Sec. 0.5. Nothing in this chapter prohibits: (1) a self-funded health benefit plan that complies with the federal Employee Retirement Income Security Act (ERISA) of 1974 (29 U.S.C. 1001 et seq.); or (2) a: (A) self-insurance program established to provide group health coverage as described in IC 5-10-8-7(b); or (B) contract for health services, as […]
Sec. 1. As used in this chapter, “coverage” means the right of an individual to receive: (1) health care services; or (2) payment or reimbursement for health care services; from a health carrier. As added by P.L.93-2020, SEC.13.
Sec. 10. As used in this chapter, “provider” means: (1) a provider facility; or (2) a practitioner. As added by P.L.93-2020, SEC.13.
Note: This version of section effective 9-15-2022. See also preceding version of this section, effective until 9-15-2022. Sec. 11. As used in this chapter, “provider facility” means any of the following: (1) A hospital licensed under IC 16-21-2. (2) An ambulatory outpatient surgical center licensed under IC 16-21-2. (3) A birthing center licensed under IC […]
Note: This version of section effective until 9-15-2022. See also following version of this section, effective 9-15-2022. Sec. 11. As used in this chapter, “provider facility” means any of the following: (1) A hospital licensed under IC 16-21-2. (2) An ambulatory outpatient surgical center licensed under IC 16-21-2. (3) An abortion clinic licensed under IC […]
Sec. 12. (a) A covered individual may request from the health carrier a good faith estimate of: (1) the amount of the cost of the nonemergency health care service that the health carrier will: (A) pay for; or (B) reimburse to; the covered individual; or (2) the applicable benefit limitations of the ordered nonemergency health […]
Sec. 13. A health carrier may provide a good faith estimate to an individual under this chapter: (1) in a writing delivered to the individual; (2) by electronic mail; or (3) through a mobile application or other Internet web based method, if available; according to the preference expressed by the individual. As added by P.L.93-2020, […]
Sec. 14. (a) A good faith estimate provided by a health carrier to an individual under this chapter must: (1) in the case of an insurer or another health carrier that pays or reimburses the cost of health care services: (A) provide a summary of the services and material items that the good faith estimate […]
Sec. 15. A health carrier that provides an Internet web site for the use of its covered individuals shall ensure that the Internet web site includes a printed notice that: (1) is designed, lettered, and featured on the Internet web site so as to be conspicuous to and readable by any individual with normal vision […]
Sec. 16. (a) If a health carrier fails or refuses: (1) to provide a good faith estimate as required by this chapter; or (2) to provide notice on the health carrier’s Internet web site as required by section 15 of this chapter; the insurance commissioner may, after notice and hearing under IC 4-21.5, impose on […]
Sec. 2. As used in this chapter, “covered individual” means an individual who is entitled to coverage from a health carrier. As added by P.L.93-2020, SEC.13.
Sec. 2.5. As used in this chapter, “episode of care” means the medical care ordered to be provided for a specific medical procedure, condition, or illness. As added by P.L.93-2020, SEC.13.
Sec. 3. As used in this chapter, “good faith estimate” means a health carrier’s reasonable estimate of: (1) the amount of the cost of a nonemergency health care service that the health carrier will: (A) pay for; or (B) reimburse to; a covered individual; or (2) the applicable benefit limitations of the nonemergency health care […]
Sec. 4. (a) As used in this chapter, “health carrier” means an entity: (1) that is subject to this title and the administrative rules adopted under this title; and (2) that enters into a contract to: (A) provide health care services; (B) deliver health care services; (C) arrange for health care services; or (D) pay […]
Sec. 5. As used in this chapter, “in network”, when used in reference to a practitioner, means that the health care services provided by the practitioner are subject to a health carrier’s network plan. As added by P.L.93-2020, SEC.13.
Sec. 6. (a) As used in this chapter, “network” means a group of provider facilities and practitioners 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. (b) The […]
Sec. 7. As used in this chapter, “network plan” means a plan of a health carrier that: (1) requires a covered individual to receive; or (2) creates incentives, including financial incentives, for a covered individual to receive; health care services from one (1) or more providers that are under contract with, managed by, or owned […]
Sec. 8. As used in this chapter, “nonemergency health care service” means a discrete service or series of services ordered by a practitioner for an episode of care for the: (1) diagnosis; (2) prevention; (3) treatment; (4) cure; or (5) relief; of a physical, mental, or behavioral health condition, illness, injury, or disease that is […]
Sec. 9. (a) As used in this chapter, “practitioner” means: (1) an individual who holds: (A) an unlimited license, certificate, or registration; (B) a limited or probationary license, certificate, or registration; (C) a temporary license, certificate, registration, or permit; (D) an intern permit; or (E) a provisional license; issued by the board (as defined in […]
Sec. 9.5. As used in this chapter, “price” means the negotiated rate between the: (1) provider facility and practitioner; and (2) covered individual’s primary health carrier; minus the amount that the health carrier will pay. As added by P.L.93-2020, SEC.13.
