reglab/housing_qa huggingface dataset:
IN Code § 5-10-8-7.7 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-7.7. Surgical Treatment for Morbid Obesity

Sec. 7.7. (a) As used in this section, "covered individual" means an individual who is covered under a health care plan.(b) As used in this section, "health care plan" means:(1) a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or(2) a contract entered into under section 7(c) of this chapter to provide health services through a prepaid health care delivery plan.(c) 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.(d) 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 is equal to weight in kilograms divided by height in meters squared.(e) Except as provided in subsection (f), the state shall provide 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.(f) The state may not provide coverage for surgical treatment of morbid obesity for a covered individual 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 covered individual; or(2) restore the covered individual's ability to maintain a major life activity (as defined in IC 4-23-29-6);and each physician documents in the covered individual's medical record the reason for the physician's determination.As added by P.L.78-2000, SEC.1. Amended by P.L.196-2005, SEC.1; P.L.102-2006, SEC.1.
IN Code § 5-10-8-7.8 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-7.8. Colorectal Cancer Testing Coverage; Exception for High Deductible Health Plans

Sec. 7.8. (a) As used in this section, "covered individual" means an individual who is:(1) covered under a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or(2) entitled to services under a contract with a health maintenance organization (as defined in IC 27-13-1-19) that is entered into or renewed under section 7(c) of this chapter.(b) A:(1) self-insurance program established under section 7(b) of this chapter to provide health care coverage; or(2) contract with a health maintenance organization that is entered into or renewed under section 7(c) of this chapter;must provide coverage for colorectal cancer examinations and laboratory tests for cancer for any nonsymptomatic covered individual.(c) For a covered individual who is:(1) at least forty-five (45) years of age; or(2) less than forty-five (45) years of age and at high risk for colorectal cancer;the coverage required under this section must meet the requirements set forth in subsection (d), except as provided in subsection (e).(d) A covered individual may not be required to pay an additional deductible or coinsurance for the colorectal cancer examination and laboratory testing benefit required by this section that is greater than an annual deductible or coinsurance established for similar benefits under the self-insurance program or contract with a health maintenance organization under which the covered individual is covered or entitled to services. If the program or contract does not cover a similar benefit, a deductible or coinsurance for the colorectal cancer examination and laboratory testing benefit may not be set at a level that materially diminishes the value of the colorectal cancer examination and laboratory testing benefit.(e) The requirements imposed under this section do not apply to a high deductible health plan, as defined by Section 223 of the Internal Revenue Code. High deductible health plans described in this subsection may not excuse a deductible requirement with respect to colorectal cancer screening in a manner inconsistent with Section 223(c)(2)(C) of the Internal Revenue Code.As added by P.L.54-2000, SEC.1. Amended by P.L.36-2020, SEC.1.
IN Code § 5-10-8-8.3 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-8.3. Former State and Legislative Employees; Health Benefit Plans

Sec. 8.3. (a) As used in this section, "department" refers to the state personnel department.(b) The department shall establish, or contract for the establishment of, at least two (2) retiree health benefit plans to be available for former employees of:(1) the state; and(2) the legislative branch of government;whose employer elects under section 8(j) of this chapter to permit its former employees to continue to participate in a health insurance program under this chapter after the employees have become eligible for Medicare coverage. At least one (1) of the plans offered to former employees must include coverage for prescription drugs comparable to a Medicare plan that provides prescription drug benefits. This subsection expires July 1, 2014.(c) The department shall not, after June 30, 2014, amend or renew a retiree health benefit plan described in subsection (b) that is in effect on June 30, 2014.(d) A retiree health benefit plan described in subsection (b) that is in effect on June 30, 2014, terminates on the first plan renewal date occurring after June 30, 2014.As added by P.L.13-2001, SEC.11. Amended by P.L.91-2014, SEC.14.
IN Code § 5-10-8-8.4 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-8.4. Revocation or Alteration by Employer

Sec. 8.4. Except as provided by an enactment of the general assembly, an election by an employer under:(1) section 8(f) of this chapter concerning the payment of a retired employee's premium; or(2) section 8(j) of this chapter concerning Medicare coverage and program eligibility;may not be revoked or altered at any time by the employer or a subsequent employer to the detriment of a person entitled to benefits under section 8.2 of this chapter.As added by P.L.184-2001, SEC.6.
IN Code § 5-10-8-8.5 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-8.5. Establishment of Retiree Health Benefit Trust Fund

Sec. 8.5. (a) The retiree health benefit trust fund is established to provide funding for a retiree health benefit plan developed under IC 5-10-8.5.(b) The trust fund shall be administered by the INPRS. The expenses of administering the trust fund shall be paid from money in the trust fund. The trust fund consists of cigarette tax revenues deposited in the fund under IC 6-7-1-28.1(7) and other appropriations, revenues, or transfers to the trust fund under IC 4-12-1.(c) The INPRS shall invest the money in the trust fund not currently needed to meet the obligations of the trust fund in the same manner and with the same limitations described in IC 5-10.5-4-1 and IC 5-10.5-5-1.(d) The trust fund is considered a trust fund for purposes of IC 4-9.1-1-7. Money may not be transferred, assigned, or otherwise removed from the trust fund by the state board of finance, the budget agency, or any other state agency.(e) The trust fund shall be established and administered in a manner that complies with Internal Revenue Code requirements concerning health reimbursement arrangement (HRA) trusts. Contributions by the state to the trust fund are irrevocable. All assets held in the trust fund must be held for the exclusive benefit of participants of the retiree health benefit plan developed under IC 5-10-8.5 and their beneficiaries. All assets in the trust fund:(1) are dedicated exclusively to providing benefits to participants of the plan and their beneficiaries according to the terms of the plan; and(2) are exempt from levy, sale, garnishment, attachment, or other legal process.(f) Money in the trust fund does not revert to the state general fund at the end of any state fiscal year.(g) The money in the trust fund is appropriated to the INPRS for providing the retiree health benefit plan developed under IC 5-10-8.5.(h) The budget agency may transfer appropriations from federal or dedicated funds to the retiree health benefit trust fund.As added by P.L.182-2009(ss), SEC.68. Amended by P.L.108-2019, SEC.85; P.L.92-2021, SEC.4.
IN Code § 5-10-8-9 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-9. Coverage of Services for Mental Illness

Sec. 9. (a) This section does not apply if the application of this section would increase the premiums of the health services policy or plan, as certified under IC 27-8-5-15.7, by more than four percent (4%) as a result of complying with subsection (c).(b) As used in this section, "coverage of services for mental illness" includes benefits with respect to mental health services as defined by the contract, policy, or plan for health services. The term includes services for the treatment of substance abuse and chemical dependency when the services are required in the treatment of a mental illness.(c) If the state enters into a contract for health services through prepaid health care delivery plans, medical self-insurance, or group health insurance for state employees, the contract may not permit treatment limitations or financial requirements on the coverage of services for mental illness if similar limitations or requirements are not imposed on the coverage of services for other medical or surgical conditions.(d) This section applies to a contract for health services through prepaid health care delivery plans, medical self-insurance, or group medical coverage for state employees that is issued, entered into, or renewed after June 30, 1997.(e) This section does not require the contract for health services to offer mental health benefits.As added by P.L.42-1997, SEC.1. Amended by P.L.81-1999, SEC.1; P.L.291-2001, SEC.230.
IN Code § 5-10-8-10 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-10. Examining Infants for Hiv; Payment

Sec. 10. (a) The state shall cover the testing required under IC 16-41-6-4 and the examinations required under IC 16-41-17-2 under a:(1) self-insurance program established or maintained under section 7(b) of this chapter to provide group health coverage; and(2) contract entered into or renewed under section 7(c) of this chapter to provide health services through a prepaid health care delivery plan.(b) Payment to a hospital for a test required under IC 16-41-6-4 must be in an amount equal to the hospital's actual cost of performing the test.As added by P.L.91-1999, SEC.1. Amended by P.L.237-2003, SEC.1.
IN Code § 5-10-8-10.5 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-10.5. Dental Care Provisions Required

Sec. 10.5. (a) As used in this section, "child" means an individual who is less than nineteen (19) years of age.(b) As used in this section, "covered individual" means a child or an individual:(1) with a physical or mental impairment that substantially limits one (1) or more of the major life activities of the individual; or(2) who:(A) has a record of; or(B) is regarded as;having an impairment described in subdivision (1).(c) If the state enters into a contract for basic health care services (as defined in IC 27-13-1-4) through prepaid health care delivery plans, medical self-insurance, or group health insurance for state employees, the contract must include coverage for anesthesia and hospital charges for dental care for a covered individual if the mental or physical condition of the covered individual requires dental treatment to be rendered in a hospital or an ambulatory outpatient surgical center. The Indications for General Anesthesia, as published in the reference manual of the American Academy of Pediatric Dentistry, are the utilization standards for determining whether performing dental procedures necessary to treat the covered individual's condition under general anesthesia constitutes appropriate treatment.(d) A health care contractor that issues a contract for basic health care services as described in subsection (c) may:(1) require prior authorization for hospitalization or treatment in an ambulatory outpatient surgical center for dental care procedures in the same manner that prior authorization is required for hospitalization or treatment of other covered medical conditions; and(2) restrict coverage to include only procedures performed by a licensed dentist who has privileges at the hospital or ambulatory outpatient surgical center.(e) This section does not apply to treatment rendered for temporal mandibular joint disorders (TMJ).As added by P.L.189-1999, SEC.1.
IN Code § 5-10-8-11 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-11. Use of Diagnostic or Procedure Codes

Sec. 11. (a) As used in this section, "administrator" means:(1) the state personnel department;(2) an entity with which the state contracts to administer health coverage under section 7(b) of this chapter; or(3) a prepaid health care delivery plan with which the state contracts under section 7(c) of this chapter.(b) As used in this section, "health care plan" has the meaning set forth in section 7.7 of this chapter.(c) As used in this section, "provider" has the meaning set forth in IC 27-8-11-1.(d) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection:(1) an administrator shall begin using the most current version of the:(A) current procedural terminology (CPT);(B) international classification of diseases (ICD);(C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);(D) current dental terminology (CDT);(E) Healthcare common procedure coding system (HCPCS); and(F) third party administrator (TPA);codes under which the administrator pays claims for services provided under a health care plan; and(2) a provider shall begin using the most current version of the:(A) current procedural terminology (CPT);(B) international classification of diseases (ICD);(C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);(D) current dental terminology (CDT);(E) Healthcare common procedure coding system (HCPCS); and(F) third party administrator (TPA);codes under which the provider submits claims for payment for services provided under a health care plan.(e) If a provider provides services that are covered under a health care plan:(1) after the effective date of the most current version of a diagnostic or procedure code described in subsection (d); and(2) before the administrator begins using the most current version of the diagnostic or procedure code;the administrator shall reimburse the provider under the version of the diagnostic or procedure code that was in effect on the date that the services were provided.As added by P.L.161-2001, SEC.1. Amended by P.L.66-2002, SEC.1.
IN Code § 5-10-8-12 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-12. Department Report of the Number of Stimulant Medication Prescriptions for Covered Children Diagnosed With Certain Disorders

Sec. 12. (a) As used in this section, "covered individual" means an individual who is covered under an employee health plan.(b) As used in this section, "employee health plan" means:(1) a self-insurance program established under section 7(b) of this chapter; or(2) a contract with a prepaid health care delivery plan entered into under section 7(c) of this chapter;that provides a prescription drug benefit.(c) The state personnel department may report to the drug utilization review board established by IC 12-15-35-19, not later than October 1 of each calendar year, the number of covered individuals who are:(1) less than eighteen (18) years of age; and(2) prescribed a stimulant medication approved by the federal Food and Drug Administration for the treatment of attention deficit disorder or attention deficit hyperactivity disorder.As added by P.L.107-2002, SEC.3.
IN Code § 5-10-8-13 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-13. Mail Order or Internet Based Pharmacy

Sec. 13. (a) As used in this section, "covered individual" means an individual who is entitled to coverage under an employee health benefit plan.(b) As used in this section, "employee health benefit plan" means a group plan of self-insurance, policy, or contract that:(1) provides coverage for prescription drugs; and(2) is established, purchased, or entered into by an employer for the benefit of the employer's employees.(c) As used in this section, "employer" means the following:(1) A public employer.(2) A state educational institution.(d) As used in this section, "mail order or Internet based pharmacy" has the meaning set forth in IC 25-26-18-1.(e) An employee health benefit plan that provides coverage for prescription drugs may designate a mail order or an Internet based pharmacy to provide prescription drugs to a covered individual.(f) An employee health benefit plan may not require a covered individual to obtain a prescription drug from a pharmacy designated under subsection (e) as a condition of coverage.As added by P.L.251-2003, SEC.1. Amended by P.L.2-2007, SEC.83.
IN Code § 5-10-8-14.8 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-14.8. Employee Health Plan Providing Coverage for Prescription Eye Drops

Sec. 14.8. (a) This section applies to an employee health plan that provides coverage for prescription eye drops.(b) As used in this section, "covered individual" means an individual who is entitled to coverage under a state employee health plan.(c) As used in this section, "state employee health plan" means one (1) of the following:(1) A self-insurance program established under section 7(b) of this chapter to provide group health coverage.(2) A contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter.(d) A state employee health plan must provide coverage for a refill of prescription eye drops if the following are met:(1) For a thirty (30) day supply, the covered individual requests the refill not earlier than twenty-five (25) days after the date the prescription eye drops were last dispensed to the covered individual.(2) For a ninety (90) day supply, the covered individual requests the refill not earlier than seventy-five (75) days after the date the prescription eye drops were last dispensed to the covered individual.(3) The prescribing practitioner has indicated on the prescription that the prescription eye drops are refillable and the refill requested by the covered individual does not exceed the refillable amount remaining on the prescription.(e) The coverage required by subsection (d) must not be subject to dollar limits, copayments, deductibles, or coinsurance provisions that are less favorable to a covered individual than the dollar limits, copayments, deductibles, or coinsurance provisions that apply to coverage for prescription drugs generally under the state employee health plan.(f) This section applies to a state employee health plan issued, delivered, amended, or renewed after December 31, 2015.As added by P.L.43-2015, SEC.1.
IN Code § 5-10-8-14.9 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-14.9. Coverage of Methadone

Sec. 14.9. (a) This section applies to an employee health plan that is established, entered into, amended, or renewed after June 30, 2015.(b) As used in this section, "state employee health plan" means one (1) of the following:(1) A self-insurance program established under section 7(b) of this chapter to provide group health coverage.(2) A contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter.(c) A state employee health plan may provide coverage for methadone if the drug is prescribed for the treatment of pain or pain management as follows:(1) If the daily dosage is not more than sixty (60) milligrams.(2) If the daily dosage is more than sixty (60) milligrams, only if:(A) prior authorization is obtained; and(B) a determination of medical necessity has been shown by the provider.As added by P.L.209-2015, SEC.1. Amended by P.L.149-2016, SEC.18.
IN Code § 5-10-8-16 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-16. High Breast Density

Sec. 16. (a) As used in this section, "covered individual" means an individual who is entitled to coverage under a state employee health plan.(b) As used in this section, "high breast density" means a condition in which there is a greater amount of breast and connective tissue in comparison to fat in the breast.(c) A state employee health plan must provide coverage for an appropriate medical screening, test, or examination for a female covered individual who is at least forty (40) years of age and who has been determined to have high breast density.As added by P.L.126-2013, SEC.1.