Title 27, INSURANCE

Sec. 7. A facility or a practitioner is not required to provide the good faith estimate if the health care service to be provided to the covered individual is scheduled to be performed within two (2) business days after the health care service is ordered. As added by P.L.93-2020,…

Sec. 8. (a) An out of network practitioner who provides health care services at an in network facility to a covered individual may not be reimbursed more for the health care services than allowed according to the rate or amount of compensation established by the covered individua…

Sec. 9. (a) The insurance commissioner may, after notice and hearing under IC 4-21.5, impose on the provider facility a civil penalty of not more than one thousand dollars ($1,000) for each violation of this chapter. (b) A civil penalty collected under this section shall be depos…

Sec. 0.5. Nothing in this chapter prohibits: (1) a self-funded health benefit plan that complies with the federal Employee Retirement Income Security Act (ERISA) of 1974 (29 U.S.C. 1001 et seq.); or (2) a: (A) self-insurance program established to provide group health coverage as…

Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to be provided health care services according to a health carrier's network plan. As added by P.L.93-2020, SEC.12.

Sec. 1.5. As used in this chapter, "episode of care" means the medical care ordered to be provided for a specific medical procedure, condition, or illness. As added by P.L.93-2020, SEC.12.

Sec. 10. (a) As used in this chapter, "provider facility" means any of the following: (1) A hospital licensed under IC 16-21-2. (2) An ambulatory outpatient surgical center licensed under IC 16-21-2. (3) A birthing center licensed under IC 16-21-2. (4) Except for an urgent care f…

Sec. 10.5. (a) As used in this chapter, "urgent care facility" means a freestanding health care facility that offers episodic, walk-in care for the treatment of acute, but not life threatening, health conditions. (b) The term does not include an emergency department of a hospital…

Sec. 11. (a) This section does not: (1) apply to an individual who is a Medicaid recipient; or (2) limit the authority of a legal representative of the patient. (b) An individual for whom a nonemergency health care service has been ordered, scheduled, or referred may request from…

Sec. 12. (a) If: (1) the individual who requests a good faith estimate from a provider facility under this chapter and has been verified as a covered individual with respect to a network plan; and (2) the provider facility from which the individual requests the good faith estimat…

Sec. 13. A provider facility may provide a good faith estimate to an individual under this chapter: (1) in a writing delivered to the individual; (2) by electronic mail; or (3) through a mobile application or other Internet web based method, if available; according to the prefere…

Sec. 14. (a) A good faith estimate provided by a provider facility to an individual under this chapter must: (1) provide a summary of the services and material items that the good faith estimate is based on; and (2) include a total figure that is a sum of the estimated prices ref…

Sec. 15. (a) Each provider must make diligent attempts to ensure that the patient is aware of the patient's right to request a good faith estimate under this chapter. The communication by a provider to the patient concerning the right to a good faith estimate must be conspicuous …

Sec. 16. If: (1) a provider facility receives a request for a good faith estimate under this chapter; and (2) the patient is eligible for Medicare coverage; the provider facility shall provide a good faith estimate to the patient within two (2) business days based on available Me…

Sec. 17. (a) If a provider facility fails or refuses: (1) to provide a good faith estimate as required by this chapter; or (2) to provide communication to a patient of information concerning the patient's right to a good faith estimate as required under section 15 of this chapter…

Sec. 18. The requirements of this chapter do not apply to a facility or practitioner that: (1) is required to comply with; and (2) is in compliance with; 45 CFR Part 149, Subparts E and G, as may be enforced and amended by the federal Department of Health and Human Services. As a…

Sec. 2. As used in this chapter, "good faith estimate" means a reasonable estimate of the price each provider anticipates charging for an episode of care for nonemergency health care services that: (1) is made by a provider under this chapter upon the request of the individual fo…

Sec. 3. (a) As used in this chapter, "health carrier" means an entity: (1) that is subject to IC 27 and the administrative rules adopted under IC 27; and (2) that enters into a contract to: (A) provide health care services; (B) deliver health care services; (C) arrange for health…

Sec. 4. As used in this chapter, "in network", when used in reference to a provider, means that the health care services provided by the provider are subject to a health carrier's network plan. As added by P.L.93-2020, SEC.12.

Sec. 5. (a) As used in this chapter, "network" means a group of provider facilities and practitioners that: (1) provide health care services to covered individuals; and (2) have agreed to, or are otherwise subject to, maximum limits on the prices for the health care services to b…

Sec. 6. As used in this chapter, "network plan" means a plan of a health carrier that: (1) requires a covered individual to receive; or (2) creates incentives, including financial incentives, for a covered individual to receive; health care services from one (1) or more providers…

Sec. 7. As used in this chapter, "nonemergency health care service" means a discrete service or series of services ordered by a practitioner for an episode of care for the purpose of: (1) diagnosis; (2) prevention; (3) treatment; (4) cure; or (5) relief; of a physical, mental, or…

Sec. 8. (a) As used in this chapter, "practitioner" means: (1) an individual who holds: (A) an unlimited license, certificate, or registration; (B) a limited or probationary license, certificate, or registration; (C) a temporary license, certificate, registration, or permit; (D) …

Sec. 8.5. As used in this chapter, "price" means the negotiated rate between the: (1) provider facility and practitioner; and (2) covered individual's primary health carrier. As added by P.L.93-2020, SEC.12.

Sec. 9. As used in this chapter, "provider" means: (1) a provider facility; or (2) a practitioner. As added by P.L.93-2020, SEC.12.

Sec. 1. (a) The following definitions apply throughout this section: (1) "Drawing" means an activity in which: (A) multiple participating persons could possibly receive a prize; and (B) the person or persons who receive a prize are determined by chance, as by randomly drawing one…

Sec. 2. (a) An insurer, by or through its employees, affiliates, insurance producers, or third-party representatives, or an insurance producer acting on the insurance producer's own behalf, may offer or provide, for free or at a discounted price, value-added products or services:…

Sec. 3. (a) A person holding a license under this title may offer or provide, for free or for less than fair market value, value-added products or services that are at least tangentially related to an insurance contract or the administration of an insurance contract if: (1) the v…

Sec. 4. The insurance commissioner may adopt rules under IC 4-22-2 to administer this chapter. As added by P.L.196-2021, SEC.33.

Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to coverage under a health plan. As added by P.L.190-2023, SEC.24.

Sec. 2. As used in this chapter, "CPT code" refers to the medical billing code that applies to a specific health care service, as published in the Current Procedural Terminology code set maintained by the American Medical Association. As added by P.L.190-2023, SEC.24.

Sec. 3. (a) As used in this chapter, "health care service" means a health care related service or product rendered or sold by a health care provider within the scope of the health care provider's license or legal authorization, including hospital, medical, surgical, mental health…

Sec. 4. (a) As used in this chapter, "health plan" means any of the following that provides coverage for health care services: (1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1). However, the term does not include the coverages described in IC 27-8-5-2.5(…

Sec. 5. As used in this chapter, "participating provider" refers to the following: (1) A health care provider that has entered into an agreement with an insurer under IC 27-8-11-3. (2) A participating provider (as defined in IC 27-13-1-24). As added by P.L.190-2023, SEC.24.…

Sec. 6. As used in this chapter, "prior authorization" means a practice implemented by a health plan through which coverage of a health care service is dependent on the covered individual or health care provider obtaining approval from the health plan before the health care servi…

Sec. 7. A health plan must: (1) offer an alternative method for submission of a claim for when the health plan has technical difficulties with the health plan's claims submission system; and (2) post notice of the alternative method for claims submission on the health plan's webs…

Sec. 8. (a) Not later than February 1 of each calendar year, a health plan must post on the health plan's website: (1) the thirty (30) most frequently submitted CPT codes that were submitted by participating providers for prior authorization during the previous calendar year; and…

Sec. 0.5. This chapter applies to a policy of health insurance coverage that is issued, delivered, amended, or renewed after December 31, 2024. As added by P.L.166-2023, SEC.2.

Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to health insurance coverage. As added by P.L.166-2023, SEC.2.

Sec. 10. The commissioner may take appropriate action to enforce this chapter by imposing a civil penalty not to exceed ten thousand dollars ($10,000) per violation. As added by P.L.166-2023, SEC.2.

Sec. 11. (a) In complying with the requirements of this chapter, an insurer or an insurer's agent may not publish or otherwise reveal information regarding the actual amount of rebates the insurer receives on a product, manufacturer, or pharmacy specific basis. This information i…

Sec. 2. As used in this chapter, "defined cost sharing" means a deductible payment or coinsurance amount imposed on a covered individual for a covered prescription drug under the covered individual's health insurance coverage. As added by P.L.166-2023, SEC.2.

Sec. 3. (a) As used in this chapter, "health insurance coverage" includes: (1) an individual policy of accident and sickness insurance (as defined in IC 27-8-5-1); (2) an individual contract (as defined in IC 27-13-1-21) that provides coverage for basic health care services (as d…

Sec. 4. As used in this chapter, "insurer" means an insurer that provides health insurance coverage to a covered individual. As added by P.L.166-2023, SEC.2.

Sec. 5. As used in this chapter, "price protection rebate" means a negotiated price concession that accrues directly or indirectly to an insurer, or another party on behalf of an insurer, if there is an increase in the wholesale acquisition cost of a prescription drug above a spe…

Sec. 6. As used in this chapter, "rebate" means: (1) a discount or other negotiated price concession, including base price concessions (whether described as a rebate or otherwise) and reasonable estimates of price protection rebates, and performance based price concessions, that …