Indiana Code
Chapter 34. Limited Service Health Maintenance Organizations
27-13-34-13. Evidence of Coverage; Required Information

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

Indiana Code

Title 27. Insurance

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

27-13-34-16. "Net Worth" and "Uncovered Expense" Defined; Computation of Net Worth; Minimum Net Worth

27-13-34-17. Required Deposit

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

27-13-34-23. Fees

27-13-34-24. Dental Care Services and Director; Review of Adverse Decisions; Complaints

27-13-34-26. Complaints; Records