Sec. 13. (a) Every subscriber of a limited service health maintenance organization shall be issued an evidence of coverage in electronic or paper form, which must contain a clear and complete statement of the following:
(1) The limited health services to which each enrollee is entitled.
(2) Any limitation of the services, kinds of services, or benefits to be provided.
(3) Any exclusions, including any copayment or other charges.
(4) Where and in what manner information is available as to where and how services may be obtained.
(5) The method for resolving complaints.
(b) Any amendment to the evidence of coverage may be provided to the subscriber in a separate document in electronic or paper form.
(c) A limited service health maintenance organization shall issue the evidence of coverage described in subsection (a) and an amendment described in subsection (b) in paper form upon the request of the subscriber.
(d) A limited service health maintenance organization shall include in the limited service health maintenance organization's enrollment materials information concerning the manner in which a subscriber may:
(1) obtain an evidence of coverage; and
(2) request the evidence of coverage in paper form.
As added by P.L.26-1994, SEC.25. Amended by P.L.125-2005, SEC.8.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 34. Limited Service Health Maintenance Organizations
27-13-34-0.1. Application of Certain Amendments to Chapter
27-13-34-1. "Enrollee" Defined
27-13-34-2. "Evidence of Coverage" Defined
27-13-34-3. "Limited Health Services" Defined
27-13-34-4. "Limited Service Health Maintenance Organization" Defined
27-13-34-5. "Provider" Defined
27-13-34-6. "Subscriber" Defined
27-13-34-7. Certificate of Authority Required; Foreign Entities
27-13-34-8. Application for Certificate of Authority; Requirements
27-13-34-9. Issuance of Certificate of Authority; Application Deficiencies; Denial of Application
27-13-34-10. Powers of Limited Service Health Maintenance Organization
27-13-34-11. Modification of Documents; Filing; Disapproval
27-13-34-12. Applicable Statutes
27-13-34-13. Evidence of Coverage; Required Information
27-13-34-14. Examinations by Commissioner
27-13-34-15. Required Contract Terms and Conditions; Exemptions
27-13-34-18. Fidelity Bonds; Deposit in Place of Bond
27-13-34-19. Annual Reports; Additional Reports
27-13-34-20. Suspension or Revocation of Certificate of Authority
27-13-34-21. Chapter Violations; Fines and Penalties
27-13-34-22. Supervision, Rehabilitation, or Liquidation; Remedies and Measures
27-13-34-24. Dental Care Services and Director; Review of Adverse Decisions; Complaints