reglab/housing_qa huggingface dataset:
IN Code § 27-13-12-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 12. Protection Against Insolvency; Net Worth Requirements|27-13-12-6. Adoption of Rules

Sec. 6. The commissioner may adopt rules to further define whether and to what extent the assets of a health maintenance organization may be considered admitted assets for purposes of complying with the requirements of this chapter.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-13-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 13. Protection Against Insolvency; Deposit Requirements|27-13-13-1. Items Deposited; Minimum Value

Sec. 1. Except as provided in this chapter, a health maintenance organization shall deposit with the commissioner or, at the discretion of the commissioner, with any bank or bank and trust company or other trustee acceptable to the commissioner through which a custodial or controlled account is used:(1) cash;(2) certificates of deposit;(3) United States government obligations acceptable to the commissioner;(4) any other securities acceptable to the commissioner; or(5) a combination of items described in subdivisions (1) through (4);which at all times must have a value of at least five hundred thousand dollars ($500,000).As added by P.L.26-1994, SEC.25.
IN Code § 27-13-13-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 13. Protection Against Insolvency; Deposit Requirements|27-13-13-2. Deposit Schedule

Sec. 2. A health maintenance organization that is in operation on July 1, 1994, shall make:(1) a deposit with the commissioner equal to two hundred fifty thousand dollars ($250,000) on July 1, 1994; and(2) an additional deposit with the commissioner equal to two hundred fifty thousand dollars ($250,000) by December 31, 1995.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-13-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 13. Protection Against Insolvency; Deposit Requirements|27-13-13-3. Deposits Considered Admitted Asset

Sec. 3. Deposits made under this chapter shall be considered an admitted asset of the health maintenance organization in the determination of the net worth of the organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-13-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 13. Protection Against Insolvency; Deposit Requirements|27-13-13-4. Income From Deposits; Replacing Deposits

Sec. 4. (a) All income from deposits made under this chapter is an asset of the organization that made the deposits.(b) A health maintenance organization that has made a deposit under this chapter may replace the deposit or any part of the deposit with an equal amount and value of:(1) cash;(2) certificates of deposit;(3) United States government obligations acceptable to the commissioner;(4) any other securities acceptable to the commissioner; or(5) any combination of subdivisions (1) through (4).(c) Any obligations of the United States government must be approved by the commissioner before being deposited or substituted under this chapter.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-13-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 13. Protection Against Insolvency; Deposit Requirements|27-13-13-5. Use of Deposit

Sec. 5. (a) A deposit made by a health maintenance organization under this chapter must be used to protect the interest of the enrollees of the health maintenance organization.(b) The commissioner may use the deposit for administrative costs that are attributable to a receivership of the health maintenance organization.(c) If the health maintenance organization is placed in receivership, the deposit made by the organization must be treated as an asset of the organization subject to IC 27-9.As added by P.L.26-1994, SEC.25. Amended by P.L.208-2018, SEC.28.
IN Code § 27-13-13-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 13. Protection Against Insolvency; Deposit Requirements|27-13-13-6. Reduction or Elimination of Deposit Requirements for Foreign Corporations

Sec. 6. The commissioner may reduce or eliminate the requirement of a deposit under this chapter for a health maintenance organization that is a foreign corporation as defined in IC 27-1-2-3 if:(1) the organization makes a deposit that meets the requirements of section 1 of this chapter with the treasurer of state, insurance commissioner, or other official body of the state or jurisdiction in which the organization is domiciled for the protection of all subscribers and enrollees of the health maintenance organization; and(2) the organization delivers to the commissioner a certificate, duly authenticated by the appropriate state official holding the deposit, that the requirements of this section have been met.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-13-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 13. Protection Against Insolvency; Deposit Requirements|27-13-13-7. Return of Deposit

Sec. 7. If:(1) a health maintenance organization ceases operation for reasons other than:(A) insolvency; or(B) receivership;(2) the organization is not a debtor in any pending bankruptcy proceeding;(3) the health maintenance organization submits a request in writing to the commissioner for the return of the deposit made by the organization; and(4) the health maintenance organization has furnished the commissioner with written proof that all claims liabilities of the health maintenance organization have been paid;the commissioner shall return all or a part of the deposit to the health maintenance organization not more than thirty (30) days after the commissioner receives written proof from the organization under subdivision (4).As added by P.L.26-1994, SEC.25.
IN Code § 27-13-13-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 13. Protection Against Insolvency; Deposit Requirements|27-13-13-8. Additional Financial Requirements

Sec. 8. (a) In addition to meeting all other financial requirements imposed by IC 27-13-12 and this chapter, a health maintenance organization that offers a point of service product shall maintain either of the following:(1) A reinsurance agreement, which must be satisfactory to the commissioner, that cedes one hundred percent (100%) of the liability for out-of-plan services.(2) A ratio of the revenues of the health maintenance organization from the point of service product to the net worth of the organization of not more than three (3) to one (1).(b) The reinsurance to which subsection (a)(1) refers may be used to:(1) directly make payments for out-of-plan services; or(2) reinsure coverage for out-of-plan services.(c) To achieve the ratio referred to in subsection (a)(2), a health maintenance organization may use reinsurance to cede part or all of the liability for out-of-plan services.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-14-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 14. Protection Against Insolvency; Liabilities|27-13-14-1. Determination of Liabilities

Sec. 1. When determining its liabilities, a health maintenance organization shall include an amount estimated in the aggregate to provide:(1) for any unearned premium;(2) for the payment of all claims for health care expenditures, whether reported or unreported:(A) that have been incurred;(B) that are unpaid; and(C) for which the organization is or may be liable; and(3) for the expense of adjustment or settlement of claims described in subdivision (2).As added by P.L.26-1994, SEC.25.
IN Code § 27-13-14-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 14. Protection Against Insolvency; Liabilities|27-13-14-2. Computation of Liabilities

Sec. 2. The liabilities of a health maintenance organization must be computed:(1) in accordance with rules adopted by the commissioner; and(2) upon reasonable consideration of the ascertained experience and character of the health maintenance organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-15-0.1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 15. Participating Providers; Contracts and Legal Actions|27-13-15-0.1. Application of Certain Amendments to Chapter

Sec. 0.1. The addition of section 4 of this chapter by P.L.74-2007 applies to a contract between a health maintenance organization and a participating provider that is entered into, amended, or renewed on or after April 26, 2007.As added by P.L.220-2011, SEC.460.
IN Code § 27-13-15-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 15. Participating Providers; Contracts and Legal Actions|27-13-15-1. Contract Requirements; Enrollee Coverage; Payment of Provider; Application

Sec. 1. (a) A contract between a health maintenance organization and a participating provider of health care services:(1) must be in writing;(2) may not prohibit the participating provider from disclosing:(A) the terms of the contract as it relates to financial or other incentives to limit medical services by the participating provider; or(B) all treatment options available to an insured, including those not covered by the insured's policy;(3) may not provide for a financial or other penalty to a provider for making a disclosure permitted under subdivision (2); and(4) must provide that in the event the health maintenance organization fails to pay for health care services as specified by the contract, the subscriber or enrollee is not liable to the participating provider for any sums owed by the health maintenance organization.(b) An enrollee is not entitled to coverage of a health care service under a group or an individual contract unless that health care service is included in the enrollee's contract.(c) A provider is not entitled to payment under a contract for health care services provided to an enrollee unless the provider has a contract or an agreement with the carrier.(d) This section applies to a contract entered, renewed, or modified after June 30, 1996.As added by P.L.26-1994, SEC.25. Amended by P.L.195-1996, SEC.7; P.L.192-1996, SEC.3.
IN Code § 27-13-15-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 15. Participating Providers; Contracts and Legal Actions|27-13-15-2. Contract Requirements Not Met; Collection of Money Owed by Health Maintenance Organization Prohibited

Sec. 2. If:(1) the contract between a health maintenance organization and a participating provider has not been reduced to writing as required by this chapter; or(2) the contract fails to contain the provision required by section 1(a)(4) of this chapter;the participating provider may not collect or attempt to collect from the subscriber or enrollee any sums that are owed by the health maintenance organization.As added by P.L.26-1994, SEC.25. Amended by P.L.203-2001, SEC.25.
IN Code § 27-13-15-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 15. Participating Providers; Contracts and Legal Actions|27-13-15-3. Actions Against Subscribers; Costs and Attorney's Fees

Sec. 3. (a) A:(1) participating provider; or(2) trustee, an agent, a representative, or an assignee of a participating provider;may not bring or maintain any legal action against a subscriber or an enrollee of a health maintenance organization to collect sums owed by the health maintenance organization.(b) Except as provided in subsection (c), if a participating provider of a health maintenance organization brings or maintains a legal action against a subscriber or enrollee for an amount owed to the participating provider by the health maintenance organization, the participating provider is liable to the subscriber or enrollee for costs and attorney's fees incurred by the subscriber or enrollee in defending the legal action.(c) A participating provider shall not be liable to the subscriber or enrollee for costs and attorney's fees described in subsection (b) if the participating provider can demonstrate a reasonable basis for believing at the time the legal action was brought and while the legal action was maintained that the health maintenance organization did not owe the sums the participating provider sought to collect from the subscriber or enrollee.As added by P.L.26-1994, SEC.25. Amended by P.L.203-2001, SEC.26.
IN Code § 27-13-15-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 15. Participating Providers; Contracts and Legal Actions|27-13-15-4. Participating Provider Agreement Prohibitions

Sec. 4. (a) As used in this section, "health maintenance organization" includes the following:(1) A limited service health maintenance organization.(2) A person that pays or administers claims on behalf of a health maintenance organization or a limited service health maintenance organization.(b) An agreement between a health maintenance organization and a participating provider under this chapter may not contain a provision that:(1) prohibits, or grants the health maintenance organization an option to prohibit, the participating provider from contracting with another health maintenance organization to accept lower payment for health care services than the payment specified in the agreement;(2) requires, or grants the health maintenance organization an option to require, the participating provider to accept a lower payment from the health maintenance organization if the participating provider agrees with another health maintenance organization to accept lower payment for health care services;(3) requires, or grants the health maintenance organization an option of, termination or renegotiation of the agreement if the participating provider agrees with another health maintenance organization to accept lower payment for health care services; or(4) requires the participating provider to disclose the participating provider's reimbursement rates under contracts with other health maintenance organizations.(c) A contract provision that violates this section is void.As added by P.L.74-2007, SEC.2.
IN Code § 27-13-15-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 15. Participating Providers; Contracts and Legal Actions|27-13-15-5. Coverage for Dialysis Treatment

Sec. 5. (a) Notwithstanding IC 27-13-1-12, as used in this section, "enrollee" refers only to an enrollee who requires dialysis treatment.(b) As used in this section, "health maintenance organization" includes the following:(1) A limited service health maintenance organization.(2) An agent of a health maintenance organization or a limited service health maintenance organization.(c) A health maintenance organization shall not require an enrollee, as a condition of coverage or reimbursement, to:(1) if the nearest dialysis facility is located within thirty (30) miles of the enrollee's home, travel more than thirty (30) miles from the enrollee's home to obtain dialysis treatment; or(2) if the nearest dialysis facility is located more than thirty (30) miles from the enrollee's home, travel a greater distance than the distance to the nearest dialysis facility to obtain dialysis treatment;regardless of whether the enrollee chooses to receive dialysis treatment at a dialysis facility that is a participating provider or a dialysis facility that is not a participating provider.As added by P.L.111-2008, SEC.6.
IN Code § 27-13-15-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 15. Participating Providers; Contracts and Legal Actions|27-13-15-6. Right to Provide Prescription Cost Information; Point of Sale Cost Limit; Pharmacist May Not Be Required to Collect Higher Copayment

Sec. 6. (a) As used in this section, "drug" means a prescription drug.(b) As used in this section, "health maintenance organization" refers to a health maintenance organization that provides coverage for drugs. The term includes the following:(1) A limited service health maintenance organization.(2) A person that administers drug benefits on behalf of a health maintenance organization or a limited service health maintenance organization.(c) As used in this section, "pharmacy" refers to a pharmacist or pharmacy that is a participating provider.(d) A pharmacy or pharmacist shall have the right to provide an enrollee with information concerning the amount of the enrollee's cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be proscribed by a health maintenance organization from discussing this information or from selling to the enrollee a more affordable alternative if an affordable alternative is available.(e) A health maintenance organization that covers prescription drugs may not include a provision that requires an enrollee to make payment for a prescription drug at the point of sale in an amount that exceeds the lesser of:(1) the contracted copayment amount; or(2) the amount of total approved charges by the health maintenance organization at the point of sale.This subsection does not prohibit the adjudication of claims in accordance with an individual contract or group contract issued or administered by a health maintenance organization. The enrollee is not liable for any additional charges or entitled to any credits as a result of the adjudicated claim.(f) The health maintenance organization or a pharmacy benefits manager may not require a pharmacy or pharmacist to collect a higher copayment for a prescription drug from an enrollee than the health maintenance organization or pharmacy benefits manager allows the pharmacy or pharmacist to retain.As added by P.L.209-2018, SEC.13. Amended by P.L.114-2020, SEC.21.
IN Code § 27-13-17-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 17. Protection Against Insolvency; Notice of Termination|27-13-17-1. Notice Requirements Before Termination of Agreement by Provider

Sec. 1. An agreement between a provider and a health maintenance organization under which the provider agrees to provide health care services must require the provider to give the organization at least sixty (60) days advance notice before terminating the agreement unless the provider or the group of providers provide thirty percent (30%) or more of the health maintenance organization services, in which case the provider must give at least one hundred twenty (120) days advance notice.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-19-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 19. Replacement Coverage in Event of Receivership|27-13-19-1. "Discontinuance" Defined

Sec. 1. As used in this chapter, "discontinuance" means the termination of the contract between a group contract holder and a health maintenance organization due to the receivership of the health maintenance organization. The term does not refer to the termination of an individual contract.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-19-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 19. Replacement Coverage in Event of Receivership|27-13-19-2. Replacement Coverage; Challenge of Enrollee

Sec. 2. (a) A carrier that provides replacement coverage with respect to group health care services after the discontinuance of the prior health maintenance organization contract or policy providing health care services must, immediately upon beginning to provide the replacement coverage, cover all enrollees who were covered under the previous health maintenance organization contract or policy on the date of discontinuance.(b) A carrier that provides replacement coverage under this section may challenge whether an individual designated as an enrollee under the previous health maintenance organization contract qualified as an enrollee under the previous health maintenance organization contract.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-19-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 19. Replacement Coverage in Event of Receivership|27-13-19-3. Provisions Reducing or Excluding Benefits

Sec. 3. (a) Except as provided in subsection (b), a provision in a succeeding carrier's contract of replacement coverage that would operate to reduce or exclude benefits on the basis that the condition giving rise to the benefits preexisted the effective date of the succeeding carrier's contract may not be applied with respect to those enrollees who were covered under the prior carrier's contract or policy on the date of discontinuance.(b) A provision in a succeeding carrier's contract of replacement coverage may operate to reduce or exclude benefits on the basis of a preexisting condition to the extent that the prior carrier's contract or policy would have required that benefits for the condition be reduced or excluded.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-20-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 20. Filing Requirements|27-13-20-1. Rates; Approval

Sec. 1. The rates to be used by a health maintenance organization, including the actuarial assumptions underlying those rates, must be filed with the commissioner for approval and:(1) must be established in accordance with actuarial principles for various categories of enrollees and, in the case of a group contract, shall not be individually determined based on the status of an enrollee's health;(2) must be developed by an actuary or other qualified person acceptable to the commissioner; and(3) may not be excessive, inadequate, or unfairly discriminatory.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-20-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 20. Filing Requirements|27-13-20-2. Approval of Documents by Commissioner

Sec. 2. (a) Except as provided in subsection (b), a document submitted to the commissioner under this chapter is deemed approved when one (1) of the following conditions is met:(1) The health maintenance organization receives a written communication of approval from the commissioner.(2) Thirty (30) days pass after the commissioner receives the document.(b) A document is not deemed approved under subsection (a)(2) if, within thirty (30) days after the commissioner receives the document, or within any period of extension granted by the commissioner, the commissioner deposits in the United States mail addressed to the health maintenance organization a written communication to the contrary. Not more than thirty (30) days after receiving the written communication from the commissioner, the health maintenance organization may request a hearing. If, not more than thirty (30) days after receiving the communication from the commissioner, the health maintenance organization requests a hearing, the commissioner shall hold a hearing upon not less than ten (10) days notice to the health maintenance organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-21-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 21. Insurance Producers of Health Maintenance Organizations and Limited Service Health Maintenance Organizations|27-13-21-1. Licensing of Insurance Producer

Sec. 1. To qualify to represent a health maintenance organization or a limited service health maintenance organization, an insurance producer shall be licensed with an accident and health or sickness qualification under IC 27-1-15.6-7.As added by P.L.26-1994, SEC.25. Amended by P.L.132-2001, SEC.18; P.L.178-2003, SEC.86.