Title 27, INSURANCE

Sec. 22. Each small employer insurer shall make reasonable disclosure in solicitation and sales materials provided to small employers of the provisions affecting premium rate changes. As added by P.L.127-1992, SEC.1.

Sec. 23. Each small employer insurer shall maintain for three (3) years at the insurer's principal place of business a complete and detailed description of the insurer's rating practices and renewal underwriting practices, including information and documentation that demonstrate …

Sec. 24. (a) Each small employer insurer shall maintain an actuarial certification verifying that the insurer is in compliance with this chapter and that the rating methods of the insurer are actuarially sound. A copy of the certification shall be retained by the insurer at the i…

Sec. 25. A small employer insurer shall make the information and documentation described in section 23 of this chapter available to the commissioner upon request. The information is proprietary and trade secret information and is not subject to disclosure by the commissioner to a…

Sec. 26. The commissioner may suspend all or any part of section 16 of this chapter as to the premium rates applicable to one (1) small employer for at least one (1) rating period upon a filing by the small employer insurer and a finding by the commissioner that either: (1) the s…

Sec. 27. (a) This section shall be applied in conformity with the requirements of 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 in effect on September 23, 20…

Sec. 28. (a) As used in this section, "health insurance plan" means coverage provided under any of the following: (1) A hospital or medical expense incurred policy or certificate. (2) A hospital or medical service plan contract. (3) A health maintenance organization subscriber co…

Sec. 29. (a) This section shall be applied in conformity with the requirements of 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 in effect on September 23, 20…

Sec. 3. As used in this chapter, "actuarial certification" means a written statement by a member of the American Academy of Actuaries that a small employer insurer is in compliance with section 16 of this chapter, based upon the person's examination, including a review of the app…

Sec. 30. Except as permitted under sections 27 and 29 of this chapter, a small employer insurer shall not modify a health insurance plan with respect to: (1) a small employer; or (2) an eligible employee or dependent; through riders, endorsements, or otherwise to restrict or excl…

Sec. 31. (a) If an eligible employee who has been continuously covered under a health insurance plan for at least ninety (90) days: (1) loses coverage under the plan as the result of: (A) termination of employment; (B) reduction of hours; (C) marriage dissolution; or (D) attainme…

Sec. 31.1. (a) This section becomes effective on the effective date of a mechanism enacted by the general assembly to offset the potential fiscal impact on small employers and small employer insurers that results from the establishment of a continuation policy under this section.…

Sec. 32. (a) If an individual: (1) becomes an eligible employee of a small employer after the date that a small employer insurer first insures an eligible employee of the small employer under a health insurance plan; and (2) is not a late enrollee; the individual and all dependen…

Sec. 33. (a) If a small employer insurer offers coverage under a health insurance plan to a small employer, the small employer insurer shall provide the employer coverage under the plan for: (1) all eligible employees of the small employer; and (2) the dependents of all eligible …

Sec. 34.1. Except as provided in 29 U.S.C. 1191a and 42 U.S.C. 300gg, a small employer insurer must: (1) offer to any small employer all products that are approved for sale in the small group market and that the insurer is actively marketing; and (2) accept any employer that appl…

Sec. 4. As used in this chapter, "base premium rate" means the lowest premium rate charged or that could have been charged under a rating system by the small employer insurer to small employers with similar case characteristics and benefit design characteristics. As added by P.L.…

Sec. 5. As used in this chapter, "benefit design characteristics" means the following: (1) Covered services. (2) Cost sharing. (3) Utilization management. (4) Managed care networks. (5) Any other features differentiating plan or benefit design. As added by P.L.127-1992, SEC.1.…

Sec. 6. As used in this chapter, "case characteristics" means demographic or other relevant characteristics of a small employer, as determined by a small employer insurer, that are considered by the insurer in the determination of premium rates for the small employer. Claim exper…

Sec. 7. As used in this chapter, "commissioner" refers to the commissioner of the department of insurance. As added by P.L.127-1992, SEC.1.

Sec. 8. As used in this chapter, "department" refers to the department of insurance. As added by P.L.127-1992, SEC.1.

Sec. 8.5. (a) As used in this chapter, "eligible employee" means an employee: (1) who is employed to work at least thirty (30) hours each week; and (2) who meets an applicable waiting period required by a small employer before gaining coverage under a health insurance policy. (b)…

Sec. 9. (a) Except as provided in section 28 of this chapter, as used in this chapter, "health insurance plan" or "plan" means any: (1) hospital or medical expense incurred policy or certificate; (2) hospital or medical service plan contract; or (3) health maintenance organizatio…

Sec. 0.1. The addition of section 4 of this chapter by P.L.74-2007 applies to a contract between a health maintenance organization and a participating provider that is entered into, amended, or renewed on or after April 26, 2007. As added by P.L.220-2011, SEC.460.

Sec. 1. (a) A contract between a health maintenance organization and a participating provider of health care services: (1) must be in writing; (2) may not prohibit the participating provider from disclosing: (A) the terms of the contract as it relates to financial or other incent…

Sec. 2. If: (1) the contract between a health maintenance organization and a participating provider has not been reduced to writing as required by this chapter; or (2) the contract fails to contain the provision required by section 1(a)(4) of this chapter; the participating provi…

Sec. 3. (a) A: (1) participating provider; or (2) trustee, an agent, a representative, or an assignee of a participating provider; may not bring or maintain any legal action against a subscriber or an enrollee of a health maintenance organization to collect sums owed by the healt…

Sec. 4. (a) As used in this section, "health maintenance organization" includes the following: (1) A limited service health maintenance organization. (2) A person that pays or administers claims on behalf of a health maintenance organization or a limited service health maintenanc…

Sec. 5. (a) Notwithstanding IC 27-13-1-12, as used in this section, "enrollee" refers only to an enrollee who requires dialysis treatment. (b) As used in this section, "health maintenance organization" includes the following: (1) A limited service health maintenance organization.…

Sec. 6. (a) As used in this section, "drug" means a prescription drug. (b) As used in this section, "health maintenance organization" refers to a health maintenance organization that provides coverage for drugs. The term includes the following: (1) A limited service health mainte…

Sec. 1. A person who is aggrieved by an agency action of the commissioner under this article may petition for judicial review of the action under IC 4-21.5-5. As added by P.L.94-1999, SEC.3.

Sec. 2. All petitions for judicial review of, and any action challenging the validity of or arising out of: (1) the approval or disapproval of; or (2) any action proposed to be taken under; any order or determination of the commissioner in connection with a plan of conversion und…

Sec. 3. A person who is aggrieved by a failure of the commissioner to act or make a determination required by this article may bring an action for mandate in the circuit court of Marion County to compel the commissioner to act or make the determination. As added by P.L.94-1999, S…

Sec. 0.1. The addition of this chapter by P.L.193-1991 applies to policies first issued or renewed after June 30, 1991. As added by P.L.220-2011, SEC.427.

Sec. 1. This chapter is supplemental to IC 27-1. As added by P.L.193-1991, SEC.1.

Sec. 2. As used in this chapter, "insurer" has the meaning set forth in IC 27-1-2-3(x). As added by P.L.193-1991, SEC.1.

Sec. 3. (a) All preprinted claim forms provided by an insurer to a claimant that are required as a condition of payment of a claim must contain a statement that clearly states in substance the following: "A person who knowingly and with intent to defraud an insurer files a statem…

Sec. 4. An insurer shall include on each identification card and on all benefit booklets that are delivered to an enrollee (as defined in IC 27-8-17-3) whose policy requires a utilization review determination (as defined in IC 27-8-17-8) a printed statement in boldface 8 point ty…

Sec. 1. As used in this chapter, "casualty and liability insurance" means the type of insurance described in IC 27-1-5-1, Class 2(h). As added by P.L.146-2015, SEC.33.

Sec. 2. As used in this chapter, "casualty insurance company" has the meaning set forth in IC 27-1-2-3(t). As added by P.L.146-2015, SEC.33.

Sec. 3. As used in this chapter, "group" means a group of individuals who: (1) have similar professional attributes; (2) belong to the group for purposes other than that of obtaining insurance; and (3) are eligible to purchase casualty and liability insurance. As added by P.L.146…

Sec. 4. As used in this chapter, "group tenant users liability insurance policy" means a policy of insurance that provides tenant users liability insurance to participating group members under one (1) master policy: (1) that is issued to a named insured; and (2) under which indiv…

Sec. 5. As used in this chapter, "tenant users liability insurance" means insurance that provides liability coverage for property damage or bodily injury to a third party caused by a vendor, exhibitor, or performer during a special event. As added by P.L.146-2015, SEC.33.

Sec. 6. An insurer that is authorized under IC 27-1-3-20 to: (1) transact business as a casualty insurance company; and (2) offer casualty and liability insurance; may provide a group tenant users liability insurance policy. As added by P.L.146-2015, SEC.33.

Sec. 0.5. (a) This chapter applies to the following: (1) A person who conducts medical claims review concerning health care services delivered to an enrollee in Indiana. (2) A person who acts as a claim review consultant concerning the: (A) appropriateness of; or (B) amount charg…

Sec. 1. (a) As used in this chapter, "claim review agent" means any entity performing medical claims review on behalf of an insurance company, a health maintenance organization, or another benefit program providing payment, reimbursement, or indemnification for health care costs …

Sec. 1.5. (a) As used in this chapter, "claim review consultant" means a person who: (1) makes a recommendation or provides consultation to: (A) an entity engaged in performing medical claims review; or (B) an insurance company, a health maintenance organization, or another benef…