Indiana Code
Chapter 25. Health Carrier Good Faith Estimates
27-2-25-14. Requirements of Good Faith Estimate; Provision of Information; Exemption From Penalties

Sec. 14. (a) A good faith estimate provided by a health carrier to an individual under this chapter must:
(1) in the case of an insurer or another health carrier that pays or reimburses the cost of health care services:
(A) provide a summary of the services and material items that the good faith estimate is based on;
(B) include a total figure that is a sum of the amounts referred to in clause (A); and
(C) state the out-of-pocket costs the covered individual will incur, if any, beyond the amount that the health carrier will pay or reimburse; and
(2) in the case of a health maintenance organization or another health carrier that provides health care services:
(A) provide a summary of the applicable benefit limitations of the health care services to which the covered individual is entitled; and
(B) state the out-of-pocket costs the covered individual will incur, if any, beyond being provided the health care services referred to in clause (A).
(b) A practitioner and provider facility shall provide a health carrier with the information needed by the health carrier to comply with the requirements under this chapter not more than two (2) business days after receiving the request.
(c) A health carrier is not subject to the penalties under section 16 of this chapter if:
(1) a provider facility or practitioner fails to provide the health carrier with the information as required under subsection (b);
(2) the health carrier provides the individual with a good faith estimate based on any information that the health carrier has; and
(3) the health carrier provides the individual with an updated good faith estimate after the provider facility or practitioner has provided the information required under subsection (b).
As added by P.L.93-2020, SEC.13.