Title 27, INSURANCE

Sec. 2. (a) As used in this chapter, "health benefit plan" means a policy, contract, certificate, or agreement that is entered into, offered by, or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. (b) The term …

Sec. 3. (a) As used in this chapter, "plan sponsor" means a person that establishes, adopts, or maintains a health benefit plan that covers individuals in Indiana. (b) The term includes a health benefit plan established, adopted, or maintained: (1) by an employer; (2) jointly by …

Sec. 4. (a) Subject to subsection (b), the plan sponsor of a health benefit plan may, on behalf of all covered individuals of the health benefit plan, provide consent: (1) to the mailing to covered individuals by electronic means otherwise required by IC 27-1-43-3 of all communic…

Sec. 5. Before providing delivery by electronic means to a covered individual for whom the plan sponsor of a health benefit plan has provided consent under section 4 of this chapter, the insurer that entered into, offered, or issued the policy, contract, certificate, or agreement…

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.3.

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.3.

Sec. 10. Nothing in this chapter prohibits an insurer from decreasing a covered individual's defined cost sharing by an amount greater than the amount required under section 8 of this chapter. As added by P.L.166-2023, SEC.3.

Sec. 11. An insurer shall disclose the following information to a plan sponsor on at least an annual basis: (1) The approximate amount of rebates expected to be received by the insurer concerning the dispensing or administration of prescription drugs to the covered individuals of…

Sec. 12. (a) The department may enforce the requirements of this chapter to the extent permissible under applicable law. (b) A violation of this chapter is an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4. (c) The department may adopt rules un…

Sec. 13. 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.3.

Sec. 14. (a) In complying with the requirements of this chapter, an insurer 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 is protected as a trade…

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.3.

Sec. 3. (a) As used in this chapter, "health insurance coverage" includes: (1) a group policy of accident and sickness insurance (as defined in IC 27-8-5-1); (2) a group contract (as defined in IC 27-13-1-16) that provides coverage for basic health care services (as defined in IC…

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.3.

Sec. 5. As used in this chapter, "plan sponsor" means an employer or organization that offers health insurance coverage to its employees or members through an insurer. As added by P.L.166-2023, SEC.3.

Sec. 6. 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. 7. 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 …

Sec. 8. An insurer shall pass through to a plan sponsor one hundred percent (100%) of all rebates concerning the dispensing or administration of prescription drugs to the covered individuals of the plan sponsor. As added by P.L.166-2023, SEC.3.

Sec. 9. (a) At the time of contracting, an insurer shall only offer to plan sponsors the following plans: (1) A plan that applies one hundred percent (100%) of the rebates to reduce premiums for all covered individuals equally. (2) A plan that calculates defined cost sharing for …

Sec. 1. This chapter applies to a policy of health insurance coverage that is issued, delivered, amended, or renewed after December 31, 2025. As added by P.L.237-2025, SEC.10.

Sec. 10. (a) Except as provided in subsection (b), when calculating a covered individual's contribution to an applicable cost sharing requirement, an insurer and administrator must include any cost sharing amounts paid: (1) by the covered individual; and (2) on behalf of the cove…

Sec. 11. An insurer and an administrator may not directly or indirectly: (1) set; (2) alter; (3) implement; or (4) condition; the terms of health insurance coverage, including the benefit design, based in part or entirely on information about the availability or amount of financi…

Sec. 12. Before December 31 of each year, each insurer and administrator shall certify to the commissioner that the insurer or administrator has fully and completely complied with the requirements of this chapter during the previous calendar year. The certification must be signed…

Sec. 13. The commissioner may adopt rules under IC 4-22-2 to implement this chapter. As added by P.L.237-2025, SEC.10.

Sec. 2. As used in this chapter, "administrator" means a person who, directly or indirectly and on behalf of an insurer: (1) underwrites; or (2) collects charges or premiums from or adjusts or settles claims on: (A) residents of Indiana; or (B) residents of another state from off…

Sec. 3. As used in this chapter, "cost sharing" means any copayment, coinsurance, deductible, or other similar charge that is: (1) required of a covered individual for a health care service covered by a policy of health insurance coverage, including a prescription drug; and (2) p…

Sec. 4. As used in this chapter, "covered individual" means an individual who is entitled to health insurance coverage. As added by P.L.237-2025, SEC.10.

Sec. 5. As used in this chapter, "health care service" means a service or good furnished for the purpose of preventing, alleviating, curing, or healing: (1) human illness; (2) physical disability; or (3) injury. As added by P.L.237-2025, SEC.10.

Sec. 6. (a) As used in this chapter, "health insurance coverage" means: (1) an individual or group 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) or a group contract (as defined in IC 27-13-1-16) tha…

Sec. 7. As used in this chapter, "insurer" means an insurer that provides health insurance coverage to a covered individual. As added by P.L.237-2025, SEC.10.

Sec. 8. As used in this chapter, "person" means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, not-for-profit corporation, unincorporated organization, government, or gov…

Sec. 9. An insurer and an administrator shall apply the annual limitation on cost sharing set forth in the federal Patient Protection and Affordable Care Act under 42 U.S.C. 18022(c)(1) to prescription drugs that: (1) are covered under a policy or contract of health insurance cov…

Sec. 1. As used in this chapter, "financial responsibility" means the ability to respond in damages as described in IC 9-25-2-3. As added by P.L.136-2015, SEC.1.

Sec. 2. As used in this chapter, "motor vehicle insurance policy" means a policy that provides the kind of coverage described in Class 2(f) of IC 27-1-5-1. As added by P.L.136-2015, SEC.1.

Sec. 3. (a) As used in this chapter, "noneconomic damages" means costs for the following: (1) Physical and emotional pain and suffering. (2) Physical impairment. (3) Emotional distress. (4) Mental anguish. (5) Loss of enjoyment. (6) Loss of companionship, services, and consortium…

Sec. 4. As used in this chapter, "uninsured motorist with a previous violation" means an individual who: (1) owns a motor vehicle: (A) that is involved in an accident; and (B) for which financial responsibility is not in effect as required by IC 9-25-4; and (2) during the immedia…

Sec. 5. An insurer may not pay noneconomic damages on a claim for coverage under a motor vehicle insurance policy issued by the insurer if the claim is for coverage for a loss incurred by an uninsured motorist with a previous violation. As added by P.L.136-2015, SEC.1.

Sec. 6. (a) Section 5 of this chapter does not apply to a claim for coverage for a loss incurred by an uninsured motorist with a previous violation who is less than eighteen (18) years of age. (b) Section 5 of this chapter does not apply to a claim for coverage for a loss incurre…

Sec. 0.3. This chapter does not apply to the Medicaid program or a managed care organization (as defined in IC 12-7-2-126.9) that provides services to a Medicaid recipient. As added by P.L.88-2026, SEC.6.

Sec. 0.5. As used in this chapter, "CARC" refers to the claim adjustment reason codes that provide the reason for a financial adjustment specified to a particular claim or service, as referenced in the transmitted Accredited Standards Committee (ASC) X12 835 standard transaction …

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.88-2026, SEC.6.

Sec. 10. An insurer may not downcode a claim based solely on the reported diagnosis code. As added by P.L.88-2026, SEC.6.

Sec. 11. If a claim is downcoded, the insurer shall: (1) notify the provider using the appropriate CARC and RARC to clearly indicate that the claim has been downcoded; and (2) provide: (A) the specific reason for the downcoding, including reference to the clinical criteria used t…

Sec. 12. (a) An insurer shall provide providers with a clear and accessible process for appealing downcoded claims, including: (1) a written or electronic notice detailing how to initiate an appeal; (2) contact information for the individual managing the appeal; and (3) a timelin…

Sec. 13. An insurer may not downcode in a targeted or discriminatory manner against providers that routinely treat patients with complex or chronic conditions. As added by P.L.88-2026, SEC.6.

Sec. 14. The department shall adopt rules under IC 4-22-2 to carry out this chapter. As added by P.L.88-2026, SEC.6.