Title 27, INSURANCE

Sec. 6. As used in this chapter, "commissioner" means the insurance commissioner appointed under IC 27-1-1-2. As added by P.L.19-2022, SEC.5.

Sec. 7. As used in this chapter, "eligible group" means two (2) or more persons who are engaged in a common enterprise, or have an economic, educational, or social affinity or relationship, including the following: (1) An entity engaged in the business of providing travel or trav…

Sec. 8. As used in this chapter, "fulfillment materials" means documentation sent to the purchaser of a travel protection plan confirming the purchase and providing the travel protection plan's coverage and assistance details. As added by P.L.19-2022, SEC.5.

Sec. 9. As used in this chapter, "group travel insurance" means travel insurance issued to any eligible group. As added by P.L.19-2022, SEC.5.

Sec. 1. As used in this chapter, "covered individual" means: (1) an enrollee; or (2) an eligible dependent of an enrollee. As added by P.L.128-1992, SEC.1.

Sec. 10. (a) To remain in effect, a certificate of registration issued under this chapter must be renewed annually. To obtain the renewal of a certificate of registration, a utilization review agent must submit an application to the commissioner. The application must be accompani…

Sec. 11. A utilization review agent must satisfy the following minimum requirements: (1) Provide toll free telephone access at least forty (40) hours each week during normal business hours. (2) Maintain a telephone call recording system capable of accepting or recording incoming …

Sec. 12. (a) A utilization review agent shall make available to an enrollee, and to a provider of record upon request, at the time an adverse utilization review determination is made: (1) a written description of the appeals procedure by which an enrollee or a provider of record …

Sec. 13. To provide documentation demonstrating that a utilization review agent is capable of satisfying the requirement of section 11(7) of this chapter, as required by section 9(b)(3) of this chapter, the utilization review agent may provide a signed statement of a physician em…

Sec. 14. (a) The department may, according to the rules adopted under section 20 of this chapter, determine that a utilization review agent satisfies the requirements set forth in section 11 of this chapter if the utilization review agent: (1) has, at the time of issuance of the …

Sec. 15. (a) The following requirements apply to an enrollee's request for certification by a utilization review agent of an admission, a service, or a procedure: (1) In the absence of contractual terms to the contrary, the enrollee is responsible for notifying the utilization re…

Sec. 16. A provider of record, an enrollee, or the agent of a provider of record or an enrollee who provides fraudulent or misleading information is subject to appropriate administrative, civil, and criminal penalties, including criminal penalties under IC 35-43-5. As added by P.…

Sec. 17. (a) If the department believes that a utilization review agent has violated this chapter, the department shall notify the utilization review agent of the alleged violation. (b) The utilization review agent shall respond to a notice given under subsection (a) within thirt…

Sec. 18. (a) This chapter does not require a utilization review agent to disclose information that is proprietary. (b) Any: (1) information concerning standards, criteria, or medical protocols used by a utilization review agent in conducting utilization review; or (2) other propr…

Sec. 19. The compensation of a utilization review agent for the performance of utilization review may not be based on: (1) the extent to which certifications are denied; or (2) the amount by which subsequent claims are reduced for payment. As added by P.L.128-1992, SEC.1.…

Sec. 2. As used in this chapter, "department" refers to the department of insurance. As added by P.L.128-1992, SEC.1.

Sec. 20. The department shall adopt rules under IC 4-22-2 necessary to carry out this chapter. As added by P.L.128-1992, SEC.1.

Sec. 3. As used in this chapter, "enrollee" means an individual who has contracted for or who participates in coverage under an insurance policy issued under insurance classes 1(b) and 2(a) of IC 27-1-5-1, health maintenance organization contract, or other benefit program providi…

Sec. 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.128-1992, SEC.1. Amended by P.L.26-1994, SEC.18.

Sec. 5. As used in this chapter, "provider of record" means the physician or other licensed practitioner identified to a utilization review agent as having primary responsibility for the care, treatment, and services rendered to a covered individual. As added by P.L.128-1992, SEC…

Sec. 6. (a) As used in this chapter, "utilization review" means a system for prospective, concurrent, or retrospective review of the medical necessity and appropriateness of health care services provided or proposed to be provided to a covered individual. (b) The term does not in…

Sec. 7. (a) As used in this chapter, "utilization review agent" means any entity performing utilization review, except the following: (1) An agency of the state or federal government. (2) An agent acting on behalf of the federal or state government. (3) Entities conducting genera…

Sec. 8. (a) As used in this chapter, "utilization review determination" means the rendering of a decision based on utilization review that denies or affirms either of the following: (1) The necessity or appropriateness of the allocation of resources. (2) The provision or proposed…

Sec. 9. (a) A utilization review agent may not conduct utilization review in Indiana unless the utilization review agent holds a certificate of registration issued by the department under this chapter. (b) To obtain a certificate of registration under this chapter, a utilization …

Sec. 1. An agreement between a provider and a health maintenance organization under which the provider agrees to provide health care services must require the provider to give the organization at least sixty (60) days advance notice before terminating the agreement unless the pro…

Sec. 1. The policies of a foreign or alien life insurance company, may, when issued in this state, contain any provision which the laws of the state, territory, district, or country under which the company is organized prescribes shall be in such policies and the method of valuat…

Sec. 2. (a) Every insurance company not organized under the laws of this state, and each domestic company electing to be taxed under this section, and doing business within this state shall, on or before March 1 of each year, report to the department, under the oath of the presid…

Sec. 3. Each foreign or alien corporation admitted to do business in this state shall keep on file in the office of the department a duly authenticated copy of each instrument amending its articles of incorporation or association, but the filing of any such instrument shall not o…

Sec. 4. (a) Any foreign or alien corporation admitted to do business in this state may alter or enlarge the character of the business which it is authorized to transact in this state under its articles of incorporation or association, and any amendments thereof filed with the dep…

Sec. 6. (a) Any foreign or alien corporation admitted to do business in this state may withdraw from this state by surrendering its certificate of authority and by filing with the department, accompanied by the fees prescribed by law, a statement of withdrawal setting forth: (1) …

Sec. 1. (a) As used in this chapter, "asset acquisition" includes every purchase, lease, exchange, merger, consolidation, succession, or other acquisition. (b) The term does not include the construction on or development of real property by or for the reporting insurer or the acq…

Sec. 10. (a) Except as provided in subsections (b) and (c), any report obtained by or disclosed to the commissioner under this chapter: (1) shall be confidential information; and (2) shall not, without the prior written consent of the insurer to which it pertains, be: (A) subject…

Sec. 11. The following information must be disclosed in any report of a material asset acquisition or asset disposition: (1) The date of the transaction. (2) The manner of the asset acquisition or asset disposition. (3) A description of the assets involved. (4) The nature and amo…

Sec. 12. (a) Insurers must report material acquisitions and dispositions on a nonconsolidated basis unless the insurer is part of a consolidated group of insurers that uses a pooling arrangement or one hundred percent (100%) reinsurance agreement that affects the solvency and int…

Sec. 13. The following information must be disclosed on a nonconsolidated basis in any report of a material nonrenewal, cancellation, or revision of a ceded reinsurance agreement: (1) The effective date of the nonrenewal, cancellation, or revision. (2) The description of the tran…

Sec. 14. (a) An insurer must report all material nonrenewals, cancellations, or revisions of ceded reinsurance agreements on a nonconsolidated basis unless: (1) the insurer is part of a consolidated group of insurers that uses a: (A) pooling arrangement; or (B) one hundred percen…

Sec. 2. As used in this chapter, "asset disposition" includes every sale, lease, exchange, merger, consolidation, mortgage, hypothecation, assignment (whether for the benefit of creditors or otherwise), abandonment, destruction, or other disposition. As added by P.L.251-1995, SEC…

Sec. 3. As used in this chapter, "domicile" means the following: (1) For a corporation, the state in which the purchasing group is incorporated. (2) For an unincorporated entity, the state of its principal place of business. As added by P.L.251-1995, SEC.17.

Sec. 4. As used in this chapter, "material acquisition" means an asset acquisition or a series of related asset acquisitions during any thirty (30) day period that: (1) is nonrecurring; (2) is not in the normal course of business; and (3) involves more than five percent (5%) of t…

Sec. 5. As used in this chapter, "material disposition" means an asset disposition or a series of related asset dispositions during any thirty (30) day period that: (1) is nonrecurring; (2) is not in the normal course of business; and (3) involves more than five percent (5%) of t…

Sec. 6. (a) As used in this chapter, "material nonrenewal, cancellation, or revision of a ceded reinsurance agreement" has the following meanings: (1) When used in connection with property and casualty business, including accident and sickness insurance business written by a prop…

Sec. 7. (a) Except as provided in subsection (b), an insurer domiciled in Indiana shall file a report with the commissioner disclosing: (1) a material acquisition; (2) a material disposition; and (3) a material nonrenewal, cancellation, or revision of a ceded reinsurance agreemen…

Sec. 8. The report required in section 7 of this chapter must be filed not later than fifteen (15) days after the end of the calendar month in which the transaction that requires the filing occurred. As added by P.L.251-1995, SEC.17.

Sec. 9. One (1) complete copy of the report, including any exhibits or other attachments filed with the report, shall be filed with the department. As added by P.L.251-1995, SEC.17. Amended by P.L.81-2012, SEC.20.

Sec. 1. As used in this chapter, "contracting entity" means a dental carrier, a third party administrator, or another person that enters into a provider network contract with providers for the delivery of dental services in the ordinary course of business. As added by P.L.17-2024…

Sec. 10. (a) As used in this chapter, "third party" means a person that enters into a contract with a contracting entity or another third party to gain access to: (1) a provider network contract; (2) dental services provided pursuant to a provider network contract; or (3) contrac…