Title 27, INSURANCE

Sec. 6. (a) It shall be the duty of the department to examine every domestic multiple employer welfare arrangement at least every five (5) years or as often as the department in its discretion may deem necessary. The expense of the examination and or investigations of such arrang…

Sec. 7. If any domestic multiple employer welfare arrangement is insolvent or in imminent danger of insolvency, or fails or suspends operation between periods of examination authorized, it is a class A misdemeanor for the highest officer then actively in charge of such multiple e…

Sec. 8. (a) A reinsurer may not issue a policy of insurance to a multiple employer welfare arrangement that does not have a certificate of registration from the department. (b) An insurance producer licensed by the department may not solicit, offer, or provide coverage through a …

Sec. 8.5. (a) This section applies: (1) only to an arrangement that provides benefits for a public entity; and (2) only with respect to the benefits provided by the arrangement to a public entity. (b) A policy of stop loss insurance issued by a reinsurer to an arrangement providi…

Sec. 9. The department of insurance shall adopt rules under IC 4-22-2 necessary to implement this chapter, including but not limited to: (1) certificate of registration requirements; (2) reinsurance requirements; (3) reserve levels; (4) deposits; (5) financial reporting; (6) fide…

Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to coverage under a policy of accident and sickness insurance. As added by P.L.185-2015, SEC.25.

Sec. 2. As used in this chapter, "health care services" has the meaning set forth in IC 27-8-11-1. As added by P.L.185-2015, SEC.25.

Sec. 3. As used in this chapter, "policy" means a policy of accident and sickness insurance (as defined in IC 27-8-5-1). The term does not include dental insurance or vision insurance. As added by P.L.185-2015, SEC.25.

Sec. 4. As used in this chapter, "provider" has the meaning set forth in IC 27-8-11-1. As added by P.L.185-2015, SEC.25.

Sec. 5. As used in this chapter, "telehealth services" means health care services delivered by use of technology allowed under IC 25-1-9.5-6, including the following: (1) Medical exams and consultations. (2) Behavioral health, including substance abuse evaluations and treatment. …

Sec. 6. (a) A policy must provide coverage for telehealth services in accordance with the same clinical criteria as the policy provides coverage for the same health care services delivered in person. (b) Coverage for telehealth services required by subsection (a) may not be subje…

Sec. 7. This chapter does not do any of the following: (1) Require a policy to provide coverage for a telehealth service that is not a covered health care service under the policy. (2) Require the use of telehealth services when the treating provider has determined that telehealt…

Sec. 0.1. The amendments made to section 12 of this chapter by P.L.69-1998 apply to contracts that are entered into, renewed, or modified after June 30, 1998. As added by P.L.220-2011, SEC.461.

Sec. 1. (a) As used in this chapter, "enrollee" means an individual who is entitled to limited health services under a contract with an entity authorized to provide or arrange for limited health services under this chapter. (b) The term includes the dependent of an individual des…

Sec. 10. (a) Subject to subsection (b), the powers of a limited service health maintenance organization include the following: (1) The purchase, lease, construction, renovation, operation, or maintenance of: (A) medical facilities that will provide limited health services; (B) eq…

Sec. 11. (a) Before making any material modification of any matter or document furnished under section 8 of this chapter, a limited service health maintenance organization shall file with the commissioner: (1) a notice of the modification; and (2) supporting documents that are ne…

Sec. 12. A limited service health maintenance organization operated under this chapter is subject to the following: (1) IC 27-1-36 concerning risk based capital, unless exempted by the commissioner under IC 27-1-36-1. (2) IC 27-13-2-10, concerning physical presence in Indiana. (3…

Sec. 13. (a) Every subscriber of a limited service health maintenance organization shall be issued an evidence of coverage in electronic or paper form, which must contain a clear and complete statement of the following: (1) The limited health services to which each enrollee is en…

Sec. 14. (a) The commissioner may examine a limited service health maintenance organization as often as is reasonably necessary to protect the interests of Indiana citizens. However, an examination of a limited service health maintenance organization domiciled in Indiana must be …

Sec. 15. All contracts with providers or with entities subcontracting for the provision of limited health services to enrollees on a prepayment basis or other basis must contain, or shall be construed to contain, the following terms and conditions: (1) If the limited service heal…

Sec. 16. (a) As used in this section, "net worth" means the excess of total assets over total liabilities, excluding liabilities that have been subordinated in a manner acceptable to the commissioner. (b) For the purposes of computing net worth, the total assets must be reduced b…

Sec. 17. (a) Each limited service health maintenance organization shall deposit in a joint-name account with: (1) the commissioner; or (2) any bank or bank and trust company or other financial institution acceptable to the commissioner through which a custodial or controlled acco…

Sec. 18. (a) Except as provided in subsection (c), a limited service health maintenance organization shall maintain in force a fidelity bond in its own name on its officers and employees: (1) in an amount not less than fifty thousand dollars ($50,000); or (2) in any other amount …

Sec. 19. (a) On or before March 1 of each year, a limited service health maintenance organization shall file with the commissioner a report that covers the preceding calendar year. The report must be: (1) made on forms prescribed by the commissioner; and (2) verified by at least …

Sec. 2. As used in this chapter, "evidence of coverage" means the certificate, agreement, or contract issued under section 13 of this chapter setting forth the coverage to which an enrollee is entitled. As added by P.L.26-1994, SEC.25.

Sec. 20. (a) The commissioner may suspend or revoke the certificate of authority issued to a limited service health maintenance organization under this chapter or deny an application submitted under this chapter upon determining that any of the following conditions exist: (1) The…

Sec. 21. (a) In place of any other penalty specified in this chapter, or when no penalty is specifically provided, whenever any limited service health maintenance organization or other person, corporation, partnership, limited liability company, or entity subject to this chapter …

Sec. 22. (a) Any supervision, rehabilitation, or liquidation of a limited service health maintenance organization shall be considered to be the supervision, rehabilitation, or liquidation of an insurance company and shall be conducted under IC 27-9. (b) A limited service health m…

Sec. 23. (a) A limited service health maintenance organization subject to this chapter shall pay to the commissioner for deposit into the department of insurance fund established by IC 27-1-3-28 the following fees: (1) For filing an application for a certificate of authority or a…

Sec. 24. (a) A limited service health maintenance organization that provides dental care services shall appoint a dental director who has an unlimited license to practice dentistry under IC 25-14 or an equivalent license issued by another state. (b) The dental director appointed …

Sec. 26. (a) The department shall maintain records concerning complaints filed against a limited service health maintenance organization that provides dental care services. (b) The department shall classify complaints described in subsection (a) in categories according to the NAI…

Sec. 3. (a) As used in this chapter, "limited health services" refers to: (1) dental care services; (2) vision care services; (3) mental health services; (4) substance abuse services; (5) pharmaceutical services; (6) podiatric care services; and (7) other services that the commis…

Sec. 4. (a) As used in this chapter, "limited service health maintenance organization" means a corporation, partnership, limited liability company, or other entity that undertakes to provide or arrange a limited health service on a prepayment basis or other basis. (b) The term do…

Sec. 5. As used in this chapter, "provider" means a physician, a dentist, an optometrist, a health facility, or other person or institution that is licensed or otherwise authorized to deliver or furnish limited health service. As added by P.L.26-1994, SEC.25.

Sec. 6. As used in this chapter, "subscriber" means a person whose employment status or other status, except for family dependency, is the basis for eligibility for limited health services under a contract with an entity authorized to provide or arrange for limited health service…

Sec. 7. (a) After December 31, 1994, a person, corporation, partnership, limited liability company, or other entity may not operate a limited service health maintenance organization in Indiana without obtaining and maintaining a certificate of authority from the commissioner unde…

Sec. 8. (a) An application for a certificate of authority to operate a limited service health maintenance organization must be filed with the commissioner on a form prescribed by the commissioner. An application must be verified by an officer or authorized representative of the a…

Sec. 9. (a) After receiving an application filed under section 8 of this chapter, the commissioner shall review the application and notify the applicant of any deficiencies in the application. (b) The commissioner shall issue a certificate of authority to an applicant if the foll…

Sec. 0.5. (a) As used in this chapter, "audit committee" means a body established by the board of directors of a domestic insurer or group of insurers for the purpose of overseeing: (1) the accounting and financial reporting processes; (2) external audits of financial statements;…

Sec. 1. As used in this chapter, "commissioner" refers to the insurance commissioner appointed under IC 27-1-1-2. As added by P.L.244-1989, SEC.2.

Sec. 10. A domestic insurer may apply in writing to the commissioner for approval to satisfy the requirements of this chapter by filing audited consolidated or combined financial statements instead of separate annual audited financial statements if the insurer is part of a group …

Sec. 11. (a) A domestic insurer required to file annual audited financial reports under this chapter shall require its independent auditor to report in writing to the board of directors or the board of director's audit committee, not more than five (5) business days after making …

Sec. 12. (a) A domestic insurer required by this chapter to file an annual audited financial report with the commissioner shall also furnish the commissioner with a written communication describing any unremediated material weaknesses (as defined in the Accounting Practices and P…

Sec. 12.1. (a) As used in this section, "independent", with respect to a member of an audit committee, means that the member, other than in the member's capacity as a member of the audit committee, the board of directors, or another board committee: (1) does not accept a consulti…

Sec. 12.3. (a) This section does not apply to a domestic insurer that meets the following requirements: (1) The domestic insurer has annual direct written and unaffiliated assumed premiums (including international direct and assumed premiums and excluding premiums reinsured with …

Sec. 12.5. (a) A domestic insurer that is required to file an annual audited financial report under this chapter that has annual direct written and assumed premiums (excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program) of at least fi…