reglab/housing_qa huggingface dataset:
IN Code § 27-13-22-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 22. Powers of Insurers and Hospital Corporations|27-13-22-1. Operation of Health Maintenance Organization by Insurer or Hospital

Sec. 1. (a) A licensed insurer or a hospital authorized to conduct business in Indiana may, through a subsidiary or an affiliate, organize and operate a health maintenance organization under this article.(b) This section does not apply to a health maintenance organization granted a certificate of authority under this article before July 1, 2001.As added by P.L.26-1994, SEC.25. Amended by P.L.203-2001, SEC.28.
IN Code § 27-13-22-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 22. Powers of Insurers and Hospital Corporations|27-13-22-2. Joint Organization or Operation as Health Maintenance Organization

Sec. 2. Notwithstanding any other law:(1) insurers;(2) hospitals; or(3) subsidiaries or affiliates of entities referred to in subdivisions (1) and (2);may jointly organize and operate a health maintenance organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-22-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 22. Powers of Insurers and Hospital Corporations|27-13-22-3. Business of Insurance Including Health Care Maintenance Organizations

Sec. 3. For the purposes of IC 27-1-2-2, the business of insurance includes the providing of health care services by a health care maintenance organization owned or operated by an insurer or a subsidiary of an insurer.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-22-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 22. Powers of Insurers and Hospital Corporations|27-13-22-4. Contracting With Health Maintenance Organizations to Provide Insurance Coverage

Sec. 4. An insurer or a hospital may contract with a health maintenance organization to provide to the health maintenance organization:(1) insurance coverage or similar protection against the cost of health care services provided through the health maintenance organization; or(2) insurance coverage in the event of the failure of the health maintenance organization to meet its obligations to enrollees or providers.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-22-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 22. Powers of Insurers and Hospital Corporations|27-13-22-5. Benefit Payments to Health Maintenance Organization; Contract Provisions

Sec. 5. Under a contract between an insurer or a hospital and a health maintenance organization under section 4 of this chapter, the insurer or hospital may make benefit payments to the health maintenance organization for health care services for which the health maintenance organization is liable.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-23-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 23. Examinations|27-13-23-1. Health Maintenance Organization Examination

Sec. 1. The commissioner may make an examination of a health maintenance organization whenever necessary for the protection of the interests of the citizens of Indiana. However, an examination of a health maintenance organization domiciled in Indiana must be conducted at least once every three (3) years.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-23-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 23. Examinations|27-13-23-2. Quality Management Program Examination

Sec. 2. The commissioner may make an examination concerning the quality management program of a health maintenance organization whenever necessary for the protection of the citizens of Indiana. However, an examination of the quality management program of a health maintenance organization domiciled in Indiana must be conducted at least once every three (3) years.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-23-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 23. Examinations|27-13-23-3. Availability of Books and Records

Sec. 3. Each health maintenance organization that is subject to an examination under this chapter shall make its books and records, and the books and records in its custody or control, available for examination and otherwise facilitate the completion of the examination.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-23-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 23. Examinations|27-13-23-4. Officers and Agents; Oaths and Examination by Commissioner

Sec. 4. When conducting an examination of a health maintenance organization, the commissioner:(1) may administer oaths to; and(2) examine;the officers and agents of the health maintenance organization concerning the business of the organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-23-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 23. Examinations|27-13-23-5. Expenses of Examination

Sec. 5. The expenses incurred by the commissioner in conducting an examination under this chapter must be paid by the health maintenance organization being examined.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-23-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 23. Examinations|27-13-23-6. Health Maintenance Organizations Outside Indiana; Reports of Other Insurance Commissioners

Sec. 6. Instead of conducting an examination of a health maintenance organization that is not domiciled in Indiana, the commissioner may accept the report of an examination made by the insurance commissioner of 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.94.
IN Code § 27-13-23-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 23. Examinations|27-13-23-7. Annual Review of Hedis Data

Sec. 7. (a) Beginning July 1, 1999, the commissioner shall review each health maintenance organization's Health Plan Employer Data and Information Set (HEDIS) data on an annual basis.(b) The commissioner may contract with an appropriate entity to conduct the reviews required under this section.As added by P.L.69-1998, SEC.9.
IN Code § 27-13-23-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 23. Examinations|27-13-23-8. Filing Examination Reports of Other States

Sec. 8. A health maintenance organization shall file a copy of any examination report filed by the insurance commissioner of another state during the preceding calendar year with the annual statement required under IC 27-13-8-1.As added by P.L.203-2001, SEC.29.
IN Code § 27-13-24-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 24. Suspension, Revocation, or Denial of Certificate of Authority|27-13-24-1. Grounds for Suspension or Revocation

Sec. 1. (a) The commissioner may suspend or revoke a certificate of authority issued under this article or deny an application submitted under this article if the commissioner finds that any of the following conditions exists:(1) The health maintenance organization is operating:(A) significantly in contravention of its basic organizational document; or(B) in a manner contrary to that described in any other information submitted under IC 27-13-2;unless amendments to the basic organizational document or other submissions that are consistent with the operations of the organization have been filed with and approved by the commissioner.(2) The health maintenance organization:(A) issues an evidence of coverage;(B) enters into a contract with a participating provider; or(C) uses a schedule of charges for health care services;that does not comply with the requirements of IC 27-13-7, IC 27-13-15, and IC 27-13-20.(3) The health maintenance organization does not provide or arrange for basic health care services.(4) The commissioner determines that the health maintenance organization is unable to fulfill its obligations to furnish health care coverage.(5) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees.(6) The health maintenance organization has failed to correct, within the time prescribed by section 2 of this chapter, any deficiency occurring due to the impairment of the prescribed minimum net worth of the health maintenance organization.(7) The health maintenance organization has failed to implement the grievance procedures required by IC 27-13-10 in a reasonable manner to resolve valid complaints.(8) The health maintenance organization or any person acting on behalf of the organization has intentionally advertised or merchandised the services of the organization in an untrue, a misrepresentative, a misleading, a deceptive, or an unfair manner.(9) The continued operation of the health maintenance organization would be hazardous to the enrollees of the organization.(10) The health maintenance organization fails to comply with the requirements provided under IC 27-13-36 through IC 27-13-40.(11) The health maintenance organization has otherwise failed substantially to comply with this article.(b) The commissioner, in a proceeding under IC 4-21.5-3-8, may impose a civil penalty of not more than twenty-five thousand dollars ($25,000) against a health maintenance organization for each cause listed in subsection (a). The civil penalties may not exceed one hundred thousand dollars ($100,000) for any one (1) health maintenance organization in one (1) calendar year. The penalty may be imposed in addition to or instead of a suspension or revocation of the certificate of authority of the health maintenance organization.As added by P.L.26-1994, SEC.25. Amended by P.L.69-1998, SEC.10.
IN Code § 27-13-24-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 24. Suspension, Revocation, or Denial of Certificate of Authority|27-13-24-2. Deficient Net Worth

Sec. 2. (a) If the commissioner finds that the net worth maintained by a health maintenance organization subject to this article is less than the minimum net worth required by IC 27-13-12, the commissioner shall:(1) give written notice to the health maintenance organization of the amount of the deficiency; and(2) require the health maintenance organization to:(A) file with the commissioner a plan for correction of the deficiency that is acceptable to the commissioner; and(B) correct the deficiency within a reasonable time, not to exceed sixty (60) days, unless an extension of time, not to exceed an additional sixty (60) days, is granted by the commissioner.(b) A deficiency described in subsection (a) is an impairment, and the failure of a health maintenance organization to correct the impairment in the time prescribed by the commissioner under subsection (a) is grounds for:(1) the suspension or revocation of the certificate of authority of the organization; or(2) placing the health maintenance organization in rehabilitation or liquidation.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-24-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 24. Suspension, Revocation, or Denial of Certificate of Authority|27-13-24-4. Action by Commissioner After Hearing

Sec. 4. (a) After a hearing, or upon failure of the health maintenance organization or applicant to appear at the hearing, the commissioner shall:(1) take whatever action the commissioner finds necessary and appropriate based on written findings; and(2) mail the decision to the health maintenance organization or applicant.(b) The action of the commissioner under this chapter is subject to review under IC 4-21.5.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-24-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 24. Suspension, Revocation, or Denial of Certificate of Authority|27-13-24-5. Application of Ic 4-21.5

Sec. 5. IC 4-21.5 applies to proceedings under this chapter to the extent IC 4-21.5 does not conflict with any section of this chapter.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-24-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 24. Suspension, Revocation, or Denial of Certificate of Authority|27-13-24-6. Prohibited Activity During Suspension

Sec. 6. A health maintenance organization whose certificate of authority is suspended may not, during the period of suspension:(1) enroll any additional enrollees, except newborn children or other newly acquired dependents of existing enrollees; or(2) engage in any advertising or solicitation.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-24-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 24. Suspension, Revocation, or Denial of Certificate of Authority|27-13-24-7. Conclusion of Affairs Following Revocation of Certificate of Authority

Sec. 7. (a) A health maintenance organization whose certificate of authority is revoked:(1) shall proceed, immediately following the effective date of the order of revocation, to wind up the affairs of the organization; and(2) may not conduct further business, except as essential to the orderly conclusion of the affairs of the organization.(b) After the certificate of authority of a health maintenance organization is revoked, the health maintenance organization may not engage in further advertising or solicitation.(c) Notwithstanding subsection (a), the commissioner may, by written order, permit further operation of a health maintenance organization after the certificate of authority of the organization is revoked if the commissioner finds the further operation of the organization to be in the best interest of enrollees.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-24-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 24. Suspension, Revocation, or Denial of Certificate of Authority|27-13-24-8. Prohibited Activities Before Hearing

Sec. 8. If the commissioner issues an order under section 3(b)(1) of this chapter and the health maintenance organization requests a hearing under section 3(d) of this chapter within the time period specified, the health maintenance organization may not:(1) enroll any additional enrollees, except newborn children or other newly acquired dependents of existing enrollees; or(2) engage in any advertising or solicitation;until the commissioner takes action under section 4 of this chapter.As added by P.L.26-1994, SEC.25. Amended by P.L.195-1996, SEC.9.
IN Code § 27-13-25-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 25. Rehabilitation or Liquidation of Health Maintenance Organizations|27-13-25-1. Rehabilitation or Liquidation as an Insurance Company; Applicability of Ic 27-9

Sec. 1. The rehabilitation or liquidation of a health maintenance organization:(1) shall be considered to be the rehabilitation or liquidation of an insurance company; and(2) shall be conducted under IC 27-9.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-25-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 25. Rehabilitation or Liquidation of Health Maintenance Organizations|27-13-25-2. Appointment of Commissioner as Rehabilitator or Liquidator; Grounds

Sec. 2. The commissioner may apply for an order appointing the commissioner as rehabilitator or liquidator to rehabilitate or liquidate a health maintenance organization:(1) upon at least one (1) of the grounds set forth in IC 27-9-3-1 or IC 27-9-3-6; or(2) when, in the commissioner's opinion, the continued operation of the health maintenance organization would be hazardous to the enrollees of the organization or the people of Indiana.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-25-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 25. Rehabilitation or Liquidation of Health Maintenance Organizations|27-13-25-3. Claims Against Health Maintenance Organization

Sec. 3. (a) In the liquidation of a health maintenance organization, the claims against the health maintenance organization by enrollees, beneficiaries, and providers qualify as class 3 claims under IC 27-9-3-40(3).(b) If an enrollee is liable to a provider for services provided under and covered by a health maintenance organization, that liability has the status of an enrollee claim in the liquidation of a health maintenance organization. If the health maintenance organization in liquidation pays the provider the amount of a claim under this subsection, then the claim of the enrollee is extinguished.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-26-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 26. Summary of Orders and Supervision|27-13-26-1. Hazardous Financial Condition; Corrective Action Ordered by Commissioner

Sec. 1. (a) If the commissioner determines that:(1) the financial condition of a health maintenance organization is such that the continued operation of the organization might be hazardous to:(A) the subscribers, enrollees, or creditors of the organization; or(B) the general public; or(2) the organization has violated any provision of this article;the commissioner may, after notice and hearing, order the health maintenance organization to take action reasonably necessary to rectify the condition or violation.(b) An order of the commissioner under subsection (a) may require a health maintenance organization to do one (1) or more of the following:(1) Reduce the total amount of present and potential liability for benefits by reinsurance or another method acceptable to the commissioner.(2) Reduce the volume of new business being accepted.(3) Reduce expenses by specified methods.(4) Suspend or limit the writing of new business for a period of time.(5) Increase the capital and surplus of the health maintenance organization by contribution.(6) Take other steps the commissioner considers appropriate under the circumstances.(c) The commissioner's order under this section may require items in addition to those set forth in subsection (b).As added by P.L.26-1994, SEC.25.
IN Code § 27-13-26-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 26. Summary of Orders and Supervision|27-13-26-2. Violation of Article

Sec. 2. For purposes of section 1(a)(2) of this chapter, the violation by a health maintenance organization of any Indiana law to which the health maintenance organization is subject is considered a violation of this article.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-26-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 26. Summary of Orders and Supervision|27-13-26-3. Adoption of Rules; Uniform Standards Set by Commissioner

Sec. 3. (a) The commissioner may adopt rules under IC 4-22-2 to do the following:(1) Set uniform standards and criteria to produce an early warning that the continued operation of a health maintenance organization might be hazardous to the subscribers, enrollees, or creditors of the organization or to the general public.(2) Set standards for evaluating the financial condition of a health maintenance organization.(b) The standards set under subsection (a)(2) must be consistent with the purposes expressed in section 1 of this chapter.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-26-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 26. Summary of Orders and Supervision|27-13-26-4. Remedies and Measures

Sec. 4. The remedies and measures available to the commissioner under this chapter are in addition to and not in 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 § 27-13-27-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 27. Fees|27-13-27-1. Filing Fees

Sec. 1. Each health maintenance organization subject to this article shall pay to the commissioner for deposit into the department of insurance fund established by IC 27-1-3-28 the following fees:(1) Three hundred fifty dollars ($350) for filing:(A) an application for a certificate of authority; or(B) an application for an amendment to a certificate of authority.(2) Fifty dollars ($50) for filing each annual report.As added by P.L.26-1994, SEC.25. Amended by P.L.173-2007, SEC.44; P.L.234-2007, SEC.198.
IN Code § 27-13-27-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 27. Fees|27-13-27-2. Fees Required by Ic 27-1-3-15

Sec. 2. In addition to the fees required by section 1 of this chapter, a health maintenance organization subject to this article must pay the fees required by IC 27-1-3-15. For purposes of IC 27-1-3-15, a contract between a health maintenance organization and a subscriber or enrollee and an evidence of coverage shall constitute a single policy.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-28-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 28. Penalties and Enforcement|27-13-28-1. Augmentation of Penalty; Damages Suffered by Enrollees or Other Members of the Public

Sec. 1. The commissioner may augment a penalty imposed under IC 27-13-24-1(b) by an amount equal to the sum that the commissioner calculates to be the damages suffered by enrollees or other members of the public. The commissioner may direct that any penalty imposed under this section be paid to the enrollees or other members of the public damaged by the health maintenance organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-28-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 28. Penalties and Enforcement|27-13-28-2. Conference to Determine Violations

Sec. 2. If the commissioner has cause to believe that a violation of this article by a health maintenance organization has occurred or is threatened, the commissioner may give notice to:(1) the health maintenance organization; and(2) the other persons who appear to be involved in the suspected violation;to arrange a conference with the alleged violators or their authorized representatives for the purpose of attempting to determine the facts relating to the suspected violation and, if a violation has occurred or is threatened, to determine an adequate and effective means of correcting or preventing the violation.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-28-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 28. Penalties and Enforcement|27-13-28-3. Procedural Requirements

Sec. 3. Proceedings under section 2 of this chapter are not governed by any formal procedural requirements and may be conducted in a manner the commissioner considers appropriate under the circumstances. However, a conference under section 2 of this chapter may not result in a rule or an order until the requirements of section 2 of this chapter are satisfied, unless the health maintenance organization consents to the rule or order.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-28-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 28. Penalties and Enforcement|27-13-28-4. Cease and Desist Orders

Sec. 4. (a) The commissioner may issue an order directing:(1) a health maintenance organization; or(2) a representative of a health maintenance organization;to cease and desist from engaging in any act or practice that violates this article.(b) Within ten (10) days after a cease and desist order is served under subsection (a), the health maintenance organization or its representative may request a hearing on the question of whether acts or practices in violation of this article have occurred. The hearing must be conducted under IC 4-21.5.As added by P.L.26-1994, SEC.25.