Indiana § 27-8-5-32 - Coverage for prescription drugs for advanced, metastatic cancer and associated conditions

§ 27-8-5-32. Coverage for prescription drugs for advanced, metastatic cancer and associated conditions

Sec. 32. (a) This section applies only to a:

(1) prescription drug that is:

(A) consistent with best practices for the treatment of advanced, metastatic cancer or an associated condition;

(B) supported by peer reviewed, evidence based literature; and

(C) approved by the federal Food and Drug Administration; and

(2) policy of accident and sickness insurance that is issued, amended, or renewed after June 30, 2026.

(b) As used in this section, "advanced, metastatic cancer" means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other areas or parts of the body.

(c) As used in this section, "associated conditions" means the symptoms or side effects directly attributable to advanced, metastatic cancer or its treatment, which based on the recommendation of a health care practitioner and in accordance with documented clinical evidence and generally accepted guidelines, would further jeopardize the health of the insured if left untreated.

(d) As used in this section, "insured" means an individual who is entitled to coverage under a policy of accident and sickness insurance.

(e) As used in this section, "policy of accident and sickness insurance" means a policy of accident and sickness insurance that provides coverage for prescription drugs.

(f) A policy of accident and sickness insurance that provides coverage for advanced, metastatic cancer and associated conditions may not require that, before the policy of accident and sickness insurance provides coverage for a prescription drug, the insured:

(1) fail to successfully respond to a different prescription drug; or

(2) prove a history of failure of a different prescription drug.

As added by P.L.52-2026, SEC.2.

IC 27-8-5.5Chapter 5.5. Accident and Sickness Insurance─Claim Forms

27-8-5.5-1Definitions 27-8-5.5-2Promulgation of forms; requisites; contents; acceptance of claims; explanation of benefits paid statements or claims summary statements 27-8-5.5-3Obtaining additional information regarding claims

IC 27-8-5.5-1Definitions Sec. 1. As used in this chapter:

(a) "Commissioner" means the insurance commissioner of Indiana.

(b) "Accident and sickness insurance" means any policy or contract of insurance described in classes 1(b), 2(a), 2(b), or 2(l), as defined in IC 27-1-5-1.

As added by Acts 1977, P.L.288, SEC.1.

IC 27-8-5.5-2Promulgation of forms; requisites; contents; acceptance of claims; explanation of benefits paid statements or claims summary statements Sec. 2. (a) The commissioner shall prescribe by rule, after consultation with providers of health care or treatment, accident and sickness insurers, hospital, medical, and dental service corporations and other prepayment organizations, such accident and sickness insurance claim forms as the commissioner determines will provide for uniformity and simplicity in insurance reporting. The forms shall include, but need not be limited to, information regarding the medical diagnosis, treatment and prognosis of the patient, together with the details of charges incident to the providing of care, treatment or services, sufficient for the purpose of meeting the proof requirements of an accident or sickness insurance policy or a hospital, medical, or dental service contract.

(b) An accident and sickness insurer may not refuse to accept a claim submitted on duly promulgated uniform claim forms. However, an insurer may accept claims submitted on any other form.

(c) Accident and sickness insurer explanation of benefits paid statements or claims summary statements sent to an insured by the accident and sickness insurer may be sent in electronic or paper form and shall be in a format and written in a manner that promotes understanding by the insured by setting forth:

(1) the total dollar amount submitted to the insurer for payment;

(2) any reduction in the amount paid due to the application of any co-payment or deductible, along with an explanation of the amount of the co-payment or deductible applied under the insured's policy;

(3) any reduction in the amount paid due to the application of any other policy limitation or exclusion as set forth in the insured's policy along with an explanation thereof;

(4) the total dollar amount paid; and

(5) the total dollar amount remaining unpaid.

In addition, the explanation shall clearly set forth a toll free number that the insured may call to obtain additional information about any of the items contained in the explanation of benefits paid or claims summary statement.

(d) The commissioner may issue an order under IC 27-1-3-19(a) directing an accident and sickness insurer to comply with subsection (c).

(e) An accident and sickness insurer does not violate subsection (c) by using a document that the accident and sickness insurer has been required to use by the federal government or the state.

(f) An accident and sickness insurer shall:

(1) inform an insured that the insured may request that the statements described in subsection (c) be sent in paper form; and

(2) send the statements in paper form upon the request of the insured.

As added by Acts 1977, P.L.288, SEC.1. Amended by P.L.252-1989, SEC.1; P.L.125-2005, SEC.4.

IC 27-8-5.5-3Obtaining additional information regarding claims Sec. 3. The adoption of uniform claim forms by the commissioner pursuant to this chapter does not preclude an insurer, hospital, medical, or dental service corporation or other pre-payment organization, from obtaining any necessary additional information regarding a claim from the claimant, provider of health care or treatment, or certifier of coverage, as may be required.

As added by Acts 1977, P.L.288, SEC.1.

IC 27-8-5.6Chapter 5.6. Accident and Sickness Insurance─Coverage for Newborns

27-8-5.6-0.1Application of certain amendments to chapter 27-8-5.6-1"Accident and sickness insurance" 27-8-5.6-2Policy provisions 27-8-5.6-3Payment of specific premium; notification of birth 27-8-5.6-4Application of chapter

IC 27-8-5.6-0.1Application of certain amendments to chapter Sec. 0.1. The amendments made to section 2 of this chapter by P.L.189-1997 apply only to a policy or contract of accident and sickness insurance that is issued or renewed after June 30, 1997.

As added by P.L.220-2011, SEC.436.

IC 27-8-5.6-1"Accident and sickness insurance" Sec. 1. (a) As used in this chapter, the term "accident and sickness insurance" means any policy or contract covering one (1) or more of the kinds of insurance described in classes 1(b) or 2(a) of IC 27-1-5-1, as governed by IC 27-8-5.

(b) The term does not include the following:

(1) Accident only, credit, dental, vision, Medicare supplement, long term care, or disability income insurance.

(2) Coverage issued as a supplement to liability insurance.

(3) Worker's compensation or similar insurance.

(4) Automobile medical payment insurance.

(5) A specified disease policy.

(6) A short term insurance plan that:

(A) may be renewed for the greater of:

(i) thirty-six (36) months; or

(ii) the maximum period permitted under federal law;

(B) has a term of not more than three hundred sixty-four (364) days; and

(C) has an annual limit of at least two million dollars ($2,000,000).

(7) A policy that provides indemnity benefits not based on any expense incurred requirement, including a plan that provides coverage for:

(A) hospital confinement, critical illness, or intensive care; or

(B) gaps for deductibles or copayments.

(8) A supplemental plan that always pays in addition to other coverage.

(9) A student health plan.

(10) An employer sponsored health benefit plan that is:

(A) provided to individuals who are eligible for Medicare; and

(B) not marketed as, or held out to be, a Medicare supplement policy.

Formerly: Acts 1975, P.L.282, SEC.1. As amended by P.L.173-2007, SEC.28; P.L.86-2018, SEC.207; P.L.288-2019, SEC.5.

IC 27-8-5.6-2Policy provisions Sec. 2. (a) Except as provided in subsection (b), all individual and group accident and sickness insurance policies or contracts which provide coverage on an expense incurred basis or a provision of service basis for:

(1) an individual insured, certificate holder, or subscriber; or

(2) a family member or child of the insured, certificate holder, or subscriber;

shall, as to such individual or family members' coverage, also provide that the insurance benefits applicable for the individual or family member shall be payable with respect to a newly born child of the insured, certificate holder, or subscriber from the moment of birth.

(b) Subsection (a) does not require the coverage of a newly born child of an insured or a subscriber under an individual accident and sickness policy or contract if the pregnancy resulting in the birth of the newly born child was a condition that existed prior to the issuance of the policy or contract. If the pregnancy resulting in the birth of a newly born child was a condition that existed prior to the issuance of the policy or contract, coverage for the newly born child under the policy or contract is subject to the underwriting practices followed by the insurer at the time of the birth of the child.

(c) The coverage for newly born children required by subsection (a) shall consist of coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. Coverage for newly born children required by subsection (a) shall include but not be limited to benefits for inpatient or outpatient expenses arising from medical and dental treatment (including orthodontic and oral surgery treatment) involved in the management of birth defects known as cleft lip and cleft palate.

Formerly: Acts 1975, P.L.282, SEC.1. As amended by P.L.259-1985, SEC.1; P.L.267-1987, SEC.6; P.L.257-1995, SEC.1; P.L.189-1997, SEC.1.

IC 27-8-5.6-3Payment of specific premium; notification of birth Sec. 3. If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child and payment of the required premium or fees must be furnished to the insurer or nonprofit service or indemnity corporation within thirty-one (31) days after the date of birth in order to have the coverage continue beyond the thirty-one (31) day period.

Formerly: Acts 1975, P.L.282, SEC.1.

IC 27-8-5.6-4Application of chapter Sec. 4. This chapter applies to accident and sickness insurance policies and contracts delivered or issued for delivery in Indiana after October 1, 1975.

As added by P.L.5-1988, SEC.148.

IC 27-8-5.7Chapter 5.7. Accident and Sickness Insurance; Provider Payment

27-8-5.7-0.5Applicability 27-8-5.7-1"Accident and sickness insurance policy" defined 27-8-5.7-2"Clean claim" defined 27-8-5.7-2.5"CPT code" 27-8-5.7-2.7"Health provider facility" 27-8-5.7-3"Insurer" defined 27-8-5.7-4"Provider" defined 27-8-5.7-5Notice of deficiencies in claims 27-8-5.7-6Payment or denial of claims; interest 27-8-5.7-6.5Prohibition on altering CPT code for claim; exceptions 27-8-5.7-6.7Prohibition on retroactive rate reduction; notice requirement 27-8-5.7-7Permitted forms 27-8-5.7-8Civil penalties 27-8-5.7-9Repealed 27-8-5.7-10Limitations on recouping, auditing, and correcting payment errors 27-8-5.7-11Claim overpayment adjustment 27-8-5.7-11.5Error in coordination of benefits; submission of claim to appropriate insurer 27-8-5.7-12Prohibition on denial of claim based on out of network provider referral

IC 27-8-5.7-0.5Applicability Sec. 0.5. Sections 6.7 and 11.5 of this chapter, as added in the 2026 session of the general assembly, and section 10 of this chapter, as amended in the 2026 session of the general assembly, apply to claims submitted under an accident and sickness insurance policy that:

(1) is issued, delivered, amended, or renewed after June 30, 2026; and

(2) provides coverage during a plan year beginning after December 31, 2026.

As added by P.L.88-2026, SEC.7.

IC 27-8-5.7-1"Accident and sickness insurance policy" defined Sec. 1. As used in this chapter, "accident and sickness insurance policy" has the meaning set forth in IC 27-8-5-1.

As added by P.L.162-2001, SEC.5.

IC 27-8-5.7-2"Clean claim" defined Sec. 2. As used in this chapter, "clean claim" means a claim submitted by a provider for payment under an accident and sickness insurance policy issued in Indiana that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment.

As added by P.L.162-2001, SEC.5.

IC 27-8-5.7-2.5"CPT code" Sec. 2.5. As used in this chapter, "CPT code" refers to the medical billing code that applies to a specific health care service, as published in the Current Procedural Terminology code set maintained by the American Medical Association.

As added by P.L.190-2023, SEC.26.

IC 27-8-5.7-2.7"Health provider facility" Sec. 2.7. As used in this chapter, "health provider facility" has the meaning set forth in IC 27-1-37-3.2.

As added by P.L.88-2026, SEC.8.

IC 27-8-5.7-3"Insurer" defined Sec. 3. As used in this chapter, "insurer" means an insurance company issued a certificate of authority in Indiana to issue accident and sickness insurance policies. The term includes:

(1) a preferred provider plan (as defined in IC 27-8-11-1); and

(2) an insurance administrator that:

(A) collects charges or premiums; and

(B) adjusts or settles claims;

in connection with coverage under an accident and sickness insurance policy.

As added by P.L.162-2001, SEC.5.

IC 27-8-5.7-4"Provider" defined Sec. 4. As used in this chapter, "provider" has the meaning set forth in IC 27-8-11-1.

As added by P.L.162-2001, SEC.5.

IC 27-8-5.7-5Notice of deficiencies in claims Sec. 5. (a) An insurer shall pay or deny each clean claim in accordance with sections 6 and 6.5 of this chapter.

(b) An insurer shall notify a provider of any deficiencies in a submitted claim not more than:

(1) thirty (30) days for a claim that is filed electronically; or

(2) forty-five (45) days for a claim that is filed on paper;

and describe any remedy necessary to establish a clean claim.

(c) Failure of an insurer to notify a provider as required under subsection (b) establishes the submitted claim as a clean claim.

As added by P.L.162-2001, SEC.5. Amended by P.L.137-2002, SEC.2; P.L.190-2023, SEC.27.

IC 27-8-5.7-6Payment or denial of claims; interest Sec. 6. (a) An insurer shall pay or deny each clean claim as follows:

(1) If the claim is filed electronically, within thirty (30) days after the date the claim is received by the insurer.

(2) If the claim is filed on paper, within forty-five (45) days after the date the claim is received by the insurer.

(b) If:

(1) an insurer fails to pay or deny a clean claim in the time required under subsection (a); and

(2) the insurer subsequently pays the claim;

the insurer shall pay the provider that submitted the claim interest on the accident and sickness insurance policy allowable amount of the claim paid under this section.

(c) Interest paid under subsection (b):

(1) accrues beginning:

(A) thirty-one (31) days after the date the claim is filed under subsection (a)(1); or

(B) forty-six (46) days after the date the claim is filed under subsection (a)(2); and

(2) stops accruing on the date the claim is paid.

(d) In paying interest under subsection (b), an insurer shall use the same interest rate as provided in IC 12-15-21-3(7)(A).

As added by P.L.162-2001, SEC.5.

IC 27-8-5.7-6.5Prohibition on altering CPT code for claim; exceptions Sec. 6.5. (a) An insurer may not alter the CPT code submitted for a clean claim or pay for a CPT code of lesser monetary value unless:

(1) the CPT code submitted is not in accordance with correct coding guidelines and rules, clinical care guidelines, or the terms and conditions of the participating provider's agreement or contract with the insurer; or

(2) the medical record of the clean claim has been reviewed by an employee or contractor of the insurer.

(b) An insurer may not alter a clean claim to only pay for the CPT codes necessary for an individual's final diagnosis, if the CPT codes billed were deemed medically necessary according to generally accepted clinical care guidelines to reach the final diagnosis.

(c) This section does not prohibit a provider from appealing a claim.

As added by P.L.190-2023, SEC.28.

IC 27-8-5.7-6.7Prohibition on retroactive rate reduction; notice requirement Sec. 6.7. (a) An insurer may not retroactively reduce the reimbursement rate for any CPT code.

(b) An insurer shall provide at least sixty (60) days written notice by:

(1) mail or electronic mail to a provider; and

(2) posting on the insurer's website;

before prospectively implementing a rate reduction for any CPT code.

As added by P.L.88-2026, SEC.9.

IC 27-8-5.7-7Permitted forms Sec. 7. A provider shall submit only the following forms for payment by an insurer:

(1) CMS-1500.

(2) CMS-1450 (UB-04).

(3) American Dental Association (ADA) claim form.

As added by P.L.162-2001, SEC.5. Amended by P.L.208-2018, SEC.10.

IC 27-8-5.7-8Civil penalties Sec. 8. (a) If the commissioner finds that an insurer has failed during any calendar year to process and pay clean claims in compliance with this chapter, the commissioner may assess an aggregate civil penalty against the insurer according to the following schedule:

(1) If the insurer has paid at least eighty-five percent (85%) but less than ninety-five percent (95%) of all clean claims received from all providers during the calendar year in compliance with this chapter, a civil penalty of up to ten thousand dollars ($10,000).

(2) If the insurer has paid at least sixty percent (60%) but less than eighty-five percent (85%) of all clean claims received from all providers during the calendar year in compliance with this chapter, a civil penalty of at least ten thousand dollars ($10,000) but not more than one hundred thousand dollars ($100,000).

(3) If the insurer has paid less than sixty percent (60%) of all clean claims received from all providers during the calendar year in compliance with this chapter, a civil penalty of at least one hundred thousand dollars ($100,000) but not more than two hundred thousand dollars ($200,000).

(b) In determining the amount of a civil penalty under this section, the commissioner shall consider whether the insurer's failure to achieve the standards established by this chapter is due to circumstances beyond the insurer's control.

(c) An insurer may contest a civil penalty imposed under this section by requesting an administrative hearing under IC 4-21.5 not more than thirty (30) days after the insurer receives notice of the assessment of the fine.

(d) If the commissioner imposes a civil penalty under this section, the commissioner may not impose a penalty against the insurer under IC 27-4-1 for the same activity.

(e) Civil penalties collected under this section shall be deposited in the state general fund.

As added by P.L.162-2001, SEC.5.

IC 27-8-5.7-9RepealedAs added by P.L.178-2003, SEC.61. Repealed by P.L.1-2007, SEC.248.

IC 27-8-5.7-10Limitations on recouping, auditing, and correcting payment errors Sec. 10. (a) An insurer may not, more than one hundred eighty (180) days after the date on which an overpayment on a provider claim was made to the provider by the insurer:

(1) request that the provider repay the overpayment; or

(2) adjust a subsequent claim filed by the provider as a method of obtaining reimbursement of the overpayment from the provider.

(b) An insurer may not recoup a paid claim more than one hundred eighty (180) days after the date on which the claim was initially paid.

(c) An insurer may not retroactively audit a paid claim more than three (3) years after the date on which the claim was initially paid.

(d) An insurer may not be required to correct a payment error to a provider if notice of the payment error is not provided within one hundred eighty (180) days after payment for a fully adjudicated claim is received.

(e) Subsections (a), (b), and (d) do not apply in cases of fraud by the provider, the insured, or the insurer with respect to the health benefits claim on which the overpayment or underpayment was made when a final determination of fraud has been made by a court.

(f) Notwithstanding subsections (a) through (d), an insurer and a hospital licensed under IC 16-21 may enter into a separate written agreement that provides for different time frames than those specified in this section.

As added by P.L.55-2006, SEC.1. Amended by P.L.88-2026, SEC.10.

IC 27-8-5.7-11Claim overpayment adjustment Sec. 11. Every subsequent claim that is adjusted by an insurer for reimbursement on an overpayment of a previous provider claim made to the provider must be accompanied by an explanation of the reason for the adjustment, including:

(1) an identification of:

(A) the claim on which the overpayment was made; and

(B) if ascertainable, the party financially responsible for the overpaid amount; and

(2) the amount of the overpayment that is being reimbursed to the insurer through the adjusted subsequent claim.

As added by P.L.55-2006, SEC.2.

IC 27-8-5.7-11.5Error in coordination of benefits; submission of claim to appropriate insurer Sec. 11.5. (a) If an insurer or a health maintenance organization (as defined in IC 27-13-36.2-2) recoups payment from a provider due to an error in coordination of benefits, the provider may submit a claim for the same services to the appropriate insurer.

(b) Except as provided in subsection (d) and notwithstanding any other provision of law, a provider may submit a claim to the appropriate insurer not later than ninety (90) days after the date the recoupment is made.

(c) A provider that submits a claim under this section shall provide documentation to the insurer demonstrating:

(1) the original submission of the claim to the initial insurer or health maintenance organization; and

(2) the recoupment of payment by the initial insurer or health maintenance organization due to an error in coordination of benefits.

(d) Nothing in this section prevents an insurer from allowing a provider more time to submit a claim.

As added by P.L.88-2026, SEC.11.

IC 27-8-5.7-12Prohibition on denial of claim based on out of network provider referral Sec. 12. (a) This section applies to a policy of accident and sickness insurance that is issued, delivered, amended, or renewed after June 30, 2025.

(b) An insurer may not deny a claim for reimbursement for a covered service or item provided to an insured on the sole basis that the referring provider is an out of network provider.

As added by P.L.144-2025, SEC.37 and P.L.215-2025, SEC.63.

IC 27-8-5.8Chapter 5.8. Insurance Benefit Cards

27-8-5.8-1"Accident and sickness insurance policy" 27-8-5.8-2"Commissioner" defined 27-8-5.8-3"Insured" defined 27-8-5.8-4Prescription drug information card 27-8-5.8-5"Health plan information card"; indication of health benefits; rules 27-8-5.8-6"Insurer"; electronic data base; required information; rules

IC 27-8-5.8-1"Accident and sickness insurance policy" Sec. 1. As used in this chapter, "accident and sickness insurance policy" means an insurance policy that provides at least one (1) of the types of insurance described in IC 27-1-5-1, Classes 1(b) and 2(a), and is issued on a group basis. The term does not include the following:

(1) Accident only, credit, dental, vision, Medicare, Medicare supplement, long term care, or disability income insurance.

(2) Coverage issued as a supplement to liability insurance.

(3) Automobile medical payment insurance.

(4) A specified disease policy.

(5) A limited benefit health insurance policy.

(6) A short term insurance plan that:

(A) may be renewed for the greater of:

(i) thirty-six (36) months; or

(ii) the maximum period permitted under federal law;

(B) has a term of not more than three hundred sixty-four (364) days; and

(C) has an annual limit of at least two million dollars ($2,000,000).

(7) A policy that provides a stipulated daily, weekly, or monthly payment to an insured during hospital confinement, without regard to the actual expense of the confinement.

(8) Worker's compensation or similar insurance.

(9) A student health insurance policy.

As added by P.L.230-2001, SEC.2. Amended by P.L.288-2019, SEC.6.

IC 27-8-5.8-2"Commissioner" defined Sec. 2. As used in this chapter, "commissioner" means the insurance commissioner appointed under IC 27-1-1-2.

As added by P.L.230-2001, SEC.2.

IC 27-8-5.8-3"Insured" defined Sec. 3. As used in this chapter, "insured" means an individual who is entitled to coverage under an accident and sickness insurance policy.

As added by P.L.230-2001, SEC.2.

IC 27-8-5.8-4Prescription drug information card Sec. 4. (a) This section applies to an insurer that:

(1) issues an accident and sickness insurance policy that provides coverage for prescription drugs or devices; and

(2) issues a card or other technology for claims processing.

This section also applies to a third party administrator for self-insured plans, a pharmacy benefit manager, or a health benefit plan administered by the state if the administrator, manager, or plan issues a card or other technology described in subdivision (2).

(b) The card or other technology issued by an insurer or another entity referred to in subsection (a) must contain uniform prescription drug information that complies with the requirements established under subsection (c).

(c) Prescription drug information cards or other technology must meet either of the following criteria:

(1) Be in a format and contain information fields approved by the National Council for Prescription Drug Programs (NCPDP) as contained in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide in effect on the October 1 most immediately preceding the issuance of the card.

(2) Contain the following information:

(A) The health benefit plan's name.

(B) The insured's name, group number, and identification number.

(C) A telephone number to inquire about pharmacy related issues.

(D) The issuer's international identification number or ANSI BIN number, labeled as RxBIN.

(E) The processor control number, labeled as RxPCN.

(F) The insured's pharmacy benefits group number if different than the medical group number, labeled as RxGRP.

Only those fields listed in clauses (A) through (F) that are required for proper adjudication of the claim must appear on the card. If the card is used to adjudicate non-pharmacy claims, then the designation "Rx" listed in clauses (D) through (F) is not required to be used by the issuer.

(d) An insurer or an insurer's agents, contractors, or administrators, including pharmacy benefits managers, may not be required to issue a prescription drug information card or other technology to a person more than one (1) time during a twelve (12) month period.

(e) The prescription drug information cards or other technology issued under this section may be used for health insurance coverage other than the coverage to which this chapter applies.

As added by P.L.230-2001, SEC.2. Amended by P.L.1-2002, SEC.111.

IC 27-8-5.8-5"Health plan information card"; indication of health benefits; rules Sec. 5. (a) As used in this section, "health plan information card" means a card that:

(1) an insurer of an accident and sickness insurance policy; or

(2) a third party administrator of a self-insured plan;

provides to an individual so that the individual may present the card to establish the eligibility of the individual or the individual's dependents to receive health benefits or services.

(b) Subject to subsection (c), a health plan information card must indicate that the health benefits and services are provided by:

(1) an insurer of an accident and sickness insurance policy; or

(2) a third party administrator of a self-insured plan.

(c) Subsection (b) applies only to a health plan information card issued:

(1) initially to a new insured; or

(2) to an insured at the time of the insured's policy renewal;

after June 30, 2020.

(d) The department of insurance shall adopt rules under IC 4-22-2 to ensure compliance with this section.

As added by P.L.111-2020, SEC.11.

IC 27-8-5.8-6"Insurer"; electronic data base; required information; rules Sec. 6. (a) As used in this section, "insurer" means:

(1) an issuer of an accident and sickness insurance policy; or

(2) a third party administrator of health benefits and services under an accident and sickness insurance policy.

(b) The electronic data base by which an insurer allows an insured or a provider to verify an insured's coverage or benefits under an accident and sickness insurance policy issued or administered by the insurer must include the following information for each insured:

(1) Whether health benefits and services under the accident and sickness insurance policy are provided by:

(A) the issuer of the accident and sickness insurance policy; or

(B) a third party administrator.

(2) Whether the accident and sickness insurance policy is subject to state or federal regulation.

(c) The department of insurance shall adopt rules under IC 4-22-2 to ensure compliance with this section.

As added by P.L.111-2020, SEC.12.

IC 27-8-5.9Chapter 5.9. Short Term Insurance Plan

27-8-5.9-1"Covered individual" 27-8-5.9-2"PPACA" 27-8-5.9-3"Short term insurance plan" 27-8-5.9-4Renewal requirements 27-8-5.9-5Coverage requirements 27-8-5.9-6Use of preferred provider plan 27-8-5.9-7Disclosures 27-8-5.9-8Similarly situated individuals 27-8-5.9-9Health promotion and disease prevention programs

IC 27-8-5.9-1"Covered individual" Sec. 1. As used in this chapter, "covered individual" means an individual entitled to coverage under a short term insurance plan.

As added by P.L.288-2019, SEC.7.

IC 27-8-5.9-2"PPACA" Sec. 2. As used in this chapter, "PPACA" has the meaning set forth in IC 27-19-2-14.

As added by P.L.288-2019, SEC.7.

IC 27-8-5.9-3"Short term insurance plan" Sec. 3. As used in this chapter, "short term insurance plan" means a policy of accident and sickness insurance (as defined in IC 27-8-5-1) that:

(1) may be renewed for the greater of:

(A) thirty-six (36) months; or

(B) the maximum period permitted under federal law;

(2) has a term of not more than three hundred sixty-four (364) days; and

(3) has an annual limit of at least two million dollars ($2,000,000).

As added by P.L.288-2019, SEC.7.

IC 27-8-5.9-4Renewal requirements Sec. 4. (a) An insurer may require an applicant for coverage under a short term insurance plan to specify, before issuance of the short term insurance plan, the number of renewals the applicant elects.

(b) After issuance of a short term insurance plan, the insurer may not require underwriting of the short term insurance plan until:

(1) all renewal periods elected under subsection (a) have ended; and

(2) the covered individual renews the short term insurance plan beyond the periods described in subdivision (1).

As added by P.L.288-2019, SEC.7.

IC 27-8-5.9-5Coverage requirements Sec. 5. A short term insurance plan must include coverage for the following:

(1) Ambulatory patient services.

(2) Hospitalization.

(3) Emergency services.

(4) Laboratory services.

As added by P.L.288-2019, SEC.7.

IC 27-8-5.9-6Use of preferred provider plan Sec. 6. (a) This section applies to an insurer that issues a short term insurance plan and undertakes a preferred provider plan under IC 27-8-11 to render health care services to covered individuals under the short term insurance plan.

(b) An insurer described in subsection (a) shall ensure that the preferred provider plan meets the following requirements:

(1) The preferred provider plan includes essential community providers in accordance with PPACA.

(2) The preferred provider plan is sufficient in number and types of providers (other than mental health and substance abuse treatment providers) to assure covered individuals' access to all health care services without unreasonable delay.

(3) The preferred provider plan is consistent with the network adequacy requirements that:

(A) apply to qualified health plan issuers under 45 CFR 156.230(a) and 45 CFR 156.230(b); and

(B) are consistent with subdivisions (1) and (2).

As added by P.L.288-2019, SEC.7.

IC 27-8-5.9-7Disclosures Sec. 7. (a) An insurer that issues a short term insurance plan shall disclose to an applicant, in bold, 10 point type, the following:

(1) That the short term insurance plan does not include coverage for the ten (10) essential health benefits required under PPACA.

(2) That the short term insurance plan does not provide the coverage that is required under PPACA.

(3) That enrollment in health coverage that provides the coverage that is required under PPACA may be done during the next PPACA open enrollment period.

(4) The dates of the next PPACA open enrollment period during which the applicant may enroll in coverage described in subdivision (3).

(b) An insurer shall obtain the signature of an applicant to whom the disclosures required by subsection (a) are made.

As added by P.L.288-2019, SEC.7.

IC 27-8-5.9-8Similarly situated individuals Sec. 8. An insurer shall not, as a condition of enrollment or continued enrollment in a short term insurance plan, require an individual to pay a premium or contribution greater than the premium or contribution for a similarly situated individual enrolled in the short term insurance plan on the basis of a health status related factor in relation to the individual or a dependent of the individual.

As added by P.L.288-2019, SEC.7.

IC 27-8-5.9-9Health promotion and disease prevention programs Sec. 9. This chapter does not prevent an insurer from establishing a premium discount, a rebate, or out-of-pocket payment modifications in return for adherence to programs of health promotion and disease prevention.

As added by P.L.288-2019, SEC.7.

IC 27-8-6Chapter 6. Reimbursement for Certain Medical Services

27-8-6-0.1Application of certain amendments to chapter 27-8-6-1Professional services for which reimbursement authorized 27-8-6-2Prior policies 27-8-6-3Application of amendments by Acts 1974, P.L.126 27-8-6-4Reimbursement for services; application of section; prohibitions excluded 27-8-6-5Indemnity for services provided by certified registered nurse anesthetist 27-8-6-6Coverage for athletic trainer services 27-8-6-7Coverage for substance abuse or chemical dependency treatment by addiction counselors, clinical addiction counselors, and marriage and family therapists 27-8-6-8Reimbursement for emergency medical services