; (C) arrange for health…

Sec. 4. As used in this chapter, "in network", when used in reference to a provider, means that the health care services provided by the provider are subject to a health carrier's network plan. As added by P.L.93-2020, SEC.12.

Sec. 5. (a) As used in this chapter, "network" means a group of provider facilities and practitioners that: (1) provide health care services to covered individuals; and (2) have agreed to, or are otherwise subject to, maximum limits on the prices for the health care services to b…

Sec. 6. As used in this chapter, "network plan" means a plan of a health carrier that: (1) requires a covered individual to receive; or (2) creates incentives, including financial incentives, for a covered individual to receive; health care services from one (1) or more providers…

Sec. 7. As used in this chapter, "nonemergency health care service" means a discrete service or series of services ordered by a practitioner for an episode of care for the purpose of: (1) diagnosis; (2) prevention; (3) treatment; (4) cure; or (5) relief; of a physical, mental, or…

Sec. 8. (a) As used in this chapter, "practitioner" means: (1) an individual who holds: (A) an unlimited license, certificate, or registration; (B) a limited or probationary license, certificate, or registration; (C) a temporary license, certificate, registration, or permit; (D) …

Sec. 8.5. As used in this chapter, "price" means the negotiated rate between the: (1) provider facility and practitioner; and (2) covered individual's primary health carrier. As added by P.L.93-2020, SEC.12.

Sec. 9. As used in this chapter, "provider" means: (1) a provider facility; or (2) a practitioner. As added by P.L.93-2020, SEC.12.