Indiana § 5-10-8-26 - Coverage for wearable cardioverter defibrillators

§ 5-10-8-26. Coverage for wearable cardioverter defibrillators

Sec. 26. (a) As used in this section, "state employee health plan" means a:

(1) self-insurance program established under section 7(b) of this chapter; or

(2) contract with a prepaid health care delivery plan entered into under section 7(c) of this chapter;

to provide group health coverage for state employees.

(b) As used in this section, "wearable cardioverter defibrillator" means a device that:

(1) is worn externally on an individual's body;

(2) continually monitors and analyzes the individual's heart rhythm; and

(3) delivers a shock to the heart when an abnormal heart rhythm is detected.

(c) A state employee health plan must provide coverage for wearable cardioverter defibrillators, including the cost of the wearable cardioverter defibrillator, any necessary accessory, and ongoing monitoring services.

(d) The coverage required under subsection (c) must be in accordance with a:

(1) local coverage determination; or

(2) national coverage determination;

as defined in 42 U.S.C. 1395ff(f) for Medicare purposes.

(e) The coverage required under this section may not be subject to an annual or lifetime limitation.

As added by P.L.190-2023, SEC.1.

IC 5-10-8.1Chapter 8.1. State Employee Health Benefits; Provider Payment

5-10-8.1-1"Administrator" defined 5-10-8.1-2"Clean claim" defined 5-10-8.1-3"Covered individual" defined 5-10-8.1-4"Health benefit plan" defined 5-10-8.1-5"Provider" defined 5-10-8.1-6Notice of deficiencies in claims 5-10-8.1-7Payment or denial of claims; interest 5-10-8.1-8Permitted forms

IC 5-10-8.1-1"Administrator" defined Sec. 1. As used in this chapter, "administrator" means:

(1) the state personnel department;

(2) an entity with which the state contracts to administer health coverage under IC 5-10-8-7(b); or

(3) a prepaid health care delivery plan with which the state contracts under IC 5-10-8-7(c).

As added by P.L.162-2001, SEC.1.

IC 5-10-8.1-2"Clean claim" defined Sec. 2. As used in this chapter, "clean claim" means a claim submitted by a provider for payment under a health benefit plan that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment.

As added by P.L.162-2001, SEC.1.

IC 5-10-8.1-3"Covered individual" defined Sec. 3. As used in this chapter, "covered individual" means an individual who is:

(1) covered under a self-insurance program established under IC 5-10-8-7(b) to provide group health coverage; or

(2) entitled to services under a contract for health services entered into or renewed under IC 5-10-8-7(c).

As added by P.L.162-2001, SEC.1.

IC 5-10-8.1-4"Health benefit plan" defined Sec. 4. As used in this chapter, "health benefit plan" means a self-insurance program established to provide group health coverage as described in IC 5-10-8-7(b), or a contract for health services as described in IC 5-10-8-7(c).

As added by P.L.162-2001, SEC.1.

IC 5-10-8.1-5"Provider" defined Sec. 5. 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.1.

IC 5-10-8.1-6Notice of deficiencies in claims Sec. 6. (a) The administrator shall pay or deny each clean claim in accordance with section 7 of this chapter.

(b) An administrator 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 administrator 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.1. Amended by P.L.137-2002, SEC.1.

IC 5-10-8.1-7Payment or denial of claims; interest Sec. 7. (a) The administrator shall pay or deny each clean claim as follows:

(1) If the claim is filed electronically, not more than thirty (30) days after the date the claim is received by the administrator.

(2) If the claim is filed on paper, not more than forty-five (45) days after the date the claim is received by the administrator.

(b) If:

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

(2) the administrator subsequently pays the claim;

the administrator shall pay the provider that submitted the claim interest on the health benefit plan 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), the administrator shall use the same interest rate as provided in IC 12-15-21-3(7)(A).

As added by P.L.162-2001, SEC.1.

IC 5-10-8.1-8Permitted forms Sec. 8. A provider shall submit only the following forms for payment by an administrator:

(1) CMS-1500.

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

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

As added by P.L.162-2001, SEC.1. Amended by P.L.208-2018, SEC.1.

IC 5-10-8.5Chapter 8.5. Retirement Medical Benefits Account

5-10-8.5-0.1Application of certain amendments to chapter 5-10-8.5-1Application of chapter 5-10-8.5-2"Account" 5-10-8.5-3Repealed 5-10-8.5-4"Department" 5-10-8.5-5"Employer" 5-10-8.5-6"Fund" 5-10-8.5-6.5"INPRS" 5-10-8.5-7"Internal Revenue Code" 5-10-8.5-8"Participant" 5-10-8.5-9"Retired participant" 5-10-8.5-9.5Transfer of service credit; eligible employee 5-10-8.5-9.6Transfer of service credit; position other than eligible employee 5-10-8.5-9.7Termination of account; transfer of funds; election 5-10-8.5-10"Subaccount" 5-10-8.5-11Account established; administered by INPRS; specific appropriation required 5-10-8.5-12Authorization to request Internal Revenue Service rulings 5-10-8.5-13Management and pooling of account assets; confidentiality of account records 5-10-8.5-14Account; subaccounts; administrative costs 5-10-8.5-15Annual employer contributions; limits for certain participants 5-10-8.5-16Employer additional contribution; eligibility; computation 5-10-8.5-17Eligibility for benefits; benefit amount 5-10-8.5-18Account benefits; coverage 5-10-8.5-19Surviving spouse or dependent use of account; forfeiture 5-10-8.5-20INPRS annual submission of information necessary to review financial status of the account

IC 5-10-8.5-0.1Application of certain amendments to chapter Sec. 0.1. The amendments made to section 18 of this chapter by P.L.124-2008 apply to premiums paid after July 31, 2007, for individual or group health coverage for a retired participant and the spouse and dependents of a retired participant.

As added by P.L.220-2011, SEC.69.

IC 5-10-8.5-1Application of chapter Sec. 1. (a) Except as provided in subsection (b), each of the following is a participant in the retirement medical benefits account:

(1) An employee of the executive, legislative, or judicial branch of state government.

(2) A state elected or appointed officer.

(3) A member of the general assembly.

(4) An elected officer paid by the state.

(5) An officer paid by the state under IC 33-23-5-10, IC 33-38-5-7, or IC 33-39-6-2.

(b) The following individuals are not participants in the retirement medical benefits account:

(1) A conservation officer of the department of natural resources.

(2) An employee of the state excise police.

(3) An employee of the state police department, other than the following:

(A) An employee of the state police department who waived coverage under a common and unified plan of self-insurance under IC 5-10-8-6 before July 1, 2011.

(B) An employee of the state police department who makes an election under IC 5-10-8.5-9.5.

(C) An employee of the state police department who makes an election under IC 5-10-8.5-9.6.

(4) An individual who becomes employed in a position described in subsection (a) after March 14, 2026.

(5) An individual whose membership in the account is terminated under section 9.7(b) of this chapter.

As added by P.L.44-2007, SEC.1. Amended by P.L.229-2011, SEC.70; P.L.104-2026, SEC.6.

IC 5-10-8.5-2"Account" Sec. 2. As used in this chapter, "account" refers to the retirement medical benefits account established by section 11 of this chapter.

As added by P.L.44-2007, SEC.1.

IC 5-10-8.5-3RepealedAs added by P.L.44-2007, SEC.1. Repealed by P.L.108-2019, SEC.86.

IC 5-10-8.5-4"Department" Sec. 4. As used in this chapter, "department" refers to the state personnel department established under IC 4-15-2.2.

As added by P.L.44-2007, SEC.1. Amended by P.L.6-2012, SEC.27.

IC 5-10-8.5-5"Employer" Sec. 5. As used in this chapter, "employer" means the following:

(1) For an elected officer, appointed officer, or employee of the executive branch of state government who is a participant in the retirement medical benefits account, the state, including any board, commission, department, division, authority, institution, establishment, facility, or governmental unit under the supervision of the state, having a payroll in relation to persons it immediately employs.

(2) For a member of the general assembly or an employee of the legislative branch of state government:

(A) the president pro tempore of the senate, for a member or an employee of the senate;

(B) the speaker of the house, for a member or an employee of the house of representatives; or

(C) the personnel subcommittee of the legislative council, for an employee of the legislative services agency.

(3) For:

(A) a justice;

(B) a judge;

(C) a prosecuting attorney;

(D) an officer described under section 1(a)(5) of this chapter; or

(E) an employee of the judicial branch of state government, including an employee of any board, commission, department, division, authority, institution, establishment, facility, or governmental unit under the supervision of the judicial branch, having a payroll in relation to persons it immediately employs;

the Indiana supreme court.

As added by P.L.44-2007, SEC.1. Amended by P.L.229-2011, SEC.71.

IC 5-10-8.5-6"Fund" Sec. 6. As used in this chapter, "fund" refers to the public employees' retirement fund established under IC 5-10.3-2-1.

As added by P.L.44-2007, SEC.1.

IC 5-10-8.5-6.5"INPRS" Sec. 6.5. "INPRS" refers to the Indiana public retirement system established by IC 5-10.5-2-1.

As added by P.L.108-2019, SEC.87.

IC 5-10-8.5-7"Internal Revenue Code" Sec. 7. As used in this chapter, "Internal Revenue Code":

(1) means the Internal Revenue Code of 1954, as in effect September 1, 1974, if permitted with respect to governmental plans; or

(2) to the extent not inconsistent with subdivision (1), has the meaning set forth in IC 6-3-1-11.

As added by P.L.44-2007, SEC.1.

IC 5-10-8.5-8"Participant" Sec. 8. As used in this chapter, "participant" means an individual for whom a subaccount is established under section 14 of this chapter.

As added by P.L.44-2007, SEC.1.

IC 5-10-8.5-9"Retired participant" Sec. 9. (a) As used in this chapter, "retired participant" means the following:

(1) A participant who is eligible for a normal, unreduced or disability retirement benefit (as determined by the Indiana public employee retirement fund of which the participant is a member) on the participant's last day of service.

(2) A participant who has completed at least ten (10) years of service as an elected or appointed officer on the participant's last day of service as an elected or appointed officer. For purposes of determining whether a participant has completed at least ten (10) years of service on the participant's last day of service for purposes of this subdivision, any partial year of service completed by the participant in the year in which the participant is appointed to fill a vacant elected office shall be considered to be one (1) complete year of service.

(3) A participant in PERF MyChoice who is at least normal retirement age on the participant's last day of service.

(b) For a participant described in subsection (a)(2) who has service with more than one (1) employer, the participant's years of service is the sum of all of the participant's years of service.

As added by P.L.44-2007, SEC.1. Amended by P.L.205-2013, SEC.75; P.L.92-2021, SEC.5.

IC 5-10-8.5-9.5Transfer of service credit; eligible employee Sec. 9.5. (a) This section applies only to a person who:

(1) was an employee of the executive, legislative, or judicial branch of state government (other than an employee described in section 1(b)(1) through 1(b)(3) of this chapter);

(2) after June 30, 2007, and before July 1, 2011, left employment in the position described in subdivision (1) and was employed by the state police department in a position other than as an eligible employee (as defined in IC 10-12-1-3); and

(3) on July 1, 2011, is employed by the state police department in a position other than as an eligible employee (as defined in IC 10-12-1-3).

(b) A person who satisfies the conditions of subsection (a) may after June 30, 2011, and before September 1, 2011, make a one (1) time irrevocable election to become a participant in the retirement medical benefits account. A person who makes an election under this subsection to become a participant in the retirement medical benefits account may not also be a participant in the state police retiree medical benefit plan.

As added by P.L.229-2011, SEC.72.

IC 5-10-8.5-9.6Transfer of service credit; position other than eligible employee Sec. 9.6. (a) This section applies only to a person who:

(1) is an employee of the executive, legislative, or judicial branch of state government (other than an employee described in section 1(b)(1) through 1(b)(3) of this chapter); and

(2) after June 30, 2011, leaves employment in the position described in subdivision (1) and becomes employed by the state police department in a position other than as an eligible employee (as defined in IC 10-12-1-3).

(b) A person who satisfies the conditions of subsection (a) may, not more than sixty (60) days after leaving employment as described in subsection (a)(1) and becoming employed by the state police department in a position other than as an eligible employee (as defined in IC 10-12-1-3), make a one (1) time irrevocable election to remain a participant in the retirement medical benefits account. A person who makes an election under this subsection to remain a participant in the retirement medical benefits account may not also be a participant in the state police retiree medical benefit plan.

As added by P.L.229-2011, SEC.73.

IC 5-10-8.5-9.7Termination of account; transfer of funds; election Sec. 9.7. (a) This section does not apply to a:

(1) retired participant or the spouse and dependents of a retired participant; or

(2) participant who is eligible to receive an additional contribution under section 16 of this chapter.

(b) Subject to applicable federal tax law, except as provided in subsection (c), the following apply after December 31, 2026:

(1) Each participant's membership in the retirement medical benefits account is terminated.

(2) The amounts in each participant's subaccount are forfeited.

(3) The INPRS shall do the following for each participant:

(A) Terminate the participant's membership in the retirement medical benefits account.

(B) Transfer the amounts in the participant's subaccount to the state general fund to be used in the manner required under subdivision (4).

(4) The state comptroller shall transfer from the state general fund to each participant's defined contribution plan under IC 5-10-1.1-1.5(a) an amount equal to the balance in each participant's subaccount at the time the subaccount was forfeited under subdivision (2) in accordance with the amounts a member would have received under section 15 of this chapter based on each member's age and years of service.

(c) Subsection (b) does not apply to a participant who makes a one (1) time irrevocable election to become a participant in a successor retirement medical benefits account. An election under this subsection must be made to the INPRS:

(1) during the open enrollment period for state employees; and

(2) not later than December 1, 2026.

As added by P.L.104-2026, SEC.7.

IC 5-10-8.5-10"Subaccount" Sec. 10. As used in this chapter, "subaccount" means a participant's allocable share of the account.

As added by P.L.44-2007, SEC.1.

IC 5-10-8.5-11Account established; administered by INPRS; specific appropriation required Sec. 11. (a) The INPRS shall adopt provisions to establish a retirement medical benefits account as a health reimbursement arrangement or as a separate fund under another applicable section of the Internal Revenue Code for the purpose of funding by an employer on a pretax basis benefits for sickness, accident, hospitalization, and medical expenses for a participant and the spouse and dependents of a participant after the participant's retirement.

(b) The INPRS shall administer the account and may request the assistance of the department, the fund, and other state agencies. The account shall be maintained as a separate account to pay benefits for sickness, accident, hospitalization, and medical expenses for retired participants and their spouses and dependents.

(c) Notwithstanding any other provision of this chapter, the INPRS may not establish the account or implement the health reimbursement arrangement unless the general assembly makes a specific appropriation to implement the health reimbursement arrangement.

(d) The INPRS may adopt rules and regulations under IC 5-10.5-4-2 that it considers appropriate or necessary to administer the account.

As added by P.L.44-2007, SEC.1. Amended by P.L.108-2019, SEC.88.

IC 5-10-8.5-12Authorization to request Internal Revenue Service rulings Sec. 12. The INPRS may request from the Internal Revenue Service any rulings or determination letters that the INPRS considers necessary or appropriate in order to implement or administer the account.

As added by P.L.44-2007, SEC.1. Amended by P.L.108-2019, SEC.89.

IC 5-10-8.5-13Management and pooling of account assets; confidentiality of account records Sec. 13. (a) The INPRS may designate the board of trustees of the fund to manage the assets in the account in the same manner and with the same limitations that apply to the management of the assets in the fund.

(b) The assets in the account may be commingled or pooled with other public funds for investment purposes.

(c) The account and subaccount records of individual participants and participants' information are confidential, except for the name and contributions made on behalf of the participant.

As added by P.L.44-2007, SEC.1. Amended by P.L.108-2019, SEC.90.

IC 5-10-8.5-14Account; subaccounts; administrative costs Sec. 14. (a) The account may consist of the following:

(1) Contributions made by a participant's employer to the account under section 15 or 16 of this chapter.

(2) All earnings on investments or deposits of the account.

(3) All contributions or payments to the account made in a manner provided by the general assembly.

(b) The administrative costs of the account shall be paid from the earnings of the account before the earnings are credited to participants' subaccounts.

(c) The INPRS shall establish a subaccount for each participant. Each participant's subaccount may be credited with:

(1) the contributions made to the account on behalf of the participant under this chapter; and

(2) after the costs described in subsection (b) are paid, the earnings attributable to the balance of the subaccount offset by the administrative costs not covered by subsection (b).

As added by P.L.44-2007, SEC.1. Amended by P.L.108-2019, SEC.91.

IC 5-10-8.5-15Annual employer contributions; limits for certain participants Sec. 15. (a) Except as provided in subsections (c), (d), and (e), a participant's employer shall make contributions annually to the account on behalf of the participant sufficient to provide the benefit described in section 17 of this chapter. For a participant meeting the eligibility rules set forth in section 17 of this chapter, the amount credited to the participant's subaccount balance shall be the sum of annual contributions and earnings for each year of service. The amount of the contribution each fiscal year must equal or exceed the following, based on the participant's age on the last day of the calendar year that is in the fiscal year in which the contribution is made:

Participant's Age in Years

Annual Contribution

Amount

Less than 30

500

At least 30, but less than 40

800

At least 40, but less than 50

1,100

At least 50

1,400

(b) The INPRS shall determine by rule the date on which the contributions are credited to participants' subaccounts.

(c) A contribution under this section shall not be made after June 30, 2011, to any of the following participants:

(1) A conservation officer of the department of natural resources.

(2) An employee of the state excise police.

(3) An employee of the state police department, other than the following:

(A) An employee of the state police department who waived coverage under a common and unified plan of self-insurance under IC 5-10-8-6 before July 1, 2011.

(B) An employee of the state police department who makes an election under IC 5-10-8.5-9.5.

(C) An employee of the state police department who makes an election under IC 5-10-8.5-9.6.

(d) For individuals who are employed on June 30, 2011, the accrued annual contributions made in accordance with subsection (a) to an account described in section 14 of this chapter on behalf of the individuals for any years the individuals were employed as described in section 1(b)(1) through 1(b)(3) of this chapter shall be transferred to the respective plans described in IC 5-10-8-6(a) for those individuals and shall be used only to reduce the unfunded other post-employment benefit (OPEB) liability of those plans and not to increase benefits or reduce premiums.

(e) A contribution under this section shall not be made after June 30, 2017, to a participant who on June 30, 2017:

(1) is eligible for a normal, unreduced retirement benefit from the public employee retirement fund of which the participant is a member; and

(2) has completed:

(A) fifteen (15) years of service with the participant's employer; or

(B) ten (10) years of service as an elected or appointed officer.

(f) Each year, the INPRS shall:

(1) report the assets and liabilities of the retiree health benefit trust fund or the 2027 retiree health benefit trust fund; and

(2) based on the assets and liabilities of the retiree health benefit trust fund or the 2027 retiree health benefit trust fund, recommend an employer contribution amount to fund the participants' benefits described in section 17 of this chapter.

As added by P.L.44-2007, SEC.1. Amended by P.L.229-2011, SEC.74; P.L.213-2015, SEC.59; P.L.108-2019, SEC.92; P.L.92-2021, SEC.6; P.L.104-2026, SEC.8.

IC 5-10-8.5-16Employer additional contribution; eligibility; computation Sec. 16. (a) Except as provided in subsection (f), if a participant meets all of the following conditions the participant is entitled to receive an additional contribution credited to the participant's subaccount and computed as described in subsection (b):

(1) The participant is, on the earlier of the participant's last day of service with the participant's employer, or July 1, 2017:

(A) eligible for a normal, unreduced retirement benefit from the public employee retirement fund of which the participant is a member; or

(B) an elected or appointed officer.

(2) The participant has terminated service:

(A) from the employer; or

(B) as an elected or appointed officer.

(3) By the earlier of the participant's last day of service or July 1, 2017, the participant has completed:

(A) fifteen (15) years of service with the employer; or

(B) ten (10) years of service as an elected or appointed officer.

(4) This subdivision does not apply to an elected or appointed officer. By the participant's last day of service with the participant's employer, the participant has applied to receive a normal, unreduced retirement benefit from the public employee retirement fund of which the participant is a member.

(b) The amount of the contribution to a participant's subaccount under this section is the product of:

(1) the participant's years of service (rounded down to the nearest whole year):

(A) with the participant's employer, determined on the earlier of:

(i) the participant's last day of service with the participant's employer; or

(ii) July 1, 2017; or

(B) as an elected or appointed officer, determined on the earlier of:

(i) the participant's last day of service as an elected or appointed officer; or

(ii) July 1, 2017; multiplied by

(2) one thousand dollars ($1,000).

(c) For a participant who has service with more than one (1) employer, the participant's years of service used in the computation under subsection (b)(1) is the sum of all of the participant's years of service determined on the earlier of:

(1) the participant's last day of service; or

(2) July 1, 2017.

(d) The participant's employer must credit the additional contribution made under this section to the participant's subaccount not later than sixty (60) days after the participant's last day of service.

(e) A participant who meets the requirements to receive an additional contribution under this section may receive the additional contribution only once, regardless of the participant's employment after the payment of the additional contribution.

(f) An additional contribution under this section shall not be made after June 30, 2011, to any of the following participants:

(1) A conservation officer of the department of natural resources.

(2) An employee of the state excise police.

(3) An employee of the state police department, other than the following:

(A) An employee of the state police department who waived coverage under a common and unified plan of self-insurance under IC 5-10-8-6 before July 1, 2011.

(B) An employee of the state police department who makes an election under IC 5-10-8.5-9.5.

(C) An employee of the state police department who makes an election under IC 5-10-8.5-9.6.

As added by P.L.44-2007, SEC.1. Amended by P.L.3-2008, SEC.25; P.L.229-2011, SEC.75; P.L.213-2015, SEC.60.

IC 5-10-8.5-17Eligibility for benefits; benefit amount Sec. 17. (a) A retired participant is entitled to receive a benefit from the account. The benefit amount is the balance in the participant's subaccount as determined under this chapter.

(b) A participant who is not a retired participant is not entitled to receive a benefit from the account when the participant separates from service.

(c) Years of service that accrued to an individual during the individual's service as an employee described in section 1(b)(1) through 1(b)(3) of this chapter may not be included in determining the individual's eligibility for the retirement medical benefits account under this chapter, regardless of whether the individual is a retired participant described in section 9 of this chapter.

As added by P.L.44-2007, SEC.1. Amended by P.L.229-2011, SEC.76; P.L.108-2019, SEC.93.

IC 5-10-8.5-18Account benefits; coverage Sec. 18. The balance in a retired participant's subaccount may be used by the retired participant and the spouse and dependents of the retired participant to pay premiums for individual or group health coverage.

As added by P.L.44-2007, SEC.1. Amended by P.L.124-2008, SEC.1.

IC 5-10-8.5-19Surviving spouse or dependent use of account; forfeiture Sec. 19. (a) The surviving spouse or dependent of a retired participant may use amounts credited to the retired participant to pay health insurance and other health care related expenses to the same extent and in the same manner as the retired participant.

(b) If a retired participant dies without a surviving spouse or dependents, unused amounts credited to the retired participant are forfeited.

(c) Any forfeited amount may be used to reduce the contributions required under this chapter.

As added by P.L.44-2007, SEC.1.

IC 5-10-8.5-20INPRS annual submission of information necessary to review financial status of the account Sec. 20. The INPRS shall submit annually to the interim study committee on pension management oversight the information necessary for it to review the financial status of the account.

As added by P.L.44-2007, SEC.1. Amended by P.L.108-2019, SEC.94.

IC 5-10-9Chapter 9. Deposits on Behalf of Local Employees

5-10-9-1"Municipal corporation" defined 5-10-9-2Deposits 5-10-9-3Payments