reglab/housing_qa huggingface dataset:
IN Code § 27-13-28-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 28. Penalties and Enforcement|27-13-28-5. Injunctive or Other Relief

Sec. 5. In the case of a violation of this article, if the commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued under section 4 of this chapter, the commissioner may institute a proceeding to obtain injunctive relief or other appropriate relief in the Marion County circuit court.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-28-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 28. Penalties and Enforcement|27-13-28-6. Failure to Comply With Net Worth Requirements; Continued Operation

Sec. 6. Notwithstanding any other provision of this article, if a health maintenance organization fails to comply with the net worth requirement of this article, the commissioner may take appropriate action to assure that the continued operation of the health maintenance organization will not be hazardous to the enrollees of the organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-28-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 28. Penalties and Enforcement|27-13-28-7. Investigations on Behalf of Enrollees or Providers Not Precluded

Sec. 7. This article does not preclude the department from investigating complaints, grievances, or appeals on behalf of enrollees or providers.As added by P.L.69-1998, SEC.11.
IN Code § 27-13-29-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 29. Statutory Construction and Relationship to Other Laws|27-13-29-1. Applicability of Provisions

Sec. 1. (a) Except as provided in subsection (b) or as otherwise provided in this article or IC 27:(1) IC 27; and(2) the provisions of IC 16 regulating hospitals;do not apply to any health maintenance organization or limited service health maintenance organization (as defined in IC 27-13-34-4) that is granted a certificate of authority under this article. However, this section does not apply to an insurer or a hospital that is licensed under Indiana law, except with respect to the health maintenance organization activities of the hospital or insurer that are authorized and regulated under this article.(b) Every:(1) health maintenance organization; and(2) limited service health maintenance organization (as defined in IC 27-13-34-4);authorized to do business in Indiana is subject to IC 27-4-1 relating to unfair methods of competition and unfair or deceptive acts or practices to the extent that IC 27-4-1 does not conflict with this article. If a provision in IC 27-4-1 conflicts with this article, this article governs and controls.As added by P.L.26-1994, SEC.25. Amended by P.L.255-1995, SEC.14; P.L.91-1998, SEC.23.
IN Code § 27-13-29-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 29. Statutory Construction and Relationship to Other Laws|27-13-29-2. Solicitation of Enrollees

Sec. 2. Provided that the solicitation otherwise complies with IC 27-13-21, the solicitation of enrollees by:(1) a health maintenance organization or limited service health maintenance organization that is granted a certificate of authority; or(2) a representative of an organization described in subdivision (1);may not be construed to violate any provision of law relating to solicitation or advertising by health professionals.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-29-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 29. Statutory Construction and Relationship to Other Laws|27-13-29-4. Risk Based Capital Requirements

Sec. 4. A:(1) health maintenance organization; or(2) limited service health maintenance organization;that is domiciled in Indiana is subject to the risk based capital requirements of IC 27-1-36, unless exempted by the commissioner under IC 27-1-36-1.As added by P.L.51-2002, SEC.11.
IN Code § 27-13-30-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 30. Filings and Reports as Public Documents|27-13-30-1. Public Records; Exemptions; Annual Financial Statement

Sec. 1. (a) All applications, filings, and reports required under this article shall be treated as public records under IC 5-14-3, except those that are:(1) trade secrets; or(2) privileged or confidential:(A) quality management information; or(B) commercial or financial information.(b) An annual financial statement required under IC 27-13-8 is not exempt from treatment as a public document under subsection (a)(2)(B).As added by P.L.26-1994, SEC.25.
IN Code § 27-13-31-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 31. Confidentiality of Medical Information and Limitation of Liability|27-13-31-1. Information Treated as Confidential; Exceptions; Privilege Against Disclosure

Sec. 1. (a) Notwithstanding IC 27-13-30, any information:(1) that pertains to the diagnosis, treatment, or health of any enrollee of a health maintenance organization or limited service health maintenance organization; and(2) that is obtained from:(A) the enrollee; or(B) any provider;by any health maintenance organization or limited service health maintenance organization;is confidential and may not be disclosed to any person, except under the circumstances set forth in subsection (b).(b) Information described in subsection (a) may be disclosed:(1) to the extent necessary to carry out this article;(2) upon the express consent of the enrollee;(3) under a statute or court order for the production of evidence or the discovery of evidence; or(4) in the event of a claim or litigation between:(A) the enrollee; and(B) the health maintenance organization or limited service health maintenance organization;in which the data or information is pertinent.(c) A health maintenance organization or limited service health maintenance organization is entitled to claim any statutory privilege against the disclosure of information described in subsection (a) that the provider who furnished the information to the health maintenance organization or limited service health maintenance organization is entitled to claim.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-31-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 31. Confidentiality of Medical Information and Limitation of Liability|27-13-31-2. Liability Limitations

Sec. 2. (a) As used in this section, "in good faith and without malice" when used to describe an action taken or a decision or recommendation made means that:(1) a reasonable effort has been taken to obtain the facts of the matter;(2) a reasonable belief exists that the action, decision, or recommendation is warranted by the facts known; and(3) if the action is described in IC 34-30-15-7, the action is made in compliance with IC 34-30-15-7.(b) As used in this section, "health care review committee" means a peer review committee under IC 34-6-2-99 (or IC 34-4-12.6-1(c) before its repeal).(c) In all actions to which this section applies, good faith shall be presumed and malice shall be required to be proven by the person aggrieved.(d) A person who, in good faith and without malice:(1) takes any action or makes a decision or recommendation as a member, an agent, or an employee of a health care review committee; or(2) furnishes any record, information, or assistance to a health care review committee;is not subject to liability for damages in any legal action in consequence of that action.(e) Neither:(1) the health maintenance organization or limited service health maintenance organization that established the health care review committee; or(2) the officers, directors, employees, or agents of the health maintenance organization or limited service health maintenance organization;are liable for damages in any civil action for the activities of a person who, in good faith and without malice, takes any action or makes a decision or recommendation as a member, an agent, or an employee of a health care review committee, or furnishes any record, information, or assistance to a health care review committee.(f) This section does not relieve any person of liability arising from treatment of a patient or an enrollee, or from a determination of the reimbursement to be provided under the terms of an insurance policy, a health maintenance organization contract, or another benefit program providing payment, reimbursement, or indemnification for health care costs based on the appropriateness of health care services delivered to an enrollee.(g) A health care review committee shall comply with IC 34-6-2-99.As added by P.L.26-1994, SEC.25. Amended by P.L.261-1995, SEC.1; P.L.1-1998, SEC.155.
IN Code § 27-13-31-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 31. Confidentiality of Medical Information and Limitation of Liability|27-13-31-3. Information and Records Subject to Subpoena or Discovery

Sec. 3. (a) Notwithstanding IC 27-13-30, the information considered by a health care review committee and the record of the actions and proceedings of the committee are confidential for purposes of IC 5-14-3-4 and not subject to subpoena or order to produce, except:(1) in proceedings before the appropriate state licensing or certifying agency; and(2) in an appeal, if permitted, from the finding or recommendation of the health care review committee.(b) If information considered by a health care review committee or records of the actions and proceedings of a health care review committee are used under subsection (a) by a state licensing or certifying agency or in an appeal, the information or records:(1) shall be kept confidential; and(2) are subject to the same provisions concerning discovery and use in legal actions as are the original information and records in the possession and control of a health care review committee.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-31-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 31. Confidentiality of Medical Information and Limitation of Liability|27-13-31-4. Quality Management Program; Access to Records

Sec. 4. To fulfill its obligations under IC 27-13-6 concerning the quality management program of the organization, a health maintenance organization is entitled to access to treatment records and other information pertaining to the diagnosis, treatment, and health status of any enrollee during the period of time the enrollee is covered by the health maintenance organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-32-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 32. Transfers of Ownership|27-13-32-1. Acquisition of Control of Health Maintenance Organization or Limited Service Health Maintenance Organization

Sec. 1. (a) This section does not apply to a health maintenance organization or a limited service health maintenance organization that is a foreign corporation.(b) As used in this section, "foreign corporation" means a corporation organized or reorganized under the law of a state or jurisdiction other than Indiana.(c) A person may not acquire control, as that term is defined in IC 27-1-23-1, of a health maintenance organization or a limited service health maintenance organization unless:(1) that person complies with the requirements of IC 27-1-23-2; and(2) the acquisition is approved by the commissioner under the procedure set forth in IC 27-1-23-2.As added by P.L.26-1994, SEC.25. Amended by P.L.185-1996, SEC.17; P.L.203-2001, SEC.30.
IN Code § 27-13-32.5-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 32.5. Voluntary Dissolution|27-13-32.5-1. Notice; Filing Articles of Dissolution

Sec. 1. Upon authorization of voluntary dissolution by the board of directors and any shareholders entitled to vote in respect of the voluntary dissolution, the board of directors shall:(1) cause a notice that the health maintenance organization is about to be dissolved to be published at least once in a newspaper of general circulation, printed and published in the English language, in the county in which the principal office of the health maintenance organization is located, and at least once in a newspaper of general circulation, printed and published in the English language in the city of Indianapolis, Marion County, Indiana;(2) cause a copy of the publication under subdivision (1) to be mailed to each subscriber;(3) file a copy of the publication under subdivision (1) with the department;(4) file a certified copy of the articles of dissolution with the department; and(5) present to the department the certificate of authority issued or renewed under IC 27-13-3-1 for cancellation.The department shall file the certified copy of the articles of dissolution, cancel the certificate of authority, endorse the cancellation on the certificate, and return the canceled certificate of authority to the health maintenance organization or its representatives.As added by P.L.203-2001, SEC.31.
IN Code § 27-13-32.5-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 32.5. Voluntary Dissolution|27-13-32.5-2. Effect on Rights of Enrollees

Sec. 2. The dissolution of a health maintenance organization under this chapter does not alter the rights of an enrollee under IC 27-13-7-13.As added by P.L.203-2001, SEC.31.
IN Code § 27-13-33-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 33. Coordination of Benefits|27-13-33-1. Coordination of Benefits Provision; Purpose

Sec. 1. Health maintenance organizations may adopt a coordination of benefits provision to:(1) avoid overinsurance; and(2) provide for the orderly payment of a claim when a person is covered by two (2) or more group health insurance or health care plans.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-33-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 33. Coordination of Benefits|27-13-33-2. Provision Consistent With 760 Iac 1-38.1

Sec. 2. If a health maintenance organization adopts a coordination of benefits provision, the provision must be consistent with the coordination of benefits provisions of 760 IAC 1-38.1.As added by P.L.26-1994, SEC.25. Amended by P.L.124-2018, SEC.95.
IN Code § 27-13-34-0.1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-0.1. Application of Certain Amendments to Chapter

Sec. 0.1. The amendments made to section 12 of this chapter by P.L.69-1998 apply to contracts that are entered into, renewed, or modified after June 30, 1998.As added by P.L.220-2011, SEC.461.
IN Code § 27-13-34-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-1. "Enrollee" Defined

Sec. 1. (a) As used in this chapter, "enrollee" means an individual who is entitled to limited health services under a contract with an entity authorized to provide or arrange for limited health services under this chapter.(b) The term includes the dependent of an individual described in subsection (a).As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-2. "Evidence of Coverage" Defined

Sec. 2. As used in this chapter, "evidence of coverage" means the certificate, agreement, or contract issued under section 13 of this chapter setting forth the coverage to which an enrollee is entitled.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-3. "Limited Health Services" Defined

Sec. 3. (a) As used in this chapter, "limited health services" refers to:(1) dental care services;(2) vision care services;(3) mental health services;(4) substance abuse services;(5) pharmaceutical services;(6) podiatric care services; and(7) other services that the commissioner determines to be limited health services.(b) The term does not include hospital or emergency services, except as those services are provided incident to a limited health service.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-4. "Limited Service Health Maintenance Organization" Defined

Sec. 4. (a) As used in this chapter, "limited service health maintenance organization" means a corporation, partnership, limited liability company, or other entity that undertakes to provide or arrange a limited health service on a prepayment basis or other basis.(b) The term does not include a provider or an entity when providing or arranging for the provision of limited health services under a contract with a limited service health maintenance organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-5. "Provider" Defined

Sec. 5. As used in this chapter, "provider" means a physician, a dentist, an optometrist, a health facility, or other person or institution that is licensed or otherwise authorized to deliver or furnish limited health service.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-6. "Subscriber" Defined

Sec. 6. As used in this chapter, "subscriber" means a person whose employment status or other status, except for family dependency, is the basis for eligibility for limited health services under a contract with an entity authorized to provide or arrange for limited health services under this chapter.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-34-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-7. Certificate of Authority Required; Foreign Entities

Sec. 7. (a) After December 31, 1994, a person, corporation, partnership, limited liability company, or other entity may not operate a limited service health maintenance organization in Indiana without obtaining and maintaining a certificate of authority from the commissioner under this chapter.(b) A for-profit or nonprofit corporation organized under the laws of another state, other than a foreign corporation defined under IC 27-1-2-3, may obtain a certificate of authority to operate a limited service health maintenance organization in Indiana if the foreign corporation is authorized to do business in Indiana under IC 23-0.5-5 and complies with this chapter.(c) A foreign corporation (as defined in IC 27-1-2-3) may obtain a certificate of authority to operate a limited service health maintenance organization in Indiana if the foreign corporation complies with this chapter.(d) A foreign or alien limited service health maintenance organization granted a certificate of authority under this chapter has the same but not greater rights and privileges than a domestic limited service health maintenance organization.As added by P.L.26-1994, SEC.25. Amended by P.L.203-2001, SEC.32; P.L.118-2017, SEC.122.
IN Code § 27-13-34-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 34. Limited Service Health Maintenance Organizations|27-13-34-9. Issuance of Certificate of Authority; Application Deficiencies; Denial of Application

Sec. 9. (a) After receiving an application filed under section 8 of this chapter, the commissioner shall review the application and notify the applicant of any deficiencies in the application.(b) The commissioner shall issue a certificate of authority to an applicant if the following conditions are met:(1) The requirements of section 8 of this chapter have been fulfilled.(2) The individuals responsible for conducting the affairs of the applicant are competent, trustworthy, possess good reputations, and have had appropriate experience, training, or education.(3) The applicant is financially responsible and may reasonably be expected to meet its obligations to enrollees and to prospective enrollees. In making this determination, the commissioner may consider:(A) the financial soundness of the arrangements of the applicant for limited health services;(B) the adequacy of the applicant's working capital, other sources of funding, and provisions for contingencies;(C) any agreement for paying the cost of the limited health services or for alternative coverage in the event of insolvency of the limited service health maintenance organization; and(D) the manner in which the requirements of sections 16 and 17 of this chapter have been fulfilled.(4) The agreements with providers for the provision of limited health services contain the provisions required by section 15 of this chapter.(5) Any deficiencies identified by the commissioner have been corrected.(c) If an application for a certificate of authority is denied, the commissioner shall notify the applicant and shall specify in the notice the reasons for the denial of the application. Within thirty (30) days after receiving the notice, the applicant may request a hearing before the commissioner under IC 4-21.5.As added by P.L.26-1994, SEC.25.