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
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
27-13-7-8. Readability Standards
27-13-7-9. Approval of Forms by Commissioner
27-13-7-10. Coverage Outside Indiana; Commissioner's Approval Not Required
27-13-7-12. Additional Information Required by Commissioner
27-13-7-13. Continuation of Coverage Statement
27-13-7-14. Post-Mastectomy Coverage
27-13-7-14.5. Coverage for Nonexperimental, Surgical Treatment of Morbid Obesity
27-13-7-14.7. Coverage for Autism Spectrum Disorders
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
27-13-7-20.2. 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
27-13-7-23. 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