reglab/housing_qa huggingface dataset:
IN Code § 27-8-5.7-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.7. Accident and Sickness Insurance; Provider Payment|27-8-5.7-5. Notice of Deficiencies in Claims

Sec. 5. (a) An insurer shall pay or deny each clean claim in accordance with section 6 of this chapter.(b) An insurer shall notify a provider of any deficiencies in a submitted claim not more than:(1) thirty (30) days for a claim that is filed electronically; or(2) forty-five (45) days for a claim that is filed on paper;and describe any remedy necessary to establish a clean claim.(c) Failure of an insurer to notify a provider as required under subsection (b) establishes the submitted claim as a clean claim.As added by P.L.162-2001, SEC.5. Amended by P.L.137-2002, SEC.2.
IN Code § 27-8-5.7-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.7. Accident and Sickness Insurance; Provider Payment|27-8-5.7-6. Payment or Denial of Claims; Interest

Sec. 6. (a) An insurer shall pay or deny each clean claim as follows:(1) If the claim is filed electronically, within thirty (30) days after the date the claim is received by the insurer.(2) If the claim is filed on paper, within forty-five (45) days after the date the claim is received by the insurer.(b) If:(1) an insurer fails to pay or deny a clean claim in the time required under subsection (a); and(2) the insurer subsequently pays the claim;the insurer shall pay the provider that submitted the claim interest on the accident and sickness insurance policy allowable amount of the claim paid under this section.(c) Interest paid under subsection (b):(1) accrues beginning:(A) thirty-one (31) days after the date the claim is filed under subsection (a)(1); or(B) forty-six (46) days after the date the claim is filed under subsection (a)(2); and(2) stops accruing on the date the claim is paid.(d) In paying interest under subsection (b), an insurer shall use the same interest rate as provided in IC 12-15-21-3(7)(A).As added by P.L.162-2001, SEC.5.
IN Code § 27-8-5.7-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.7. Accident and Sickness Insurance; Provider Payment|27-8-5.7-7. Permitted Forms

Sec. 7. A provider shall submit only the following forms for payment by an insurer:(1) CMS-1500.(2) CMS-1450 (UB-04).(3) American Dental Association (ADA) claim form.As added by P.L.162-2001, SEC.5. Amended by P.L.208-2018, SEC.10.
IN Code § 27-8-5.7-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.7. Accident and Sickness Insurance; Provider Payment|27-8-5.7-8. Civil Penalties

Sec. 8. (a) If the commissioner finds that an insurer has failed during any calendar year to process and pay clean claims in compliance with this chapter, the commissioner may assess an aggregate civil penalty against the insurer according to the following schedule:(1) If the insurer has paid at least eighty-five percent (85%) but less than ninety-five percent (95%) of all clean claims received from all providers during the calendar year in compliance with this chapter, a civil penalty of up to ten thousand dollars ($10,000).(2) If the insurer has paid at least sixty percent (60%) but less than eighty-five percent (85%) of all clean claims received from all providers during the calendar year in compliance with this chapter, a civil penalty of at least ten thousand dollars ($10,000) but not more than one hundred thousand dollars ($100,000).(3) If the insurer has paid less than sixty percent (60%) of all clean claims received from all providers during the calendar year in compliance with this chapter, a civil penalty of at least one hundred thousand dollars ($100,000) but not more than two hundred thousand dollars ($200,000).(b) In determining the amount of a civil penalty under this section, the commissioner shall consider whether the insurer's failure to achieve the standards established by this chapter is due to circumstances beyond the insurer's control.(c) An insurer may contest a civil penalty imposed under this section by requesting an administrative hearing under IC 4-21.5 not more than thirty (30) days after the insurer receives notice of the assessment of the fine.(d) If the commissioner imposes a civil penalty under this section, the commissioner may not impose a penalty against the insurer under IC 27-4-1 for the same activity.(e) Civil penalties collected under this section shall be deposited in the state general fund.As added by P.L.162-2001, SEC.5.
IN Code § 27-8-5.7-10 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.7. Accident and Sickness Insurance; Provider Payment|27-8-5.7-10. Claim Payment Errors

Sec. 10. (a) An insurer may not, more than two (2) years after the date on which an overpayment on a provider claim was made to the provider by the insurer:(1) request that the provider repay the overpayment; or(2) adjust a subsequent claim filed by the provider as a method of obtaining reimbursement of the overpayment from the provider.(b) An insurer may not be required to correct a payment error to a provider more than two (2) years after the date on which a payment on a provider claim was made to the provider by the insurer.(c) This section does not apply in cases of fraud by the provider, the insured, or the insurer with respect to the claim on which the overpayment or underpayment was made.As added by P.L.55-2006, SEC.1.
IN Code § 27-8-5.7-11 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.7. Accident and Sickness Insurance; Provider Payment|27-8-5.7-11. Claim Overpayment Adjustment

Sec. 11. Every subsequent claim that is adjusted by an insurer for reimbursement on an overpayment of a previous provider claim made to the provider must be accompanied by an explanation of the reason for the adjustment, including:(1) an identification of:(A) the claim on which the overpayment was made; and(B) if ascertainable, the party financially responsible for the overpaid amount; and(2) the amount of the overpayment that is being reimbursed to the insurer through the adjusted subsequent claim.As added by P.L.55-2006, SEC.2.
IN Code § 27-8-5.8-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.8. Insurance Benefit Cards|27-8-5.8-1. "Accident and Sickness Insurance Policy"

Sec. 1. As used in this chapter, "accident and sickness insurance policy" means an insurance policy that provides at least one (1) of the types of insurance described in IC 27-1-5-1, Classes 1(b) and 2(a), and is issued on a group basis. The term does not include the following:(1) Accident only, credit, dental, vision, Medicare, Medicare supplement, long term care, or disability income insurance.(2) Coverage issued as a supplement to liability insurance.(3) Automobile medical payment insurance.(4) A specified disease policy.(5) A limited benefit health insurance policy.(6) A short term insurance plan that:(A) may be renewed for the greater of:(i) thirty-six (36) months; or(ii) the maximum period permitted under federal law;(B) has a term of not more than three hundred sixty-four (364) days; and(C) has an annual limit of at least two million dollars ($2,000,000).(7) A policy that provides a stipulated daily, weekly, or monthly payment to an insured during hospital confinement, without regard to the actual expense of the confinement.(8) Worker's compensation or similar insurance.(9) A student health insurance policy.As added by P.L.230-2001, SEC.2. Amended by P.L.288-2019, SEC.6.
IN Code § 27-8-5.8-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.8. Insurance Benefit Cards|27-8-5.8-2. "Commissioner" Defined

Sec. 2. As used in this chapter, "commissioner" means the insurance commissioner appointed under IC 27-1-1-2.As added by P.L.230-2001, SEC.2.
IN Code § 27-8-5.8-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.8. Insurance Benefit Cards|27-8-5.8-3. "Insured" Defined

Sec. 3. As used in this chapter, "insured" means an individual who is entitled to coverage under an accident and sickness insurance policy.As added by P.L.230-2001, SEC.2.
IN Code § 27-8-5.8-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.8. Insurance Benefit Cards|27-8-5.8-4. Prescription Drug Information Card

Sec. 4. (a) This section applies to an insurer that:(1) issues an accident and sickness insurance policy that provides coverage for prescription drugs or devices; and(2) issues a card or other technology for claims processing.This section also applies to a third party administrator for self-insured plans, a pharmacy benefit manager, or a health benefit plan administered by the state if the administrator, manager, or plan issues a card or other technology described in subdivision (2).(b) The card or other technology issued by an insurer or another entity referred to in subsection (a) must contain uniform prescription drug information that complies with the requirements established under subsection (c).(c) Prescription drug information cards or other technology must meet either of the following criteria:(1) Be in a format and contain information fields approved by the National Council for Prescription Drug Programs (NCPDP) as contained in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide in effect on the October 1 most immediately preceding the issuance of the card.(2) Contain the following information:(A) The health benefit plan's name.(B) The insured's name, group number, and identification number.(C) A telephone number to inquire about pharmacy related issues.(D) The issuer's international identification number or ANSI BIN number, labeled as RxBIN.(E) The processor control number, labeled as RxPCN.(F) The insured's pharmacy benefits group number if different than the medical group number, labeled as RxGRP.Only those fields listed in clauses (A) through (F) that are required for proper adjudication of the claim must appear on the card. If the card is used to adjudicate non-pharmacy claims, then the designation "Rx" listed in clauses (D) through (F) is not required to be used by the issuer.(d) An insurer or an insurer's agents, contractors, or administrators, including pharmacy benefits managers, may not be required to issue a prescription drug information card or other technology to a person more than one (1) time during a twelve (12) month period.(e) The prescription drug information cards or other technology issued under this section may be used for health insurance coverage other than the coverage to which this chapter applies.As added by P.L.230-2001, SEC.2. Amended by P.L.1-2002, SEC.111.
IN Code § 27-8-5.8-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.8. Insurance Benefit Cards|27-8-5.8-5. "Health Plan Information Card"; Indication of Health Benefits; Rules

Sec. 5. (a) As used in this section, "health plan information card" means a card that:(1) an insurer of an accident and sickness insurance policy; or(2) a third party administrator of a self-insured plan;provides to an individual so that the individual may present the card to establish the eligibility of the individual or the individual's dependents to receive health benefits or services.(b) Subject to subsection (c), a health plan information card must indicate that the health benefits and services are provided by:(1) an insurer of an accident and sickness insurance policy; or(2) a third party administrator of a self-insured plan.(c) Subsection (b) applies only to a health plan information card issued:(1) initially to a new insured; or(2) to an insured at the time of the insured's policy renewal;after June 30, 2020.(d) The department of insurance shall adopt rules under IC 4-22-2 to ensure compliance with this section.As added by P.L.111-2020, SEC.11.
IN Code § 27-8-5.8-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.8. Insurance Benefit Cards|27-8-5.8-6. "Insurer"; Electronic Data Base; Required Information; Rules

Sec. 6. (a) As used in this section, "insurer" means:(1) an issuer of an accident and sickness insurance policy; or(2) a third party administrator of health benefits and services under an accident and sickness insurance policy.(b) The electronic data base by which an insurer allows an insured or a provider to verify an insured's coverage or benefits under an accident and sickness insurance policy issued or administered by the insurer must include the following information for each insured:(1) Whether health benefits and services under the accident and sickness insurance policy are provided by:(A) the issuer of the accident and sickness insurance policy; or(B) a third party administrator.(2) Whether the accident and sickness insurance policy is subject to state or federal regulation.(c) The department of insurance shall adopt rules under IC 4-22-2 to ensure compliance with this section.As added by P.L.111-2020, SEC.12.
IN Code § 27-8-5.9-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.9. Short Term Insurance Plan|27-8-5.9-1. "Covered Individual"

Sec. 1. As used in this chapter, "covered individual" means an individual entitled to coverage under a short term insurance plan.As added by P.L.288-2019, SEC.7.
IN Code § 27-8-5.9-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.9. Short Term Insurance Plan|27-8-5.9-2. "Ppaca"

Sec. 2. As used in this chapter, "PPACA" has the meaning set forth in IC 27-19-2-14.As added by P.L.288-2019, SEC.7.
IN Code § 27-8-5.9-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.9. Short Term Insurance Plan|27-8-5.9-3. "Short Term Insurance Plan"

Sec. 3. As used in this chapter, "short term insurance plan" means a policy of accident and sickness insurance (as defined in IC 27-8-5-1) that:(1) may be renewed for the greater of:(A) thirty-six (36) months; or(B) the maximum period permitted under federal law;(2) has a term of not more than three hundred sixty-four (364) days; and(3) has an annual limit of at least two million dollars ($2,000,000).As added by P.L.288-2019, SEC.7.
IN Code § 27-8-5.9-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.9. Short Term Insurance Plan|27-8-5.9-4. Renewal Requirements

Sec. 4. (a) An insurer may require an applicant for coverage under a short term insurance plan to specify, before issuance of the short term insurance plan, the number of renewals the applicant elects.(b) After issuance of a short term insurance plan, the insurer may not require underwriting of the short term insurance plan until:(1) all renewal periods elected under subsection (a) have ended; and(2) the covered individual renews the short term insurance plan beyond the periods described in subdivision (1).As added by P.L.288-2019, SEC.7.
IN Code § 27-8-5.9-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.9. Short Term Insurance Plan|27-8-5.9-5. Coverage Requirements

Sec. 5. A short term insurance plan must include coverage for the following:(1) Ambulatory patient services.(2) Hospitalization.(3) Emergency services.(4) Laboratory services.As added by P.L.288-2019, SEC.7.
IN Code § 27-8-5.9-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.9. Short Term Insurance Plan|27-8-5.9-6. Use of Preferred Provider Plan

Sec. 6. (a) This section applies to an insurer that issues a short term insurance plan and undertakes a preferred provider plan under IC 27-8-11 to render health care services to covered individuals under the short term insurance plan.(b) An insurer described in subsection (a) shall ensure that the preferred provider plan meets the following requirements:(1) The preferred provider plan includes essential community providers in accordance with PPACA.(2) The preferred provider plan is sufficient in number and types of providers (other than mental health and substance abuse treatment providers) to assure covered individuals' access to all health care services without unreasonable delay.(3) The preferred provider plan is consistent with the network adequacy requirements that:(A) apply to qualified health plan issuers under 45 CFR 156.230(a) and 45 CFR 156.230(b); and(B) are consistent with subdivisions (1) and (2).As added by P.L.288-2019, SEC.7.
IN Code § 27-8-5.9-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.9. Short Term Insurance Plan|27-8-5.9-7. Disclosures

Sec. 7. (a) An insurer that issues a short term insurance plan shall disclose to an applicant, in bold, 10 point type, the following:(1) That the short term insurance plan does not include coverage for the ten (10) essential health benefits required under PPACA.(2) That the short term insurance plan does not provide the coverage that is required under PPACA.(3) That enrollment in health coverage that provides the coverage that is required under PPACA may be done during the next PPACA open enrollment period.(4) The dates of the next PPACA open enrollment period during which the applicant may enroll in coverage described in subdivision (3).(b) An insurer shall obtain the signature of an applicant to whom the disclosures required by subsection (a) are made.As added by P.L.288-2019, SEC.7.
IN Code § 27-8-5.9-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.9. Short Term Insurance Plan|27-8-5.9-8. Similarly Situated Individuals

Sec. 8. An insurer shall not, as a condition of enrollment or continued enrollment in a short term insurance plan, require an individual to pay a premium or contribution greater than the premium or contribution for a similarly situated individual enrolled in the short term insurance plan on the basis of a health status related factor in relation to the individual or a dependent of the individual.As added by P.L.288-2019, SEC.7.
IN Code § 27-8-5.9-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5.9. Short Term Insurance Plan|27-8-5.9-9. Health Promotion and Disease Prevention Programs

Sec. 9. This chapter does not prevent an insurer from establishing a premium discount, a rebate, or out-of-pocket payment modifications in return for adherence to programs of health promotion and disease prevention.As added by P.L.288-2019, SEC.7.
IN Code § 27-8-6-0.1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 6. Reimbursement for Certain Medical Services|27-8-6-0.1. Application of Certain Amendments to Chapter

Sec. 0.1. The addition of section 4 of this chapter by P.L.153-1990 applies to a group or an individual policy or agreement providing comprehensive accident and health benefits that is issued, entered into, or renewed after June 30, 1990.As added by P.L.220-2011, SEC.437.
IN Code § 27-8-6-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 6. Reimbursement for Certain Medical Services|27-8-6-1. Professional Services for Which Reimbursement Authorized

Sec. 1. Notwithstanding any provision of any individual or group policy of accident and health insurance, or any provision of a policy, contract, plan, or agreement for hospital or medical service or indemnity, wherever such policy, contract, plan, or agreement provides for reimbursement for any service which is in the lawful scope of practice of a duly licensed dentist, health service provider in psychology, podiatrist, osteopath, optometrist, or chiropractor, the person entitled to benefits or the person performing services under the policy, contract, plan, or agreement shall be entitled to reimbursement on an equal basis for such service, whether the service is performed by a physician, dentist, health service provider in psychology, podiatrist, osteopath, optometrist, or chiropractor duly licensed under the laws of this state.Formerly: Acts 1969, c.409, s.1; Acts 1974, P.L.126, SEC.1. As amended by P.L.260-1985, SEC.1.
IN Code § 27-8-6-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 6. Reimbursement for Certain Medical Services|27-8-6-2. Prior Policies

Sec. 2. The provisions of section 1 of this chapter shall not apply to any policy, contract, plan, or agreement in effect prior to May 1, 1969.Formerly: Acts 1969, c.409, s.2. As amended by P.L.252-1985, SEC.311.
IN Code § 27-8-6-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 6. Reimbursement for Certain Medical Services|27-8-6-3. Application of Amendments by Acts 1974, p.l.126

Sec. 3. The amendments to this chapter made by Acts 1974, P.L.126 do not apply to a policy, contract, plan, or agreement in effect before June 11, 1974.As added by P.L.1-1989, SEC.55.
IN Code § 27-8-6-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 6. Reimbursement for Certain Medical Services|27-8-6-4. Reimbursement for Services; Application of Section; Prohibitions Excluded

Sec. 4. (a) This section does not apply to any of the following:(1) A health maintenance organization (as defined in IC 27-13-1-19) or limited service health maintenance organization (as defined in IC 27-13-34-4).(2) A preferred provider plan (as defined in IC 27-8-11-1).(3) An employee benefit program that is subject to the federal Employee Retirement Income Security Act (29 U.S.C. 1001 et seq.).(4) Worker's compensation for an injury to or occupational disease of an employee under IC 22-3.(b) A group or individual policy or agreement providing comprehensive accident and health benefits must reimburse an insured for services rendered by a provider licensed under IC 25-10 within the scope of that provider's license in the same manner as that policy or agreement reimburses an insured for services rendered by a provider licensed under IC 25-22.5 within the scope of that provider's license. The policy or agreement may not exclude or otherwise limit reimbursement for any service that a provider licensed under IC 25-10 renders under the scope of that provider's license in the diagnosis and treatment of any illness or injury. This section does not require that a health care policy or agreement cover a particular illness or injury.(c) This section does not prohibit the following:(1) The application of coinsurance and deductible provisions to providers licensed under IC 25-10 on the same basis as those provisions are applied to providers licensed under IC 25-22.5.(2) The application of cost containment or quality assurance measures to providers licensed under IC 25-10 on the same basis as those measures are applied to providers licensed under IC 25-22.5.(3) A review of the necessity of services that applies to services rendered by providers licensed under IC 25-10 on the same basis as the review applies to services provided by providers licensed under IC 25-22.5.As added by P.L.153-1990, SEC.1. Amended by P.L.26-1994, SEC.12.