Title 27, INSURANCE

Sec. 6. As used in this chapter, "insurer" means the following: (1) An insurer (as defined in IC 27-1-2-3(x)) that issues a policy of accident and sickness insurance (as defined in IC 27-8-5-1). (2) A health maintenance organization (as defined in IC 27-13-1-19) that provides cov…

Sec. 7. As used in this chapter, "provider" means an individual or entity licensed or legally authorized to provide health care services. As added by P.L.88-2026, SEC.6.

Sec. 7.5. As used in this chapter, "RARC" refers to remittance advice remark codes that provide: (1) supplemental information about a financial adjustment indicated by a CARC; or (2) information about remittance processing. As added by P.L.88-2026, SEC.6.

Sec. 8. Notwithstanding any other law or regulation to the contrary, an insurer may not use downcoding in a manner that prevents a provider from: (1) submitting a health benefits claim for the actual health care service performed; and (2) collecting reimbursement from the insurer…

Sec. 9. (a) An insurer may not use an automated: (1) process; (2) system; or (3) tool, including artificial intelligence; as the sole basis to downcode a claim based on medical necessity without the review of the covered individual's medical record by an employee or contractor of…

Sec. 1. As used in this chapter: (a) "Commissioner" means the insurance commissioner of Indiana. (b) "Accident and sickness insurance" means any policy or contract of insurance described in classes 1(b), 2(a), 2(b), or 2(l), as defined in IC 27-1-5-1. As added by Acts 1977, P.L.2…

Sec. 2. (a) The commissioner shall prescribe by rule, after consultation with providers of health care or treatment, accident and sickness insurers, hospital, medical, and dental service corporations and other prepayment organizations, such accident and sickness insurance claim f…

Sec. 3. The adoption of uniform claim forms by the commissioner pursuant to this chapter does not preclude an insurer, hospital, medical, or dental service corporation or other pre-payment organization, from obtaining any necessary additional information regarding a claim from th…

Sec. 0.1. The amendments made to section 2 of this chapter by P.L.189-1997 apply only to a policy or contract of accident and sickness insurance that is issued or renewed after June 30, 1997. As added by P.L.220-2011, SEC.436.

Sec. 1. (a) As used in this chapter, the term "accident and sickness insurance" means any policy or contract covering one (1) or more of the kinds of insurance described in classes 1(b) or 2(a) of IC 27-1-5-1, as governed by IC 27-8-5. (b) The term does not include the following:…

Sec. 2. (a) Except as provided in subsection (b), all individual and group accident and sickness insurance policies or contracts which provide coverage on an expense incurred basis or a provision of service basis for: (1) an individual insured, certificate holder, or subscriber; …

Sec. 3. If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child and payment of the required premium or fees must be furnished to the insurer or nonprofit …

Sec. 4. This chapter applies to accident and sickness insurance policies and contracts delivered or issued for delivery in Indiana after October 1, 1975. As added by P.L.5-1988, SEC.148.

Sec. 0.5. Sections 6.7 and 11.5 of this chapter, as added in the 2026 session of the general assembly, and section 10 of this chapter, as amended in the 2026 session of the general assembly, apply to claims submitted under an accident and sickness insurance policy that: (1) is is…

Sec. 1. As used in this chapter, "accident and sickness insurance policy" has the meaning set forth in IC 27-8-5-1. As added by P.L.162-2001, SEC.5.

Sec. 10. (a) An insurer may not, more than one hundred eighty (180) days after the date on which an overpayment on a provider claim was made to the provider by the insurer: (1) request that the provider repay the overpayment; or (2) adjust a subsequent claim filed by the provider…

Sec. 11. Every subsequent claim that is adjusted by an insurer for reimbursement on an overpayment of a previous provider claim made to the provider must be accompanied by an explanation of the reason for the adjustment, including: (1) an identification of: (A) the claim on which…

Sec. 11.5. (a) If an insurer or a health maintenance organization (as defined in IC 27-13-36.2-2) recoups payment from a provider due to an error in coordination of benefits, the provider may submit a claim for the same services to the appropriate insurer. (b) Except as provided …

Sec. 12. (a) This section applies to a policy of accident and sickness insurance that is issued, delivered, amended, or renewed after June 30, 2025. (b) An insurer may not deny a claim for reimbursement for a covered service or item provided to an insured on the sole basis that t…

Sec. 2. As used in this chapter, "clean claim" means a claim submitted by a provider for payment under an accident and sickness insurance policy issued in Indiana that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. As added …

Sec. 2.5. 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.26.

Sec. 2.7. As used in this chapter, "health provider facility" has the meaning set forth in IC 27-1-37-3.2. As added by P.L.88-2026, SEC.8.

Sec. 3. As used in this chapter, "insurer" means an insurance company issued a certificate of authority in Indiana to issue accident and sickness insurance policies. The term includes: (1) a preferred provider plan (as defined in IC 27-8-11-1); and (2) an insurance administrator …

Sec. 4. As used in this chapter, "provider" has the meaning set forth in IC 27-8-11-1. As added by P.L.162-2001, SEC.5.

Sec. 5. (a) An insurer shall pay or deny each clean claim in accordance with sections 6 and 6.5 of this chapter. (b) An insurer shall notify a provider of any deficiencies in a submitted claim not more than: (1) thirty (30) days for a claim that is filed electronically; or (2) fo…

Sec. 6. (a) An insurer shall pay or deny each clean claim as follows: (1) If the claim is filed electronically, within thirty (30) days after the date the claim is received by the insurer. (2) If the claim is filed on paper, within forty-five (45) days after the date the claim is…

Sec. 6.5. (a) An insurer may not alter the CPT code submitted for a clean claim or pay for a CPT code of lesser monetary value unless: (1) the CPT code submitted is not in accordance with correct coding guidelines and rules, clinical care guidelines, or the terms and conditions o…

Sec. 6.7. (a) An insurer may not retroactively reduce the reimbursement rate for any CPT code. (b) An insurer shall provide at least sixty (60) days written notice by: (1) mail or electronic mail to a provider; and (2) posting on the insurer's website; before prospectively implem…

Sec. 7. A provider shall submit only the following forms for payment by an insurer: (1) CMS-1500. (2) CMS-1450 (UB-04). (3) American Dental Association (ADA) claim form. As added by P.L.162-2001, SEC.5. Amended by P.L.208-2018, SEC.10.

Sec. 8. (a) If the commissioner finds that an insurer has failed during any calendar year to process and pay clean claims in compliance with this chapter, the commissioner may assess an aggregate civil penalty against the insurer according to the following schedule: (1) If the in…

Sec. 1. As used in this chapter, "accident and sickness insurance policy" means an insurance policy that provides at least one (1) of the types of insurance described in IC 27-1-5-1, Classes 1(b) and 2(a), and is issued on a group basis. The term does not include the following: (…

Sec. 2. As used in this chapter, "commissioner" means the insurance commissioner appointed under IC 27-1-1-2. As added by P.L.230-2001, SEC.2.

Sec. 3. As used in this chapter, "insured" means an individual who is entitled to coverage under an accident and sickness insurance policy. As added by P.L.230-2001, SEC.2.

Sec. 4. (a) This section applies to an insurer that: (1) issues an accident and sickness insurance policy that provides coverage for prescription drugs or devices; and (2) issues a card or other technology for claims processing. This section also applies to a third party administ…

Sec. 5. (a) As used in this section, "health plan information card" means a card that: (1) an insurer of an accident and sickness insurance policy; or (2) a third party administrator of a self-insured plan; provides to an individual so that the individual may present the card to …

Sec. 6. (a) As used in this section, "insurer" means: (1) an issuer of an accident and sickness insurance policy; or (2) a third party administrator of health benefits and services under an accident and sickness insurance policy. (b) The electronic data base by which an insurer a…

Sec. 1. As used in this chapter, "covered individual" means an individual entitled to coverage under a short term insurance plan. As added by P.L.288-2019, SEC.7.

Sec. 2. As used in this chapter, "PPACA" has the meaning set forth in IC 27-19-2-14. As added by P.L.288-2019, SEC.7.

Sec. 3. As used in this chapter, "short term insurance plan" means a policy of accident and sickness insurance (as defined in IC 27-8-5-1) that: (1) may be renewed for the greater of: (A) thirty-six (36) months; or (B) the maximum period permitted under federal law; (2) has a ter…

Sec. 4. (a) An insurer may require an applicant for coverage under a short term insurance plan to specify, before issuance of the short term insurance plan, the number of renewals the applicant elects. (b) After issuance of a short term insurance plan, the insurer may not require…

Sec. 5. A short term insurance plan must include coverage for the following: (1) Ambulatory patient services. (2) Hospitalization. (3) Emergency services. (4) Laboratory services. As added by P.L.288-2019, SEC.7.

Sec. 6. (a) This section applies to an insurer that issues a short term insurance plan and undertakes a preferred provider plan under IC 27-8-11 to render health care services to covered individuals under the short term insurance plan. (b) An insurer described in subsection (a) s…

Sec. 7. (a) An insurer that issues a short term insurance plan shall disclose to an applicant, in bold, 10 point type, the following: (1) That the short term insurance plan does not include coverage for the ten (10) essential health benefits required under PPACA. (2) That the sho…

Sec. 8. An insurer shall not, as a condition of enrollment or continued enrollment in a short term insurance plan, require an individual to pay a premium or contribution greater than the premium or contribution for a similarly situated individual enrolled in the short term insura…

Sec. 9. This chapter does not prevent an insurer from establishing a premium discount, a rebate, or out-of-pocket payment modifications in return for adherence to programs of health promotion and disease prevention. As added by P.L.288-2019, SEC.7.

Sec. 1. (a) Any foreign insurance company which is admitted to transact business in Indiana may, upon complying with the requirements for formation of a domestic company under IC 27-1-6, become a domestic insurer. When those requirements have been met, the commissioner may issue …