Indiana Code
Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage
27-13-7-27. Reimbursement for Emergency Medical Services

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 organization" means a provider of emergency medical services that is certified by the Indiana emergency medical services commission as an advanced life support provider organization under rules adopted under IC 16-31-3.
(d) An individual contract and a group contract that provide coverage for emergency medical services must provide reimbursement for emergency medical services that are:
(1) rendered by an emergency medical services provider organization;
(2) within the emergency medical services provider organization's scope of practice;
(3) performed or provided as advanced life support services; and
(4) performed or provided during a response initiated through the 911 system regardless of whether the patient is transported.
(e) Reimbursement for basic and advanced life support services through a contract to which this section applies must be provided on an equal basis regardless of whether the services involve transportation of the patient by ambulance.
(f) If multiple emergency medical services provider organizations qualify and submit a claim for reimbursement under this section, the health maintenance organization:
(1) may reimburse under this section only for one (1) claim per patient encounter; and
(2) shall reimburse the claim submitted by the emergency medical services provider organization that performed or provided the majority of advanced life support services.
(g) The department may adopt rules under IC 4-22-2, including emergency rules under IC 4-22-2-37.1, to implement this section.
(h) This section does not require an individual contract or a group contract to provide coverage for emergency medical services.
As added by P.L.115-2020, SEC.5. Amended by P.L.170-2022, SEC.39.

Structure Indiana Code

Indiana Code

Title 27. Insurance

Article 13. Health Maintenance Organizations

Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage

27-13-7-0.1. Application of Certain Amendments to Chapter

27-13-7-1. Persons Entitled to Copies of Contracts

27-13-7-2. Deceptive Contract Provisions Prohibited

27-13-7-3. Contract Provisions

27-13-7-4. Compliance With Requirements; Ten Day Grace Period

27-13-7-5. Evidence of Coverage

27-13-7-6. Evidence of Coverage; Prohibited Provisions

27-13-7-7. Evidence of Coverage; Required Statement

27-13-7-7.5. Prohibition on Coverage of Abortion; Exceptions; Coverage Through Rider or Endorsement

27-13-7-7.5-b. Prohibition on Coverage of Abortion; Exceptions; Coverage Through Rider or Endorsement

27-13-7-8. Readability Standards

27-13-7-9. Approval of Forms by Commissioner

27-13-7-10. Coverage Outside Indiana; Commissioner's Approval Not Required

27-13-7-11. Filing of Form With Commissioner; Review Period; Approval; Withdrawal of Approval; Hearing

27-13-7-12. Additional Information Required by Commissioner

27-13-7-13. Continuation of Coverage Statement

27-13-7-14. Post-Mastectomy Coverage

27-13-7-14.2. "Treatment of a Mental Illness or Substance Abuse"; "Act"; "Nonqualitative Treatment Limitations"; Reporting and Analysis Requirements for Individual and Group Contracts

27-13-7-14.5. Coverage for Nonexperimental, Surgical Treatment of Morbid Obesity

27-13-7-14.7. Coverage for Autism Spectrum Disorders

27-13-7-14.8. Treatment Limitations or Financial Requirements on Coverage of Services for Mental Illness

27-13-7-15. Dental Care Provisions Required

27-13-7-15.3. Breast Cancer Screening Mammography

27-13-7-16. Prostate Specific Antigen Test

27-13-7-17. Coverage for Colorectal Cancer Screening; Exception for Grandfathered Health Plans

27-13-7-18. Inherited Metabolic Disease Coverage

27-13-7-19. Coverage for Orthotic Devices and Prosthetic Devices

27-13-7-20. Prohibition on Chemotherapy Coverage Limitations

27-13-7-20.1. Individual or Group Contract Providing Coverage for Prescription Eye Drops; Refill of Prescription Eye Drops; Requirements

27-13-7-20.2. Coverage for Care Related to Cancer Clinical Trials

27-13-7-20.4. Applicability; Coverage for Methadone for Treatment of Pain

27-13-7-21. High Breast Density

27-13-7-22. Coverage of Telehealth Services; Prohibition on Requiring Use of Specific Information Technology Application

27-13-7-23. Step Therapy Protocol

27-13-7-24. Coverage for Anatomical Gifts, Transplantation, or Related Health Care Services

27-13-7-24.5. Coverage for Chronic Pain Management

27-13-7-26. Coverage for Pediatric Neuropsychiatric Disorders

27-13-7-27. Reimbursement for Emergency Medical Services