Sec. 1. (a) As used in this chapter, “accident and sickness insurance policy” means an insurance policy that provides one (1) or more of the kinds of insurance described in Class 1(b) and 2(a) of IC 27-1-5-1. (b) The term does not include the following: (1) Accident only, credit, dental, vision, Medicare supplement, long term […]
Sec. 10. An insurer shall establish and maintain a grievance procedure that complies with the requirements of this chapter for the resolution of grievances initiated by a covered individual. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
Sec. 11. The commissioner may examine the grievance procedure of any insurer. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
Sec. 12. An insurer shall maintain all grievance records received by the insurer after the most recent examination of the insurer’s grievance procedure by the commissioner. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
Sec. 13. (a) An insurer shall provide, at the request of the insured, covered individual, or legal representative of the insured or covered individual, and upon policy issuance, at each policy renewal, and with any notice of denial of a claim, timely, adequate, and appropriate notice to each insured, covered individual, or legal representative, of: […]
Sec. 14. (a) A covered individual may file a grievance orally or in writing. (b) An insurer shall make available to covered individuals a toll free telephone number through which a grievance may be filed. The toll free telephone number must: (1) be staffed by a qualified representative of the insurer; (2) be available for […]
Sec. 15. (a) An insurer shall establish procedures to assist covered individuals in filing grievances. (b) A covered individual may designate a representative to file a grievance for the covered individual and to represent the covered individual in a grievance under this chapter. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
Sec. 16. (a) An insurer shall establish written policies and procedures for the timely resolution of grievances filed under this chapter. The policies and procedures must include the following: (1) An acknowledgment of the grievance, given orally or in writing, to the covered individual within five (5) business days after receipt of the grievance. (2) […]
Sec. 17. (a) An insurer shall establish written policies and procedures for the timely resolution of appeals of grievance decisions. The procedures for registering and responding to oral and written appeals of grievance decisions must include the following: (1) Written or oral acknowledgment of the appeal not more than five (5) business days after the […]
Sec. 19. (a) An insurer shall each year file with the commissioner a description of the grievance procedure of the insurer established under this chapter, including: (1) the total number of grievances handled through the procedure during the preceding calendar year; (2) a compilation of the causes underlying those grievances; and (3) a summary of […]
Sec. 2. As used in this chapter, “commissioner” refers to the insurance commissioner appointed under IC 27-1-1-2. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.1-2002, SEC.113.
Sec. 20. The department may adopt rules under IC 4-22-2 to implement this chapter. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
Sec. 3. As used in this chapter, “covered individual” means an individual who is covered under an accident and sickness insurance policy. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
Sec. 4. As used in this chapter, “department” refers to the department of insurance. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
Sec. 5. As used in this chapter, “external grievance” means the independent review under IC 27-8-29 of a grievance filed under this chapter. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
Sec. 6. As used in this chapter, “grievance” means any dissatisfaction expressed by or on behalf of a covered individual regarding: (1) a determination that a service or proposed service is not appropriate or medically necessary; (2) a determination that a service or proposed service is experimental or investigational; (3) the availability of participating providers; […]
Sec. 7. As used in this chapter, “grievance procedure” means a written procedure established and maintained by an insurer for filing, investigating, and resolving grievances and appeals. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
Sec. 8. As used in this chapter, “insured” means: (1) an individual whose employment status or other status except family dependency is the basis for coverage under a group accident and sickness insurance policy; or (2) in the case of an individual accident and sickness insurance policy, the individual in whose name the policy is […]
Sec. 9. As used in this chapter, “insurer” means any person who delivers or issues for delivery an accident and sickness insurance policy or certificate in Indiana. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
