reglab/housing_qa huggingface dataset:
IN Code § 27-13-7-14.8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-14.8. Treatment Limitations or Financial Requirements on Coverage of Services for Mental Illness

Sec. 14.8. (a) As used in this section, "coverage of services for a mental illness" includes the services defined under the contract with the health maintenance organization. However, the term does not include services for the treatment of substance abuse or chemical dependency.(b) This section applies to a group or individual contract with a health maintenance organization that:(1) is issued, entered into, or renewed after December 31, 1999; and(2) is issued to an employer that employs more than fifty (50) full-time employees.(c) This section does not apply to a legal business entity that has obtained an exemption under IC 27-8-5-15.7.(d) A group or individual contract with a health maintenance organization may not permit treatment limitations or financial requirements on the coverage of services for a mental illness if similar limitations or requirements are not imposed on the coverage of services for other medical or surgical conditions.(e) A health maintenance organization that enters into an individual contract or a group contract that provides coverage of services for the treatment of substance abuse and chemical dependency when the services are required in the treatment of a mental illness shall offer to provide the coverage without treatment limitations or financial requirements if similar limitations or requirements are not imposed on the coverage of services for other medical or surgical conditions.(f) This section does not require a group or individual contract with a health maintenance organization to offer mental health benefits.As added by P.L.42-1997, SEC.3. Amended by P.L.81-1999, SEC.5; P.L.226-2003, SEC.2.
IN Code § 27-13-7-15 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-15. Dental Care Provisions Required

Sec. 15. (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, "enrollee" means an enrollee who is 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; and(2) who:(A) has a record of; or(B) is regarded as;having an impairment described in subdivision (1).(c) A health maintenance organization that provides basic health care services shall include coverage under the terms and conditions of the benefits contract for anesthesia and hospital charges for an enrollee for dental care if the mental or physical condition of the enrollee 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 enrollee's condition under general anesthesia constitutes appropriate treatment.(d) A health maintenance organization 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.3.
IN Code § 27-13-7-15.3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-15.3. Breast Cancer Screening Mammography

Sec. 15.3. (a) As used in this section, "breast cancer screening mammography" has the meaning set forth in IC 27-8-14-2.(b) As used in this section, "woman at risk" has the meaning set forth in IC 27-8-14-5.(c) Except as provided in subsection (g), a health maintenance organization issued a certificate of authority in Indiana shall provide breast cancer screening mammography as a covered service under every group contract that provides coverage for basic health care services.(d) Except as provided in subsection (g), the coverage that a health maintenance organization must provide under this section must include the following:(1) If the enrollee is at least thirty-five (35) years of age but less than forty (40) years of age and a female, coverage for at least one (1) baseline breast cancer screening mammography performed upon the enrollee before the enrollee becomes forty (40) years of age.(2) If the enrollee is less than forty (40) years of age and a woman at risk, one (1) breast cancer screening mammography performed upon the enrollee every year.(3) If the enrollee is at least forty (40) years of age and a female, one (1) breast cancer screening mammography performed upon the enrollee every year.(4) Any additional mammography views that are required for proper evaluation.(5) Ultrasound services, if determined medically necessary by the physician treating the enrollee.(e) Except as provided in subsection (g), the coverage that a health maintenance organization must provide under this section may not be subject to a contract provision that is less favorable to an enrollee or a subscriber than contract provisions applying to physical illness generally under the health maintenance organization contract.(f) Except as provided in subsection (g), the coverage that a health maintenance organization must provide under this section is in addition to services specifically provided for x-rays, laboratory testing, or wellness examinations.(g) In the case of coverage that is not employer based, the health maintenance organization must offer to provide the coverage described in subsections (c) through (f).As added by P.L.170-1999, SEC.5.
IN Code § 27-13-7-16 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-16. Prostate Specific Antigen Test

Sec. 16. (a) As used in this section, "prostate specific antigen test" means a standard blood test performed to determine the level of prostate specific antigen in the blood.(b) Except as provided in subsection (f), a health maintenance organization issued a certificate of authority in Indiana shall provide prostate specific antigen testing as a covered service under every group contract that provides coverage for basic health care services.(c) Except as provided in subsection (f), the coverage required under subsection (b) must include the following:(1) At least one (1) prostate specific antigen test annually for a male enrollee who is at least fifty (50) years of age.(2) At least one (1) prostate specific antigen test annually for a male enrollee who is less than fifty (50) years of age and who is at high risk for prostate cancer according to the American Cancer Society guidelines.(d) Except as provided in subsection (f), the coverage that a health maintenance organization must provide under this section may not be subject to a contract provision that is less favorable to an enrollee than a contract provision applying to physical illness generally under the health maintenance organization contract.(e) Except as provided in subsection (f), the coverage that a health maintenance organization must provide under this section is in addition to services specifically provided for x-rays, laboratory testing, or wellness examinations.(f) In the case of coverage that is not employer based, the health maintenance organization must offer to provide the coverage described in subsections (b) through (e).As added by P.L.170-1999, SEC.6. Amended by P.L.124-2018, SEC.89.
IN Code § 27-13-7-17 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-17. Colorectal Cancer Testing Coverage; Exception for High Deductible Health Plans

Sec. 17. (a) As used in this section, "colorectal cancer testing" means examinations and laboratory tests for cancer for any nonsymptomatic enrollee.(b) Except as provided in subsection (e), a health maintenance organization issued a certificate of authority in Indiana shall provide colorectal cancer testing as a covered service under every group contract that provides coverage for basic health care services(c) For an enrollee 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 colorectal cancer testing required under this section must meet the requirements set forth in subsection (d), except as provided in subsection (f).(d) An enrollee may not be required to pay a copayment for the colorectal cancer testing benefit required by this section that is greater than a copayment established for similar benefits under the group contract under which the enrollee is entitled to services. If the group contract does not cover a similar covered service, the copayment for the colorectal cancer testing benefit may not be set at a level that materially diminishes the value of the colorectal cancer testing benefit.(e) In the case of coverage that is not employer based, the health maintenance organization is required only to offer to provide colorectal cancer testing as a covered service under a proposed group contract providing coverage for basic health care services.(f) 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.3. Amended by P.L.1-2001, SEC.34; P.L.124-2018, SEC.90; P.L.36-2020, SEC.3.
IN Code § 27-13-7-18 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-18. Inherited Metabolic Disease Coverage

Sec. 18. (a) As used in this section, "inherited metabolic disease" means a disease:(1) caused by inborn errors of amino acid, organic acid, or urea cycle metabolism; and(2) treatable by the dietary restriction of one (1) or more amino acids.(b) As used in this section, "medical food" means a formula that is:(1) intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation; and(2) formulated to be consumed or administered enterally under the direction of a physician.(c) A group health maintenance organization contract that provides coverage for basic health care services must provide coverage for medical food that is:(1) medically necessary; and(2) prescribed for an enrollee by the enrollee's treating physician for treatment of the enrollee's inherited metabolic disease.(d) The coverage that must be provided under this section shall not be subject to dollar limits, copayments, or deductibles that are less favorable to an enrollee than the dollar limits, copayments, or deductibles that apply to coverage for:(1) prescription drugs generally under the group contract, if prescription drugs are covered under the group contract; or(2) physical illness generally under the group contract, if prescription drugs are not covered under the group contract.As added by P.L.166-2003, SEC.3.
IN Code § 27-13-7-19 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-19. Coverage for Orthotic Devices and Prosthetic Devices

Sec. 19. (a) As used in this section, "orthotic device" means a medically necessary custom fabricated brace or support that is designed as a component of a prosthetic device.(b) As used in this section, "prosthetic device" means an artificial leg or arm.(c) An individual contract or a group contract that provides coverage for basic health care services must provide coverage for orthotic devices and prosthetic devices, including repairs or replacements, that:(1) are provided or performed by a person that is:(A) accredited as required under 42 U.S.C. 1395m(a)(20); or(B) a qualified practitioner (as defined in 42 U.S.C. 1395m(h)(1)(F)(iii));(2) are determined by the enrollee's physician to be medically necessary to restore or maintain the enrollee's ability to perform activities of daily living or essential job related activities; and(3) are not solely for comfort or convenience.(d) The:(1) coverage required under subsection (c) must be equal to the coverage that is provided for the same device, repair, or replacement under the federal Medicare program (42 U.S.C. 1395 et seq.); and(2) reimbursement under the coverage required under subsection (c) must be equal to the reimbursement that is provided for the same device, repair, or replacement under the federal Medicare reimbursement schedule, unless a different reimbursement rate is negotiated.This subsection does not require a deductible under an individual contract or a group contract to be equal to a deductible under the federal Medicare program.(e) Except as provided in subsections (f) and (g), the coverage required under subsection (c):(1) may be subject to; and(2) may not be more restrictive than;the provisions that apply to other benefits under the individual contract or group contract.(f) The coverage required under subsection (c) may be subject to utilization review, including periodic review, of the continued medical necessity of the benefit.(g) Any lifetime maximum coverage limitation that applies to prosthetic devices and orthotic devices:(1) must not be included in; and(2) must be equal to;the lifetime maximum coverage limitation that applies to all other items and services generally under the individual contract or group contract.(h) For purposes of this subsection, "items and services" does not include preventive services for which coverage is provided under a high deductible health plan (as defined in 26 U.S.C. 220(c)(2) or 26 U.S.C. 223(c)(2)). The coverage required under subsection (c) may not be subject to a deductible, copayment, or coinsurance provision that is less favorable to an enrollee than the deductible, copayment, or coinsurance provisions that apply to other items and services generally under the individual contract or group contract.As added by P.L.109-2008, SEC.3.
IN Code § 27-13-7-20 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-20. Prohibition on Chemotherapy Coverage Limitations

Sec. 20. (a) This section applies to an individual contract or a group contract that provides coverage for both of the following:(1) Orally administered cancer chemotherapy.(2) Cancer chemotherapy that is administered intravenously or by injection.(b) As used in this section, "cancer chemotherapy" means medication that is prescribed by a physician to kill or slow the growth of cancer cells.(c) Coverage for orally administered cancer chemotherapy under an individual contract or a group contract must not be subject to dollar limits, copayments, deductibles, or coinsurance provisions that are less favorable to an enrollee than the dollar limits, copayments, deductibles, or coinsurance provisions that apply to coverage for cancer chemotherapy that is administered intravenously or by injection under the individual contract or group contract.As added by P.L.46-2009, SEC.2.
IN Code § 27-13-7-20.1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-20.1. Individual or Group Contract Providing Coverage for Prescription Eye Drops; Refill of Prescription Eye Drops; Requirements

Sec. 20.1. (a) This section applies to an individual contract or a group contract that provides coverage for prescription eye drops.(b) An individual contract or a group contract must provide coverage for a refill of prescription eye drops if the following are met:(1) For a thirty (30) day supply, the enrollee requests the refill not earlier than twenty-five (25) days from the date the prescription eye drops were last dispensed to the enrollee.(2) For a ninety (90) day supply, the enrollee requests the refill not earlier than seventy-five (75) days from the date the prescription eye drops were last dispensed to the enrollee.(3) The prescribing practitioner has indicated on the prescription that the prescription eye drops are refillable and the refill requested by the enrollee does not exceed the refillable amount remaining on the prescription.(c) The coverage required by subsection (b) must not be subject to dollar limits, copayments, deductibles, or coinsurance provisions that are less favorable to an enrollee than the dollar limits, copayments, deductibles, or coinsurance provisions that apply to coverage for prescription drugs generally under the individual contract or group contract.(d) This section applies to an individual contract or a group contract issued, delivered, amended, or renewed after December 31, 2015.As added by P.L.43-2015, SEC.3.
IN Code § 27-13-7-20.4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-20.4. Applicability; Coverage for Methadone for Treatment of Pain

Sec. 20.4. (a) This section applies to an individual contract or a group contract that is entered into, amended, or renewed after June 30, 2015.(b) An individual contract or a group contract may provide coverage for methadone if the drug is prescribed for the treatment of pain or pain management only 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.20.
IN Code § 27-13-7-21 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-21. High Breast Density

Sec. 21. (a) 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.(b) An individual contract or a group contract that provides coverage for basic health care services must provide coverage for an appropriate medical screening, test, or examination for a female enrollee 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.5.
IN Code § 27-13-7-22 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-22. Coverage of Telehealth Services; Prohibition on Requiring Use of Specific Information Technology Application

Sec. 22. (a) An individual contract or a group contract must provide coverage for telehealth services in accordance with the same clinical criteria as the individual contract or the group contract provides coverage for the same health care services delivered to an enrollee in person.(b) Coverage for telehealth services required by subsection (a) may not be subject to a dollar limit, copayment, or coinsurance requirement that is less favorable to an enrollee than the dollar limit, copayment, or coinsurance requirement that applies to the same health care services delivered to an enrollee in person.(c) Any annual or lifetime dollar limit that applies to telehealth services must be the same annual or lifetime dollar limit that applies in the aggregate to all items and services covered under the individual contract or the group contract.(d) This section does not do any of the following:(1) Require an individual contract or a group contract to provide coverage for a telehealth service that is not a covered health care service under the individual contract or group contract.(2) Require the use of telehealth services when the treating provider has determined that telehealth services are inappropriate.(3) Prevent the use of utilization review concerning coverage for telehealth services in the same manner as utilization review is used concerning coverage for the same health care services delivered to an enrollee in person.(e) A separate consent for telehealth services may not be required.(f) If a policy provides coverage for telehealth services via:(1) secure videoconferencing;(2) store and forward technology; or(3) remote patient monitoring technology;between a provider in one (1) location and a patient in another location, the policy may not require the use of a specific information technology application for those services.As added by P.L.185-2015, SEC.27. Amended by P.L.85-2021, SEC.32.
IN Code § 27-13-7-24 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-24. Coverage for Anatomical Gifts, Transplantation, or Related Health Care Services

Sec. 24. (a) As used in this section, "disability" has the meaning set forth in 42 U.S.C. 12102.(b) As used in this section, "enrollee" means an enrollee who has a disability.(c) As used in this section, "group contract" means a group contract that provides coverage for anatomical gifts, transplantation, or related health care services.(d) As used in this section, "health maintenance organization" includes an administrator that is licensed under IC 27-1-25 and administers an individual contract or a group contract.(e) As used in this section, "individual contract" means an individual contract that provides coverage for anatomical gifts, transplantation, or related health care services.(f) A health maintenance organization shall not deny coverage for anatomical gifts, transplantation, or related health care services under an individual contract or a group contract based solely on the disability of the enrollee.As added by P.L.2-2019, SEC.10.