27-8-28-20. Adoption of Rules
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.
27-8-28-19. Grievance Procedure Filing; Complaint Analysis and Reporting
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 […]
27-8-28-5. “External Grievance”
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.
27-8-28-6. “Grievance”
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; […]
27-8-28-7. “Grievance Procedure”
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.
27-8-28-8. “Insured”
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 […]
27-8-28-9. “Insurer”
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.
27-8-28-10. Grievance Procedure to Comply With Chapter Requirements
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.
27-8-28-11. Commissioner May Examine Procedure
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.
27-8-28-12. Grievance Records
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.