reglab/housing_qa huggingface dataset:
IN Code § 27-13-6-10 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 6. Quality Management Programs|27-13-6-10. Hospital Accreditation

Sec. 10. (a) A health maintenance organization may not refuse to enter into an agreement with a hospital solely because the hospital has not obtained accreditation from an accreditation organization that:(1) establishes standards for the organization and operation of hospitals;(2) requires the hospital to undergo a survey process for a fee paid by the hospital; and(3) was organized and formed in 1951.(b) This section does not prohibit a health maintenance organization from using performance indicators or quality standards that:(1) are developed by private organizations; and(2) do not rely upon a survey process for a fee charged to the hospital to evaluate performance.As added by P.L.259-1995, SEC.3.
IN Code § 27-13-7-0.1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-0.1. Application of Certain Amendments to Chapter

Sec. 0.1. The following amendments to this chapter apply as follows:(1) The addition of sections 15.3 and 16 of this chapter by P.L.170-1999 applies to health maintenance organization contracts that are issued, delivered, or renewed after June 30, 1999.(2) The addition of section 18 of this chapter by P.L.166-2003 applies to a health maintenance organization contract that is entered into, delivered, amended, or renewed after December 31, 2003.(3) The amendments made to section 14 of this chapter by P.L.204-2003 apply to an individual contract or a group contract that is entered into, delivered, amended, or renewed after June 30, 2003.(4) The amendments made to section 14.8 of this chapter by P.L.226-2003 apply to a group or an individual contract with a health maintenance organization that is entered into, delivered, amended, or renewed after June 30, 2003.(5) The amendments made to section 14.5 of this chapter by P.L.196-2005 apply to a health maintenance organization contract that is entered into, delivered, amended, or renewed after June 30, 2005.(6) The amendments made to section 3 of this chapter by P.L.218-2007 apply to a health maintenance organization contract that is entered into, delivered, amended, or renewed after June 30, 2007.(7) The addition of section 19 of this chapter by P.L.109-2008 applies to an individual contract or a group contract that is entered into, delivered, amended, or renewed after June 30, 2008.As added by P.L.220-2011, SEC.457.
IN Code § 27-13-7-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-1. Persons Entitled to Copies of Contracts

Sec. 1. Any holder of a group or an individual contract with a health maintenance organization is entitled to a copy of the group or individual contract.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-7-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-2. Deceptive Contract Provisions Prohibited

Sec. 2. A contract or an evidence of coverage referred to in section 1 or section 5 of this chapter may not contain provisions or statements that are unjust, unfair, inequitable, misleading, or deceptive or that encourage misrepresentation prohibited by IC 27-1-15.6-12 or IC 27-4-1-4.As added by P.L.26-1994, SEC.25. Amended by P.L.132-2001, SEC.16.
IN Code § 27-13-7-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-3. Contract Provisions

Sec. 3. (a) A contract referred to in section 1 of this chapter must clearly state the following:(1) The name and address of the health maintenance organization.(2) Eligibility requirements.(3) Benefits and services within the service area.(4) Emergency care benefits and services.(5) Any out-of-area benefits and services.(6) Copayments, deductibles, and other out-of-pocket costs.(7) Limitations and exclusions.(8) Enrollee termination provisions.(9) Any enrollee reinstatement provisions.(10) Claims procedures.(11) Enrollee grievance procedures.(12) Continuation of coverage provisions.(13) Conversion provisions.(14) Extension of benefit provisions.(15) Coordination of benefit provisions.(16) Any subrogation provisions.(17) A description of the service area.(18) The entire contract provisions.(19) The term of the coverage provided by the contract.(20) Any right of cancellation of the group or individual contract holder.(21) Right of renewal provisions.(22) Provisions regarding reinstatement of a group or an individual contract holder.(23) Grace period provisions.(24) A provision on conformity with state law.(25) A provision or provisions that comply with the:(A) guaranteed renewability; and(B) group portability;requirements of the federal Health Insurance Portability and Accountability Act of 1996 (26 U.S.C. 9801(c)(1)).(26) That the contract provides, upon request of the subscriber, coverage for a child of the subscriber until the date the child becomes twenty-six (26) years of age.(b) For purposes of subsection (a), an evidence of coverage which is filed with a contract may be considered part of the contract.As added by P.L.26-1994, SEC.25. Amended by P.L.91-1998, SEC.22; P.L.218-2007, SEC.50; P.L.160-2011, SEC.27.
IN Code § 27-13-7-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-4. Compliance With Requirements; Ten Day Grace Period

Sec. 4. (a) An individual contract must comply with all provisions of section 3(a) of this chapter and provide for a period of ten (10) days during which the individual entering into the contract with the health maintenance organization may:(1) examine the contract; and(2) if the individual decides, return the contract to the health maintenance organization and obtain a refund of the premium paid.(b) If:(1) services were received during the ten (10) day period referred to in subsection (a); and(2) the individual returns the contract to receive a refund of the premium paid;the individual must pay for the services received during the ten (10) day period.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-7-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-5. Evidence of Coverage

Sec. 5. (a) A subscriber under a group contract must receive an evidence of coverage from:(1) the group contract holder; or(2) the health maintenance organization.(b) A group contract holder or health maintenance organization may provide the evidence of coverage required under subsection (a) in electronic or paper form. The group contract holder or health maintenance organization shall provide the evidence of coverage in paper form upon the request of the subscriber.(c) A health maintenance organization shall include in the health maintenance organization's enrollment materials information concerning the manner in which a subscriber may:(1) obtain an evidence of coverage; and(2) request the evidence of coverage in paper form.As added by P.L.26-1994, SEC.25. Amended by P.L.125-2005, SEC.6.
IN Code § 27-13-7-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-6. Evidence of Coverage; Prohibited Provisions

Sec. 6. The evidence of coverage required by section 5 of this chapter may not contain provisions or statements:(1) that are unfair, unjust, inequitable, misleading, or deceptive; or(2) that encourage misrepresentation prohibited by IC 27-1-15.6-12 or IC 27-4-1-4.As added by P.L.26-1994, SEC.25. Amended by P.L.132-2001, SEC.17.
IN Code § 27-13-7-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-7. Evidence of Coverage; Required Statement

Sec. 7. The evidence of coverage required by section 5 of this chapter must contain a clear statement of the matters set forth in section 3(a) of this chapter.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-7-7.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-7.5. Prohibition on Coverage of Abortion; Exceptions; Coverage Through Rider or Endorsement

Sec. 7.5. (a) A health maintenance organization that provides coverage for basic health care services and that is entered into, delivered, amended, or renewed after December 31, 2014, under a group contract or an individual contract may not provide coverage for abortion, except in the following cases:(1) The pregnant woman became pregnant through an act of rape or incest.(2) An abortion is necessary to avert the pregnant woman's death or a substantial and irreversible impairment of a major bodily function of the pregnant woman.(b) A health maintenance organization that enters into a group contract or an individual contract described in subsection (a) may offer coverage for abortion through a rider or an endorsement.As added by P.L.124-2014, SEC.2.
IN Code § 27-13-7-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-8. Readability Standards

Sec. 8. The commissioner may adopt rules under IC 4-22-2 establishing readability standards for individual contracts and evidence of coverage forms.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-7-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-9. Approval of Forms by Commissioner

Sec. 9. Subject to sections 10 and 11 of this chapter:(1) a group or an individual contract;(2) an evidence of coverage; or(3) an amendment to:(A) a group or an individual contract; or(B) an evidence of coverage;may not be delivered or issued for delivery in Indiana unless the form has been filed with and approved by the commissioner.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-7-10 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-10. Coverage Outside Indiana; Commissioner's Approval Not Required

Sec. 10. If:(1) an evidence of coverage that is issued under and incorporated into a contract issued in Indiana is intended for delivery in another state;(2) the evidence of coverage has been approved for use in the state in which it is to be delivered; and(3) the evidence of coverage is not delivered in Indiana;the evidence of coverage need not be submitted to the commissioner in Indiana for approval.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-7-11 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-11. Filing of Form With Commissioner; Review Period; Approval; Withdrawal of Approval; Hearing

Sec. 11. (a) A form required by this chapter must be filed with the commissioner at least thirty (30) days before the form is:(1) delivered; or(2) issued for delivery;in Indiana.(b) At any time during the thirty (30) day period referred to in subsection (a), the commissioner may extend the period for review for an additional thirty (30) days.(c) The commissioner must give notice in writing of an extension of a review period under subsection (b).(d) If the commissioner does not take action on a form submitted to the commissioner within the thirty (30) day period and any period of extension, the form is considered approved.(e) At any time after notice and for cause shown, the commissioner may withdraw approval of any form, effective thirty (30) days after notice of the withdrawal of the approval is issued.(f) When the commissioner:(1) disapproves a filing; or(2) withdraws approval of a form;under this section, the commissioner shall give the health maintenance organization written notice of the reasons for the disapproval or withdrawal of approval. The notice must inform the health maintenance organization that it may, not more than thirty (30) days after it receives the notice, request a hearing concerning the disapproval or withdrawal of approval. If the health maintenance organization requests a hearing not more than thirty (30) days after it receives the notice, the commissioner shall hold a hearing upon not less than ten (10) days notice to the health maintenance organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-7-12 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-12. Additional Information Required by Commissioner

Sec. 12. The commissioner may require the submission of any information the commissioner considers necessary to determine whether to approve or disapprove a filing under this chapter.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-7-13 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-13. Continuation of Coverage Statement

Sec. 13. (a) A health maintenance organization must include in each contract a written statement that if the contract is terminated by the health maintenance organization, an enrollee who is hospitalized for a medical or surgical condition on the date of termination will have continuation of coverage for inpatient covered services.(b) The continuation of coverage referred to in subsection (a) is not required after one (1) of the following occurs:(1) The discharge of the enrollee from the hospital.(2) Sixty (60) days pass after the contract is terminated by the health maintenance organization.(3) The hospitalized enrollee obtains from another carrier coverage that includes the coverage provided by the terminating health maintenance organization.(4) A contract holder terminates the contract with the health maintenance organization, as determined by:(A) the effective date specified in written communication sent by the contract holder to the health maintenance organization, which effective date shall be at least fifteen (15) days after the date the written communication is placed in the United States mail or sent by facsimile transmission; or(B) the failure to pay a premium within the grace period permitted under the contract.(5) Termination of an enrollee by a health maintenance organization due to:(A) the enrollee knowingly providing false information to the health maintenance organization;(B) the enrollee's failure to comply with the rules of the health maintenance organization stated in the contract; or(C) the enrollee's failure to pay a premium within the grace period permitted under contract.(c) In order to satisfy the requirements of subsection (a), a health maintenance organization may provide benefits that exceed the continuation of coverage required by this section, either in the types or time period of health care services covered, or both.(d) If an enrollee terminates the enrollee's coverage, the health maintenance organization is not required to provide continuation of coverage to that enrollee under this section after the termination.(e) This section does not apply to a termination of coverage as the result of the receivership of a health maintenance organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-7-14 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-14. Post-Mastectomy Coverage

Sec. 14. (a) As used in this section, "mastectomy" means the removal of all or part of the breast for reasons that are determined by a licensed physician to be medically necessary.(b) A contract with a health maintenance organization that provides coverage for a mastectomy must provide coverage as required under 29 U.S.C. 1185b, including coverage for:(1) prosthetic devices; and(2) reconstructive surgery incident to a mastectomy including:(A) all stages of reconstruction of the breast on which the mastectomy has been performed; and(B) surgery and reconstruction of the other breast to produce symmetry;in the manner determined by the attending physician and the patient to be appropriate.(c) In addition to the coverage required by 29 U.S.C. 1185b, a health maintenance organization contract that provides coverage for a mastectomy must provide coverage for:(1) custom fabricated breast prostheses; and(2) one (1) additional breast prosthesis per breast affected by the mastectomy.(d) Coverage required under this section is subject to:(1) the deductible and coinsurance provisions applicable to a mastectomy; and(2) all other terms and conditions applicable to other services under the contract.(e) A health maintenance organization shall provide to an enrollee, at the time that an individual contract or a group contract is entered into and annually thereafter, written notice of the coverage required under this section. Notice that is sent by the health maintenance organization that meets the requirements set forth in 29 U.S.C. 1185b constitutes compliance with this subsection.(f) The coverage required under this section applies to a contract with a health maintenance organization that provides coverage for a mastectomy, regardless of whether an individual who:(1) underwent a mastectomy; and(2) is covered under the contract;was covered under the contract at the time of the mastectomy.(g) Except as provided in subsection (c), this section does not require a health maintenance organization to provide coverage related to post mastectomy care that exceeds the coverage required for post mastectomy care under federal law.As added by P.L.150-1997, SEC.5. Amended by P.L.2-1998, SEC.71; P.L.96-2002, SEC.3; P.L.204-2003, SEC.2; P.L.67-2020, SEC.3.
IN Code § 27-13-7-14.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-14.5. Coverage for Nonexperimental, Surgical Treatment of Morbid Obesity

Sec. 14.5. (a) As used in this section, "health care provider" means a:(1) physician licensed under IC 25-22.5; or(2) hospital licensed under IC 16-21;that provides health care services for surgical treatment of morbid obesity.(b) As used in this section, "morbid obesity" means:(1) a body mass index of at least thirty-five (35) kilograms per meter squared with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; or(2) a body mass index of at least forty (40) kilograms per meter squared without comorbidity.For purposes of this subsection, body mass index equals weight in kilograms divided by height in meters squared.(c) Except as provided in subsection (d), a health maintenance organization that provides coverage for basic health care services under a group contract shall offer coverage for nonexperimental, surgical treatment by a health care provider of morbid obesity:(1) that has persisted for at least five (5) years; and(2) for which nonsurgical treatment that is supervised by a physician has been unsuccessful for at least six (6) consecutive months.(d) A health maintenance organization that provides coverage for basic health care services may not provide coverage for surgical treatment of morbid obesity for an enrollee who is less than twenty-one (21) years of age unless two (2) physicians licensed under IC 25-22.5 determine that the surgery is necessary to:(1) save the life of the enrollee; or(2) restore the enrollee's ability to maintain a major life activity (as defined in IC 4-23-29-6);and each physician documents in the enrollee's medical record the reason for the physician's determination.As added by P.L.78-2000, SEC.3. Amended by P.L.196-2005, SEC.6; P.L.102-2006, SEC.5.
IN Code § 27-13-7-14.7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-14.7. Coverage for Autism Spectrum Disorders

Sec. 14.7. (a) As used in this section, "autism spectrum disorder" means a neurological condition, including Asperger's syndrome and autism, as defined in the Diagnostic and Statistical Manual of Mental Disorders.(b) A group contract with a health maintenance organization that provides basic health care services must provide services for the treatment of an autism spectrum disorder of an enrollee. Services provided to an enrollee under this subsection are limited to services that are prescribed by the enrollee's treating physician in accordance with a treatment plan. A health maintenance organization may not deny or refuse to provide services to, or refuse to renew, refuse to reissue, or otherwise terminate or restrict coverage under a group contract to services to an individual solely because the individual is diagnosed with an autism spectrum disorder.(c) The services required under subsection (b) may not be subject to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable to an enrollee than the dollar limits, deductibles, copayments, or coinsurance provisions that apply to physical illness generally under the contract with the health maintenance organization.(d) A health maintenance organization that enters into an individual contract that provides basic health care services must offer to provide services for the treatment of an autism spectrum disorder of an enrollee. Services provided to an enrollee under this subsection are limited to services that are prescribed by the enrollee's treating physician in accordance with a treatment plan. A health maintenance organization may not deny or refuse to provide services to, or refuse to renew, refuse to reissue, or otherwise terminate or restrict coverage under an individual contract to services to an individual solely because the individual is diagnosed with an autism spectrum disorder.(e) The services that must be offered under subsection (d) may not be subject to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable to an enrollee than the dollar limits, deductibles, copayments, or coinsurance provisions that apply to physical illness generally under the contract with the health maintenance organization.As added by P.L.148-2001, SEC.3. Amended by P.L.188-2013, SEC.24; P.L.124-2018, SEC.88.