reglab/housing_qa huggingface dataset:
IN Code § 27-13-7-24.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-24.5. Coverage for Chronic Pain Management

Sec. 24.5. (a) This section applies to each of the following:(1) An individual contract.(2) A group contract.(b) As used in this section, "chronic pain" means pain that:(1) persists beyond the usual course of an acute disease or healing of an injury; or(2) may be associated with an acute or chronic pathologic process that causes continuous or intermittent pain for a period of months or years.(c) As used in this section, "chronic pain management" means evidence based health care products and services intended to relieve chronic pain that has lasted for at least three (3) months. The term includes:(1) prescription drugs;(2) physical therapy;(3) occupational therapy;(4) chiropractic care;(5) osteopathic manipulative treatment; and(6) athletic trainer services.(d) An individual contract and a group contract must provide coverage for medically necessary chronic pain management prescribed by an enrollee's treating practitioner.(e) The coverage required by this section may not be subject to annual or lifetime limitation, deductible, copayment, or coinsurance provisions that are more restrictive than the annual or lifetime limitation, deductible, copayment, or coinsurance provisions that apply generally under the individual contract or group contract.As added by P.L.149-2019, SEC.6.
IN Code § 27-13-7-26 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-26. Coverage for Pediatric Neuropsychiatric Disorders

Sec. 26. (a) An individual contract and a group contract must provide coverage for treatment of:(1) pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS); and(2) pediatric acute-onset neuropsychiatric syndrome (PANS);including treatment with intravenous immunoglobulin therapy.(b) The coverage required by this section may not be subject to annual or lifetime limitation, deductible, copayment, or coinsurance provisions that are more restrictive than the annual or lifetime limitation, deductible, copayment, or coinsurance provisions that apply generally under the individual contract or group contract.As added by P.L.130-2020, SEC.16.
IN Code § 27-13-7-27 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 7. Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage|27-13-7-27. Reimbursement for Emergency Medical Services

Sec. 27. (a) This section applies to each of the following:(1) An individual contract.(2) A group contract.(b) As used in this section, "emergency medical services" has the meaning set forth in IC 16-18-2-110.(c) As used in this section, "emergency medical services provider organization" means a provider of emergency medical services that is certified by the Indiana emergency medical services commission as an advanced life support provider organization under rules adopted under IC 16-31-3.(d) An individual contract and a group contract that provide coverage for emergency medical services must provide reimbursement for emergency medical services that are:(1) rendered by an emergency medical services provider organization;(2) within the emergency medical services provider organization's scope of practice;(3) performed or provided as advanced life support services; and(4) performed or provided during a response initiated through the 911 system regardless of whether the patient is transported.(e) If multiple emergency medical services provider organizations qualify and submit a claim for reimbursement under this section, the health maintenance organization:(1) may reimburse under this section only for one (1) claim per patient encounter; and(2) shall reimburse the claim submitted by the emergency medical services provider organization that performed or provided the majority of advanced life support services.(f) The department may adopt rules under IC 4-22-2, including emergency rules under IC 4-22-2-37.1, to implement this section.(g) This section does not require an individual contract or a group contract to provide coverage for emergency medical services.As added by P.L.115-2020, SEC.5.
IN Code § 27-13-8-0.1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 8. Annual Report|27-13-8-0.1. Application of Certain Amendments to Chapter

Sec. 0.1. The amendments made to section 2 of this chapter by P.L.133-1999 apply to external grievances filed by enrollees after January 1, 2000.As added by P.L.220-2011, SEC.458.
IN Code § 27-13-8-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 8. Annual Report|27-13-8-1. Filing

Sec. 1. On or before March 1 of each year, a health maintenance organization must file with the commissioner a report that covers the preceding calendar year. The report must be:(1) made on forms prescribed by the commissioner; and(2) verified by at least two (2) principal officers of the health maintenance organization.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-8-1.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 8. Annual Report|27-13-8-1.5. Preparation of Annual Statement

Sec. 1.5. (a) Each health maintenance organization authorized to conduct business in Indiana and required to file an Annual Statement Blank with the department under this chapter shall prepare the health maintenance organization's statement:(1) on the Annual Statement Blank;(2) in accordance with Annual Statement Instructions; and(3) following practices and procedures prescribed by the Accounting Practices and Procedures Manual.(b) To the extent that the Annual Statement Instructions require disclosure under subsection (a) of compensation paid to or on behalf of a health maintenance organization's officers, directors, or employees, the information may be filed with the department as an exhibit separate from the Annual Statement Blank. The compensation information described under this subsection shall be maintained by the department as confidential and may not be disclosed to the public under IC 5-14-3.As added by P.L.203-2001, SEC.20. Amended by P.L.124-2018, SEC.91.
IN Code § 27-13-8-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 8. Annual Report|27-13-8-3. Annual Statement Blank; Quarterly Reports

Sec. 3. (a) This section applies to a domestic health maintenance organization that is authorized to transact business in Indiana.(b) On or before March 1 of each year, a health maintenance organization shall file with the NAIC and with the department a copy of the health maintenance organization's Annual Statement Blank and additional filings prescribed by the commissioner for the preceding year. A health maintenance organization shall also file quarterly statements with the NAIC and with the department, on or before May 15, August 15, and November 15 of each year, in a form prescribed by the commissioner. The information filed with the NAIC under this subsection:(1) must be:(A) in the same format; and(B) of the same scope;as is required by the commissioner under section 1 of this chapter;(2) to the extent required by the NAIC, must include the signed jurat page and the actuarial certification; and(3) must be filed electronically in accordance with NAIC electronic filing specifications.The commissioner may, for good cause shown, grant an exemption from the requirement of this section to domestic health maintenance organizations that operate only in Indiana. If a health maintenance organization files any amendment or addendum to the health maintenance organization's Annual Statement Blank or quarterly statement with the commissioner, the health maintenance organization shall also file a copy of the amendment or addendum with the NAIC. Annual Statement Blanks and quarterly financial statements are considered filed with the NAIC when delivered to the address designated by the NAIC for the filings, regardless of whether the filing is accompanied by any applicable fee.(c) The commissioner may, for good cause shown, grant a health maintenance organization an extension of time for the filing required by subsection (b).(d) In the absence of actual malice:(1) members of the NAIC;(2) duly authorized committees, subcommittees, and task forces of members of the NAIC;(3) delegates of members of the NAIC;(4) employees of the NAIC; and(5) other persons responsible for collecting, reviewing, analyzing, and disseminating information developed from the filing of Annual Statement Blanks under this section;shall be considered to be acting as agents of the commissioner under the authority of this section and are not subject to civil liability for libel, slander, or any other cause of action by virtue of the collection, review, analysis, or dissemination of the data and information collected from the filings required by this section.(e) The commissioner may suspend, revoke, or refuse to renew the certificate of authority of a health maintenance organization that fails to file the health maintenance organization's Annual Statement Blank or quarterly statements with the NAIC or with the department within the time allowed by subsection (b) or (c).As added by P.L.203-2001, SEC.22. Amended by P.L.124-2018, SEC.93.
IN Code § 27-13-8-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 8. Annual Report|27-13-8-4. Civil Penalties

Sec. 4. (a) The commissioner may impose a civil penalty of five hundred dollars ($500), after notice and hearing under IC 4-21.5-3, on a health maintenance organization that fails to file an annual statement under this chapter.(b) A domestic health maintenance organization that fails to file an audited annual financial statement under section 2(a)(1) of this chapter before June 1 of each year without obtaining an extension is subject to a civil penalty of fifty dollars ($50) per day until the report is received by the commissioner.As added by P.L.203-2001, SEC.23.
IN Code § 27-13-9-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 9. Information to Enrollees or Subscribers|27-13-9-1. List of Providers

Sec. 1. (a) Upon:(1) the enrollment; and(2) each reenrollment;of a subscriber, a health maintenance organization must provide to the subscriber in electronic or paper form a list of providers who provide health care services through the health maintenance organization. The health maintenance organization must also provide the list of providers in electronic or paper form to a potential enrollee upon request.(b) A health maintenance organization shall:(1) inform a subscriber or potential enrollee that the subscriber or potential enrollee may request a list described in subsection (a) in paper form; and(2) provide the list in paper form upon the request of the subscriber or potential enrollee.As added by P.L.26-1994, SEC.25. Amended by P.L.69-1998, SEC.7; P.L.125-2005, SEC.7.
IN Code § 27-13-9-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 9. Information to Enrollees or Subscribers|27-13-9-2. Notice of Change in Operation of Health Maintenance Organization

Sec. 2. Not more than thirty (30) days after any material change in the operation of a health maintenance organization that will directly affect the subscribers or enrollees of the organization, the health maintenance organization shall provide notice of the change to the subscribers or enrollees affected by the change.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-9-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 9. Information to Enrollees or Subscribers|27-13-9-3. Termination of Provider

Sec. 3. (a) A health maintenance organization shall notify an enrollee in writing of the termination of:(1) the provider who currently provides primary health care services to that enrollee;(2) any other participating provider seen by the enrollee during the previous year; and(3) a hospital.(b) After the termination of the provider who provided primary health care services to an enrollee, the health maintenance organization shall assist the enrollee in transferring to another participating primary care provider.(c) If a health maintenance organization notifies an enrollee of the termination of a hospital, the notice must include the names of all participating providers employed by the hospital.As added by P.L.26-1994, SEC.25. Amended by P.L.133-1999, SEC.3; P.L.196-2001, SEC.2.
IN Code § 27-13-9-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 9. Information to Enrollees or Subscribers|27-13-9-4. Information on Services and Filing Grievances; Telephone Number

Sec. 4. A health maintenance organization shall provide to each enrollee and subscriber:(1) information on:(A) how services can be obtained;(B) where additional information on access to services can be obtained;(C) how to file a grievance under IC 27-13-10 and IC 27-13-10.1;(D) the health maintenance organization's:(i) structure;(ii) health care benefits and exclusions; and(iii) criteria for denying coverage; and(E) costs for which the enrollee or subscriber is responsible; and(2) a toll free telephone number through which the enrollee can contact the health maintenance organization at no cost to the enrollee to obtain information and to file grievances.The information under this section must be provided to a potential enrollee of the health maintenance organization upon request.As added by P.L.26-1994, SEC.25. Amended by P.L.191-1997, SEC.3; P.L.69-1998, SEC.8; P.L.133-1999, SEC.4.
IN Code § 27-13-9-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 9. Information to Enrollees or Subscribers|27-13-9-5. Prescription Drug Information Card

Sec. 5. (a) This section applies to a health maintenance organization that provides coverage for prescription drugs or devices and issues a card or other technology for claims processing.(b) The card or other technology issued by a health maintenance organization must contain uniform prescription drug information that complies with the requirements established under subsection (c).(c) Prescription drug information cards or other technology must meet either of the following criteria:(1) Be in a format and contain information fields approved by the National Council for Prescription Drug Programs (NCPDP) as contained in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide in effect on the October 1 most immediately preceding the issuance of the card.(2) Contain the following information:(A) The health benefit plan's name.(B) The enrollee's name, group number, and identification number.(C) A telephone number to inquire about pharmacy related issues.(D) The issuer's international identification number or ANSI BIN number, labeled as RxBIN.(E) The processor control number, labeled as RxPCN.(F) The insured's pharmacy benefits group number if different than medical group number, labeled as RxGRP.Only those fields listed in clauses (A) through (F) that are required for proper adjudication of the claim must appear on the card. If the card is used to adjudicate non-pharmacy claims, then the designation "Rx" listed in clauses (D) through (F) is not required to be used by the issuer.(d) A health maintenance organization may not be required to issue a prescription drug information card or other technology to a person more than one (1) time during a twelve (12) month period.(e) The prescription drug information cards or other technology issued under this section may be used for health care service coverage other than the coverage to which this chapter applies.As added by P.L.230-2001, SEC.3. Amended by P.L.1-2002, SEC.123.
IN Code § 27-13-9-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 9. Information to Enrollees or Subscribers|27-13-9-6. "Health Plan Information Card"; Indication of Benefits and Health Care Services

Sec. 6. (a) As used in this section, "health plan information card" means a card that:(1) a health maintenance organization; or(2) a third party administrator of a self-insured plan;provides to an individual so that the individual may present the card to establish the eligibility of the individual or the individual's dependents to receive benefits or health care services.(b) A health plan information card must indicate that the benefits and health care services are provided by:(1) a health maintenance organization; or(2) a third party administrator.(c) Subsection (b) applies only to a health plan information card issued:(1) initially to an individual as a new enrollee; or(2) to an individual at the time of the individual’s renewal of enrollment;in a health maintenance organization after June 30, 2020.(d) The department of insurance shall adopt rules under IC 4-22-2 to ensure compliance with this section.As added by P.L.111-2020, SEC.14.
IN Code § 27-13-9-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 9. Information to Enrollees or Subscribers|27-13-9-7. Electronic Data Base Requirements; Rulemaking Authority

Sec. 7. (a) The electronic data base by which a health maintenance organization or by which a third party administrator of benefits and health care services offered under a health maintenance organization contract allows an enrollee or a provider to verify an enrollee's coverage or benefits under a health maintenance organization contract must include the following information for each enrollee:(1) Whether benefits and health care services under the health maintenance organization contract are provided by:(A) the health maintenance organization; or(B) a third party administrator.(2) Whether the health maintenance organization contract is a self-funded or fully-funded plan.(b) The department shall adopt rules under IC 4-22-2 to ensure compliance with this section.As added by P.L.111-2020, SEC.15.
IN Code § 27-13-10-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 10. Grievance Procedures|27-13-10-1. Establishment of Procedures

Sec. 1. A health maintenance organization or limited service health maintenance organization shall establish and maintain a grievance procedure for the resolution of grievances initiated by enrollees and subscribers of the organization. The grievance procedure of a health maintenance organization or limited service health maintenance organization must be approved by the commissioner.As added by P.L.26-1994, SEC.25. Amended by P.L.191-1997, SEC.4.
IN Code § 27-13-10-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 10. Grievance Procedures|27-13-10-2. Examination by Commissioner

Sec. 2. The commissioner may examine the grievance procedures of health maintenance organizations and limited service health maintenance organizations.As added by P.L.26-1994, SEC.25.
IN Code § 27-13-10-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 10. Grievance Procedures|27-13-10-3. Records of Grievances

Sec. 3. A health maintenance organization or limited service health maintenance organization shall maintain records regarding all grievances of enrollees that the organization has received since the examination by the commissioner of the grievance procedure of the organization that immediately preceded the receipt of the grievances.As added by P.L.26-1994, SEC.25. Amended by P.L.191-1997, SEC.5.
IN Code § 27-13-10-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 10. Grievance Procedures|27-13-10-4. Notice of Grievance Related Information

Sec. 4. (a) A health maintenance organization shall provide, at the request of the enrollee, subscriber, or legal representative of the enrollee or subscriber, and upon contract issuance, at each contract renewal, and with any notice of denial of a claim, timely, adequate, and appropriate notice to each enrollee, subscriber, or legal representative, of:(1) the grievance procedure under this chapter and IC 27-13-10.1;(2) information on how to file:(A) a grievance under this chapter; and(B) a request for an external grievance review under IC 27-13-10.1; and(3) the address for the Internet web site established by the department under IC 27-1-3-33.(b) A health maintenance organization shall prominently display on all notices to enrollees and subscribers the telephone number and address at which a grievance may be filed.(c) A written description of the enrollee's or subscriber's right to file a grievance must be posted by the provider in a conspicuous public location in each facility that offers services on behalf of a health maintenance organization.As added by P.L.191-1997, SEC.6. Amended by P.L.133-1999, SEC.5; P.L.18-2016, SEC.5.
IN Code § 27-13-10-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 10. Grievance Procedures|27-13-10-5. Filing; Oral or Written Grievance; Telephone Number; Date

Sec. 5. (a) An enrollee or a subscriber may file a grievance orally or in writing.(b) A health maintenance organization shall make available to enrollees and subscribers a toll free telephone number through which grievances may be filed. The toll free number must:(1) be staffed by a qualified representative of the health maintenance organization;(2) be available for at least forty (40) normal business hours per week; and(3) accept grievances in the languages of the major population groups served.(c) A grievance is considered to be filed on the first date it is received, either by telephone or in writing.As added by P.L.191-1997, SEC.7.
IN Code § 27-13-10-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 13. Health Maintenance Organizations|Chapter 10. Grievance Procedures|27-13-10-6. Filing; Procedures; Representative

Sec. 6. (a) A health maintenance organization shall establish procedures to assist enrollees and subscribers in filing grievances.(b) An enrollee or subscriber may designate a representative to file a grievance for the enrollee or subscriber and to represent the enrollee or subscriber in a grievance under this chapter.As added by P.L.191-1997, SEC.8.