Sec. 5. (a) As used in this chapter, "health plan" means any of the following that provides coverage for health care services:
(1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1). However, the term does not include the coverages described in IC 27-8-5-2.5(a).
(2) A contract with a health maintenance organization (as defined in IC 27-13-1-19) that provides coverage for basic health care services (as defined in IC 27-13-1-4).
(3) After December 31, 2020, the Medicaid risk based managed care program under IC 12-15.
(b) The term includes a person that administers any of the following:
(1) A policy described in subsection (a)(1).
(2) A contract described in subsection (a)(2).
(3) A self-insurance program established under IC 5-10-8-7(b) to provide health care coverage.
(4) After December 31, 2020, Medicaid risk based managed care.
As added by P.L.77-2018, SEC.2. Amended by P.L.265-2019, SEC.3.
Structure Indiana Code
Article 1. Department of Insurance
Chapter 37.5. Health Care Service Prior Authorization
27-1-37.5-1. Application of Chapter
27-1-37.5-2. "Covered Individual"
27-1-37.5-4. "Health Care Service"
27-1-37.5-6. "Participating Provider"
27-1-37.5-7. "Prior Authorization"
27-1-37.5-8. "Urgent Care Situation"
27-1-37.5-10. Request for Prior Authorization; Electronic Transmission; Standardized Form
27-1-37.5-11. Response to Request for Prior Authorization; Timing; Incomplete Request
27-1-37.5-12. Claim for Which Prior Authorization Was Given; Denial; Resubmission of Claim
27-1-37.5-14. Contrary Contract Provision Void
27-1-37.5-15. Violation of Chapter
27-1-37.5-16. Department of Insurance; Standardized Prior Authorization Form