Indiana § 27-8-6-8 - Reimbursement for emergency medical services

§ 27-8-6-8. Reimbursement for emergency medical services

Sec. 8. (a) As used in this section, "emergency medical services" has the meaning set forth in IC 16-18-2-110.

(b) As used in this section, "emergency medical services provider organization" means a provider of emergency medical services that is certified by the Indiana emergency medical services commission as an advanced life support provider organization under rules adopted under IC 16-31-3.

(c) As used in this section, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1. However, for purposes of this section, 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) Automobile medical payment insurance.

(4) A specified disease policy.

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

(6) A short term insurance plan (as defined in IC 27-8-5.9-3).

(d) A policy of accident and sickness insurance that provides coverage for emergency medical services must provide reimbursement for emergency medical services that are:

(1) rendered by an emergency medical services provider organization;

(2) within the emergency medical services provider organization's scope of practice;

(3) performed or provided as advanced life support services; and

(4) performed or provided:

(A) during a response initiated through the 911 system; or

(B) as part of a mobile integrated healthcare program described in IC 16-31-12;

regardless of whether the patient is transported.

(e) Reimbursement for basic and advanced life support services through a policy to which this section applies must be provided on an equal basis regardless of whether the services involve transportation of the patient by ambulance.

(f) If multiple emergency medical services provider organizations qualify and submit a claim for reimbursement under this section for an encounter, the insurer:

(1) may reimburse under this section only for one (1) claim per patient encounter; and

(2) shall reimburse the claim submitted by the emergency medical services provider organization that performed or provided the majority of advanced life support services for the patient.

(g) The department may adopt rules under IC 4-22-2 to implement this section.

(h) This section does not require a policy of accident and sickness insurance to provide coverage for emergency medical services.

As added by P.L.115-2020, SEC.4. Amended by P.L.170-2022, SEC.37; P.L.93-2024, SEC.198; P.L.236-2025, SEC.11.

IC 27-8-7Chapter 7. RepealedRepealed by P.L.26-1994, SEC.28.

IC 27-8-8Chapter 8. Indiana Life and Health Insurance Guaranty Association Law

27-8-8-0.3Coverage obligations affected by statutory amendments; governing law 27-8-8-1Repealed 27-8-8-1.5Repealed 27-8-8-2Definitions 27-8-8-2.1Policy, contract, rider descriptions; plan sponsor; residency 27-8-8-2.3Coverage provided; exclusions; limitations 27-8-8-3Creation of association; membership; accounts; supervision 27-8-8-4Board of directors 27-8-8-5Impaired insurers; insolvent insurers; liens; association powers and duties 27-8-8-5.2Association election to succeed to rights and duties of impaired or insolvent insurer; reinsurance 27-8-8-5.4Association obligations to person entitled to coverage 27-8-8-5.5Venue; appeal bond 27-8-8-6Assessments 27-8-8-6.2Member protesting assessment 27-8-8-6.5Association requests for information 27-8-8-7Association plan of operation 27-8-8-8Powers and duties of commissioner; appeals to commissioner; notice of effect of chapter 27-8-8-9Detection and prevention of insurer insolvencies or impairments; actions of board of directors 27-8-8-10Records of board meetings; disclosure of records; association status as creditor; application of impaired or insolvent insurer's assets 27-8-8-11Distributions to affiliates; recovery 27-8-8-12Examination and regulation of association; financial report 27-8-8-13Association tax and fee exemption 27-8-8-14Liability for performance under chapter 27-8-8-15Insolvent insurer proceedings; stay; setting aside judgment 27-8-8-16Recoupment of assessments 27-8-8-16.2Premium surcharge or assignment in lieu of credit 27-8-8-17Refunds from association 27-8-8-18Advertising referring to association; association summary document