reglab/housing_qa huggingface dataset:
IN Code § 27-1-37.4-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.4. Electronic Prescription Drug Prior Authorization|27-1-37.4-5. Application of Chapter

Sec. 5. Section 4 of this chapter does not apply if a prescribing health care provider or dispensing pharmacist lacks:(1) broadband Internet access;(2) an electronic medical record system; or(3) a sufficient number of covered individuals as patients or customers, as determined by the commissioner, to warrant the financial expense that compliance with section 4 of this chapter would require.As added by P.L.45-2017, SEC.1.
IN Code § 27-1-37.4-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.4. Electronic Prescription Drug Prior Authorization|27-1-37.4-6. Contradictory Contract Provisions

Sec. 6. A contractual provision that:(1) is contained in a contract that is entered into, amended, or renewed after December 31, 2017; and(2) contradicts this chapter;is void.As added by P.L.45-2017, SEC.1.
IN Code § 27-1-37.4-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.4. Electronic Prescription Drug Prior Authorization|27-1-37.4-7. Rulemaking

Sec. 7. The commissioner may adopt rules under IC 4-22-2 to implement this chapter.As added by P.L.45-2017, SEC.1.
IN Code § 27-1-37.4-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.4. Electronic Prescription Drug Prior Authorization|27-1-37.4-8. "Step Therapy Protocol"; Notice of Denial; Required Information

Sec. 8. (a) As used in this section, "step therapy protocol" means a protocol that specifies, as a condition of coverage under a health plan, the order in which certain prescription drugs must be used to treat a covered individual's condition.(b) A health plan that denies prior authorization for a prescription drug described in subdivision (1) or (2) shall provide, in the notice of denial, an alternative list of prescription drugs or alternative treatments as follows:(1) If:(A) the prescription drug is not included in the health plan's formulary; and(B) there is at least one (1) alternative prescription drug in the same therapeutic classification (as defined in IC 12-15-35-17.5);the alternative list must specify the alternative prescription drugs described in clause (B) that are covered by the health plan.(2) If the prescription drug is prescribed to treat a condition for which coverage under the health plan requires use of a step therapy protocol, the alternative list must specify the alternative prescription drugs or alternative treatments that are required by the step therapy protocol.As added by P.L.246-2019, SEC.23 and P.L.264-2019, SEC.12.
IN Code § 27-1-37.5-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-1. Application of Chapter

Sec. 1. (a) Except as provided in sections 10, 11, 12, and 13 of this chapter, this chapter applies beginning September 1, 2018.(b) This chapter does not apply to a step therapy protocol exception procedure under IC 27-8-5-30 or IC 27-13-7-23.(c) This chapter does not apply to a health plan that is offered by a local unit public employer under a program of group health insurance provided under IC 5-10-8-2.6.As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-2. "Covered Individual"

Sec. 2. As used in this chapter, "covered individual" means an individual who is covered under a health plan.As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-3. "Cpt Code"

Sec. 3. As used in this chapter, "CPT code" refers to the medical billing code that applies to a specific health care service, as published in the Current Procedural Terminology code set maintained by the American Medical Association.As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-4. "Health Care Service"

Sec. 4. (a) As used in this chapter, "health care service" means a health care related service or product rendered or sold by a health care provider within the scope of the health care provider's license or legal authorization, including hospital, medical, surgical, mental health, and substance abuse services or products.(b) The term does not include the following:(1) Dental services.(2) Vision services.(3) Long term rehabilitation treatment.(4) Pharmaceutical services or products.As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-5. "Health Plan"

Sec. 5. (a) As used in this chapter, "health plan" means any of the following that provides coverage for health care services:(1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1). However, the term does not include the coverages described in IC 27-8-5-2.5(a).(2) A contract with a health maintenance organization (as defined in IC 27-13-1-19) that provides coverage for basic health care services (as defined in IC 27-13-1-4).(3) After December 31, 2020, the Medicaid risk based managed care program under IC 12-15.(b) The term includes a person that administers any of the following:(1) A policy described in subsection (a)(1).(2) A contract described in subsection (a)(2).(3) A self-insurance program established under IC 5-10-8-7(b) to provide health care coverage.(4) After December 31, 2020, Medicaid risk based managed care.As added by P.L.77-2018, SEC.2. Amended by P.L.265-2019, SEC.3.
IN Code § 27-1-37.5-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-6. "Participating Provider"

Sec. 6. As used in this chapter, "participating provider" refers to the following:(1) A health care provider that has entered into an agreement with an insurer under IC 27-8-11-3.(2) A participating provider (as defined in IC 27-13-1-24).As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-7. "Prior Authorization"

Sec. 7. As used in this chapter, "prior authorization" means a practice implemented by a health plan through which coverage of a health care service is dependent on the covered individual or health care provider obtaining approval from the health plan before the health care service is rendered. The term includes prospective or utilization review procedures conducted before a health care service is rendered.As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-8. "Urgent Care Situation"

Sec. 8. As used in this chapter, "urgent care situation" means a situation in which a covered individual's treating physician has determined that the covered individual's condition is likely to result in:(1) adverse health consequences or serious jeopardy to the covered individual's life, health, or safety; or(2) due to the covered individual's psychological state, serious jeopardy to the life, health, or safety of another individual;unless treatment of the covered individual's condition for which prior authorization is sought occurs earlier than the period generally considered by the medical profession to be reasonable to treat routine or non-life threatening conditions.As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-9. Availability of Prior Authorization Information; Requirements; New Requirements; Address Change; Notices

Sec. 9. (a) A health plan shall make available to participating providers on the health plan's Internet web site or portal the applicable CPT code for the specific health care services for which prior authorization is required.(b) A health plan shall make available to participating providers, on the health plan's Internet web site or portal, a list of the health plan's prior authorization requirements, including specific information that a provider must submit to establish a complete request for prior authorization. This subsection does not prevent a health plan from requiring specific additional information upon review of the request for prior authorization.(c) A health plan shall, not less than forty-five (45) days before the prior authorization requirement becomes effective, disclose to a participating provider any new prior authorization requirement.(d) A disclosure made under subsection (c) must:(1) be sent via electronic or United States mail and conspicuously labeled "Notice of Changes to Prior Authorization Requirements"; and(2) specifically identify the location on the health plan's Internet web site or portal of the new prior authorization requirement.However, a health plan is considered to have met the requirements of this subsection if the health plan conspicuously posts the information required by this subsection, including the effective date of the new prior authorization requirement, on the health plan's Internet web site.(e) A participating provider shall, not more than seven (7) days after the change is made, notify the health plan of a change in the participating provider's electronic or United States mail address.As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-10 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-10. Request for Prior Authorization; Electronic Transmission; Standardized Form

Sec. 10. (a) This section applies to a request for prior authorization delivered to a health plan after December 31, 2019.(b) A health plan shall accept a request for prior authorization delivered to the health plan by a covered individual's health care provider through a secure electronic transmission. A health care provider shall submit a request for prior authorization through a secure electronic transmission. A health plan shall provide for:(1) a secure electronic transmission; and(2) acknowledgment of receipt, by use of a transaction number or another reference code;of a request for prior authorization and any supporting information.(c) Subsection (b) does not apply and a health plan that requires prior authorization shall accept a request for prior authorization that is not submitted through a secure electronic transmission if a covered individual's health care provider and the health plan have entered into an agreement under which the health plan agrees to process prior authorization requests that are not submitted through a secure electronic transmission because:(1) secure electronic transmission of prior authorization requests would cause financial hardship for the health care provider;(2) the area in which the health care provider is located lacks sufficient Internet access; or(3) the health care provider has an insufficient number of covered individuals as patients or customers, as determined by the commissioner, to warrant the financial expense that compliance with subsection (b) would require.(d) If a covered individual's health care provider is described in subsection (c), the health plan shall accept from the health care provider a request for prior authorization as follows:(1) The prior authorization request must be made on the standardized prior authorization form established by the department under section 16 of this chapter.(2) The health plan shall provide for secure electronic transmission and acknowledgement of receipt of the standardized prior authorization form and any supporting information for the prior authorization by use of a transaction number or another reference code.As added by P.L.77-2018, SEC.2. Amended by P.L.208-2018, SEC.8.
IN Code § 27-1-37.5-11 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-11. Response to Request for Prior Authorization; Timing; Incomplete Request

Sec. 11. (a) This section applies to a prior authorization request delivered to a health plan after December 31, 2019.(b) A health plan shall respond to a request delivered under section 10 of this chapter as follows:(1) If the request is delivered under section 10(b) of this chapter, the health plan shall immediately send to the requesting health care provider an electronic receipt for the request.(2) If the request is for an urgent care situation, the health plan shall respond with a prior authorization determination not more than seventy-two (72) hours after receiving the request.(3) If the request is for a nonurgent care situation, the health plan shall respond with a prior authorization determination not more than seven (7) business days after receiving the request.(c) If a request delivered under section 10 of this chapter is incomplete:(1) the health plan shall respond within the period required by subsection (b) and indicate the specific additional information required to process the request;(2) if the request was delivered under section 10(b) of this chapter, upon receiving the response under subdivision (1), the health care provider shall immediately send to the health plan an electronic receipt for the response made under subdivision (1); and(3) if the request is for an urgent care situation, the health care provider shall respond to the request for additional information not more than seventy-two (72) hours after the health care provider receives the response under subdivision (1).(d) If a request delivered under section 10 of this chapter is denied, the health plan shall respond within the period required by subsection (b) and indicate the specific reason for the denial.As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-12 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-12. Claim for Which Prior Authorization Was Given; Denial; Resubmission of Claim

Sec. 12. (a) This section applies to a claim for a health care service rendered by a participating provider:(1) for which:(A) prior authorization is requested after December 31, 2019; and(B) a health plan gives prior authorization; and(2) that is rendered in accordance with:(A) the prior authorization; and(B) all terms and conditions of the participating provider's agreement or contract with the health plan.(b) The health plan shall not deny the claim described in subsection (a) unless:(1) the:(A) request for prior authorization; or(B) claim;contains fraudulent or materially incorrect information; or(2) the covered individual is not covered under the health plan on the date on which the health care service is rendered.(c) If:(1) the claim described in subsection (a) contains an unintentional and inaccurate inconsistency with the request for prior authorization; and(2) the inconsistency results in denial of the claim;the health care provider may resubmit the claim with accurate, corrected information.As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-13 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-13. Unanticipated, Medically Necessary Health Care Service; Denial; Payment for Health Care Service With Prior Authorization

Sec. 13. (a) This section applies to a claim filed after December 31, 2018, for a medically necessary health care service rendered by a participating provider, the necessity of which:(1) is not anticipated at the time prior authorization is obtained for another health care service; and(2) is determined at the time the other health care service is rendered.(b) The health plan shall not deny a claim described in subsection (a) based solely on lack of prior authorization for the unanticipated health care service.(c) The health plan:(1) shall not deny payment for a health care service that is rendered in accordance with:(A) a prior authorization; and(B) all terms and conditions of the participating provider's agreement or contract with the health plan; and(2) may:(A) require retrospective review of; and(B) withhold payment for;an unanticipated health care service described in subsection (a).As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-14 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-14. Contrary Contract Provision Void

Sec. 14. A provision that:(1) is contained in a policy or contract that is entered into, amended, or renewed after June 30, 2018; and(2) contradicts this chapter;is void.As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-15 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-15. Violation of Chapter

Sec. 15. A violation of this chapter by a health plan is an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4.As added by P.L.77-2018, SEC.2.
IN Code § 27-1-37.5-16 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 37.5. Health Care Service Prior Authorization|27-1-37.5-16. Department of Insurance; Standardized Prior Authorization Form

Sec. 16. (a) Except as provided in subsection (b), the department shall establish, post, and maintain on the department's Internet web site a standardized prior authorization form for use by health care providers and health plans for purposes of any notice or authorization required by a health plan with respect to payment for a health care service rendered to a covered individual.(b) After December 31, 2020, a Medicaid managed care organization (as defined in IC 12-7-2-126.9) shall use a standardized prior authorization form prescribed by the office of the secretary of family and social services.As added by P.L.77-2018, SEC.2. Amended by P.L.265-2019, SEC.4.
IN Code § 27-1-38-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 38. Regulation of Depository Institutions|27-1-38-1. "Affiliate" Defined

Sec. 1. As used in this chapter, "affiliate" means a company that controls, is controlled by, or is under common control with another company.As added by P.L.130-2002, SEC.2.
IN Code § 27-1-38-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 38. Regulation of Depository Institutions|27-1-38-2. "Customer" Defined

Sec. 2. As used in this section, "customer" means an individual who purchases, applies to purchase, or is solicited to purchase insurance primarily for personal, family, or household purposes.As added by P.L.130-2002, SEC.2.
IN Code § 27-1-38-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 38. Regulation of Depository Institutions|27-1-38-3. "Depository Institution" Defined

Sec. 3. As used in this chapter, "depository institution" means a depository financial institution (as defined in IC 28-9-2-6).As added by P.L.130-2002, SEC.2.
IN Code § 27-1-38-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 38. Regulation of Depository Institutions|27-1-38-4. "Insurance Producer" Defined

Sec. 4. As used in this section, "insurance producer" has the meaning set forth in IC 27-1-15.6-2.As added by P.L.130-2002, SEC.2.
IN Code § 27-1-38-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 38. Regulation of Depository Institutions|27-1-38-5. "Person That Sells, Solicits, Advertises, or Offers Insurance on Behalf of a Depository Institution" Defined

Sec. 5. As used in this chapter, "person that sells, solicits, advertises, or offers insurance on behalf of a depository institution" means a person to which one (1) of the following applies:(1) The person represents to a customer that the sale, solicitation, advertisement, or offer of insurance is by or on behalf of the depository institution.(2) The depository institution:(A) refers a customer to the person; and(B) has a contractual arrangement with the person to receive commissions or fees on sales of insurance that result from referrals to the person.(3) Documents that provide evidence of the sale, solicitation, advertisement, or offer of insurance identify or refer to the depository institution.As added by P.L.130-2002, SEC.2.
IN Code § 27-1-38-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 38. Regulation of Depository Institutions|27-1-38-6. Application of Chapter

Sec. 6. This chapter does not apply to credit insurance.As added by P.L.130-2002, SEC.2.
IN Code § 27-1-38-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 38. Regulation of Depository Institutions|27-1-38-8. Required Disclosure Concerning Insurance Related to a Loan or a Credit Extension

Sec. 8. (a) A depository institution or the affiliate of a depository institution that:(1) lends money or extends credit; and(2) solicits insurance primarily for personal, family, or household purposes;shall disclose in writing to a customer that the insurance related to the loan or credit extension may be purchased from an insurer or insurance producer chosen by the customer, subject only to the ability of the depository institution or affiliate to reasonably reject an insurer or insurance producer as described in section 7(4) of this chapter.(b) A disclosure under subsection (a) must inform the customer that the customer's choice of insurer or insurance producer does not affect:(1) the decision of the depository institution or the affiliate of a depository institution regarding the loan or credit extension; or(2) the terms of the loan or credit extension;except that the depository institution or the affiliate of a depository institution may impose reasonable requirements concerning the creditworthiness of the insurer and the scope of insurance coverage chosen, as described in section 7(4) of this chapter.As added by P.L.130-2002, SEC.2.
IN Code § 27-1-38-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 1. Department of Insurance|Chapter 38. Regulation of Depository Institutions|27-1-38-9. Required Disclosures Before Sale of Insurance

Sec. 9. (a) This section applies as follows:(1) To an affiliate of a depository institution only to the extent that the affiliate sells, solicits, advertises, or offers insurance at the office of a depository institution or on behalf of a depository institution.(2) To the:(A) sale of;(B) solicitation for; or(C) application for;insurance by an individual primarily for personal, family, or household purposes and only to the extent that a disclosure is accurate.(b) A depository institution or an affiliate of a depository institution that solicits, sells, advertises, or offers insurance, and a person that sells, solicits, advertises, or offers insurance on behalf of a depository institution, shall disclose to a customer, in writing where practicable, in a clear and conspicuous manner, and before a sale of insurance, that the insurance:(1) is not a deposit;(2) is not insured by the Federal Deposit Insurance Corporation or another federal government agency;(3) is not guaranteed by the depository institution, the affiliate of a depository institution, or the person that sells, solicits, advertises, or offers insurance on behalf of a depository institution; and(4) involves investment risk including possible loss of value, if appropriate.As added by P.L.130-2002, SEC.2.