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 […]
27-8-28-16. Policies and Procedures for Timely Resolution of Grievances
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) […]
27-8-28-1. “Accident and Sickness Insurance Policy”
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 […]
27-8-28-17. Policies and Procedures for Timely Resolution of Appeals of Grievance Decisions; Filing of Report for Violation
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 […]
27-8-28-2. “Commissioner”
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.
27-8-28-3. “Covered Individual”
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.
27-8-28-4. “Department”
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.
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; […]