reglab/housing_qa huggingface dataset:
IN Code § 27-13-1-32 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 1. Definitions|27-13-1-32. "Subscriber"

Sec. 32. "Subscriber" means:(1) an individual whose employment status or other status, except family dependency, is the basis for eligibility for enrollment in the health maintenance organization; or(2) in the case of an individual contract, the person in whose name the contract is issued.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-1-33 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 1. Definitions|27-13-1-33. "Subscriber Premiums"

Sec. 33. "Subscriber premiums" means money or any other thing of value paid or given in consideration to a health maintenance organization, agent, or solicitor on account of or in connection with a contract under which a health maintenance organization provides or arranges for the delivery of health care benefits to enrollees.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-1-34 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 1. Definitions|27-13-1-34. "Telehealth Services"

Sec. 34. "Telehealth services" means health care services delivered by use of technology allowed under IC 25-1-9.5-6, including the following:(1) Medical exams and consultations.(2) Behavioral health, including substance abuse evaluations and treatment.As added by P.L.185-2015, SEC.26. Amended by P.L.85-2021, SEC.31.
IN Code § 27-13-2-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 2. Establishment of Health Maintenance Organizations|27-13-2-1. Persons Applying for Certificate of Authority

Sec. 1. Notwithstanding any other law, any person may apply to the commissioner for a certificate of authority to establish and operate a health maintenance organization under this article.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-2-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 2. Establishment of Health Maintenance Organizations|27-13-2-2. Certificate of Authority Required

Sec. 2. (a) A person may not establish or operate a health maintenance organization without obtaining a certificate of authority under this article.(b) If a participating provider contracts with another provider under a contract that complies with IC 27-13-15 to provide health services on a prepaid basis to enrollees of a health maintenance organization that holds a certificate of authority, neither provider, with respect to the contract is:(1) considered to be engaged in the business of insurance; or(2) required to obtain a certificate of authority under this article.As added by P.L.26-1994, SEC.25. Amended by P.L.195-1996, SEC.3.
IN Code § 27-13-2-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 2. Establishment of Health Maintenance Organizations|27-13-2-3. Foreign Entities Obtaining Certificate of Authority

Sec. 3. (a) A foreign corporation, other than a foreign corporation defined under IC 27-1-2-3, may obtain a certificate of authority if the foreign corporation:(1) is authorized to do business in Indiana under IC 23-0.5-5; and(2) complies with this article.(b) A foreign corporation (as defined in IC 27-1-2-3) may obtain a certificate of authority if the foreign corporation complies with this article.(c) A foreign or alien health maintenance organization granted a certificate of authority under this section has the same but no greater rights and privileges than a domestic health maintenance organization.As added by P.L.26-1994, SEC.25. Amended by P.L.203-2001, SEC.15; P.L.118-2017, SEC.121.
IN Code § 27-13-2-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 2. Establishment of Health Maintenance Organizations|27-13-2-4. Certificate of Authority Application; Verification; Form

Sec. 4. An application for a certificate of authority to operate a health maintenance organization must be:(1) verified by an officer or authorized representative of the applicant; and(2) submitted on a form prescribed by the commissioner.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-2-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 2. Establishment of Health Maintenance Organizations|27-13-2-6. Certificate of Authority Application; Modifications or Amendments

Sec. 6. (a) An applicant shall submit to the commissioner any modifications or amendments to the items of information required in an application under section 5 of this chapter.(b) The commissioner may adopt rules under this section that provide that any modifications or amendments to the items of information in the application required of a health maintenance organization:(1) must be submitted to the commissioner before the modification or amendment takes effect:(A) for the approval of the commissioner; or(B) for the information of the commissioner only; or(2) must be indicated by the health maintenance organization to the commissioner at the time of the next succeeding site visit or examination of the organization by the department of insurance.(c) A health maintenance organization shall file any assumed corporate name with the department at least thirty (30) days before assuming the name.As added by P.L.26-1994, SEC.25. Amended by P.L.203-2001, SEC.16.
IN Code § 27-13-2-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 2. Establishment of Health Maintenance Organizations|27-13-2-7. Certificate of Authority Application; Approval of Modifications or Amendments

Sec. 7. Any modification or amendment requiring the approval of the commissioner under rules adopted under section 6 of this chapter is considered approved unless the commissioner disapproves the modification or amendment not more than thirty (30) days after the modification or amendment is submitted. However, the commissioner may postpone the action, if necessary for proper consideration, and if the commissioner gives written notice of the postponement to the applicant before the expiration of the thirty (30) day period.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-2-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 2. Establishment of Health Maintenance Organizations|27-13-2-8. Waiver of Rights Under Bankruptcy Laws

Sec. 8. The commissioner may not issue a certificate of authority to operate a health maintenance organization unless the applicant has submitted to the commissioner a written waiver of the health maintenance organization's rights under the federal bankruptcy laws.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-2-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 2. Establishment of Health Maintenance Organizations|27-13-2-9. Prohibited Names

Sec. 9. (a) A health maintenance organization established under this article may not:(1) use as a part of its corporate name the words "United States", "Federal", "government", "official", or any word that would imply that the company is an administrative agency of the state of Indiana or of the United States, or that it is subject to supervision of any department other than the department of insurance; or(2) take or assume a corporate name the same as, or confusingly similar to, an existing name of any other insurance company or other entity licensed or regulated under IC 27, unless at the same time:(A) the other company changes its corporate name or withdraws from transacting business in Indiana; and(B) the written consent of the other company, signed and verified under oath by its secretary, is filed with the department.(b) This section does not affect the right of any health maintenance organization that:(1) exists under the laws of Indiana as of July 1, 2001;(2) exists under the laws of Indiana as of July 1, 2001, and thereafter reorganizes or reincorporates under this article; or(3) is authorized to transact business in Indiana as of July 1, 2001;to continue the use of its corporate name.As added by P.L.203-2001, SEC.17.
IN Code § 27-13-2-10 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 2. Establishment of Health Maintenance Organizations|27-13-2-10. Application of Other Laws to Domestic Health Maintenance Organizations

Sec. 10. (a) A domestic health maintenance organization that is admitted to transact business in Indiana shall do the following:(1) If the health maintenance organization is a domestic health maintenance organization admitted to transact business in Indiana after June 30, 2011, comply with IC 27-1-6-21.(2) If the health maintenance organization changes the physical location of its home office, provide written notice to the department and all subscribers at least thirty (30) days before the location is changed, including the address and telephone number of the new location.(b) A domestic health maintenance organization operating under this article is subject to IC 27-1-7-11.As added by P.L.11-2011, SEC.37.
IN Code § 27-13-3-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 3. Issuance of Certificates of Authority|27-13-3-1. Satisfaction of Requirements

Sec. 1. After receiving a completed application, the commissioner shall issue a certificate of authority to operate a health maintenance organization to the applicant if:(1) the application fee is received by the commissioner; and(2) the commissioner is satisfied that the following requirements are met:(A) The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy, and have good reputations.(B) The health maintenance organization will effectively provide or arrange for the provision of the health care services covered in the health maintenance organization's individual and group contracts on a prepaid basis, through insurance or other means, except to the extent of reasonable requirements for copayments and deductibles.(C) The health maintenance organization complies with IC 27-13-12 through IC 27-13-19.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-3-1.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 3. Issuance of Certificates of Authority|27-13-3-1.5. Approval of Certificate of Authority

Sec. 1.5. (a) Except as provided in subsection (b), a completed application for a certificate of authority is considered approved one hundred twenty (120) days after the completed application is submitted to the commissioner.(b) If the commissioner issues an order under IC 27-13-24-3(b) within one hundred twenty (120) days after a completed application is submitted under subsection (a), the review and processing of the application are subject to IC 27-13-24-3 and IC 27-13-24-4.As added by P.L.195-1996, SEC.4.
IN Code § 27-13-3-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 3. Issuance of Certificates of Authority|27-13-3-2. Denial of Application

Sec. 2. An application for a certificate of authority may be denied only after the commissioner complies with the requirements set forth in IC 27-13-24.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-4-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 4. Powers of Health Maintenance Organizations|27-13-4-1. General Powers

Sec. 1. (a) Subject to section 3 of this chapter, the powers of a health maintenance organization include the following:(1) The purchase, lease, construction, renovation, operation, or maintenance of:(A) hospitals and medical facilities;(B) equipment for hospitals and medical facilities; and(C) other property reasonably required for the principal office of the health maintenance organization or for purposes necessary in the transaction of the business of the organization.(2) Engaging in transactions between affiliated entities, including loans and the transfer of responsibility under any or all contracts:(A) between affiliates; or(B) between the health maintenance organization and the parent organization of the health maintenance organization.(3) The furnishing of health care services through:(A) providers;(B) provider associations; and(C) agents for providers;who are under contract with or are employed by the health maintenance organization. The contracts with providers, provider associations, or agents of providers may include fee for service, cost plus, capitation, or other payment or risk-sharing arrangements.(4) Contracting with any person for the performance on behalf of the health maintenance organization of certain functions, including:(A) marketing;(B) enrollment; and(C) administration.(5) Contracting with:(A) an insurance company licensed in Indiana;(B) an authorized reinsurer; or(C) a hospital authorized to conduct business in Indiana;for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization.(6) The offering of point-of-service products.(7) The joint marketing of products with:(A) an insurance company that is licensed in Indiana; or(B) a hospital that is authorized to conduct business in Indiana;if the company that is offering each product is clearly identified.(8) Administration of the provision of health care services at the expense of a self-funded plan.(b) A health maintenance organization may offer any of the following:(1) Plans that include only basic health care services.(2) Plans that include basic health care services and other health care services.(3) Plans that include health care services other than basic health care services so long as at least one (1) of the plans offered by the health maintenance organization includes basic health care services.(c) Notwithstanding subsection (a)(5), a health maintenance organization may not take credit for reinsurance unless the risk is ceded to a reinsurer qualified under IC 27-6-10.1.As added by P.L.26-1994, SEC.25. Amended by P.L.2-1995, SEC.111; P.L.203-2001, SEC.18; P.L.130-2020, SEC.15.
IN Code § 27-13-4-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 4. Powers of Health Maintenance Organizations|27-13-4-2. Asset of Health Maintenance Organization as an Admitted Asset

Sec. 2. Nothing in this chapter qualifies an asset of a health maintenance organization as an admitted asset.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-4-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 4. Powers of Health Maintenance Organizations|27-13-4-3. Filing Notice With Commissioner Before Exercising Power; Disapproval of Exercise of Power; Exemptions From Filing Requirement

Sec. 3. (a) A domestic health maintenance organization must file notice with the commissioner, with supporting information that the commissioner deems adequate, before exercising any power granted in:(1) section 1(a)(1); or(2) section 1(a)(4);of this chapter if the proposed transaction is equal to or greater than ten percent (10%) of the health maintenance organization's admitted assets.(b) A domestic health maintenance organization must file notice with the commissioner, with the supporting information that the commissioner deems adequate, before exercising any power granted in section 1(a)(2), if the proposed transaction is equal to or greater than three percent (3%) of the health maintenance organization's admitted assets.(c) The commissioner may disapprove an exercise of power referred to in a notice received under subsection (a) or (b) only if, in the opinion of the commissioner, the exercise of the power would:(1) substantially and adversely affect the financial soundness of the health maintenance organization; and(2) endanger the ability of the health maintenance organization to meet its obligations.(d) If the commissioner does not disapprove an exercise of power referred to in a notice received under subsection (a) or (b) within thirty (30) days after the notice is filed with the commissioner, the exercise of power is considered approved.(e) The commissioner may adopt rules under IC 4-22-2 exempting from the filing requirement of this section certain activities that have a minimal effect on:(1) the financial soundness of the health maintenance organization; and(2) the ability of the health maintenance organization to meet its obligations.As added by P.L.26-1994, SEC.25. Amended by P.L.203-2001, SEC.19.
IN Code § 27-13-5-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 5. Fiduciary Responsibilities|27-13-5-1. Persons Having Fiduciary Responsibilities

Sec. 1. Any:(1) director;(2) officer;(3) employee; or(4) partner;of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the organization has a fiduciary responsibility to the organization for the funds.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-5-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 5. Fiduciary Responsibilities|27-13-5-2. Fidelity Bond or Fidelity Insurance

Sec. 2. A health maintenance organization shall maintain in force a fidelity bond or fidelity insurance on the directors, officers, employees, and partners referred to in section 1 of this chapter:(1) in an amount:(A) not less than two hundred and fifty thousand dollars ($250,000) for each health maintenance organization; or(B) not more than five million dollars ($5,000,000) in the aggregate on behalf of all health maintenance organizations owned by a common parent organization; or(2) in an amount prescribed by the commissioner.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-6-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 6. Quality Management Programs|27-13-6-1. Procedures; Establishment

Sec. 1. (a) A health maintenance organization shall establish procedures based on professionally recognized standards to assess and monitor the health care services provided to enrollees of the organization.(b) The procedures established under this section must include mechanisms to implement corrective action when necessary and to assess the availability, accessibility, and continuity of care.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-6-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 6. Quality Management Programs|27-13-6-2. Internal Quality Management Program Required

Sec. 2. A health maintenance organization shall have an ongoing internal quality management program to monitor and evaluate the health care services it provides, including:(1) primary and specialist physician services; and(2) ancillary and preventive health care services;across all institutional and noninstitutional settings.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-6-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 6. Quality Management Programs|27-13-6-3. Quality Management Program Requirements

Sec. 3. The quality management program required by section 2 of this chapter must include at least the following:(1) A written statement of the scope and purpose of the health maintenance organization's quality management program, including a written statement of goals and objectives that emphasizes improved health status in evaluating the quality of care rendered to enrollees.(2) The organizational structure responsible for quality management activities.(3) Any contractual arrangements, when appropriate, for delegation of quality management activities.(4) Confidentiality of policies and procedures.(5) A system of ongoing evaluation activities.(6) A system of focused evaluation activities.(7) A system for credentialing providers and performing peer review activities.(8) Duties and responsibilities of the designated physician responsible for the quality management activities.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-6-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 6. Quality Management Programs|27-13-6-4. Written Statement of Quality Management Activities

Sec. 4. The quality management program required by section 2 of this chapter must contain a written statement describing the system of ongoing quality management activities, including the following:(1) Problem assessment, identification, selection, and study.(2) Corrective action, monitoring, evaluation, and reassessment.(3) Interpretation and analysis of patterns of care rendered to individual patients by individual providers.(4) Comparison between patterns of care, including outcomes, rendered to patients by providers and the cost to the health maintenance organization of that care.(5) A written statement describing the system of focused quality assurance activities based on representative samples of the enrolled population that identifies method of topic selection, study, data collection, analysis, interpretation, and report format.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-6-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 6. Quality Management Programs|27-13-6-5. Written Plans for Correcting Insufficient Service

Sec. 5. The quality management program required by section 2 of this chapter must contain written plans for taking appropriate corrective action whenever the quality management program determines that:(1) inappropriate or substandard services have been provided; or(2) services that should have been provided were not provided.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-6-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 6. Quality Management Programs|27-13-6-6. Patient Record System

Sec. 6. A health maintenance organization shall ensure the use and maintenance of an adequate patient record system that will facilitate:(1) documentation and retrieval of clinical information to enable the health maintenance organization to evaluate continuity and coordination of patient care; and(2) the assessment of the quality of health and medical care provided to enrollees.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-6-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 6. Quality Management Programs|27-13-6-7. Reporting Quality Management Program Activities

Sec. 7. A health maintenance organization shall establish a mechanism for periodic reporting of quality management program activities to the governing body, providers, and appropriate staff of the organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-6-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 6. Quality Management Programs|27-13-6-8. Records of Proceedings; Confidentiality

Sec. 8. A health maintenance organization shall:(1) record the proceedings of formal quality management program activities; and(2) maintain its documentation of the quality management program in a confidential manner.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-6-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 6. Quality Management Programs|27-13-6-9. Inspection of Records by Commissioner

Sec. 9. The commissioner may inspect the records of a health maintenance organization's quality management program. The health maintenance organization shall cooperate with the inspections by making available to the commissioner the records requested by the commissioner, while protecting the confidentiality of enrollee medical records.As added by P.L.26-1994, SEC.25.