reglab/housing_qa huggingface dataset:
IN Code § 27-13-34-10 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-10. Powers of Limited Service Health Maintenance Organization

Sec. 10. (a) Subject to subsection (b), the powers of a limited service health maintenance organization include the following:(1) The purchase, lease, construction, renovation, operation, or maintenance of:(A) medical facilities that will provide limited health services;(B) equipment for medical facilities providing limited health services; and(C) other property reasonably required for the principal office of the limited service health maintenance organization or for purposes necessary in the transaction of the business of the organization.(2) Engaging in transactions between affiliated entities, including loans and the transfer of responsibility under any or all contracts:(A) between affiliates; or(B) between the limited service health maintenance organization and the parent organization of the limited service health maintenance organization.(3) The furnishing of limited health services through the following:(A) Providers.(B) Provider associations.(C) Agents for providers who are under contract with or are employed by the limited service health maintenance organization. The contracts with providers, provider associations, or agents for providers may include fee for service, cost plus, capitation, or other payment or risk-sharing agreements.(4) Contracting with any person for the performance on behalf of the limited service health maintenance organization of certain functions, including:(A) marketing;(B) enrollment; and(C) administration.(5) Contracting with:(A) an insurance company licensed in Indiana; or(B) an authorized reinsurer for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the limited service health maintenance organization.(6) The offering of point-of-service products for the limited health services for which the limited service health maintenance organization is licensed so long as the limited service health maintenance organization complies with the reinsurance or ratio requirements of IC 27-13-13-8.(7) The joint marketing of products with:(A) an insurance company that is licensed in Indiana; or(B) a health maintenance organization that is authorized to conduct business in Indiana;if the company that is offering each product is clearly identified.(8) Providing limited health services at the expense of a self-funded plan.(b) Nothing in this section qualifies an asset of a prepaid limited health service organization as an admitted asset.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-11 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-11. Modification of Documents; Filing; Disapproval

Sec. 11. (a) Before making any material modification of any matter or document furnished under section 8 of this chapter, a limited service health maintenance organization shall file with the commissioner:(1) a notice of the modification; and(2) supporting documents that are necessary to fully explain the modification.(b) If a limited service health maintenance organization desires to add one (1) or more limited health services, it must:(1) file a notice with the commissioner;(2) submit the information required by section 8 of this chapter concerning each limited health service to be added, if that information is different from the information filed with the application of the limited service health maintenance organization; and(3) demonstrate compliance with sections 16, 17, 18, and 23 of this chapter with respect to each limited health service to be added by the organization.(c) If the commissioner does not disapprove a filing under subsection (a) or (b) within thirty (30) days after the commissioner receives the filing, or within any period of extension granted by the commissioner, the filing shall be deemed approved.(d) If a filing under subsection (a) or (b) is disapproved, the commissioner shall:(1) notify the limited service health maintenance organization of the disapproval of the filing in writing deposited in the United States mail addressed to the limited service health maintenance organization; and(2) specify the reasons for disapproval of the filing in the notice.(e) Within thirty (30) days after it receives a notice of disapproval under subsection (d), the limited service health maintenance organization may request a hearing before the commissioner under IC 4-21.5 concerning the disapproval of the filing. If, not more than thirty (30) days after receiving the notice from the commissioner, the limited service health maintenance organization requests a hearing, the commissioner shall hold a hearing upon not less than ten (10) days notice to the limited service health maintenance organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-12 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-12. Applicable Statutes

Sec. 12. A limited service health maintenance organization operated under this chapter is subject to the following:(1) IC 27-1-36 concerning risk based capital, unless exempted by the commissioner under IC 27-1-36-1.(2) IC 27-13-2-10, concerning physical presence in Indiana.(3) IC 27-13-8, except for IC 27-13-8-2(a)(6) concerning reports.(4) IC 27-13-9-3 concerning termination of providers.(5) IC 27-13-10-1 through IC 27-13-10-3 concerning grievance procedures.(6) IC 27-13-11 concerning investments.(7) IC 27-13-15-1(a)(2) through IC 27-13-15-1(a)(3) concerning gag clauses in contracts.(8) IC 27-13-21 concerning producers.(9) IC 27-13-29 concerning statutory construction and relationship to other laws.(10) IC 27-13-30 concerning public records.(11) IC 27-13-31 concerning confidentiality of medical information and limitation of liability.(12) IC 27-13-36-5 and IC 27-13-36-6 concerning referrals to out of network providers and continuation of care.(13) IC 27-13-40 concerning comparison sheets of services provided by the limited service health maintenance organization.As added by P.L.26-1994, SEC.25. Amended by P.L.191-1997, SEC.14; P.L.69-1998, SEC.12; P.L.133-1999, SEC.8; P.L.51-2002, SEC.12; P.L.11-2011, SEC.38.
IN Code § 27-13-34-13 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-13. Evidence of Coverage; Required Information

Sec. 13. (a) Every subscriber of a limited service health maintenance organization shall be issued an evidence of coverage in electronic or paper form, which must contain a clear and complete statement of the following:(1) The limited health services to which each enrollee is entitled.(2) Any limitation of the services, kinds of services, or benefits to be provided.(3) Any exclusions, including any copayment or other charges.(4) Where and in what manner information is available as to where and how services may be obtained.(5) The method for resolving complaints.(b) Any amendment to the evidence of coverage may be provided to the subscriber in a separate document in electronic or paper form.(c) A limited service health maintenance organization shall issue the evidence of coverage described in subsection (a) and an amendment described in subsection (b) in paper form upon the request of the subscriber.(d) A limited service health maintenance organization shall include in the limited service health maintenance organization's enrollment materials information concerning the manner in which a subscriber may:(1) obtain an evidence of coverage; and(2) request the evidence of coverage in paper form.As added by P.L.26-1994, SEC.25. Amended by P.L.125-2005, SEC.8.
IN Code § 27-13-34-14 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-14. Examinations by Commissioner

Sec. 14. (a) The commissioner may examine a limited service health maintenance organization as often as is reasonably necessary to protect the interests of Indiana citizens. However, an examination of a limited service health maintenance organization domiciled in Indiana must be conducted at least one (1) time every three (3) years.(b) A limited service health maintenance organization:(1) shall make its relevant books and records, and the books and records in its custody and control, available for examination under this section; and(2) in every way cooperate with the commissioner to facilitate the examination.(c) The expenses of an examination under this section shall be paid by the organization being examined.(d) Instead of conducting an examination of a limited service health maintenance organization that is not domiciled in Indiana, the commissioner may accept the report of an examination made by the chief administrative officer who regulates insurance in another state, if the other state is accredited by the NAIC.As added by P.L.26-1994, SEC.25. Amended by P.L.124-2018, SEC.96.
IN Code § 27-13-34-15 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-15. Required Contract Terms and Conditions; Exemptions

Sec. 15. All contracts with providers or with entities subcontracting for the provision of limited health services to enrollees on a prepayment basis or other basis must contain, or shall be construed to contain, the following terms and conditions:(1) If the limited service health maintenance organization fails to pay for limited health services for any reason whatsoever, including insolvency or breach of this contract, the enrollees shall not be liable to the provider for any sums owed to the provider under this contract.(2) No provider or agent, trustee, representative, or assignee of a provider may maintain an action at law or attempt to collect from the enrollee sums that the limited service health maintenance organization owes to the provider.(3) These provisions do not prohibit the collection of:(A) uncovered charges consented to by enrollees; or(B) copayments;from enrollees.(4) The contract may not provide for a financial or other penalty to a primary care provider for making a referral permitted under IC 27-13-36-5(a), but may provide for reasonable cost sharing between the primary care provider and the limited service health maintenance organization for the additional costs incurred as a result of services provided by an out of network provider.(5) These provisions survive the termination of this contract, regardless of the reason for the termination.(6) For not more than ninety (90) days after the termination of this contract, the provider must complete procedures in progress on an enrollee receiving treatment for a specific condition, at the same schedule of copayment or other applicable charge that is in effect on the effective date of termination of the contract.(7) An amendment to the provisions of this contract set forth in subdivisions (1) through (6) must be:(A) submitted to; and(B) approved by;the commissioner before it becomes effective.As added by P.L.26-1994, SEC.25. Amended by P.L.69-1998, SEC.13.
IN Code § 27-13-34-16 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-16. "Net Worth" and "Uncovered Expense" Defined; Computation of Net Worth; Minimum Net Worth

Sec. 16. (a) As used in this section, "net worth" means the excess of total assets over total liabilities, excluding liabilities that have been subordinated in a manner acceptable to the commissioner.(b) For the purposes of computing net worth, the total assets must be reduced by the value assigned to the following intangible assets:(1) Goodwill.(2) Going concern value.(3) Organizational expense.(4) Start-up costs.(5) Long term prepayments of deferred charges.(6) Nonreturnable deposits.(7) Obligations of officers, directors, owners, or affiliates, except short term obligations of affiliates for goods or services that:(A) arise in the normal course of business;(B) are payable on the same terms as equivalent transactions with nonaffiliates; and(C) are not past due.(c) As used in this section, "uncovered expense" means the cost of health care services:(1) that are the obligation of a limited service health maintenance organization;(2) for which an enrollee may be liable in the event of the insolvency of the organization; and(3) for which alternative arrangements acceptable to the commissioner have not been made to cover the costs.(d) For purposes of the definition of "uncovered expense" set forth in subsection (c), costs incurred by a provider who has agreed in writing not to bill enrollees, except for permissible supplemental charges, shall be considered a covered expense.(e) Each limited service health maintenance organization must, at all times, have and maintain net worth equal to the greater of:(1) fifty thousand dollars ($50,000); or(2) two and one-half percent (2.5%) of the annual gross subscription income of the organization, up to a maximum of two hundred fifty thousand dollars ($250,000).(f) A limited service health maintenance organization shall maintain as a claim or loss reserve, in cash or obligations of the United States government, assets sufficient to discharge all liabilities on all uncovered expenses arising under policies issued.(g) The commissioner may adopt rules under IC 4-22-2 to further define whether and to what extent the assets of a limited service health maintenance organization may be considered to be admitted assets for the purposes of complying with the requirements of this chapter.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-17 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-17. Required Deposit

Sec. 17. (a) Each limited service health maintenance organization shall deposit in a joint-name account with:(1) the commissioner; or(2) any bank or bank and trust company or other financial institution acceptable to the commissioner through which a custodial or controlled account is used;cash, securities acceptable to the commissioner, or any combination of these, in an amount equal to fifty thousand dollars ($50,000).(b) For the purposes of section 16 of this chapter:(1) a deposit made by an organization under this section shall be treated as an admitted asset of the organization in the determination of net worth; and(2) all income from deposits of an organization under this section shall be an asset of the organization.(c) An organization may withdraw:(1) a deposit made under this section; or(2) any part of the deposit;after making a substitute deposit of equal amount and value.(d) Any obligations of the United States government deposited with the commissioner under this section must be approved by the commissioner before being substituted under subsection (c).(e) The deposit made by a limited service health maintenance organization under this section shall be used to protect the interest of the enrollees of the organization and to assure continuation of limited health care services to enrollees of a limited service health maintenance organization that is in rehabilitation or conservation.(f) If a limited service health maintenance organization is placed in rehabilitation or liquidation, the deposit made by the organization under this section shall be an asset subject to IC 27-9.(g) The commissioner is not required to but may reduce or eliminate the deposit requirement of this section for a limited service health maintenance organization if the organization:(1) has made an acceptable deposit with the state or jurisdiction in which the organization is domiciled for the protection of all enrollees, wherever located; and(2) delivers to the commissioner a certificate to that effect, authenticated by the appropriate state official holding the deposit.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-18 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-18. Fidelity Bonds; Deposit in Place of Bond

Sec. 18. (a) Except as provided in subsection (c), a limited service health maintenance organization shall maintain in force a fidelity bond in its own name on its officers and employees:(1) in an amount not less than fifty thousand dollars ($50,000); or(2) in any other amount prescribed by the commissioner.(b) The fidelity bond required by this section must be issued by an insurance company not affiliated in any way with the limited service health maintenance organization, that is licensed to do business in Indiana. However, if a fidelity bond is not available from an insurance company that holds a certificate of authority in Indiana, a limited service health maintenance organization may satisfy the requirement of this section by maintaining a fidelity bond procured by a surplus lines insurance producer not affiliated in any way with the limited service health maintenance organization who holds a license issued under IC 27-1-15.8.(c) Instead of maintaining a fidelity bond under subsection (a), a limited service health maintenance organization may deposit with the commissioner:(1) cash;(2) certificates of deposit;(3) United States government obligations acceptable to the commissioner;(4) any other securities acceptable to the commissioner of the types referred to in IC 27-13-11-1; or(5) a combination of the items described in subdivisions (1) through (4).A deposit made under this subsection is in addition to any other required deposit, and must also be maintained in joint custody with the commissioner in the amount and subject to the same conditions required for a fidelity bond under this section.As added by P.L.26-1994, SEC.25. Amended by P.L.132-2001, SEC.19; P.L.178-2003, SEC.87.
IN Code § 27-13-34-19 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-19. Annual Reports; Additional Reports

Sec. 19. (a) On or before March 1 of each year, a limited service health maintenance organization shall file with the commissioner a report that covers the preceding calendar year. The report must be:(1) made on forms prescribed by the commissioner; and(2) verified by at least two (2) principal officers of the limited service health maintenance organization.(b) In addition to the report required by subsection (a), a limited service health maintenance organization shall file with the commissioner on or before June 1 of each year an audited financial statement of the limited service health maintenance organization for the preceding calendar year.(c) The commissioner may require any additional reports necessary to enable the commissioner to carry out the duties of the commissioner under this chapter.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-21 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-21. Chapter Violations; Fines and Penalties

Sec. 21. (a) In place of any other penalty specified in this chapter, or when no penalty is specifically provided, whenever any limited service health maintenance organization or other person, corporation, partnership, limited liability company, or entity subject to this chapter has been found to have violated any provision of this chapter, the commissioner may:(1) issue and cause to be served upon the organization, person, or entity charged with the violation a copy of the findings and an order requiring the organization, person, or entity to cease and desist from engaging in the act or practice that constitutes the violation; and(2) impose a monetary penalty of not more than two thousand five hundred dollars ($2,500) for each violation, but not to exceed an aggregate penalty of twenty-five thousand dollars ($25,000).(b) A limited service health maintenance organization may appeal any action taken by the commissioner under this section within thirty (30) days after receiving notice of the action by requesting a hearing before the commissioner under IC 4-21.5.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-22 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-22. Supervision, Rehabilitation, or Liquidation; Remedies and Measures

Sec. 22. (a) Any supervision, rehabilitation, or liquidation of a limited service health maintenance organization shall be considered to be the supervision, rehabilitation, or liquidation of an insurance company and shall be conducted under IC 27-9.(b) A limited service health maintenance organization is not subject to IC 27-6-8 or IC 27-8-8.(c) The remedies and measures available to the commissioner under this chapter are in addition to and not in the place of the remedies and measures available to the commissioner under IC 27-9.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-23 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-23. Fees

Sec. 23. (a) A limited service health maintenance organization subject to this chapter shall pay to the commissioner for deposit into the department of insurance fund established by IC 27-1-3-28 the following fees:(1) For filing an application for a certificate of authority or an amendment to an application, three hundred fifty dollars ($350).(2) For filing each annual report, fifty dollars ($50).(b) In addition to the fees required by subsection (a), a limited service health maintenance organization subject to this chapter must pay the fees required by IC 27-1-3-15.As added by P.L.26-1994, SEC.25. Amended by P.L.173-2007, SEC.45; P.L.234-2007, SEC.199.