Title 27, INSURANCE

Sec. 8. If a person with whom a provider contracts receives notice from a provider under section 6 of this chapter, the person with whom a provider contracts may not require the provider to comply with the proposed amendment. As added by P.L.196-2001, SEC.1.

Sec. 9. Except in an emergency, a provider who elects to terminate a health provider contract under this section shall, before providing services to a patient who is covered by the contract, notify the patient that the provider's contract has been or will be terminated. As added …

Sec. 1. As used in this chapter, "health benefit plan" means coverage for health care services provided under: (1) a policy of accident and sickness insurance (as defined in IC 27-8-5-1); (2) a contract with a health maintenance organization under IC 27-13; or (3) any other benef…

Sec. 2. As used in this chapter, "health benefit plan provider" means a person that provides coverage under a health benefit plan. As added by P.L.258-2001, SEC.1.

Sec. 3. As used in this chapter, "health insurance educator" refers to the health insurance educator appointed under section 6 of this chapter. As added by P.L.258-2001, SEC.1.

Sec. 4. As used in this chapter, "position" means the position of health insurance educator established under section 5 of this chapter. As added by P.L.258-2001, SEC.1.

Sec. 5. The department shall establish the position of health insurance educator within the department. As added by P.L.258-2001, SEC.1.

Sec. 6. The commissioner shall appoint a health insurance educator who must possess expertise in the areas of health benefit plans, education, and advocacy. As added by P.L.258-2001, SEC.1.

Sec. 7. The department may contract with a nonprofit organization to provide the services required under this chapter. As added by P.L.258-2001, SEC.1.

Sec. 8. (a) The health insurance educator shall do the following: (1) Assist health benefit plan consumers in making informed choices regarding health benefit plans by providing information about the following: (A) The purchase, or enrollment in, a health benefit plan. (B) The ma…

Sec. 0.1. The addition of this chapter by P.L.55-2008 applies to a health care contract that is entered into, amended, or renewed after June 30, 2008. As added by P.L.220-2011, SEC.425.

Sec. 1. Unless otherwise specified in this chapter, the definitions in IC 27-8-11-1 apply throughout this chapter. As added by P.L.55-2008, SEC.1.

Sec. 10. Subject to applicable continuity of care requirements, a third party's right to exercise a contractor's rights and responsibilities under a health care contract terminates on the date that the health care contract is terminated. As added by P.L.55-2008, SEC.1.

Sec. 11. A health care contract may provide for arbitration of disputes arising under this chapter. As added by P.L.55-2008, SEC.1.

Sec. 2. As used in this chapter, "affiliate" has the meaning set forth in IC 27-1-25-1. As added by P.L.55-2008, SEC.1.

Sec. 3. As used in this chapter, "contractor" refers to a person with a primary business purpose of entering into health care contracts with providers. As added by P.L.55-2008, SEC.1.

Sec. 4. As used in this chapter, "covered individual" means an individual who is entitled to coverage under a health plan. As added by P.L.55-2008, SEC.1.

Sec. 5. (a) As used in this chapter, "health plan" means a plan through which coverage is provided for health care services through insurance, prepayment, reimbursement, or otherwise. The term includes the following: (1) An employee welfare benefit plan (as defined in 29 U.S.C. 1…

Sec. 6. As used in this chapter, "health care contract" means a contract between a person and a provider specifying the rights and responsibilities of the: (1) person; and (2) provider; in relation to payment for and delivery of health care services to a covered individual. As ad…

Sec. 7. A contractor may not lease, rent, or otherwise grant access to a provider's health care services under a health care contract unless the contractor complies with one (1) of the following: (1) The third party to which the access is granted is: (A) an employer or another en…

Sec. 8. (a) A contractor that leases, rents, or otherwise grants access to a provider's health care services as described in section 7(2) of this chapter shall maintain an Internet web page or a toll free telephone number through which the provider may obtain a listing, updated a…

Sec. 9. A contractor that leases, rents, or otherwise grants access to a provider's health care services under section 7 of this chapter shall ensure that an explanation of benefits or remittance advice furnished to the provider that delivers health care services under the health…

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.45-2017, SEC.1.

Sec. 2. As used in this chapter, "health plan" means any of the following that provides coverage for prescription drugs: (1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1). (2) A contract with a health maintenance organization (as defined in IC 27-13-1-19…

Sec. 3. As used in this chapter, "prior authorization" includes a health plan requirement that a prescription drug be authorized for payment by the health plan before the prescription drug is provided to a particular covered individual. As added by P.L.45-2017, SEC.1.

Sec. 4. A health plan shall accept and respond to a request for prior authorization delivered to the health plan by a covered individual's: (1) prescribing health care provider; or (2) dispensing pharmacist; through an electronic transmission that complies with the technical stan…

Sec. 5. Section 4 of this chapter does not apply if a prescribing health care provider or dispensing pharmacist lacks: (1) broadband Internet access; (2) an electronic medical record system; or (3) a sufficient number of covered individuals as patients or customers, as determined…

Sec. 6. A contractual provision that: (1) is contained in a contract that is entered into, amended, or renewed after December 31, 2017; and (2) contradicts this chapter; is void. As added by P.L.45-2017, SEC.1.

Sec. 7. The commissioner may adopt rules under IC 4-22-2 to implement this chapter. As added by P.L.45-2017, SEC.1.

Sec. 8. (a) As used in this section, "step therapy protocol" means a protocol that specifies, as a condition of coverage under a health plan, the order in which certain prescription drugs must be used to treat a covered individual's condition. (b) A health plan that denies prior …

Sec. 1. (a) This chapter does not apply to a step therapy protocol exception procedure under IC 5-10-8-17, IC 27-8-5-30, or IC 27-13-7-23. (b) This chapter does not apply to a health plan that is offered by a local unit public employer under a program of group health insurance pr…

Sec. 1.5. As used in this chapter, "adverse determination" means a decision by a utilization review entity to deny, reduce, or terminate benefit coverage of a health care service furnished or proposed to be furnished to a covered individual on the grounds that the health care ser…

Sec. 1.6. As used in this chapter, "authorization" means a determination by a utilization review entity that: (1) a health care service: (A) has been reviewed; and (B) based on the information provided, satisfies the utilization review entity's requirements for medical necessity;…

Sec. 1.7. As used in this chapter, "clinical peer" means the following: (1) Except as provided in subdivision (3), for a review of a request from a physician, a physician who: (A) holds a current and valid license under IC 25-22.5, has been granted reciprocity under IC 25-1-21, i…

Sec. 1.8. As used in this chapter, "clinical criteria" means: (1) written policies; (2) written screen procedures; (3) drug formularies or lists of covered drugs; (4) determination rules; (5) determination abstracts; (6) clinical protocols; (7) practice guidelines; (8) medical pr…

Sec. 1.9. (a) As used in this chapter, "cosmetic surgery" means any procedure that: (1) is directed at improving the patient's appearance; and (2) does not meaningfully: (A) promote the proper function of the body; or (B) prevent or treat illness or disease. (b) The term does not…

Sec. 10. (a) This section does not apply to prior authorization for a prescription drug. (b) A utilization review entity shall accept a request for prior authorization delivered to the utilization review entity by a covered individual's health care provider through a secure elect…

Sec. 12. (a) This section applies to a claim for a health care service rendered by a health care provider: (1) for which: (A) prior authorization is requested after June 30, 2025; and (B) a utilization review entity gives prior authorization; and (2) that is rendered in accordanc…

Sec. 13. (a) This section applies to a claim filed after June 30, 2025, for a medically necessary health care service rendered by a health care provider, the necessity of which: (1) is not anticipated at the time of scheduling another health care service that: (A) was authorized …

Sec. 13.7. (a) This section does not apply to the following: (1) A state employee health plan (as defined in IC 5-10-8-6.7(a)). (2) The Medicaid program. (b) A utilization review entity may not require prior authorization for the first twelve (12): (1) physical therapy; or (2) ch…

Sec. 14. A provision that: (1) is contained in a policy or contract that is entered into, amended, or renewed after June 30, 2025; and (2) contradicts this chapter; is void. As added by P.L.77-2018, SEC.2. Amended by P.L.144-2025, SEC.24.

Sec. 15. A violation of this chapter by a utilization review entity is an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4. As added by P.L.77-2018, SEC.2. Amended by P.L.144-2025, SEC.25.

Sec. 16. (a) Except as provided in subsection (b), the department shall establish, post, and maintain on the department's website a standardized prior authorization form for use by health care providers and utilization review entities for purposes of any notice or authorization r…

Sec. 17. (a) As used in this section, "necessary information" includes the results of any face-to-face clinical evaluation, second opinion, or other clinical information that is directly applicable to the requested health care service that may be required. (b) If a utilization re…

Sec. 19. (a) A utilization review entity shall make any current prior authorization requirements and restrictions, including written clinical criteria, readily accessible on the utilization review entity's website to covered individuals, health care providers, and the general pub…

Sec. 2. As used in this chapter, "covered individual" means an individual who is covered under a health plan. The term includes a covered individual's legally authorized representative. As added by P.L.77-2018, SEC.2. Amended by P.L.144-2025, SEC.8.