Indiana Code
Chapter 5. Accident and Sickness Insurance─policy Provisions
27-8-5-15.8. "Treatment of a Mental Illness or Substance Abuse"; "Act"; "Nonqualitative Treatment Limitations"; Insurer Reporting and Analysis Requirements

Sec. 15.8. (a) As used in this section, "treatment of a mental illness or substance abuse" means:
(1) treatment for a mental illness, as defined in IC 12-7-2-130(1); and
(2) treatment for drug abuse or alcohol abuse.
(b) As used in this section, "act" refers to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Act of 2008 and any amendments thereto, plus any federal guidance or regulations relevant to that act, including 45 CFR 146.136, 45 CFR 147.136, 45 CFR 147.160, and 45 CFR 156.115(a)(3).
(c) As used in this section, "nonquantitative treatment limitations" refers to those limitations described in 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR 146.136.
(d) An insurer that issues a policy of accident and sickness insurance that provides coverage of services for treatment of a mental illness or substance abuse shall submit a report to the department not later than December 31 of each year that contains the following information:
(1) A description of the processes:
(A) used to develop or select the medical necessity criteria for coverage of services for treatment of a mental illness or substance abuse; and
(B) used to develop or select the medical necessity criteria for coverage of services for treatment of other medical or surgical conditions.
(2) Identification of all nonquantitative treatment limitations that are applied to:
(A) coverage of services for treatment of a mental illness or substance abuse; and
(B) coverage of services for treatment of other medical or surgical conditions;
within each classification of benefits.
(e) There may be no separate nonquantitative treatment limitations that apply to coverage of services for treatment of a mental illness or substance abuse that do not apply to coverage of services for treatment of other medical or surgical conditions within any classification of benefits.
(f) An insurer that issues a policy of accident and sickness insurance that provides coverage of services for treatment of a mental illness or substance abuse shall also submit an analysis showing the insurer's compliance with this section and the act to the department not later than December 31 of each year. The analysis must do the following:
(1) Identify the factors used to determine that a nonquantitative treatment limitation will apply to a benefit, including factors that were considered but rejected.
(2) Identify and define the specific evidentiary standards used to define the factors and any other evidence relied upon in designing each nonquantitative treatment limitation.
(3) Provide the comparative analyses, including the results of the analyses, performed to determine the following:
(A) That the processes and strategies used to design each nonquantitative treatment limitation for coverage of services for treatment of a mental illness or substance abuse are comparable to, and applied no more stringently than, the processes and strategies used to design each nonquantitative treatment limitation for coverage of services for treatment of other medical or surgical conditions.
(B) That the processes and strategies used to apply each nonquantitative treatment limitation for treatment of a mental illness or substance abuse are comparable to, and applied no more stringently than, the processes and strategies used to apply each nonquantitative limitation for treatment of other medical or surgical conditions.
(g) The department shall adopt rules to ensure compliance with this section and the applicable provisions of the act.
As added by P.L.103-2020, SEC.4.

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