Title 27, INSURANCE

Sec. 14. (a) As used in this section, "mastectomy" means the removal of all or part of the breast for reasons that are determined by a licensed physician to be medically necessary. (b) A contract with a health maintenance organization that provides coverage for a mastectomy must …

Sec. 14.2. (a) As used in this section, "treatment of a mental illness or substance abuse" means: (1) treatment for a mental illness, as defined in IC 12-7-2.1-226(1); and (2) treatment for drug abuse or alcohol abuse. (b) As used in this section, "act" refers to the Paul Wellsto…

Sec. 14.5. (a) As used in this section, "health care provider" means a: (1) physician licensed under IC 25-22.5; or (2) hospital licensed under IC 16-21; that provides health care services for surgical treatment of morbid obesity. (b) As used in this section, "morbid obesity" mea…

Sec. 14.7. (a) As used in this section, "autism spectrum disorder" means a neurological condition, including Asperger's syndrome and autism, as defined in the Diagnostic and Statistical Manual of Mental Disorders. (b) A group contract with a health maintenance organization that p…

Sec. 14.8. (a) As used in this section, "coverage of services for a mental illness" includes the services defined under the contract with the health maintenance organization. However, the term does not include services for the treatment of substance abuse or chemical dependency. …

Sec. 15. (a) As used in this section, "child" means an individual who is less than nineteen (19) years of age. (b) As used in this section, "enrollee" means an enrollee who is a child or an individual: (1) with a physical or mental impairment that substantially limits one (1) or …

Sec. 15.3. (a) As used in this section, "breast cancer screening mammography" has the meaning set forth in IC 27-8-14-2. (b) As used in this section, "woman at risk" has the meaning set forth in IC 27-8-14-5. (c) Except as provided in subsection (g), a health maintenance organiza…

Sec. 16. (a) As used in this section, "prostate specific antigen test" means a standard blood test performed to determine the level of prostate specific antigen in the blood. (b) Except as provided in subsection (f), a health maintenance organization issued a certificate of autho…

Sec. 17. (a) As used in this section, "colorectal cancer testing" means examinations and laboratory tests for cancer for any nonsymptomatic enrollee. (b) As used in this section, "follow-up colonoscopy" means a colonoscopy that is performed as a follow-up to a colorectal cancer s…

Sec. 18. (a) As used in this section, "inherited metabolic disease" means a disease: (1) caused by inborn errors of amino acid, organic acid, or urea cycle metabolism; and (2) treatable by the dietary restriction of one (1) or more amino acids. (b) As used in this section, "medic…

Sec. 19. (a) As used in this section, "orthotic device" means a medically necessary custom fabricated brace or support that is designed as a component of a prosthetic device. (b) As used in this section, "prosthetic device" means an artificial leg or arm. (c) An individual contra…

Sec. 2. A contract or an evidence of coverage referred to in section 1 or section 5 of this chapter may not contain provisions or statements that are unjust, unfair, inequitable, misleading, or deceptive or that encourage misrepresentation prohibited by IC 27-1-15.6-12 or IC 27-4…

Sec. 20. (a) This section applies to an individual contract or a group contract that provides coverage for both of the following: (1) Orally administered cancer chemotherapy. (2) Cancer chemotherapy that is administered intravenously or by injection. (b) As used in this section, …

Sec. 20.1. (a) This section applies to an individual contract or a group contract that provides coverage for prescription eye drops. (b) An individual contract or a group contract must provide coverage for a refill of prescription eye drops if the following are met: (1) For a thi…

Sec. 20.2. (a) As used in this section, "care method" means the use of a particular drug or device in a particular manner. (b) As used in this section, "clinical trial" means a Phase I, II, III, or IV research study: (1) that is conducted: (A) using a particular care method to pr…

Sec. 20.4. (a) This section applies to an individual contract or a group contract that is entered into, amended, or renewed after June 30, 2015. (b) An individual contract or a group contract may provide coverage for methadone if the drug is prescribed for the treatment of pain o…

Sec. 21. (a) As used in this section, "high breast density" means a condition in which there is a greater amount of breast and connective tissue in comparison to fat in the breast. (b) An individual contract or a group contract that provides coverage for basic health care service…

Sec. 22. (a) An individual contract or a group contract must provide coverage for telehealth services in accordance with the same clinical criteria as the individual contract or the group contract provides coverage for the same health care services delivered to an enrollee in per…

Sec. 23. (a) As used in this section, "group contract" refers to a group contract that provides coverage for prescription drugs. (b) As used in this section, "health maintenance organization" refers to a health maintenance organization that provides coverage for prescription drug…

Sec. 24. (a) As used in this section, "disability" has the meaning set forth in 42 U.S.C. 12102. (b) As used in this section, "enrollee" means an enrollee who has a disability. (c) As used in this section, "group contract" means a group contract that provides coverage for anatomi…

Sec. 24.5. (a) This section applies to each of the following: (1) An individual contract. (2) A group contract. (b) As used in this section, "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 …

Sec. 26. (a) An individual contract and a group contract must provide coverage for treatment of: (1) pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS); and (2) pediatric acute-onset neuropsychiatric syndrome (PANS); including treatm…

Sec. 27. (a) This section applies to each of the following: (1) An individual contract. (2) A group contract. (b) As used in this section, "emergency medical services" has the meaning set forth in IC 16-18-2-110. (c) As used in this section, "emergency medical services provider o…

Sec. 28. An individual contract and a group contract shall consider services provided to an individual while detained under IC 12-26-5 as medically necessary when provided in accordance with generally accepted clinical care guidelines. As added by P.L.205-2023, SEC.25.

Sec. 28.5. (a) This section applies to an individual contract or a group contract that is entered into, amended, or renewed after June 30, 2023. (b) As used in this section, "wearable cardioverter defibrillator" means a device that: (1) is worn externally on an individual's body;…

Sec. 29.5. (a) This section applies only to: (1) a prescription drug that is: (A) consistent with best practices for the treatment of advanced, metastatic cancer or an associated condition; (B) supported by peer reviewed, evidence based literature; and (C) approved by the federal…

Sec. 3. (a) A contract referred to in section 1 of this chapter must clearly state the following: (1) The name and address of the health maintenance organization. (2) Eligibility requirements. (3) Benefits and services within the service area. (4) Emergency care benefits and serv…

Sec. 4. (a) An individual contract must comply with all provisions of section 3(a) of this chapter and provide for a period of ten (10) days during which the individual entering into the contract with the health maintenance organization may: (1) examine the contract; and (2) if t…

Sec. 5. (a) A subscriber under a group contract must receive an evidence of coverage from: (1) the group contract holder; or (2) the health maintenance organization. (b) A group contract holder or health maintenance organization may provide the evidence of coverage required under…

Sec. 6. The evidence of coverage required by section 5 of this chapter may not contain provisions or statements: (1) that are unfair, unjust, inequitable, misleading, or deceptive; or (2) that encourage misrepresentation prohibited by IC 27-1-15.6-12 or IC 27-4-1-4. As added by P…

Sec. 7. The evidence of coverage required by section 5 of this chapter must contain a clear statement of the matters set forth in section 3(a) of this chapter. As added by P.L.26-1994, SEC.25.

Sec. 7.5. (a) A health maintenance organization that provides coverage for basic health care services and that is entered into, delivered, amended, or renewed after December 31, 2014, under a group contract or an individual contract may not provide coverage for abortion unless th…

Sec. 8. The commissioner may adopt rules under IC 4-22-2 establishing readability standards for individual contracts and evidence of coverage forms. As added by P.L.26-1994, SEC.25.

Sec. 9. Subject to sections 10 and 11 of this chapter: (1) a group or an individual contract; (2) an evidence of coverage; or (3) an amendment to: (A) a group or an individual contract; or (B) an evidence of coverage; may not be delivered or issued for delivery in Indiana unless …

Sec. 1. Except as otherwise specifically provided in this chapter, IC 5-14 applies to all filings made under this article. As added by P.L.94-1999, SEC.3.

Sec. 2. Filings, information, and documents made with or provided to the commissioner under this article may include information that might be damaging to a converting mutual or its affiliates if made available to competitors. Subject to section 3 of this chapter, all documents c…

Sec. 3. (a) Subject to subsection (c), the commissioner may disclose to any person all or part of any document marked "confidential" in the commissioner's possession as the result of being filed under this article if the following conditions are met: (1) The commissioner must giv…

Sec. 1. Except as provided in a professional employer agreement, the following apply to a co-employment relationship: (1) The client: (A) may exercise and enforce all rights; and (B) is obligated to perform all duties and responsibilities; that otherwise apply to an employer in a…

Sec. 2. (a) Except as provided in this article, the co-employment relationship between a client and a PEO, and between a co-employer and a covered employee, is governed by the professional employer agreement. (b) A professional employer agreement must specify the following: (1) T…

Sec. 3. A PEO shall provide written notice to each covered employee who is affected by a professional employer agreement entered into by the PEO concerning the general nature of the co-employment relationship between and among the PEO, the client, and the covered employee. As add…

Sec. 4. (a) Except as expressly provided by the professional employer agreement: (1) a client: (A) is solely responsible for: (i) the quality, adequacy, or safety of goods or services produced or sold in the client's business; (ii) directing, supervising, training, and controllin…

Sec. 5. A PEO that offers, markets, sells, administers, or provides professional employer services under a professional employer agreement as provided in this article is not: (1) engaged in the business of insurance; or (2) acting as an administrator (as defined in IC 27-1-25-1).…

Sec. 6. (a) A business license fee or another fee that is based upon gross receipts must, in the case of a PEO, be based upon the administrative fee of the PEO. (b) A tax assessed on a per capita or per employee basis must be assessed against a: (1) client for covered employees; …

Sec. 1. A discount medical card program organization shall file an annual report with the department not later than three (3) months after the end of the discount medical card program organization's fiscal year. As added by P.L.73-2006, SEC.3.

Sec. 2. A report filed under section 1 of this chapter must be on a form prescribed by the commissioner and must include the following: (1) If the information is different from the initial application for a registration or from the last annual report, a: (A) list of the name and …

Sec. 3. (a) The department shall notify a discount medical card program organization that is not in compliance with this chapter. (b) A discount medical card program organization that fails to file an annual report as required under this chapter shall pay to the department for de…