Indiana Code
Title 27. Insurance
Article 13. Health Maintenance Organizations

27-13-2-7. Certificate of Authority Application; Approval of Modifications or Amendments - Sec. 7. Any modification or amendment requiring the approval of...

27-13-2-8. Waiver of Rights Under Bankruptcy Laws - Sec. 8. The commissioner may not issue a certificate of...

27-13-2-9. Prohibited Names - Sec. 9. (a) A health maintenance organization established under this...

27-13-2-10. Application of Other Laws to Domestic Health Maintenance Organizations - Sec. 10. (a) A domestic health maintenance organization that is...

Chapter 3. Issuance of Certificates of Authority

27-13-3-1. Satisfaction of Requirements - Sec. 1. After receiving a completed application, the commissioner shall...

27-13-3-1.5. Approval of Certificate of Authority - Sec. 1.5. (a) Except as provided in subsection (b), a...

27-13-3-2. Denial of Application - Sec. 2. An application for a certificate of authority may...

Chapter 4. Powers of Health Maintenance Organizations

27-13-4-1. General Powers - Sec. 1. (a) Subject to section 3 of this chapter,...

27-13-4-2. Asset of Health Maintenance Organization as an Admitted Asset - Sec. 2. Nothing in this chapter qualifies an asset of...

27-13-4-3. Filing Notice With Commissioner Before Exercising Power; Disapproval of Exercise of Power; Exemptions From Filing Requirement - Sec. 3. (a) A domestic health maintenance organization must file...

Chapter 5. Fiduciary Responsibilities

27-13-5-1. Persons Having Fiduciary Responsibilities - Sec. 1. Any: (1) director; (2) officer; (3) employee; or...

27-13-5-2. Fidelity Bond or Fidelity Insurance - Sec. 2. A health maintenance organization shall maintain in force...

Chapter 6. Quality Management Programs

27-13-6-1. Procedures; Establishment - Sec. 1. (a) A health maintenance organization shall establish procedures...

27-13-6-2. Internal Quality Management Program Required - Sec. 2. A health maintenance organization shall have an ongoing...

27-13-6-3. Quality Management Program Requirements - Sec. 3. The quality management program required by section 2...

27-13-6-4. Written Statement of Quality Management Activities - Sec. 4. The quality management program required by section 2...

27-13-6-5. Written Plans for Correcting Insufficient Service - Sec. 5. The quality management program required by section 2...

27-13-6-6. Patient Record System - Sec. 6. A health maintenance organization shall ensure the use...

27-13-6-7. Reporting Quality Management Program Activities - Sec. 7. A health maintenance organization shall establish a mechanism...

27-13-6-8. Records of Proceedings; Confidentiality - Sec. 8. A health maintenance organization shall: (1) record the...

27-13-6-9. Inspection of Records by Commissioner - Sec. 9. The commissioner may inspect the records of a...

27-13-6-10. Hospital Accreditation - Sec. 10. (a) A health maintenance organization may not refuse...

Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage

27-13-7-0.1. Application of Certain Amendments to Chapter - Sec. 0.1. The following amendments to this chapter apply as...

27-13-7-1. Persons Entitled to Copies of Contracts - Sec. 1. Any holder of a group or an individual...

27-13-7-2. Deceptive Contract Provisions Prohibited - Sec. 2. A contract or an evidence of coverage referred...

27-13-7-3. Contract Provisions - Sec. 3. (a) A contract referred to in section 1...

27-13-7-4. Compliance With Requirements; Ten Day Grace Period - Sec. 4. (a) An individual contract must comply with all...

27-13-7-5. Evidence of Coverage - Sec. 5. (a) A subscriber under a group contract must...

27-13-7-6. Evidence of Coverage; Prohibited Provisions - Sec. 6. The evidence of coverage required by section 5...

27-13-7-7. Evidence of Coverage; Required Statement - Sec. 7. The evidence of coverage required by section 5...

27-13-7-7.5. Prohibition on Coverage of Abortion; Exceptions; Coverage Through Rider or Endorsement - Note: This version of section effective until 9-15-2022. See also...

27-13-7-7.5-b. Prohibition on Coverage of Abortion; Exceptions; Coverage Through Rider or Endorsement - Note: This version of section effective 9-15-2022. See also preceding...

27-13-7-8. Readability Standards - Sec. 8. The commissioner may adopt rules under IC 4-22-2...

27-13-7-9. Approval of Forms by Commissioner - Sec. 9. Subject to sections 10 and 11 of this...

27-13-7-10. Coverage Outside Indiana; Commissioner's Approval Not Required - Sec. 10. If: (1) an evidence of coverage that is...

27-13-7-11. Filing of Form With Commissioner; Review Period; Approval; Withdrawal of Approval; Hearing - Sec. 11. (a) A form required by this chapter must...

27-13-7-12. Additional Information Required by Commissioner - Sec. 12. The commissioner may require the submission of any...

27-13-7-13. Continuation of Coverage Statement - Sec. 13. (a) A health maintenance organization must include in...

27-13-7-14. Post-Mastectomy Coverage - Sec. 14. (a) As used in this section, "mastectomy" means...

27-13-7-14.2. "Treatment of a Mental Illness or Substance Abuse"; "Act"; "Nonqualitative Treatment Limitations"; Reporting and Analysis Requirements for Individual and Group Contracts - Sec. 14.2. (a) As used in this section, "treatment of...

27-13-7-14.5. Coverage for Nonexperimental, Surgical Treatment of Morbid Obesity - Sec. 14.5. (a) As used in this section, "health care...

27-13-7-14.7. Coverage for Autism Spectrum Disorders - Sec. 14.7. (a) As used in this section, "autism spectrum...

27-13-7-14.8. Treatment Limitations or Financial Requirements on Coverage of Services for Mental Illness - Sec. 14.8. (a) As used in this section, "coverage of...

27-13-7-15. Dental Care Provisions Required - Sec. 15. (a) As used in this section, "child" means...

27-13-7-15.3. Breast Cancer Screening Mammography - Sec. 15.3. (a) As used in this section, "breast cancer...

27-13-7-16. Prostate Specific Antigen Test - Sec. 16. (a) As used in this section, "prostate specific...

27-13-7-17. Coverage for Colorectal Cancer Screening; Exception for Grandfathered Health Plans - Sec. 17. (a) As used in this section, "colorectal cancer...

27-13-7-18. Inherited Metabolic Disease Coverage - Sec. 18. (a) As used in this section, "inherited metabolic...

27-13-7-19. Coverage for Orthotic Devices and Prosthetic Devices - Sec. 19. (a) As used in this section, "orthotic device"...

27-13-7-20. Prohibition on Chemotherapy Coverage Limitations - Sec. 20. (a) This section applies to an individual contract...

27-13-7-20.1. Individual or Group Contract Providing Coverage for Prescription Eye Drops; Refill of Prescription Eye Drops; Requirements - Sec. 20.1. (a) This section applies to an individual contract...

27-13-7-20.2. Coverage for Care Related to Cancer Clinical Trials - Sec. 20.2. (a) As used in this section, "care method"...

27-13-7-20.4. Applicability; Coverage for Methadone for Treatment of Pain - Sec. 20.4. (a) This section applies to an individual contract...

27-13-7-21. High Breast Density - Sec. 21. (a) As used in this section, "high breast...

27-13-7-22. Coverage of Telehealth Services; Prohibition on Requiring Use of Specific Information Technology Application - Sec. 22. (a) An individual contract or a group contract...

27-13-7-23. Step Therapy Protocol - Sec. 23. (a) As used in this section, "group contract"...

27-13-7-24. Coverage for Anatomical Gifts, Transplantation, or Related Health Care Services - Sec. 24. (a) As used in this section, "disability" has...

27-13-7-24.5. Coverage for Chronic Pain Management - Sec. 24.5. (a) This section applies to each of the...

27-13-7-26. Coverage for Pediatric Neuropsychiatric Disorders - Sec. 26. (a) An individual contract and a group contract...

27-13-7-27. Reimbursement for Emergency Medical Services - Sec. 27. (a) This section applies to each of the...

Chapter 8. Annual Report

27-13-8-0.1. Application of Certain Amendments to Chapter - Sec. 0.1. The amendments made to section 2 of this...

27-13-8-1. Filing - Sec. 1. On or before March 1 of each year,...

27-13-8-1.5. Preparation of Annual Statement - Sec. 1.5. (a) Each health maintenance organization authorized to conduct...

27-13-8-2. Filings With Commissioner; Complaint Analysis and Reporting - Sec. 2. (a) In addition to the report required by...

27-13-8-3. Annual Statement Blank; Quarterly Reports - Sec. 3. (a) This section applies to a domestic health...

27-13-8-4. Civil Penalties - Sec. 4. (a) The commissioner may impose a civil penalty...

Chapter 9. Information to Enrollees or Subscribers

27-13-9-1. List of Providers - Sec. 1. (a) Upon: (1) the enrollment; and (2) each...

27-13-9-2. Notice of Change in Operation of Health Maintenance Organization - Sec. 2. Not more than thirty (30) days after any...

27-13-9-3. Termination of Provider - Sec. 3. (a) A health maintenance organization shall notify an...

27-13-9-4. Information on Services and Filing Grievances; Telephone Number - Sec. 4. A health maintenance organization shall provide to each...

27-13-9-5. Prescription Drug Information Card - Sec. 5. (a) This section applies to a health maintenance...

27-13-9-6. "Health Plan Information Card"; Indication of Benefits and Health Care Services - Sec. 6. (a) As used in this section, "health plan...

27-13-9-7. Electronic Data Base Requirements; Rulemaking Authority - Sec. 7. (a) The electronic data base by which a...

Chapter 10. Grievance Procedures

27-13-10-1. Establishment of Procedures - Sec. 1. A health maintenance organization or limited service health...

27-13-10-2. Examination by Commissioner - Sec. 2. The commissioner may examine the grievance procedures of...

27-13-10-3. Records of Grievances - Sec. 3. A health maintenance organization or limited service health...

27-13-10-4. Notice of Grievance Related Information - Sec. 4. (a) A health maintenance organization shall provide, at...

27-13-10-5. Filing; Oral or Written Grievance; Telephone Number; Date - Sec. 5. (a) An enrollee or a subscriber may file...

27-13-10-6. Filing; Procedures; Representative - Sec. 6. (a) A health maintenance organization shall establish procedures...

27-13-10-7. Resolution of Grievances - Sec. 7. (a) A health maintenance organization shall establish written...

27-13-10-8. Appeals of Grievance Decisions; Filing of Report for Violation - Sec. 8. (a) A health maintenance organization shall establish written...

27-13-10-11. Action Against Provider Representing Enrollee or Subscriber - Sec. 11. A health maintenance organization may not take action...

27-13-10-12. Approval of Grievance and Appeals Procedures - Sec. 12. (a) Notwithstanding IC 27-13, the department shall approve...

27-13-10-13. Adoption of Rules - Sec. 13. The department may adopt rules under IC 4-22-2...

Chapter 10.1. External Review of Grievances

27-13-10.1-0.1. Application of Chapter - Sec. 0.1. The addition of this chapter by P.L.133-1999 applies...

27-13-10.1-1. External Grievance Procedure Established - Sec. 1. A health maintenance organization shall establish and maintain...

27-13-10.1-2. Requirements of Procedure - Sec. 2. (a) An external grievance procedure established under section...

27-13-10.1-3. Cooperation With Review Organization; Requirements of Enrollee - Sec. 3. (a) An enrollee who files an appeal under...

27-13-10.1-4. Requirements of Independent Review Organization - Sec. 4. (a) An independent review organization shall: (1) for...

27-13-10.1-4.5. Information From Independent Review Organization - Sec. 4.5. Upon the request of an enrollee who is...

27-13-10.1-5. Determination Binding on Health Maintenance Organization - Sec. 5. A determination made under section 4 of this...

27-13-10.1-6. Reconsideration of Resolution - Sec. 6. (a) If at any time during an external...

27-13-10.1-7. Terms of Coverage Unchanged - Sec. 7. This chapter does not add to or otherwise...

27-13-10.1-8. Certification of Independent Review Organizations - Sec. 8. (a) The department shall establish and maintain a...

27-13-10.1-9. Confidentiality - Sec. 9. Except as provided in section 8(g) of this...

27-13-10.1-10. Immunity From Civil Liability - Sec. 10. (a) An independent review organization is immune from...

27-13-10.1-11. Medicare Review - Sec. 11. If an enrollee has the right to an...

27-13-10.1-12. Adoption of Rules - Sec. 12. The department may adopt rules under IC 4-22-2...

Chapter 11. Investments

27-13-11-1. Permitted Investments - Sec. 1. Except for investments under IC 27-13-4-1(a)(1), the funds...

Chapter 12. Protection Against Insolvency; Net Worth Requirements

27-13-12-1. "Net Worth" Defined; Computation - Sec. 1. (a) As used in this chapter, "net worth"...

27-13-12-2. Initial Minimum Net Worth - Sec. 2. Before issuing a certificate of authority to a...

27-13-12-3. Maintenance of Minimum Net Worth - Sec. 3. Except as provided in sections 4 and 5...

27-13-12-4. Net Worth Schedule - Sec. 4. A health maintenance organization licensed before July 1,...

27-13-12-5. Consideration of Debts - Sec. 5. (a) In determining net worth under this chapter,...

27-13-12-6. Adoption of Rules - Sec. 6. The commissioner may adopt rules to further define...

Chapter 13. Protection Against Insolvency; Deposit Requirements

27-13-13-1. Items Deposited; Minimum Value - Sec. 1. Except as provided in this chapter, a health...

27-13-13-2. Deposit Schedule - Sec. 2. A health maintenance organization that is in operation...

27-13-13-3. Deposits Considered Admitted Asset - Sec. 3. Deposits made under this chapter shall be considered...

27-13-13-4. Income From Deposits; Replacing Deposits - Sec. 4. (a) All income from deposits made under this...

27-13-13-5. Use of Deposit - Sec. 5. (a) A deposit made by a health maintenance...

27-13-13-6. Reduction or Elimination of Deposit Requirements for Foreign Corporations - Sec. 6. The commissioner may reduce or eliminate the requirement...

27-13-13-7. Return of Deposit - Sec. 7. If: (1) a health maintenance organization ceases operation...

27-13-13-8. Additional Financial Requirements - Sec. 8. (a) In addition to meeting all other financial...

27-13-13-9. Repealed - As added by P.L.203-2001, SEC.24. Repealed by P.L.208-2018, SEC.29.

Chapter 14. Protection Against Insolvency; Liabilities

27-13-14-1. Determination of Liabilities - Sec. 1. When determining its liabilities, a health maintenance organization...

27-13-14-2. Computation of Liabilities - Sec. 2. The liabilities of a health maintenance organization must...

Chapter 15. Participating Providers; Contracts and Legal Actions

27-13-15-0.1. Application of Certain Amendments to Chapter - Sec. 0.1. The addition of section 4 of this chapter...

27-13-15-1. Contract Requirements; Enrollee Coverage; Payment of Provider; Application - Sec. 1. (a) A contract between a health maintenance organization...

27-13-15-2. Contract Requirements Not Met; Collection of Money Owed by Health Maintenance Organization Prohibited - Sec. 2. If: (1) the contract between a health maintenance...

27-13-15-3. Actions Against Subscribers; Costs and Attorney's Fees - Sec. 3. (a) A: (1) participating provider; or (2) trustee,...

27-13-15-4. Participating Provider Agreement Prohibitions - Sec. 4. (a) As used in this section, "health maintenance...

27-13-15-5. Coverage for Dialysis Treatment - Sec. 5. (a) Notwithstanding IC 27-13-1-12, as used in this...

27-13-15-6. Right to Provide Prescription Cost Information; Point of Sale Cost Limit; Pharmacist May Not Be Required to Collect Higher Copayment - Sec. 6. (a) As used in this section, "drug" means...

Chapter 16. Repealed - Repealed by P.L.208-2018, SEC.30.

Chapter 17. Protection Against Insolvency; Notice of Termination

27-13-17-1. Notice Requirements Before Termination of Agreement by Provider - Sec. 1. An agreement between a provider and a health...

Chapter 18. Repealed - Repealed by P.L.208-2018, SEC.31.

Chapter 19. Replacement Coverage in Event of Receivership

27-13-19-1. "Discontinuance" Defined - Sec. 1. As used in this chapter, "discontinuance" means the...

27-13-19-2. Replacement Coverage; Challenge of Enrollee - Sec. 2. (a) A carrier that provides replacement coverage with...

27-13-19-3. Provisions Reducing or Excluding Benefits - Sec. 3. (a) Except as provided in subsection (b), a...

Chapter 20. Filing Requirements

27-13-20-1. Rates; Approval - Sec. 1. The rates to be used by a health...

27-13-20-2. Approval of Documents by Commissioner - Sec. 2. (a) Except as provided in subsection (b), a...

Chapter 21. Insurance Producers of Health Maintenance Organizations and Limited Service Health Maintenance Organizations

27-13-21-1. Licensing of Insurance Producer - Sec. 1. To qualify to represent a health maintenance organization...

Chapter 22. Powers of Insurers and Hospital Corporations

27-13-22-1. Operation of Health Maintenance Organization by Insurer or Hospital - Sec. 1. (a) A licensed insurer or a hospital authorized...

27-13-22-2. Joint Organization or Operation as Health Maintenance Organization - Sec. 2. Notwithstanding any other law: (1) insurers; (2) hospitals;...

27-13-22-3. Business of Insurance Including Health Care Maintenance Organizations - Sec. 3. For the purposes of IC 27-1-2-2, the business...

27-13-22-4. Contracting With Health Maintenance Organizations to Provide Insurance Coverage - Sec. 4. An insurer or a hospital may contract with...

27-13-22-5. Benefit Payments to Health Maintenance Organization; Contract Provisions - Sec. 5. Under a contract between an insurer or a...

Chapter 23. Examinations

27-13-23-1. Health Maintenance Organization Examination - Sec. 1. The commissioner may make an examination of a...

27-13-23-2. Quality Management Program Examination - Sec. 2. The commissioner may make an examination concerning the...

27-13-23-3. Availability of Books and Records - Sec. 3. Each health maintenance organization that is subject to...

27-13-23-4. Officers and Agents; Oaths and Examination by Commissioner - Sec. 4. When conducting an examination of a health maintenance...

27-13-23-5. Expenses of Examination - Sec. 5. The expenses incurred by the commissioner in conducting...

27-13-23-6. Health Maintenance Organizations Outside Indiana; Reports of Other Insurance Commissioners - Sec. 6. Instead of conducting an examination of a health...

27-13-23-7. Annual Review of Hedis Data - Sec. 7. (a) Beginning July 1, 1999, the commissioner shall...

27-13-23-8. Filing Examination Reports of Other States - Sec. 8. A health maintenance organization shall file a copy...

Chapter 24. Suspension, Revocation, or Denial of Certificate of Authority

27-13-24-1. Grounds for Suspension or Revocation - Sec. 1. (a) The commissioner may suspend or revoke a...

27-13-24-2. Deficient Net Worth - Sec. 2. (a) If the commissioner finds that the net...

27-13-24-3. Procedures; Written Order; Revised Application; Hearing - Sec. 3. (a) The commissioner may: (1) suspend or revoke...

27-13-24-4. Action by Commissioner After Hearing - Sec. 4. (a) After a hearing, or upon failure of...

27-13-24-5. Application of Ic 4-21.5 - Sec. 5. IC 4-21.5 applies to proceedings under this chapter...

27-13-24-6. Prohibited Activity During Suspension - Sec. 6. A health maintenance organization whose certificate of authority...

27-13-24-7. Conclusion of Affairs Following Revocation of Certificate of Authority - Sec. 7. (a) A health maintenance organization whose certificate of...

27-13-24-8. Prohibited Activities Before Hearing - Sec. 8. If the commissioner issues an order under section...

Chapter 25. Rehabilitation or Liquidation of Health Maintenance Organizations

27-13-25-1. Rehabilitation or Liquidation as an Insurance Company; Applicability of Ic 27-9 - Sec. 1. The rehabilitation or liquidation of a health maintenance...

27-13-25-2. Appointment of Commissioner as Rehabilitator or Liquidator; Grounds - Sec. 2. The commissioner may apply for an order appointing...

27-13-25-3. Claims Against Health Maintenance Organization - Sec. 3. (a) In the liquidation of a health maintenance...

Chapter 26. Summary of Orders and Supervision

27-13-26-1. Hazardous Financial Condition; Corrective Action Ordered by Commissioner - Sec. 1. (a) If the commissioner determines that: (1) the...

27-13-26-2. Violation of Article - Sec. 2. For purposes of section 1(a)(2) of this chapter,...

27-13-26-3. Adoption of Rules; Uniform Standards Set by Commissioner - Sec. 3. (a) The commissioner may adopt rules under IC...

27-13-26-4. Remedies and Measures - Sec. 4. The remedies and measures available to the commissioner...

Chapter 27. Fees

27-13-27-1. Filing Fees - Sec. 1. Each health maintenance organization subject to this article...

27-13-27-2. Fees Required by Ic 27-1-3-15 - Sec. 2. In addition to the fees required by section...

Chapter 28. Penalties and Enforcement

27-13-28-1. Augmentation of Penalty; Damages Suffered by Enrollees or Other Members of the Public - Sec. 1. The commissioner may augment a penalty imposed under...

27-13-28-2. Conference to Determine Violations - Sec. 2. If the commissioner has cause to believe that...

27-13-28-3. Procedural Requirements - Sec. 3. Proceedings under section 2 of this chapter are...

27-13-28-4. Cease and Desist Orders - Sec. 4. (a) The commissioner may issue an order directing:...

27-13-28-5. Injunctive or Other Relief - Sec. 5. In the case of a violation of this...

27-13-28-6. Failure to Comply With Net Worth Requirements; Continued Operation - Sec. 6. Notwithstanding any other provision of this article, if...

27-13-28-7. Investigations on Behalf of Enrollees or Providers Not Precluded - Sec. 7. This article does not preclude the department from...

Chapter 29. Statutory Construction and Relationship to Other Laws

27-13-29-1. Applicability of Provisions - Sec. 1. (a) Except as provided in subsection (b) or...

27-13-29-2. Solicitation of Enrollees - Sec. 2. Provided that the solicitation otherwise complies with IC...

27-13-29-3. Repealed - As added by P.L.26-1994, SEC.25. Repealed by P.L.227-1995, SEC.2.

27-13-29-4. Risk Based Capital Requirements - Sec. 4. A: (1) health maintenance organization; or (2) limited...

Chapter 30. Filings and Reports as Public Documents

27-13-30-1. Public Records; Exemptions; Annual Financial Statement - Sec. 1. (a) All applications, filings, and reports required under...

Chapter 31. Confidentiality of Medical Information and Limitation of Liability

27-13-31-1. Information Treated as Confidential; Exceptions; Privilege Against Disclosure - Sec. 1. (a) Notwithstanding IC 27-13-30, any information: (1) that...

27-13-31-2. Liability Limitations - Sec. 2. (a) As used in this section, "in good...

27-13-31-3. Information and Records Subject to Subpoena or Discovery - Sec. 3. (a) Notwithstanding IC 27-13-30, the information considered by...

27-13-31-4. Quality Management Program; Access to Records - Sec. 4. To fulfill its obligations under IC 27-13-6 concerning...

Chapter 32. Transfers of Ownership

27-13-32-1. Acquisition of Control of Health Maintenance Organization or Limited Service Health Maintenance Organization - Sec. 1. (a) This section does not apply to a...

Chapter 32.5. Voluntary Dissolution

27-13-32.5-1. Notice; Filing Articles of Dissolution - Sec. 1. Upon authorization of voluntary dissolution by the board...

27-13-32.5-2. Effect on Rights of Enrollees - Sec. 2. The dissolution of a health maintenance organization under...

Chapter 33. Coordination of Benefits

27-13-33-1. Coordination of Benefits Provision; Purpose - Sec. 1. Health maintenance organizations may adopt a coordination of...

27-13-33-2. Provision Consistent With 760 Iac 1-38.1 - Sec. 2. If a health maintenance organization adopts a coordination...

Chapter 34. Limited Service Health Maintenance Organizations

27-13-34-0.1. Application of Certain Amendments to Chapter - Sec. 0.1. The amendments made to section 12 of this...

27-13-34-1. "Enrollee" Defined - Sec. 1. (a) As used in this chapter, "enrollee" means...

27-13-34-2. "Evidence of Coverage" Defined - Sec. 2. As used in this chapter, "evidence of coverage"...

27-13-34-3. "Limited Health Services" Defined - Sec. 3. (a) As used in this chapter, "limited health...

27-13-34-4. "Limited Service Health Maintenance Organization" Defined - Sec. 4. (a) As used in this chapter, "limited service...

27-13-34-5. "Provider" Defined - Sec. 5. As used in this chapter, "provider" means a...

27-13-34-6. "Subscriber" Defined - Sec. 6. As used in this chapter, "subscriber" means a...

27-13-34-7. Certificate of Authority Required; Foreign Entities - Sec. 7. (a) After December 31, 1994, a person, corporation,...

27-13-34-8. Application for Certificate of Authority; Requirements - Sec. 8. (a) An application for a certificate of authority...

27-13-34-9. Issuance of Certificate of Authority; Application Deficiencies; Denial of Application - Sec. 9. (a) After receiving an application filed under section...

27-13-34-10. Powers of Limited Service Health Maintenance Organization - Sec. 10. (a) Subject to subsection (b), the powers of...

27-13-34-11. Modification of Documents; Filing; Disapproval - Sec. 11. (a) Before making any material modification of any...

27-13-34-12. Applicable Statutes - Sec. 12. A limited service health maintenance organization operated under...

27-13-34-13. Evidence of Coverage; Required Information - Sec. 13. (a) Every subscriber of a limited service health...

27-13-34-14. Examinations by Commissioner - Sec. 14. (a) The commissioner may examine a limited service...

27-13-34-15. Required Contract Terms and Conditions; Exemptions - Sec. 15. All contracts with providers or with entities subcontracting...

27-13-34-16. "Net Worth" and "Uncovered Expense" Defined; Computation of Net Worth; Minimum Net Worth - Sec. 16. (a) As used in this section, "net worth"...

27-13-34-17. Required Deposit - Sec. 17. (a) Each limited service health maintenance organization shall...

27-13-34-18. Fidelity Bonds; Deposit in Place of Bond - Sec. 18. (a) Except as provided in subsection (c), a...

27-13-34-19. Annual Reports; Additional Reports - Sec. 19. (a) On or before March 1 of each...

27-13-34-20. Suspension or Revocation of Certificate of Authority - Sec. 20. (a) The commissioner may suspend or revoke the...

27-13-34-21. Chapter Violations; Fines and Penalties - Sec. 21. (a) In place of any other penalty specified...

27-13-34-22. Supervision, Rehabilitation, or Liquidation; Remedies and Measures - Sec. 22. (a) Any supervision, rehabilitation, or liquidation of a...

27-13-34-23. Fees - Sec. 23. (a) A limited service health maintenance organization subject...

27-13-34-24. Dental Care Services and Director; Review of Adverse Decisions; Complaints - Sec. 24. (a) A limited service health maintenance organization that...

27-13-34-26. Complaints; Records - Sec. 26. (a) The department shall maintain records concerning complaints...

Chapter 35. General Rulemaking Authority

27-13-35-1. Adoption of Rules to Carry Out Article - Sec. 1. The commissioner may adopt reasonable rules under IC...

Chapter 36. Patient Protection; Clinical Decision Making; Access to Personnel and Facilities

27-13-36-1. Medical Director; Individual to Develop Treatment Policies and Consult With Treating Providers - Sec. 1. (a) Each health maintenance organization shall appoint a...

27-13-36-2. Sufficient Number and Type of Primary Care Providers - Sec. 2. Beginning July 1, 1999, each health maintenance organization...

27-13-36-2.5. Discrimination on Basis of Provider's License or Certification Prohibited - Sec. 2.5. (a) A health maintenance organization may not discriminate...

27-13-36-3. Adequate Number of Services and Providers Within Reasonable Proximity of Subscribers - Sec. 3. (a) The provisions of this section do not...

27-13-36-4. Specialty Areas of Primary Care Providers - Sec. 4. Beginning July 1, 1999, primary care providers shall...

27-13-36-5. Referrals to Out of Network Providers - Sec. 5. (a) The provisions of the section do not...

27-13-36-6. Continuation of Care Provisions - Sec. 6. (a) A health maintenance organization shall include provisions...

27-13-36-7. Telephone Access for Authorization of Care - Sec. 7. Each health maintenance organization shall provide the following:...

27-13-36-8. Guidelines for Establishing Reasonable Periods for Appointments - Sec. 8. (a) Each health maintenance organization shall establish guidelines...

27-13-36-9. Coverage and Reimbursement for Expenses for Care Obtained in an Emergency - Sec. 9. (a) As used in this section, "care obtained...

27-13-36-10. Access Plan to Meet Needs of Vulnerable, Underserved, and Non-English Speaking Enrollees - Sec. 10. Each health maintenance organization shall demonstrate to the...

27-13-36-11. Standards for Continuity of Care - Sec. 11. The health maintenance organization shall develop standards for...

27-13-36-12. Payment to Enrollee for Service Rendered by Nonparticipating Provider; Requirements - Sec. 12. (a) As used in this section, "nonparticipating provider"...

Chapter 36.2. Provider Payment

27-13-36.2-1. "Clean Claim" Defined - Sec. 1. As used in this chapter, "clean claim" means...

27-13-36.2-2. "Health Maintenance Organization" Defined - Sec. 2. As used in this chapter, "health maintenance organization"...

27-13-36.2-3. Notice of Deficiencies in Claims - Sec. 3. (a) A health maintenance organization shall pay or...

27-13-36.2-4. Payment or Denial of Claims; Interest - Sec. 4. (a) A health maintenance organization shall pay or...

27-13-36.2-5. Permitted Forms - Sec. 5. A provider shall submit only the following forms...

27-13-36.2-6. Civil Penalties - Sec. 6. (a) If the commissioner finds that a health...

27-13-36.2-7. Repealed - As added by P.L.178-2003, SEC.88. Repealed by P.L.1-2007, SEC.248.

27-13-36.2-8. Claim Payment Errors - Sec. 8. (a) A health maintenance organization may not, more...

27-13-36.2-9. Claim Overpayment Adjustment - Sec. 9. Every subsequent claim that is adjusted by a...

Chapter 37. Patient Protection; Choice of Health Care Professional

27-13-37-1. Enrollees Allowed to Choose Primary Care Provider From List - Sec. 1. (a) A health maintenance organization shall allow each...

27-13-37-2. Use of Participating Provider Other Than Primary Care Provider - Sec. 2. (a) Each health maintenance organization shall develop a...

27-13-37-3. Continuity of Care and Referrals When Specialty Care Warranted - Sec. 3. Beginning July 1, 1999, each health maintenance organization...

27-13-37-4. Point-of-Service Products; Dental Care Services - Sec. 4. (a) Each health maintenance organization shall offer to...

27-13-37-5. Second Medical Opinions - Sec. 5. Each health maintenance organization shall allow an enrollee...

Chapter 37.5. Mail Order and Internet Pharmacy Designation

27-13-37.5-0.1. Application of Chapter - Sec. 0.1. This chapter applies to an individual contract or...

27-13-37.5-1. "Mail Order or Internet Based Pharmacy" - Sec. 1. As used in this chapter, "mail order or...

27-13-37.5-2. Designation of Mail Order or Internet Based Pharmacy - Sec. 2. (a) A health maintenance organization may designate, under...

Chapter 38. Patient Protection; Drugs and Devices; Drug Utilization Review Program

27-13-38-1. Drug and Devices Formularies - Sec. 1. (a) A health maintenance organization may apply a...

27-13-38-2. Substitution of Brand Name Drugs - Sec. 2. Subject to IC 16-42-22: (1) a pharmacist shall...

27-13-38-3. Drug Utilization Review Programs; Contents - Sec. 3. Each health maintenance organization that has a prescription...

27-13-38-4. Drug Utilization Review Programs; Primary Emphasis - Sec. 4. The primary emphasis of the drug utilization review...

27-13-38-5. Drug Utilization Review Programs; Confidentiality of Enrollees - Sec. 5. The name of an enrollee that is discovered...

27-13-38-6. Adoption of Rules - Sec. 6. The commissioner, with input and assistance from the...

27-13-38-7. Prescription Drug Coverage - Sec. 7. (a) The definitions in IC 27-13-7-23 apply throughout...

27-13-38-8. Application; Definitions; Denial of Coverage to Synchronize Prohibited; Coverage of Synchronization - Sec. 8. (a) This section does not apply to a...

Chapter 39. Patient Protection; Experimental Treatments

27-13-39-1. Procedures Regarding Experimental Treatments - Sec. 1. (a) A health maintenance organization shall develop and...

27-13-39-2. Disclosure of Coverage Limitations - Sec. 2. (a) A health maintenance organization that limits coverage...

27-13-39-3. Written Explanation of Denial of Coverage of Experimental Treatment; Review - Sec. 3. (a) If a health maintenance organization denies coverage...

Chapter 40. Patient Protection; Health Maintenance Organization Comparison Sheets

27-13-40-1. Availability of Comparison Sheets - Sec. 1. Beginning January 1, 2000, each health maintenance organization...

27-13-40-2. Requirements for Comparison Sheets - Sec. 2. (a) The comparison sheet required under section 1...

27-13-40-3. Persons to Be Provided Comparison Sheets - Sec. 3. A health maintenance organization shall provide a completed...

Chapter 41. Claims

27-13-41-1. Use of Diagnostic or Procedure Codes - Sec. 1. Not more than ninety (90) days after the...

27-13-41-2. Reimbursement - Sec. 2. If a provider provides health care services that...

Chapter 42. Specific Reporting Requirements

27-13-42-1. Allowing a Health Maintenance Organization to Report the Number of Children Enrollees Who Are Prescribed Stimulant Medication for the Treatment of Certain Disorders - Sec. 1. A health maintenance organization that enters into an...

Chapter 43. Credentialing

27-13-43-1. Application of Chapter - Sec. 1. (a) Except as provided in subsection (b), this...

27-13-43-2. Provider Credentialing - Sec. 2. (a) The department shall prescribe the credentialing application...

27-13-43-3. Provisional Credentialing; Criteria; Reimbursement; Termination - Sec. 3. (a) Notwithstanding section 2 of this chapter, if...

27-13-43-4. Fully Credentialed Provider Reimbursement; Requirements - Sec. 4. (a) A fully credentialed provider shall be reimbursed...

<< Previous

Next >>

Indiana Code Title 27. Insurance Article 13. Health Maintenance Organizations

Indiana Code
Title 27. Insurance
Article 13. Health Maintenance Organizations