Title 27, INSURANCE

Sec. 2. The commissioner may make an examination concerning the quality management program of a health maintenance organization whenever necessary for the protection of the citizens of Indiana. However, an examination of the quality management program of a health maintenance orga…

Sec. 3. Each health maintenance organization that is subject to an examination under this chapter shall make its books and records, and the books and records in its custody or control, available for examination and otherwise facilitate the completion of the examination. As added …

Sec. 4. When conducting an examination of a health maintenance organization, the commissioner: (1) may administer oaths to; and (2) examine; the officers and agents of the health maintenance organization concerning the business of the organization. As added by P.L.26-1994, SEC.25…

Sec. 5. The expenses incurred by the commissioner in conducting an examination under this chapter must be paid by the health maintenance organization being examined. As added by P.L.26-1994, SEC.25.

Sec. 6. Instead of conducting an examination of a health maintenance organization that is not domiciled in Indiana, the commissioner may accept the report of an examination made by the insurance commissioner of another state if the other state is accredited by the NAIC. As added …

Sec. 7. (a) Beginning July 1, 1999, the commissioner shall review each health maintenance organization's Health Plan Employer Data and Information Set (HEDIS) data on an annual basis. (b) The commissioner may contract with an appropriate entity to conduct the reviews required und…

Sec. 8. A health maintenance organization shall file a copy of any examination report filed by the insurance commissioner of another state during the preceding calendar year with the annual statement required under IC 27-13-8-1. As added by P.L.203-2001, SEC.29.

Sec. 1. This chapter applies to a policy of property or casualty insurance that is entered into, amended, or renewed after June 30, 2017. As added by P.L.148-2017, SEC.8.

Sec. 10. This chapter does not require an insurer that issued a policy of property or casualty insurance to pay a claim to an innocent coinsured if the final settlement for the property loss is less than sixty percent (60%) of available insurance proceeds under the policy. As add…

Sec. 11. This chapter does not prohibit an insurer from application of reasonable standards of proof to rebut an assertion that an individual meets the requirements to be considered an innocent coinsured under section 5 of this chapter. As added by P.L.148-2017, SEC.8.

Sec. 12. This chapter does not affect an insurer's right of subrogation under a policy of property or casualty insurance to recover payments made from the person that is responsible for the property loss. As added by P.L.148-2017, SEC.8.

Sec. 2. As used in this chapter, "authorized agency" means the following: (1) The state fire marshal or a fire department acting under IC 36-8-17. (2) The superintendent of the state police. (3) The prosecuting attorney responsible for prosecutions in the county where damage to p…

Sec. 3. As used in this chapter, "available insurance proceeds" means: (1) the proceeds payable under a policy of property or casualty insurance: (A) to an innocent coinsured; and (B) based on a claim for property loss to the innocent coinsured's primary residence; minus (2) proc…

Sec. 4. (a) As used in this chapter, "final settlement" means a determination: (1) of the amount owed to an innocent coinsured by an insurer: (A) under the building coverage part of a policy of property or casualty insurance; and (B) for property loss to the innocent coinsured's …

Sec. 5. As used in this chapter, "innocent coinsured" means an individual who: (1) is insured under a policy of property or casualty insurance; (2) did not have knowledge of, cooperate in, or intentionally contribute to a property loss that was caused or arranged by another indiv…

Sec. 6. As used in this chapter, "insurer" means an insurance company that issues or delivers a policy of property or casualty insurance. As added by P.L.148-2017, SEC.8.

Sec. 7. As used in this chapter, "property or casualty insurance" means a type of insurance described in Class 2 and Class 3 of IC 27-1-5-1. However, the term does not mean insurance described in Class 2(a) of IC 27-1-5-1. As added by P.L.148-2017, SEC.8.

Sec. 8. (a) An insurer may not deny, exclude, or limit payment of a claim made: (1) by an innocent coinsured; (2) for coverage of a property loss to the primary residence of the innocent coinsured; and (3) under a policy of property or casualty insurance; unless the denial, exclu…

Sec. 9. An insurer may not: (1) refuse to renew; (2) refuse to issue; or (3) add a surcharge or rating factor to a premium for; a policy of property or casualty insurance solely on the basis that an insured or a prospective insured under the policy of property or casualty insuran…

Sec. 1. This chapter applies to: (1) every policy of accident and sickness insurance (as defined in IC 27-8-5-1), whether written on an individual basis, a group basis, a franchise basis, or a blanket basis; and (2) every group contract (as defined in IC 27-13-1-16) or individual…

Sec. 2. As used in this chapter, "at-home postdelivery care" refers to health care provided to a woman at her residence by a physician licensed under IC 25-22.5 or a registered nurse or an advanced practice registered nurse licensed under IC 25-23 whose scope of practice includes…

Sec. 3. As used in this chapter, "maternity benefits" refers to the provision of health care to a woman before, during, and after delivery of a child, including physician, hospital, laboratory, and ultrasound services. As added by P.L.194-1996, SEC.1.

Sec. 4. (a) Except as provided in section 5 of this chapter, every policy or group contract that provides maternity benefits must provide minimum benefits to a mother and her newborn child that cover: (1) a minimum length of postpartum stay at a hospital licensed under IC 16-21 t…

Sec. 5. (a) If the patients’ attending physician determines further inpatient care is not necessary for the mother or newborn child, a policy or group contract that provides maternity benefits under this chapter may provide under the policy or group contract a shorter length of p…

Sec. 1. (a) The commissioner may suspend or revoke a certificate of authority issued under this article or deny an application submitted under this article if the commissioner finds that any of the following conditions exists: (1) The health maintenance organization is operating:…

Sec. 2. (a) If the commissioner finds that the net worth maintained by a health maintenance organization subject to this article is less than the minimum net worth required by IC 27-13-12, the commissioner shall: (1) give written notice to the health maintenance organization of t…

Sec. 3. (a) The commissioner may: (1) suspend or revoke a certificate of authority; (2) deny an application for a certificate of authority; or (3) impose an administrative penalty; under this article only after complying with this section. (b) The commissioner may: (1) suspend or…

Sec. 4. (a) After a hearing, or upon failure of the health maintenance organization or applicant to appear at the hearing, the commissioner shall: (1) take whatever action the commissioner finds necessary and appropriate based on written findings; and (2) mail the decision to the…

Sec. 5. IC 4-21.5 applies to proceedings under this chapter to the extent IC 4-21.5 does not conflict with any section of this chapter. As added by P.L.26-1994, SEC.25.

Sec. 6. A health maintenance organization whose certificate of authority is suspended may not, during the period of suspension: (1) enroll any additional enrollees, except newborn children or other newly acquired dependents of existing enrollees; or (2) engage in any advertising …

Sec. 7. (a) A health maintenance organization whose certificate of authority is revoked: (1) shall proceed, immediately following the effective date of the order of revocation, to wind up the affairs of the organization; and (2) may not conduct further business, except as essenti…

Sec. 8. If the commissioner issues an order under section 3(b)(1) of this chapter and the health maintenance organization requests a hearing under section 3(d) of this chapter within the time period specified, the health maintenance organization may not: (1) enroll any additional…

Sec. 1. As used in this chapter: (a) "Administrator" means a person who directly or indirectly and on behalf of an insurer underwrites, collects charges or premiums from, or adjusts or settles claims on residents of Indiana in connection with life, annuity, or health coverage off…

Sec. 10. (a) An administrator having a written agreement with an insurer shall provide written notice, which must first be approved by the insurer, to covered persons advising them of the relationship among the administrator, the covered person, and the insurer. (b) When the admi…

Sec. 11.1. (a) If the home state of a person is Indiana, the person shall: (1) apply to act as an administrator in Indiana upon the uniform application for third party administrator license; (2) pay an application fee in an amount determined by the commissioner; and (3) receive a…

Sec. 12.2. (a) An administrator that: (1) performs the duties of an administrator in Indiana; and (2) does not hold a license issued under section 11.1 of this chapter; shall obtain a nonresident administrator license under this section by filing a uniform application for third p…

Sec. 12.3. (a) An administrator that is licensed under section 11.1 of this chapter shall, not later than July 1 of each year unless the commissioner grants an extension of time for good cause, file a report for the previous calendar year that complies with the following: (1) The…

Sec. 12.4. (a) The commissioner shall deny, suspend, or revoke a license issued under this chapter if the commissioner determines that the administrator: (1) is in unsound financial condition; (2) engages in methods or practices in the conduct of the administrator's business so a…

Sec. 13. (a) Except as provided by section 4(b) of this chapter, and except that all provisions of the written agreement between the administrator and an insurer shall be treated by the commissioner as confidential and shall not be open to any member of the public for inspection …

Sec. 14. The commissioner may, under IC 4-22-2, adopt regulations necessary to implement this chapter. As added by Acts 1980, P.L.168, SEC.2.

Sec. 15. (a) An administrator acting without a license issued under this chapter commits a Class C infraction. (b) The commissioner shall notify the prosecuting attorney or the attorney general of Indiana of violations under subsection (a). As added by Acts 1980, P.L.168, SEC.2. …

Sec. 16. (a) A presumption of control arising under section 1(e) of this chapter may be rebutted by a showing made in the manner provided under IC 27-1-23-3(k) that control does not exist in fact. (b) In the absence of a presumption that control exists in fact, the commissioner m…

Sec. 2. (a) An administrator may act only if there is a written agreement between the administrator and an insurer. This agreement must conform to the requirements of this chapter, which apply to the functions performed by the administrator. (b) An agreement between an administra…

Sec. 3. (a) If an insurer utilizes the services of an administrator: (1) premiums or charges for coverage paid by or on behalf of the covered individual are considered to have been received by the insurer when paid to the administrator; and (2) claims or return premiums paid by t…

Sec. 4. (a) An administrator: (1) shall maintain at its principal administrative office books and records of all transactions between the administrator and insurers for at least five (5) years after the creation of the books and records; or (2) may transfer the books and records …

Sec. 5. An administrator may use advertising relating to the business underwritten by an insurer only to the extent that the advertising has been approved in writing by that insurer before the advertising is used. As added by Acts 1980, P.L.168, SEC.2. Amended by P.L.160-2003, SE…