reglab/housing_qa huggingface dataset:
IN Code § 27-8-5-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-4. Effect of Other Policy Provisions or Policy Conflicting With Chapter

Sec. 4. (a) No policy provision which is not subject to section 3 of this chapter shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this chapter.(b) A policy delivered or issued for delivery to any person in this state in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the rights, duties, and obligations of the insurer, the insured, and the beneficiary shall be governed by the provisions of this chapter.Formerly: Acts 1953, c.15, s.169.4. As amended by P.L.252-1985, SEC.303.
IN Code § 27-8-5-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-5. Application; Attaching Copy to Policy; Furnishing Copy to Insured; Alterations; Effect of False Statements

Sec. 5. (a) The insured shall not be bound by any statement made in an application for a policy unless a copy of such application is attached to or endorsed on the policy when issued as a part of the policy. If any such policy delivered or issued for delivery to any person in this state shall be reinstated or renewed, and the insured or the beneficiary or assignee of such policy shall make written request to the insurer for a copy of the application, if any, for such reinstatement or renewal, the insurer shall within fifteen (15) days after the receipt of such request at its home office or any branch office of the insurer, deliver or mail to the person making such request, a copy of such application. If such copy shall not be so delivered or mailed, the insurer shall be precluded from introducing such application as evidence in any action or proceeding based upon or involving such policy or its reinstatement or renewal.(b) No alteration of any written application for any such policy shall be made by any person other than the applicant without the applicant's written consent, except that insertions may be made by the insurer, for administrative purposes only, in such manner as to indicate clearly that such insertions are not to be ascribed to the applicant.(c) The falsity of any statement in the application for any policy covered by this chapter may not bar the right to recovery under the policy unless such false statement materially affected either the acceptance of the risk or the hazard assumed by the insurer.Formerly: Acts 1953, c.15, s.169.5. As amended by P.L.252-1985, SEC.304; P.L.136-2018, SEC.196.
IN Code § 27-8-5-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-6. Defenses of Insurer; Acts Not Constituting Waiver

Sec. 6. The acknowledgment by any insurer of the receipt of notice given under any policy covered by this chapter, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim under the policy shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under such policy.Formerly: Acts 1953, c.15, s.169.6. As amended by P.L.252-1985, SEC.305; P.L.136-2018, SEC.197.
IN Code § 27-8-5-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-7. Acceptance of Premium for Period Beyond Termination Date; Effect; Misstatement of Age

Sec. 7. If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.Formerly: Acts 1953, c.15, s.169.7.
IN Code § 27-8-5-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-8. Exemption of Accident and Sickness Coverage Incidental to Designated Other Forms of Insurance

Sec. 8. Except as otherwise expressly indicated in this section, nothing contained in sections 1 through 7 of this chapter shall apply to or affect:(1) any policy of worker's compensation insurance or any policy of liability insurance with or without supplementary coverage in the policy;(2) any policy or contract of reinsurance;(3) as to sections 2 through 7 of this chapter, any blanket or group policy of insurance;(4) life insurance, endowment, or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to accident and sickness insurance as:(A) provide additional benefits in case of death or dismemberment or loss of sight by accident; or(B) operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant shall become totally and permanently disabled, as defined by the contract or supplemental contract;(5) as to sections 2 through 5 of this chapter, any policies of accident and sickness insurance issued on the industrial plan with premiums payable on a weekly basis; or(6) transportation ticket policies sold only at public transportation stations or at public transportation ticket offices by public transportation employees, as to such of the required provisions set out in section 3 of this chapter as are incongruous with the coverage and conditions of the policies.Formerly: Acts 1953, c.15, s.169.8; Acts 1955, c.129, s.1. As amended by P.L.252-1985, SEC.306; P.L.28-1988, SEC.105.
IN Code § 27-8-5-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-9. Exemption of Certain Individual Policies

Sec. 9. An individual accident and sickness insurance policy form or any form of rider or endorsement appertaining to such a policy form, which could have been lawfully used or delivered or issued for delivery to any person in this state immediately before February 20, 1953, may be used or delivered or issued for delivery to any such person at any time prior to January 1, 1956, without being subject to the provisions of sections 2, 3, and 4 of this chapter.Formerly: Acts 1953, c.15, s.169.9. As amended by P.L.252-1985, SEC.307.
IN Code § 27-8-5-11 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-11. Franchise Plan; Accident and Sickness Insurance; Definitions, Limitations, Requirements, and Standards

Sec. 11. No policy of accident and sickness insurance on a franchise plan shall be delivered or issued for delivery to any person in this state unless it conforms to the definitions, limitations, requirements and standards in this section prescribed:(A) Qualified Groups.(1) Two (2) or more employees of any employer, inclusive of any governmental division, department or agency.(2) Ten (10) or more members of any trade, occupational or professional association or of a labor union, or of any other association or group which has had an active existence for at least two (2) years and which has a constitution or by-laws and was formed in good faith for purposes other than that of obtaining insurance.(3) Members of the family and dependents of persons eligible under (1) or (2) above may be included in the group with such eligible persons.(B) Nature of Insurance Coverage. The insurance policies issued to members of a qualified group shall be written on identical individual policy form or forms, varying only as to amounts and kinds of coverage applied for by such persons, and such policy form or forms shall otherwise fulfill the requirements of sections 2 through 9 of this chapter. The premiums for such policies may be paid to the insurer periodically by the employer, with or without payroll deduction, or by the association for its members, or by some designated person acting on behalf of such employer or association.(C) Rates, Benefits, Underwriting Procedures. Premium rates, benefits and underwriting procedures relating to such individual policies may differ from those relating to comparable individual policies issued singly, but as between comparable groups such rates, benefits and procedures shall be nondiscriminatory.Formerly: Acts 1953, c.15, s.169.11. As amended by Acts 1981, P.L.248, SEC.1.
IN Code § 27-8-5-12 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-12. Supplementary Character of Chapter

Sec. 12. This chapter while independent in its enactment of any other statute, is nevertheless a supplement to IC 27-1 and shall be so considered and construed. Accordingly, all general provisions of IC 27-1 shall be fully and completely applicable to the sections of this chapter in the same manner as though such sections were part of IC 27-1.Formerly: Acts 1953, c.15, s.169.12. As amended by P.L.252-1985, SEC.308.
IN Code § 27-8-5-13 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-13. Repeal of 1935 Act

Sec. 13. Acts 1935, c.162, s.174 is hereby expressly repealed except as to policies issued before February 20, 1953, and except as to policies which under section 9 of this chapter continue to be issued under said section 174 prior to January 1, 1956.Formerly: Acts 1953, c.15, s.169.13. As amended by P.L.252-1985, SEC.309.
IN Code § 27-8-5-14 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-14. Exception of Fraternal Benefit Associations

Sec. 14. The provisions of sections 2 and 3 of this chapter shall not be applicable to fraternal benefit associations or societies.Formerly: Acts 1953, c.15, s.169.15; Acts 1957, c.20, s.1. As amended by P.L.252-1985, SEC.310.
IN Code § 27-8-5-15.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-15.5. Inpatient Services for Treatment of Mental Illness or Substance Abuse

Sec. 15.5. (a) As used in this section:"Alcohol abuse" has the meaning set forth in IC 12-7-2-10."Community mental health center" has the meaning set forth in IC 12-7-2-38 and IC 12-7-2-39."Division of mental health and addiction" refers to the division created under IC 12-21-1-1."Drug abuse" has the meaning set forth in IC 12-7-2-72."Inpatient services" means services that require the beneficiary of the services to remain overnight in the facility in which the services are offered."Mental illness" has the meaning set forth in IC 12-7-2-130(1)."Psychiatric hospital" has the meaning set forth in IC 12-7-2-151."State department of health" refers to the department established under IC 16-19-1-1."Substance abuse" means drug abuse or alcohol abuse.(b) An insurance policy that provides coverage for inpatient services for the treatment of:(1) mental illness;(2) substance abuse; or(3) both mental illness and substance abuse;may not exclude coverage for inpatient services for the treatment of mental illness or substance abuse that are provided by a community mental health center or by any psychiatric hospital licensed by the state department of health or the division of mental health and addiction to offer those services.As added by P.L.258-1985, SEC.1. Amended by P.L.2-1992, SEC.784; P.L.2-1993, SEC.150; P.L.215-2001, SEC.104.
IN Code § 27-8-5-15.6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-15.6. Treatment Limitations or Financial Requirements on Coverage of Services for Mental Illness

Sec. 15.6. (a) As used in this section, "coverage of services for a mental illness" includes the services defined under the policy of accident and sickness insurance. However, the term does not include services for the treatment of substance abuse or chemical dependency.(b) This section applies to a policy of accident and sickness insurance that:(1) is issued on an individual basis or a group basis;(2) is issued, entered into, or renewed after December 31, 1999; and(3) is issued to an employer that employs more than fifty (50) full-time employees.(c) This section does not apply to the following:(1) A legal business entity that has obtained an exemption under section 15.7 of this chapter.(2) Accident only, credit, dental, vision, Medicare supplement, long term care, or disability income insurance.(3) Coverage issued as a supplement to liability insurance.(4) Worker's compensation or similar insurance.(5) Automobile medical payment insurance.(6) A specified disease policy.(7) 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).(8) A policy that provides indemnity benefits not based on any expense incurred requirement, including a plan that provides coverage for:(A) hospital confinement, critical illness, or intensive care; or(B) gaps for deductibles or copayments.(9) A supplemental plan that always pays in addition to other coverage.(10) A student health plan.(11) An employer sponsored health benefit plan that is:(A) provided to individuals who are eligible for Medicare; and(B) not marketed as, or held out to be, a Medicare supplement policy.(d) A group or individual insurance policy or agreement may not permit treatment limitations or financial requirements on the coverage of services for a mental illness if similar limitations or requirements are not imposed on the coverage of services for other medical or surgical conditions.(e) An insurer that issues a policy of accident and sickness insurance that provides coverage of services for the treatment of substance abuse and chemical dependency when the services are required in the treatment of a mental illness shall offer to provide the coverage without treatment limitations or financial requirements if similar limitations or requirements are not imposed on the coverage of services for other medical or surgical conditions.(f) This section does not require a group or individual insurance policy or agreement to offer mental health benefits.(g) The benefits delivered under this section may be delivered under a managed care system.As added by P.L.42-1997, SEC.2. Amended by P.L.81-1999, SEC.3; P.L.226-2003, SEC.1; P.L.173-2007, SEC.24; P.L.288-2019, SEC.3.
IN Code § 27-8-5-15.7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-15.7. Exemption of Policies or Contracts From Laws Resulting in Certain Annual Premium Increases

Sec. 15.7. (a) The department shall exempt a policy or contract issued by an insurer or health maintenance organization under IC 5-10-8-9, section 15.6 of this chapter, or IC 27-13-7-14.8 by documenting to the department that compliance with the requirements of IC 5-10-8-9(c), section 15.6(d) of this chapter, or IC 27-13-7-14.8(d) have increased the annual premium or rates charged for the policy or health maintenance organization contract by more than four percent (4%) per year. An insurer or a health maintenance organization that applies for an exemption under this section shall provide documentation that is certified by an independent member of the American Academy of Actuaries of actual mental health claims incurred for a period of not less than six (6) months to substantiate the insurer's or health maintenance organization's assertion of increased claims and administrative costs by more than four percent (4%) per year.(b) Documents submitted under this section must be available for public inspection.As added by P.L.81-1999, SEC.4.
IN Code § 27-8-5-16.3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-16.3. "Small Employer"; Implementation of Program for Joint Purchase of Health Insurance; Rules

Sec. 16.3. (a) As used in this section, "small employer" has the meaning set forth in IC 27-8-15-14.(b) The commissioner and the office of the secretary of family and social services may implement a program to allow two (2) or more small employers to join together to purchase health insurance, as described in section 16(8) of this chapter.(c) The commissioner shall adopt rules under IC 4-22-2 necessary to implement this section.As added by P.L.16-2009, SEC.29.
IN Code § 27-8-5-16.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-16.5. Conditions for Issuance of Certificate to Resident of Indiana Under Group Policy Delivered or Issued in Another State

Sec. 16.5. (a) As used in this section, "delivery state" means any state other than Indiana in which a policy is delivered or issued for delivery.(b) Except as provided in subsection (c), (d), or (e), a certificate may not be issued to a resident of Indiana pursuant to a group policy that is delivered or issued for delivery in a state other than Indiana.(c) A certificate may be issued to a resident of Indiana pursuant to a group policy not described in subsection (d) that is delivered or issued for delivery in a state other than Indiana if:(1) the delivery state has a law substantially similar to section 16 of this chapter;(2) the delivery state has approved the group policy; and(3) the policy or the certificate contains provisions that are:(A) substantially similar to the provisions required by:(i) section 19 of this chapter;(ii) section 21 of this chapter; and(iii) IC 27-8-5.6; and(B) consistent with the requirements set forth in:(i) section 24 of this chapter;(ii) IC 27-8-6;(iii) IC 27-8-14;(iv) IC 27-8-23;(v) 760 IAC 1-38.1; and(vi) 760 IAC 1-39.(d) A certificate may be issued to a resident of Indiana under an association group policy, a discretionary group policy, or a trust group policy that is delivered or issued for delivery in a state other than Indiana if:(1) the delivery state has a law substantially similar to section 16 of this chapter;(2) the delivery state has approved the group policy; and(3) the policy or the certificate contains provisions that are:(A) substantially similar to the provisions required by:(i) section 19 of this chapter or, if the policy or certificate is described in section 2.5(b)(2) of this chapter, section 2.5 of this chapter;(ii) section 19.3 of this chapter if the policy or certificate contains a waiver of coverage;(iii) section 21 of this chapter; and(iv) IC 27-8-5.6; and(B) consistent with the requirements set forth in:(i) section 15.6 of this chapter;(ii) section 24 of this chapter;(iii) section 26 of this chapter;(iv) IC 27-8-6;(v) IC 27-8-14;(vi) IC 27-8-14.1;(vii) IC 27-8-14.5;(viii) IC 27-8-14.7;(ix) IC 27-8-14.8;(x) IC 27-8-20;(xi) IC 27-8-23;(xii) IC 27-8-24.3;(xiii) IC 27-8-26;(xiv) IC 27-8-28;(xv) IC 27-8-29;(xvi) 760 IAC 1-38.1; and(xvii) 760 IAC 1-39.(e) A certificate may be issued to a resident of Indiana pursuant to a group policy that is delivered or issued for delivery in a state other than Indiana if the commissioner determines that the policy pursuant to which the certificate is issued meets the requirements set forth in section 17(a) of this chapter.(f) This section does not affect any other provision of Indiana law governing the terms or benefits of coverage provided to a resident of Indiana under any certificate or policy of insurance.As added by P.L.185-1996, SEC.12. Amended by P.L.96-2002, SEC.1; P.L.211-2003, SEC.3; P.L.127-2006, SEC.2; P.L.11-2011, SEC.30.
IN Code § 27-8-5-17 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-17. Exceptions; Discretionary Groups; Group Accident and Sickness Insurance

Sec. 17. (a) A group accident and sickness insurance policy shall not be delivered or issued for delivery in Indiana to a group that is not described in section 16(1)(A), 16(2)(A), 16(3)(A), 16(4)(A), 16(5)(A), 16(6)(A), 16(7), or 16(8) of this chapter unless:(1) the group applies to the commissioner for approval as a discretionary group;(2) the commissioner reviews the group according to the same standards as a group described in section 16 of this chapter; and(3) the commissioner finds that:(A) the issuance of the policy is not contrary to the best interest of the public;(B) the issuance of the policy would result in economies of acquisition or administration; and(C) the benefits of the policy are reasonable in relation to the premiums charged.(b) Except as otherwise provided in this chapter, an insurer may exclude or limit the coverage under a policy described in subsection (a) on any person as to whom evidence of individual insurability is not satisfactory to the insurer.As added by P.L.257-1985, SEC.3. Amended by P.L.268-1987, SEC.2; P.L.125-1992, SEC.2; P.L.185-1996, SEC.13; P.L.218-2007, SEC.47; P.L.11-2011, SEC.31.
IN Code § 27-8-5-18 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 5. Accident and Sickness Insurance─policy Provisions|27-8-5-18. Extension to Family Members or Dependents; Premiums; Exclusions; Group Accident and Sickness Insurance

Sec. 18. (a) Except for a policy that conforms to the description in section 16(2) of this chapter, a group accident and sickness insurance policy may be extended to insure the employees or members, or any class or classes of employees or members, with respect to their family members or dependents, subject to subsections (b) and (c).(b) The premium for the insurance must be paid from funds contributed by the employer, union, association, or other person to whom the policy has been issued or from funds contributed by the covered persons, or from both sources of funds. Except as provided in subsection (c), a policy on which no part of the premium for the coverage of family members or dependents is to be derived from funds contributed by the covered persons must insure all eligible employees or members, or any class or classes of eligible employees or members, with respect to their spouses and dependent children.(c) Except as provided in section 24 of this chapter, an insurer may exclude or limit the coverage on any family member or dependent as to whom evidence of individual insurability is not satisfactory to the insurer.As added by P.L.257-1985, SEC.4. Amended by P.L.125-1992, SEC.3.