Title 27, INSURANCE

Sec. 1. This chapter does not apply to a mail order pharmacy or to specialty drugs. As added by P.L.202-2017, SEC.20.

Sec. 2. As used in this chapter, "covered individual" means an insured individual who is entitled to coverage under a policy of accident and sickness insurance. As added by P.L.202-2017, SEC.20.

Sec. 3. As used in this chapter, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1. The term includes only a policy that: (1) is issued on an individual or a group basis; and (2) provides coverage for prescription medications. As added by P.L.20…

Sec. 4. As used in this chapter, "synchronize" means to use a single pharmacy dispensing process as a means of coordinating the covered individual's medications at the same time when: (1) a particular medication: (A) is of a formulation that can be effectively split; and (B) does…

Sec. 5. A policy of accident and sickness insurance that provides coverage for prescription drugs may not deny coverage for the refill of any drug prescribed for the treatment of a chronic illness that is made in accordance with a plan between the covered individual and a pharmac…

Sec. 6. A policy of accident and sickness insurance must provide coverage for a medication that is dispensed in a quantity that allows synchronization of the covered individual's medications in accordance with a plan made between the covered individual and the pharmacy to synchro…

Sec. 1. This chapter applies to a policy of accident and sickness insurance that provides coverage for prescription eye drops. As added by P.L.43-2015, SEC.2.

Sec. 2. As used in this chapter, "insured" means an individual who is entitled to coverage under a policy of accident and sickness insurance. As added by P.L.43-2015, SEC.2.

Sec. 3. As used in this chapter, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1. As added by P.L.43-2015, SEC.2.

Sec. 4. (a) A policy of accident and sickness insurance must provide coverage for a refill of prescription eye drops if the following are met: (1) For a thirty (30) day supply, the insured requests the refill not earlier than twenty-five (25) days after the date the prescription …

Sec. 1. This chapter applies to a policy of accident and sickness insurance that is issued, amended, or renewed after June 30, 2015. As added by P.L.209-2015, SEC.19.

Sec. 3. As used in this chapter, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1. As added by P.L.209-2015, SEC.19.

Sec. 4. A policy of accident and sickness insurance may provide coverage for methadone if the drug is prescribed for the treatment of pain or pain management only as follows: (1) If the daily dosage is not more than sixty (60) milligrams. (2) If the daily dosage is more than sixt…

Sec. 1. Upon authorization of voluntary dissolution by the board of directors and any shareholders entitled to vote in respect of the voluntary dissolution, the board of directors shall: (1) cause a notice that the health maintenance organization is about to be dissolved to be pu…

Sec. 2. The dissolution of a health maintenance organization under this chapter does not alter the rights of an enrollee under IC 27-13-7-13. As added by P.L.203-2001, SEC.31.

Sec. 1. As used in this chapter, "chronic pain" means pain that: (1) persists beyond the usual course of an acute disease or healing of an injury; or (2) may be associated with an acute or chronic pathologic process that causes continuous or intermittent pain for a period of mont…

Sec. 2. As used in this chapter, "chronic pain management" means evidence based health care products and services intended to relieve chronic pain that has lasted for at least three (3) months. The term includes: (1) prescription drugs; (2) physical therapy; (3) occupational ther…

Sec. 3. As used in this chapter, "insured" means an individual entitled to coverage under a policy of accident and sickness insurance. As added by P.L.149-2019, SEC.5.

Sec. 4. As used in this chapter, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1. The term does not include the following: (1) Dental insurance. (2) A supplemental plan that always pays in addition to other coverage. As added by P.L.149-2019, …

Sec. 5. A policy of accident and sickness insurance must provide coverage for medically necessary chronic pain management prescribed by an insured's treating practitioner. As added by P.L.149-2019, SEC.5.

Sec. 6. The coverage required by this chapter may not be subject to annual or lifetime limitation, deductible, copayment, or coinsurance provisions that are more restrictive than the annual or lifetime limitation, deductible, copayment, or coinsurance provisions that apply genera…

Sec. 0.5. Sections 4.7 and 9.5 of this chapter, as added in the 2026 session of the general assembly, and section 8 of this chapter, as amended in the 2026 session of the general assembly, apply to claims submitted under an individual contract and a group contract that: (1) is en…

Sec. 1. As used in this chapter, "clean claim" means a claim submitted by a provider for payment for health care services provided to an enrollee that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. As added by P.L.162-2001, …

Sec. 10. (a) This section applies to an individual contract and a group contract that is entered into, delivered, amended, or renewed after June 30, 2025. (b) A health maintenance organization may not deny a claim for reimbursement for a covered service or item provided to an enr…

Sec. 2. As used in this chapter, "health maintenance organization" includes: (1) an insurance administrator that: (A) collects charges or premiums; and (B) adjusts or settles claims; in connection with coverage under a contract with a health maintenance organization; and (2) a li…

Sec. 2.3. 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.13.

Sec. 3. (a) A health maintenance organization shall pay or deny each clean claim in accordance with section 4 of this chapter. (b) A health maintenance organization shall notify a provider of any deficiencies in a submitted claim not more than: (1) thirty (30) days for a claim th…

Sec. 4. (a) A health maintenance organization shall pay or deny each clean claim as follows: (1) If the claim is filed electronically, not more than thirty (30) days after the date the claim is received by the health maintenance organization. (2) If the claim is filed on paper, n…

Sec. 4.5. (a) A health maintenance organization may not alter the CPT code (as defined in IC 27-1-37.5-3) submitted for a clean claim or pay for a CPT code (as defined in IC 27-1-37.5-3) of lesser monetary value unless: (1) the CPT code submitted is not in accordance with correct…

Sec. 4.7. (a) A health maintenance organization may not retroactively reduce the reimbursement rate for any CPT code (as defined in IC 27-1-37.5-3). (b) A health maintenance organization shall provide at least sixty (60) days notice by: (1) mail or electronic mail to a provider; …

Sec. 5. A provider shall submit only the following forms for payment by a health maintenance organization: (1) CMS-1500. (2) CMS-1450 (UB-04). (3) American Dental Association (ADA) claim form. As added by P.L.162-2001, SEC.6. Amended by P.L.208-2018, SEC.32.

Sec. 6. (a) If the commissioner finds that a health maintenance organization 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 health maintenance organization acc…

Sec. 8. (a) A health maintenance organization 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 health maintenance organization: (1) request that the provider repay the overpayment; or (2) a…

Sec. 9. Every subsequent claim that is adjusted by a health maintenance organization 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: …

Sec. 9.5. (a) If an insurer (as defined in IC 27-8-5.7-3) or a health maintenance organization 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 health maintenance organization. (b…

Sec. 1. This chapter applies to a hospital health care provider contract entered into, amended, or renewed after June 30, 2025. As added by P.L.216-2025, SEC.43.

Sec. 2. (a) As used in this chapter, "health carrier" means an entity that enters into a contract to: (1) provide health care services; (2) deliver health care services; (3) arrange for health care services; or (4) pay for or reimburse any of the cost of health care services. (b)…

Sec. 3. As used in this chapter, "hospital" means a hospital licensed under IC 16-21. As added by P.L.216-2025, SEC.43.

Sec. 4. As used in this chapter, "hospital health care provider contract" means an agreement between a hospital and a health carrier concerning terms and conditions of reimbursement for health care services provided to an individual under any of the following: (1) An employee wel…

Sec. 5. A hospital may not enter into a hospital health care provider contract that includes a provision that links to or negotiates reimbursement or terms under a separate: (1) hospital health care provider contract; or (2) product. As added by P.L.216-2025, SEC.43.

Sec. 0.5. This chapter does not apply to the termination of a health provider contract under IC 27-1-37-9. As added by P.L.158-2024, SEC.13.

Sec. 1. As used in this chapter, "health maintenance organization" means a person that undertakes to provide or arrange for the delivery of health care services to individuals on a prepaid basis, except for the individual's responsibility for copayments or deductibles. The term i…

Sec. 10. Except as provided in section 7(2) of this chapter, a health provider contract provision that is contrary to this chapter is void. As added by P.L.196-2001, SEC.1.

Sec. 11. This chapter does not apply to an amendment to a health provider contract that is required to comply with a state or federal law. As added by P.L.196-2001, SEC.1.

Sec. 2. As used in this chapter, "health provider contract" means an agreement with a provider relating to terms and conditions of reimbursement for health care services provided to an individual under: (1) an employee welfare benefit plan (as defined in 29 U.S.C. 1002 et seq.); …

Sec. 3. (a) As used in this chapter, "person" means an individual, an agency, a political subdivision, a partnership, a corporation, an association, or any other entity that enters into a health provider contract with a provider. (b) The term does not include a health care provid…