Indiana Code
Chapter 5. Accident and Sickness Insurance─policy Provisions
27-8-5-19.3. Association and Discretionary Group Policies of Accident and Sickness Insurance; Waiver of Coverage

Sec. 19.3. (a) This section applies to an association or a discretionary group policy of accident and sickness insurance:
(1) under which a certificate of coverage is issued after June 30, 2005, to an individual member of the association or discretionary group;
(2) under which a member of the association or discretionary group is individually underwritten; and
(3) that is not employer based.
(b) Notwithstanding sections 19 and 19.2 of this chapter and any other law, and except as provided in subsection (e), a policy described in subsection (a) may contain a waiver of coverage for a specified condition and any complications that arise from the specified condition if:
(1) the waiver period does not exceed ten (10) years; and
(2) all of the following conditions are met:
(A) The insurer provides to the applicant before issuance of the certificate written notice explaining the waiver of coverage for the specified condition and complications arising from the specified condition.
(B) The:
(i) offer of coverage; and
(ii) certificate of coverage;
include the waiver in a separate section stating in bold print that the applicant is receiving coverage with an exception for the waived condition.
(C) The:
(i) offer of coverage; and
(ii) certificate of coverage;
do not include more than two (2) waivers per individual.
(D) The waiver period is concurrent with and not in addition to any applicable preexisting condition limitation or exclusionary period.
(E) The insurer agrees to:
(i) review the underwriting basis for the waiver upon request one (1) time per year; and
(ii) remove the waiver if the insurer determines that evidence of insurability is satisfactory.
(F) The insurer discloses to the applicant that the applicant may decline the offer of coverage, and that any individual to whom the waiver would have applied may apply for a policy issued by the Indiana comprehensive health insurance association under IC 27-8-10.
(G) An insurance benefit card issued by the insurer to the applicant includes a telephone number for verification of coverage waived.
(c) The insurer shall require an applicant to initial the written notice provided under subsection (b)(2)(A) and the waiver included in the offer of coverage and in the certificate of coverage under subsection (b)(2)(B) to acknowledge acceptance of the waiver of coverage.
(d) An offer of coverage under a policy that includes a waiver under this section does not preclude eligibility for an Indiana comprehensive health insurance association policy under IC 27-8-10-5.1.
(e) A policy described in subsection (a) may not include a waiver of coverage for a:
(1) mental health condition; or
(2) developmental disability.
(f) An insurer may not, on the basis of a waiver contained in a policy as provided in this section, deny coverage for any condition or complication that is not specified as required in the:
(1) written notice under subsection (b)(2)(A); and
(2) offer of coverage and certificate of coverage under subsection (b)(2)(B).
(g) An insurer that removes a waiver under subsection (b)(2)(E) shall not consider the condition or any complication to which the waiver previously applied in making policy renewal and underwriting determinations.
(h) Upon the expiration of the waiver period allowed under this section, the insurer shall:
(1) remove the waiver;
(2) not consider the condition or any complication to which the waiver previously applied in making policy underwriting determinations; and
(3) renew the policy in accordance with 45 CFR 148.122.
As added by P.L.211-2005, SEC.2.

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