Title 27, INSURANCE

Sec. 21. (a) As used in this section, "high breast density" means a condition in which there is a greater amount of breast and connective tissue in comparison to fat in the breast. (b) An individual contract or a group contract that provides coverage for basic health care service…

Sec. 22. (a) An individual contract or a group contract must provide coverage for telehealth services in accordance with the same clinical criteria as the individual contract or the group contract provides coverage for the same health care services delivered to an enrollee in per…

Sec. 23. (a) As used in this section, "group contract" refers to a group contract that provides coverage for prescription drugs. (b) As used in this section, "health maintenance organization" refers to a health maintenance organization that provides coverage for prescription drug…

Sec. 24. (a) As used in this section, "disability" has the meaning set forth in 42 U.S.C. 12102. (b) As used in this section, "enrollee" means an enrollee who has a disability. (c) As used in this section, "group contract" means a group contract that provides coverage for anatomi…

Sec. 24.5. (a) This section applies to each of the following: (1) An individual contract. (2) A group contract. (b) As used in this section, "chronic pain" means pain that: (1) persists beyond the usual course of an acute disease or healing of an injury; or (2) may be associated …

Sec. 26. (a) An individual contract and a group contract 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 treatm…

Sec. 27. (a) This section applies to each of the following: (1) An individual contract. (2) A group contract. (b) As used in this section, "emergency medical services" has the meaning set forth in IC 16-18-2-110. (c) As used in this section, "emergency medical services provider o…

Sec. 28. An individual contract and a group contract shall consider services provided to an individual while detained under IC 12-26-5 as medically necessary when provided in accordance with generally accepted clinical care guidelines. As added by P.L.205-2023, SEC.25.

Sec. 28.5. (a) This section applies to an individual contract or a group contract that is entered into, amended, or renewed after June 30, 2023. (b) As used in this section, "wearable cardioverter defibrillator" means a device that: (1) is worn externally on an individual's body;…

Sec. 29.5. (a) This section applies only to: (1) a prescription drug that is: (A) consistent with best practices for the treatment of advanced, metastatic cancer or an associated condition; (B) supported by peer reviewed, evidence based literature; and (C) approved by the federal…

Sec. 3. (a) A contract referred to in section 1 of this chapter must clearly state the following: (1) The name and address of the health maintenance organization. (2) Eligibility requirements. (3) Benefits and services within the service area. (4) Emergency care benefits and serv…

Sec. 4. (a) An individual contract must comply with all provisions of section 3(a) of this chapter and provide for a period of ten (10) days during which the individual entering into the contract with the health maintenance organization may: (1) examine the contract; and (2) if t…

Sec. 5. (a) A subscriber under a group contract must receive an evidence of coverage from: (1) the group contract holder; or (2) the health maintenance organization. (b) A group contract holder or health maintenance organization may provide the evidence of coverage required under…

Sec. 6. The evidence of coverage required by section 5 of this chapter may not contain provisions or statements: (1) that are unfair, unjust, inequitable, misleading, or deceptive; or (2) that encourage misrepresentation prohibited by IC 27-1-15.6-12 or IC 27-4-1-4. As added by P…

Sec. 7. The evidence of coverage required by section 5 of this chapter must contain a clear statement of the matters set forth in section 3(a) of this chapter. As added by P.L.26-1994, SEC.25.

Sec. 7.5. (a) A health maintenance organization that provides coverage for basic health care services and that is entered into, delivered, amended, or renewed after December 31, 2014, under a group contract or an individual contract may not provide coverage for abortion unless th…

Sec. 8. The commissioner may adopt rules under IC 4-22-2 establishing readability standards for individual contracts and evidence of coverage forms. As added by P.L.26-1994, SEC.25.

Sec. 9. Subject to sections 10 and 11 of this chapter: (1) a group or an individual contract; (2) an evidence of coverage; or (3) an amendment to: (A) a group or an individual contract; or (B) an evidence of coverage; may not be delivered or issued for delivery in Indiana unless …

Sec. 1. Except as otherwise specifically provided in this chapter, IC 5-14 applies to all filings made under this article. As added by P.L.94-1999, SEC.3.

Sec. 2. Filings, information, and documents made with or provided to the commissioner under this article may include information that might be damaging to a converting mutual or its affiliates if made available to competitors. Subject to section 3 of this chapter, all documents c…

Sec. 3. (a) Subject to subsection (c), the commissioner may disclose to any person all or part of any document marked "confidential" in the commissioner's possession as the result of being filed under this article if the following conditions are met: (1) The commissioner must giv…

Sec. 1. Except as provided in a professional employer agreement, the following apply to a co-employment relationship: (1) The client: (A) may exercise and enforce all rights; and (B) is obligated to perform all duties and responsibilities; that otherwise apply to an employer in a…

Sec. 2. (a) Except as provided in this article, the co-employment relationship between a client and a PEO, and between a co-employer and a covered employee, is governed by the professional employer agreement. (b) A professional employer agreement must specify the following: (1) T…

Sec. 3. A PEO shall provide written notice to each covered employee who is affected by a professional employer agreement entered into by the PEO concerning the general nature of the co-employment relationship between and among the PEO, the client, and the covered employee. As add…

Sec. 4. (a) Except as expressly provided by the professional employer agreement: (1) a client: (A) is solely responsible for: (i) the quality, adequacy, or safety of goods or services produced or sold in the client's business; (ii) directing, supervising, training, and controllin…

Sec. 5. A PEO that offers, markets, sells, administers, or provides professional employer services under a professional employer agreement as provided in this article is not: (1) engaged in the business of insurance; or (2) acting as an administrator (as defined in IC 27-1-25-1).…

Sec. 6. (a) A business license fee or another fee that is based upon gross receipts must, in the case of a PEO, be based upon the administrative fee of the PEO. (b) A tax assessed on a per capita or per employee basis must be assessed against a: (1) client for covered employees; …

Sec. 1. A discount medical card program organization shall file an annual report with the department not later than three (3) months after the end of the discount medical card program organization's fiscal year. As added by P.L.73-2006, SEC.3.

Sec. 2. A report filed under section 1 of this chapter must be on a form prescribed by the commissioner and must include the following: (1) If the information is different from the initial application for a registration or from the last annual report, a: (A) list of the name and …

Sec. 3. (a) The department shall notify a discount medical card program organization that is not in compliance with this chapter. (b) A discount medical card program organization that fails to file an annual report as required under this chapter shall pay to the department for de…