Title 27, INSURANCE

Sec. 8. As used in this chapter, "provider" means an individual licensed or legally authorized to provide health care services. As added by P.L.119-2026, SEC.1.

Sec. 9. As used in this chapter, "qualified dispute" means a distinct item or service that is included in a request for independent dispute resolution. As added by P.L.119-2026, SEC.1.

Sec. 1. As used in this chapter, "IPEP" refers to the Indiana Public Employers' Plan, Inc., which was originally incorporated under the name Indiana Employers' Compensation Plan, Inc., as a domestic nonprofit corporation on December 11, 1989. As added by P.L.117-2021, SEC.4.

Sec. 2. As used in this chapter, "political subdivision" has the meaning set forth in IC 34-6-2.1-155. As added by P.L.117-2021, SEC.4. Amended by P.L.186-2025, SEC.147.

Sec. 3. (a) Before December 31, 2030, IPEP shall apply to the insurance commissioner for a certificate of authority to transact the business of insurance in Indiana as a domestic tax exempt reciprocal insurance company. (b) The bylaws or articles of incorporation prepared by IPEP…

Sec. 4. (a) After: (1) receiving a certificate of authority from the insurance commissioner to transact the business of insurance in Indiana as a domestic tax exempt reciprocal insurance company; and (2) making any changes in structure and legal status necessary or beneficial to …

Sec. 1. As used in this chapter, "direct to employer health care arrangement" means an arrangement between: (1) a hospital; (2) a hospital system; (3) an Indiana nonprofit hospital system; or (4) a narrow network of hospitals; and an employer that provides health care benefits fo…

Sec. 10. (a) Beginning September 1, 2026, a hospital that is not a part of an Indiana nonprofit hospital system shall offer a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare. (b) The benchmark describ…

Sec. 11. (a) Not later than thirty (30) days after a request by a contract holder of a direct to employer health care arrangement, a third party administrator that has contracted to administer a direct to employer health care arrangement shall provide claims data to the contract …

Sec. 2. As used in this chapter, "full Medicare" refers to the amount the Medicare program pays for a covered service, including all hospital-specific Medicare adjustments. As added by P.L.216-2025, SEC.46.

Sec. 3. (a) As used in this chapter and except as provided in subsection (b), "hospital" means an acute care hospital licensed under IC 16-21. (b) The term does not include the following: (1) A hospital specifically intended to diagnose, care, and treat the following: (A) Individ…

Sec. 4. As used in this chapter, "hospital system" means one (1) or more hospitals, all of which are related by direct or indirect common control or ownership. As added by P.L.216-2025, SEC.46.

Sec. 5. As used in this chapter, "Indiana nonprofit hospital system" means a hospital system that: (1) is organized as a nonprofit corporation or a charitable trust under Indiana law or the laws of any other state or country and that is: (A) eligible for tax exempt bond financing…

Sec. 6. As used in this chapter, "narrow network" means an arrangement that limits the hospitals that a covered individual may use to obtain covered services under an employee benefit plan. As added by P.L.216-2025, SEC.46.

Sec. 7. As used in this chapter, "prices" means the amounts that are paid for patient care services. As added by P.L.216-2025, SEC.46.

Sec. 8. As used in this chapter, "third party administrator" means an individual or entity that performs administrative services for a direct to employer health care arrangement. As added by P.L.216-2025, SEC.46.

Sec. 9. (a) Beginning September 1, 2025, an Indiana nonprofit hospital system shall offer a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare. (b) The benchmark described in subsection (a) shall be calc…

Sec. 1. As used in this chapter, "governmental hospital" means an acute care hospital licensed under IC 16-21-2 that is governed by: (1) IC 16-22-2; (2) IC 16-22-8; or (3) IC 16-23. As added by P.L.203-2023, SEC.21.

Sec. 2. As used in this chapter, "independent hospital" means a private nonprofit acute care hospital licensed under IC 16-21-2 that meets the following criteria: (1) Is either: (A) not directly or indirectly owned or controlled by an entity that is headquartered outside of the c…

Sec. 3. (a) As used in this chapter, "Indiana nonprofit hospital system" means a hospital that: (1) is organized as a nonprofit corporation or a charitable trust under Indiana law or the laws of any other state or country and that is: (A) eligible for tax exempt bond financing; o…

Sec. 4. As used in this chapter, "prices" means allowables that are paid for patient care services. As added by P.L.203-2023, SEC.21.

Sec. 5. The department shall contract with a third party to do the following: (1) Calculate an Indiana nonprofit hospital system's prices from the commercially insured market, categorized by: (A) self-funded plan prices; (B) fully-funded plan prices; (C) the individual market pri…

Sec. 6. (a) Before March 1, 2024, and before March 1 of each subsequent year, an Indiana nonprofit hospital system shall submit the following: (1) Information the department or the department's third party contractor determines is necessary to make the assessments required in thi…

Sec. 7. (a) The department shall contract with a third party to make the calculations required by this section. The third party contractor shall make the calculations described in subsection (b) concerning an Indiana nonprofit hospital system's prices from the commercially insure…

Sec. 8. Before December 1, 2024, and before December 1 of each subsequent year, the department shall submit a report of the third party contractor's findings in section 7 of this chapter in an electronic format under IC 5-14-6 to the health care cost oversight task force establis…

Sec. 9. Information under this chapter must be provided in accordance with the federal Health Insurance Portability and Accountability Act, As added by P.L.203-2023, SEC.21.

Sec. 1. This chapter applies to a health plan entered into or renewed after June 30, 2025. As added by P.L.237-2025, SEC.9.

Sec. 10. The department shall adopt rules under IC 4-22-2 to effectuate the provisions of this chapter. As added by P.L.237-2025, SEC.9.

Sec. 2. As used in this chapter, "covered individual" means an individual entitled to coverage under a health plan. As added by P.L.237-2025, SEC.9.

Sec. 3. As used in this chapter, "health care provider" means an individual or entity that is licensed, certified, registered, or regulated by an entity described in IC 25-0.5-11. As added by P.L.237-2025, SEC.9.

Sec. 4. As used in this chapter, "health care services" means any services or products rendered by a health care provider within the scope of the provider's license or legal authorization. As added by P.L.237-2025, SEC.9.

Sec. 5. (a) As used in this chapter, "health plan" means any of the following: (1) A self-insurance program established under IC 5-10-8-7(b) to provide group coverage. (2) A prepaid health care delivery plan through which health services are provided under IC 5-10-8-7(c). (3) A p…

Sec. 6. As used in this chapter, "network" means a group of health care providers 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 be provided to the co…

Sec. 7. A health plan shall credit toward a covered individual's deductible and annual maximum out-of-pocket expenses any amount the covered individual pays directly to any health care provider for a medically necessary covered health care service if a claim for the health care s…

Sec. 8. (a) A health plan shall: (1) establish a procedure by which a covered individual may claim a credit under section 7 of this chapter; and (2) identify documentation necessary to support a claim for a credit under section 7 of this chapter. (b) A health plan may either: (1)…

Sec. 9. A health plan shall display information about the procedure and documentation described in section 8 of this chapter on the health plan's website, including a link to the website for the all payer claims data base established under IC 27-1-44.5. As added by P.L.237-2025, …

Sec. 1. The following definitions apply throughout this chapter: (1) "Business day" means a day other than Saturday or Sunday, or a legal holiday listed in IC 1-1-9-1. (2) "Commissioner" refers to the insurance commissioner appointed under IC 27-1-1-2. (3) "Department" refers to …

Sec. 10. (a) A managed care organization that is liable for an assessment under this chapter shall keep accurate and complete records and pertinent documents that are relevant to the organization's assessment under this chapter, as may be required by the department or the office.…

Sec. 11. (a) For good cause shown by a managed care organization due to financial or other difficulties, as determined by the office, the office is authorized to grant grace periods, of up to thirty (30) days, for the managed care organization's payment of an installment payment …

Sec. 12. The office may adopt rules under IC 4-22-2 to implement this chapter. As added by P.L.216-2025, SEC.47.

Sec. 2. (a) Subject to subsections (b) and (c) and this chapter, a fee is authorized. (b) The fee may not be assessed without approval from the United States Department of Health and Human Services. (c) The assessment of the fee shall cease upon the United States Department of He…

Sec. 3. The office may, subject to section 6 of this chapter, assess a fee upon managed care organizations to support administration of the state Medicaid program. As added by P.L.216-2025, SEC.47.

Sec. 4. The fee collected under this chapter may only be used to pay the state's share of the cost of Medicaid services provided under the Medicaid program (42 U.S.C. 1396 et seq.). As added by P.L.216-2025, SEC.47.

Sec. 5. (a) Not later than May 30, 2025, and after consulting with the secretary or the secretary's designee regarding compliance with 42 U.S.C. 1396b(w)(7)(A)(viii) and 42 CFR 433.56(a)(8) and the types of managed care organizations recognized under Indiana law, the commissioner…

Sec. 6. (a) The fee must meet the requirements of the federal Medicaid statutes and regulations for permissible health care related taxes. (b) The office may request a waiver from the United States Department of Health and Human Services of the broad based and uniformity requirem…

Sec. 7. The office shall submit a written request to the United States Department of Health and Human Services for approval of the managed care assessment fee on or after June 30, 2025. Subject to the requirements of this chapter, the office is authorized to negotiate with the Un…