Indiana Code
Chapter 5. Accident and Sickness Insurance─policy Provisions
27-8-5-1.5. Filing, Review, Approval, and Disapproval Process

Sec. 1.5. (a) This section applies to a policy of accident and sickness insurance issued on an individual, a group, a franchise, or a blanket basis, including a policy issued by an assessment company or a fraternal benefit society.
(b) As used in this section, "commissioner" refers to the insurance commissioner appointed under IC 27-1-1-2.
(c) As used in this section, "grossly inadequate filing" means a policy form filing:
(1) that fails to provide key information, including state specific information, regarding a product, policy, or rate; or
(2) that demonstrates an insufficient understanding of applicable legal requirements.
(d) As used in this section, "policy form" means a policy, a contract, a certificate, a rider, an endorsement, an evidence of coverage, or any amendment that is required by law to be filed with the commissioner for approval before use in Indiana.
(e) As used in this section, "type of insurance" refers to a type of coverage listed on the National Association of Insurance Commissioners Uniform Life, Accident and Health, Annuity and Credit Product Coding Matrix under the heading "Continuing Care Retirement Communities", "Health", "Long Term Care", or "Medicare Supplement".
(f) Each person having a role in the filing process described in subsection (i) shall act in good faith and with due diligence in the performance of the person's duties.
(g) A policy form, including a policy form of a policy, contract, certificate, rider, endorsement, evidence of coverage, or amendment that is issued through a health benefit exchange (as defined in IC 27-19-2-8), may not be issued or delivered in Indiana unless the policy form has been filed with and approved by the commissioner.
(h) The commissioner shall do the following:
(1) Create a document containing a list of all product filing requirements for each type of insurance, with appropriate citations to the law, administrative rule, or bulletin that specifies the requirement, including the citation for the type of insurance to which the requirement applies.
(2) Make the document described in subdivision (1) available on the department of insurance Internet site.
(3) Update the document described in subdivision (1) at least annually and not more than thirty (30) days following any change in a filing requirement.
(i) The filing process is as follows:
(1) A filer shall submit a policy form filing that:
(A) includes a copy of the document described in subsection (h);
(B) indicates the location within the policy form or supplement that relates to each requirement contained in the document described in subsection (h); and
(C) certifies that the policy form meets all requirements of state law.
(2) The commissioner shall review a policy form filing and, not more than thirty (30) days after the commissioner receives the filing under subdivision (1):
(A) approve the filing; or
(B) provide written notice of a determination:
(i) that deficiencies exist in the filing; or
(ii) that the commissioner disapproves the filing.
A written notice provided by the commissioner under clause (B) must be based only on the requirements set forth in the document described in subsection (h) and must cite the specific requirements not met by the filing. A written notice provided by the commissioner under clause (B)(i) must state the reasons for the commissioner's determination in sufficient detail to enable the filer to bring the policy form into compliance with the requirements not met by the filing.
(3) A filer may resubmit a policy form that:
(A) was determined deficient under subdivision (2) and has been amended to correct the deficiencies; or
(B) was disapproved under subdivision (2) and has been revised.
A policy form resubmitted under this subdivision must meet the requirements set forth as described in subdivision (1) and must be resubmitted not more than thirty (30) days after the filer receives the commissioner's written notice of deficiency or disapproval. If a policy form is not resubmitted within thirty (30) days after receipt of the written notice, the commissioner's determination regarding the policy form is final.
(4) The commissioner shall review a policy form filing resubmitted under subdivision (3) and, not more than thirty (30) days after the commissioner receives the resubmission:
(A) approve the resubmitted policy form; or
(B) provide written notice that the commissioner disapproves the resubmitted policy form.
A written notice of disapproval provided by the commissioner under clause (B) must be based only on the requirements set forth in the document described in subsection (h), must cite the specific requirements not met by the filing, and must state the reasons for the commissioner's determination in detail. The commissioner's approval or disapproval of a resubmitted policy form under this subdivision is final, except that the commissioner may allow the filer to resubmit a further revised policy form if the filer, in the filer's resubmission under subdivision (3), introduced new provisions or materially modified a substantive provision of the policy form. If the commissioner allows a filer to resubmit a further revised policy form under this subdivision, the filer must resubmit the further revised policy form not more than thirty (30) days after the filer receives notice under clause (B), and the commissioner shall issue a final determination on the further revised policy form not more than thirty (30) days after the commissioner receives the further revised policy form.
(5) If the commissioner disapproves a policy form filing under this subsection, the commissioner shall notify the filer, in writing, of the filer's right to a hearing as described in subsection (m). A disapproved policy form filing may not be used for a policy of accident and sickness insurance unless the disapproval is overturned in a hearing conducted under this subsection.
(6) If the commissioner does not take any action on a policy form that is filed or resubmitted under this subsection in accordance with any applicable period specified in subdivision (2), (3), or (4), the policy form filing is considered to be approved.
(j) Except as provided in this subsection, the commissioner may not disapprove a policy form resubmitted under subsection (i)(3) or (i)(4) for a reason other than a reason specified in the original notice of determination under subsection (i)(2)(B). The commissioner may disapprove a resubmitted policy form for a reason other than a reason specified in the original notice of determination under subsection (i)(2) if:
(1) the filer has introduced a new provision in the resubmission;
(2) the filer has materially modified a substantive provision of the policy form in the resubmission;
(3) there has been a change in requirements applying to the policy form; or
(4) there has been reviewer error and the written disapproval fails to state a specific requirement with which the policy form does not comply.
(k) The commissioner may return a grossly inadequate filing to the filer without triggering a deadline set forth in this section.
(l) The commissioner may disapprove a policy form if:
(1) the benefits provided under the policy form are not reasonable in relation to the premium charged; or
(2) the policy form contains provisions that are unjust, unfair, inequitable, misleading, or deceptive, or that encourage misrepresentation of the policy.
(m) Upon disapproval of a filing under this section, the commissioner shall provide written notice to the filer or insurer of the right to a hearing within twenty (20) days of a request for a hearing.
(n) Unless a policy form approved under this chapter contains a material error or omission, the commissioner may not:
(1) retroactively disapprove the policy form; or
(2) examine the filer of the policy form during a routine or targeted market conduct examination for compliance with a policy form filing requirement that was not in existence at the time the policy form was filed.
As added by P.L.173-2007, SEC.22. Amended by P.L.111-2008, SEC.3; P.L.278-2013, SEC.24; P.L.124-2018, SEC.76.

Structure Indiana Code

Indiana Code

Title 27. Insurance

Article 8. Life, Accident, and Health

Chapter 5. Accident and Sickness Insurance─policy Provisions

27-8-5-0.1. Application of Certain Amendments to Chapter

27-8-5-1. Policy of Accident and Sickness Insurance; Filing; Review; Conformity With Federal Act

27-8-5-1.5. Filing, Review, Approval, and Disapproval Process

27-8-5-2. Requirements for Issuance and Delivery of Policy

27-8-5-2.5. Coverage Under Individual, and Certain Association Group, Policies of Accident and Sickness Insurance; Waivers

27-8-5-2.6. Repealed

27-8-5-2.7. Individual Policy of Accident and Sickness Insurance; Waiver of Coverage

27-8-5-3. Required Provisions; Statutory Option Provisions; Inapplicable or Inconsistent Provisions; Order of Provisions; Third Party Ownership; Requirements of Other Jurisdictions; Filing Procedure

27-8-5-4. Effect of Other Policy Provisions or Policy Conflicting With Chapter

27-8-5-5. Application; Attaching Copy to Policy; Furnishing Copy to Insured; Alterations; Effect of False Statements

27-8-5-6. Defenses of Insurer; Acts Not Constituting Waiver

27-8-5-7. Acceptance of Premium for Period Beyond Termination Date; Effect; Misstatement of Age

27-8-5-8. Exemption of Accident and Sickness Coverage Incidental to Designated Other Forms of Insurance

27-8-5-9. Exemption of Certain Individual Policies

27-8-5-10. Repealed

27-8-5-11. Franchise Plan; Accident and Sickness Insurance; Definitions, Limitations, Requirements, and Standards

27-8-5-12. Supplementary Character of Chapter

27-8-5-13. Repeal of 1935 Act

27-8-5-14. Exception of Fraternal Benefit Associations

27-8-5-15. Blanket Accident and Sickness Insurance; Qualification of Groups; Policy Provisions; Payment of Benefits

27-8-5-15.5. Inpatient Services for Treatment of Mental Illness or Substance Abuse

27-8-5-15.6. Treatment Limitations or Financial Requirements on Coverage of Services for Mental Illness

27-8-5-15.7. Exemption of Policies or Contracts From Laws Resulting in Certain Annual Premium Increases

27-8-5-15.8. "Treatment of a Mental Illness or Substance Abuse"; "Act"; "Nonqualitative Treatment Limitations"; Insurer Reporting and Analysis Requirements

27-8-5-16. Policy of Group Accident and Sickness Insurance; Requirements

27-8-5-16.3. "Small Employer"; Implementation of Program for Joint Purchase of Health Insurance; Rules

27-8-5-16.5. Conditions for Issuance of Certificate to Resident of Indiana Under Group Policy Delivered or Issued in Another State

27-8-5-17. Exceptions; Discretionary Groups; Group Accident and Sickness Insurance

27-8-5-18. Extension to Family Members or Dependents; Premiums; Exclusions; Group Accident and Sickness Insurance

27-8-5-19. Contents; Group Accident and Sickness Insurance

27-8-5-19.2. Repealed

27-8-5-19.3. Association and Discretionary Group Policies of Accident and Sickness Insurance; Waiver of Coverage

27-8-5-20. Notice of Right to Return Policy

27-8-5-21. Adopted Children

27-8-5-22. Refund of Unused Premiums

27-8-5-23. Statute or Rule Mandating Particular Types of Health Care Coverage; Applications to Insurer

27-8-5-24. Insured Issued New Policy Within Year After Cancellation or Nonrenewal; Mandatory Coverage

27-8-5-25. Maternity Benefits; Replacement of Discontinued Policy; Prohibition on Preexisting Condition Limitation or Exclusion of Coverage

27-8-5-26. Post-Mastectomy Coverage

27-8-5-27. Dental Care Provisions Required

27-8-5-28. Coverage of Child to 26 Years of Age

27-8-5-29. Health Plans Offered Through Health Benefit Exchange

27-8-5-30. Step Therapy Protocol

27-8-5-31. Repealed

27-8-5-31.5. Insurer Removing Prescription Drug From Formulary or Changing Cost Sharing; Written Notice and Appeal Process