Indiana § 27-1-48-8 - Information required to be posted on health plan's website

§ 27-1-48-8. Information required to be posted on health plan's website

Sec. 8. (a) Not later than February 1 of each calendar year, a health plan must post on the health plan's website:

(1) the thirty (30) most frequently submitted CPT codes that were submitted by participating providers for prior authorization during the previous calendar year; and

(2) the percentage of the thirty (30) most frequently submitted CPT codes that were approved in the previous calendar year, disaggregated by CPT code.

(b) A health plan must maintain the information required under subsection (a) on the health plan's website, organized by year and on a single and easily accessible web page.

As added by P.L.190-2023, SEC.24.

IC 27-1-48.5Chapter 48.5. Out-of-Pocket Expense Credit

27-1-48.5-1Applicability 27-1-48.5-2"Covered individual" 27-1-48.5-3"Health care provider" 27-1-48.5-4"Health care services" 27-1-48.5-5"Health plan" 27-1-48.5-6"Network" 27-1-48.5-7Credit; deductible and out-of-pocket expenses 27-1-48.5-8Procedure and documentation for claiming a credit 27-1-48.5-9Requirement to display information on health plan's website 27-1-48.5-10Adoption of rules

IC 27-1-48.5-1Applicability Sec. 1. This chapter applies to a health plan entered into or renewed after June 30, 2025.

As added by P.L.237-2025, SEC.9.

IC 27-1-48.5-2"Covered individual" Sec. 2. As used in this chapter, "covered individual" means an individual entitled to coverage under a health plan.

As added by P.L.237-2025, SEC.9.

IC 27-1-48.5-3"Health care provider" Sec. 3. As used in this chapter, "health care provider" means an individual or entity that is licensed, certified, registered, or regulated by an entity described in IC 25-0.5-11.

As added by P.L.237-2025, SEC.9.

IC 27-1-48.5-4"Health care services" Sec. 4. As used in this chapter, "health care services" means any services or products rendered by a health care provider within the scope of the provider's license or legal authorization.

As added by P.L.237-2025, SEC.9.

IC 27-1-48.5-5"Health plan" Sec. 5. (a) As used in this chapter, "health plan" means any of the following:

(1) A self-insurance program established under IC 5-10-8-7(b) to provide group coverage.

(2) A prepaid health care delivery plan through which health services are provided under IC 5-10-8-7(c).

(3) A policy of accident and sickness insurance as defined in IC 27-8-5-1, but not including any insurance, plan, or policy set forth in IC 27-8-5-2.5(a).

(4) An individual contract (as defined in IC 27-13-1-21) or a group contract (as defined in IC 27-13-1-16) with a health maintenance organization that provides coverage for basic health care services (as defined in IC 27-13-1-4).

(b) The term includes a person that administers any of the following:

(1) A self-insurance program established under IC 5-10-8-7(b) to provide group coverage.

(2) A prepaid health care delivery plan through which health services are provided under IC 5-10-8-7(c).

(3) A policy of accident and sickness insurance as defined in IC 27-8-5-1, but not including any insurance, plan, or policy set forth in IC 27-8-5-2.5(a).

(4) An individual contract (as defined in IC 27-13-1-21) or a group contract (as defined in IC 27-13-1-16) with a health maintenance organization that provides coverage for basic health care services (as defined in IC 27-13-1-4).

(c) The term includes hospital, medical, surgical, and pharmaceutical services or products.

As added by P.L.237-2025, SEC.9.

IC 27-1-48.5-6"Network" Sec. 6. As used in this chapter, "network" means a group of health care providers that:

(1) provide health care services to covered individuals; and

(2) have agreed to, or are otherwise subject to, maximum limits on the prices for the health care services to be provided to the covered individuals.

As added by P.L.237-2025, SEC.9.

IC 27-1-48.5-7Credit; deductible and out-of-pocket expenses Sec. 7. A health plan shall credit toward a covered individual's deductible and annual maximum out-of-pocket expenses any amount the covered individual pays directly to any health care provider for a medically necessary covered health care service if a claim for the health care service is not submitted to the health plan and the amount paid by the covered individual to the health care provider is less than the average discounted rate for the health care service paid to a health care provider in the health plan's network.

As added by P.L.237-2025, SEC.9.

IC 27-1-48.5-8Procedure and documentation for claiming a credit Sec. 8. (a) A health plan shall:

(1) establish a procedure by which a covered individual may claim a credit under section 7 of this chapter; and

(2) identify documentation necessary to support a claim for a credit under section 7 of this chapter.

(b) A health plan may either:

(1) publish average discounted rates that the health plan has negotiated to pay health care providers for health care services; or

(2) refer to average or typical rates on the all payer claims data base established under IC 27-1-44.5;

for purposes of a covered individual claiming a credit under section 7 of this chapter.

(c) A covered individual may use the data on average or typical rates reported on the all payer claims data base established under IC 27-1-44.5 to determine the average discounted rate for a health care service under section 7 of this chapter.

As added by P.L.237-2025, SEC.9.

IC 27-1-48.5-9Requirement to display information on health plan's website Sec. 9. A health plan shall display information about the procedure and documentation described in section 8 of this chapter on the health plan's website, including a link to the website for the all payer claims data base established under IC 27-1-44.5.

As added by P.L.237-2025, SEC.9.

IC 27-1-48.5-10Adoption of rules Sec. 10. The department shall adopt rules under IC 4-22-2 to effectuate the provisions of this chapter.

As added by P.L.237-2025, SEC.9.

IC 27-1-49Chapter 49. Individual Prescription Drug Rebates

27-1-49-0.5Application of chapter 27-1-49-1"Covered individual" 27-1-49-2"Defined cost sharing" 27-1-49-3"Health insurance coverage" 27-1-49-4"Insurer" 27-1-49-5"Price protection rebate" 27-1-49-6"Rebate" 27-1-49-7Defined cost sharing for prescription drugs 27-1-49-8Decrease of defined cost sharing 27-1-49-9Enforcement of chapter; violations 27-1-49-10Civil penalty 27-1-49-11Disclosure of information; trade secret; confidentiality requirements