reglab/housing_qa huggingface dataset:
IN Code § 27-8-10-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 10. Comprehensive Health Insurance|27-8-10-8. Civil or Criminal Liability of Association or Members

Sec. 8. Neither the participation by carriers or members in the association, the establishment of rates, forms, or procedures for coverages issued by the association, nor any joint or collective action required by this chapter shall be the basis of any legal action, civil, or criminal liability against the association or members of it either jointly or separately.As added by Acts 1981, P.L.249, SEC.1.
IN Code § 27-8-10-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 10. Comprehensive Health Insurance|27-8-10-9. Medicare Supplement Policies

Sec. 9. (a) The association may issue Medicare supplement policies to individuals who reside in Indiana.(b) A Medicare supplement policy issued under this section:(1) must be based on a model policy adopted by the commissioner under IC 27-8-13-10.1; and(2) must meet the standards for Medicare supplement policy benefits established under IC 27-8-13-10.1.(c) A Medicare supplement policy issued under this section is not subject to the deductible and coinsurance requirements and the eligibility restrictions applying to association policies under sections 4 and 5.1 of this chapter. However, the association may provide that an individual is not eligible for a Medicare supplement policy issued under this section unless the individual has applied to one (1) carrier for a Medicare supplement policy and the application of the individual has been rejected.As added by P.L.116-1994, SEC.69.
IN Code § 27-8-10-10 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 10. Comprehensive Health Insurance|27-8-10-10. Eligibility Guidelines

Sec. 10. Before January 1, 1996, the board of directors of the association shall establish eligibility guidelines for the issuance of an association policy under this chapter to prohibit an:(1) employer;(2) insurance producer; or(3) insurance broker;from placing in or referring to the association an individual who works for an employer who offers employees an employee welfare benefit plan (as defined in 29 U.S.C. 1002).As added by P.L.93-1995, SEC.9. Amended by P.L.178-2003, SEC.64.
IN Code § 27-8-10-11.2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 10. Comprehensive Health Insurance|27-8-10-11.2. Use of Diagnostic or Procedure Codes

Sec. 11.2. (a) Not more than ninety (90) days after the date of the version specified in IC 27-1-1.5 of a diagnostic or procedure code described in this subsection:(1) the association shall begin using the version specified in IC 27-1-1.5 of the:(A) Current Procedural Terminology (CPT);(B) International Classification of Diseases (ICD);(C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);(D) Current Dental Terminology (CDT);(E) Healthcare Common Procedure Coding System (HCPCS); and(F) third party administrator (TPA);codes under which the association pays claims for services provided under an association policy; and(2) a health care provider shall begin using the version specified in IC 27-1-1.5 of the:(A) Current Procedural Terminology (CPT);(B) International Classification of Diseases (ICD);(C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);(D) Current Dental Terminology (CDT);(E) Healthcare Common Procedure Coding System (HCPCS); and(F) third party administrator (TPA);codes under which the health care provider submits claims for payment for services provided under an association policy.(b) If a health care provider provides services that are covered under an association policy:(1) after the date of the version specified in IC 27-1-1.5 of a diagnostic or procedure code described in subsection (a); and(2) before the association begins using the version of the diagnostic or procedure code;the association shall reimburse the health care provider under the version of the diagnostic or procedure code that was specified in IC 27-1-1.5 on the date that the services were provided.As added by P.L.161-2001, SEC.3. Amended by P.L.66-2002, SEC.15; P.L.124-2018, SEC.78.
IN Code § 27-8-11-0.1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-0.1. Application of Certain Amendments to Chapter

Sec. 0.1. The addition of section 9 of this chapter by P.L.74-2007 applies to an agreement between an insurer and a provider that is entered into, amended, or renewed on or after April 26, 2007.As added by P.L.220-2011, SEC.441.
IN Code § 27-8-11-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-1. Definitions

Sec. 1. (a) The definitions in this section apply throughout this chapter.(b) "Credentialing" means a process through which an insurer makes a determination:(1) based on criteria established by the insurer; and(2) concerning whether a provider is eligible to:(A) provide health care services to an insured; and(B) receive reimbursement for the health care services;under an agreement entered into between the provider and the insurer under section 3 of this chapter.(c) "Health care services":(1) means health care related services or products rendered or sold by a provider within the scope of the provider's license or legal authorization; and(2) includes hospital, medical, surgical, dental, vision, and pharmaceutical services or products.(d) "Insured" means an individual entitled to reimbursement for expenses of health care services under a policy issued or administered by an insurer.(e) "Insurer" means an insurance company authorized in this state to issue policies that provide reimbursement for expenses of health care services.(f) "Person" means an individual, an agency, a political subdivision, a partnership, a corporation, an association, or any other entity.(g) "Preferred provider plan" means an undertaking to enter into agreements with providers relating to terms and conditions of reimbursements for the health care services of insureds, members, or enrollees relating to the amounts to be charged to insureds, members, or enrollees for health care services.(h) "Provider" means an individual or entity duly licensed or legally authorized to provide health care services.As added by P.L.140-1984, SEC.1. Amended by P.L.31-1988, SEC.22; P.L.26-2005, SEC.1.
IN Code § 27-8-11-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-2. Conflicting Provisions

Sec. 2. To the extent of any conflict between this chapter and IC 27-4-1-4, IC 27-8-5-15, IC 27-8-6-1, or any other statutory provision, this chapter prevails over the conflicting provision. Agreements may be entered into under section 3(a)(1) of this chapter notwithstanding any contradictory policy provision prescribed under IC 27-8-5-3(a)(9).As added by P.L.140-1984, SEC.1. Amended by P.L.1-2010, SEC.111.
IN Code § 27-8-11-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-4. Accessibility and Availability Terms; Reasonable Standards

Sec. 4. Policies issued under section 3(a)(3) or section 3.1 of this chapter (before its repeal) may not contain terms or conditions that would operate unreasonably to restrict the access and availability of health care services for the insured. The commissioner of insurance may, under IC 4-22-2, adopt rules binding upon insurers prescribing reasonable standards relating to the accessibility and availability of health care services for persons insured under policies described in section 3(a)(3) or section 3.1 of this chapter (before its repeal).As added by P.L.140-1984, SEC.1. Amended by P.L.134-1994, SEC.3; P.L.1-1999, SEC.61.
IN Code § 27-8-11-4.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-4.5. Permitted Disclosures by Providers; Coverage of Benefit or Service; Payment of Provider; Application

Sec. 4.5. (a) An agreement between an insurer and provider under section 3 of this chapter may not prohibit a provider from disclosing:(1) financial incentives to the provider;(2) all treatment options available to an insured, including those not covered by the insured's policy.(b) An insurer may not penalize a provider financially or in any other manner for making a disclosure permitted under subsection (a).(c) An insured is not entitled to coverage of a benefit or service under a health insurance policy unless that benefit or service is included in the insured's health insurance policy.(d) A provider is not entitled to payment under a policy for benefits or services provided to an insured unless the provider has a contract or an agreement with the insurer.(e) This section applies to a contract entered, renewed, or modified after June 30, 1996.As added by P.L.192-1996, SEC.1.
IN Code § 27-8-11-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-5. Preferred Provider Plans; Filing Sworn Statement

Sec. 5. Each person that organizes a preferred provider plan under this chapter shall file with the commissioner before March 1 of each year a statement, under oath, upon a form prescribed by the commissioner that covers the preceding calendar year and includes the following:(1) The name and address of each person that has organized a preferred provider plan.(2) The names and addresses of the providers with whom the preferred provider plan has entered into agreements under section 3 of this chapter.(3) The geographical area, by counties, within which the preferred provider plan provides or arranges for health care services for insureds, members or enrollees.(4) The number of insureds, members or enrollees covered by the agreements listed in subdivision (2).As added by P.L.31-1988, SEC.23.
IN Code § 27-8-11-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-6. Preferred Provider Plans; Hospital Accreditation

Sec. 6. (a) A preferred provider plan may not refuse to enter into an agreement with a hospital solely because the hospital has not obtained accreditation from an accreditation organization that:(1) establishes standards for the organization and operation of hospitals;(2) requires the hospital to undergo a survey process for a fee paid by the hospital; and(3) was organized and formed in 1951.(b) This section does not prohibit a preferred provider plan from using performance indicators or quality standards that:(1) are developed by private organizations; and(2) do not rely upon a survey process for a fee charged to the hospital to evaluate performance.As added by P.L.259-1995, SEC.2.
IN Code § 27-8-11-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-7. Provider Credentialing

Sec. 7. (a) This section applies to an insurer that issues or administers a policy that provides coverage for basic health care services (as defined in IC 27-13-1-4).(b) The department of insurance shall prescribe the credentialing application form used by the Council for Affordable Quality Healthcare (CAQH) in electronic or paper format, which must be used by:(1) a provider who applies for credentialing by an insurer; and(2) an insurer that performs credentialing activities.(c) An insurer shall notify a provider concerning a deficiency on a completed credentialing application form submitted by the provider not later than thirty (30) business days after the insurer receives the completed credentialing application form.(d) An insurer shall notify a provider concerning the status of the provider's completed credentialing application not later than:(1) sixty (60) days after the insurer receives the completed credentialing application form; and(2) every thirty (30) days after the notice is provided under subdivision (1), until the insurer makes a final credentialing determination concerning the provider.(e) Notwithstanding subsection (d), if an insurer fails to issue a credentialing determination within thirty (30) days after receiving a completed credentialing application form from a provider, the insurer shall provisionally credential the provider if the provider meets the following criteria:(1) The provider has submitted a completed and signed credentialing application form and any required supporting material to the insurer.(2) The provider was previously credentialed by the insurer in Indiana and in the same scope of practice for which the provider has applied for provisional credentialing.(3) The provider is a member of a provider group that is credentialed and a participating provider with the insurer.(4) The provider is a network provider with the insurer.(f) The criteria for issuing provisional credentialing under subsection (e) may not be less stringent than the standards and guidelines governing provisional credentialing from the National Committee for Quality Assurance or its successor organization.(g) Once an insurer fully credentials a provider that holds provisional credentialing, reimbursement payments under the contract shall be retroactive to the date of the provisional credentialing. The insurer shall reimburse the provider at the rates determined by the contract between the provider and the insurer.(h) If an insurer does not fully credential a provider that is provisionally credentialed under subsection (e), the provisional credentialing is terminated on the date the insurer notifies the provider of the adverse credentialing determination. The insurer is not required to reimburse for services rendered while the provider was provisionally credentialed.As added by P.L.26-2005, SEC.2. Amended by P.L.195-2018, SEC.18.
IN Code § 27-8-11-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-8. Provider Directories

Sec. 8. (a) An insurer may provide to an insured in electronic or paper form a directory of providers with which the insurer has entered into an agreement under section 3 of this chapter.(b) An insurer that provides a directory described in subsection (a) shall:(1) inform the insured that the insured may request the directory in paper form; and(2) provide the directory in paper form upon the request of the insured.As added by P.L.125-2005, SEC.5.
IN Code § 27-8-11-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-9. Preferred Provider Agreement Prohibitions

Sec. 9. (a) As used in this section, "insurer" includes the following:(1) An administrator licensed under IC 27-1-25.(2) A person that pays or administers claims on behalf of an insurer.(b) An agreement between an insurer and a provider under this chapter may not contain a provision that:(1) prohibits, or grants the insurer an option to prohibit, the provider from contracting with another insurer to accept lower payment for health care services than the payment specified in the agreement;(2) requires, or grants the insurer an option to require, the provider to accept a lower payment from the insurer if the provider agrees with another insurer to accept lower payment for health care services;(3) requires, or grants the insurer an option of, termination or renegotiation of the agreement if the provider agrees with another insurer to accept lower payment for health care services; or(4) requires the provider to disclose the provider's reimbursement rates under contracts with other insurers.(c) A provision that:(1) is contained in an agreement between an insurer and a provider under this chapter; and(2) violates this section;is void.As added by P.L.74-2007, SEC.1.
IN Code § 27-8-11-10 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-10. Coverage for Dialysis Treatment

Sec. 10. (a) As used in this section, "dialysis facility" means an outpatient facility in Indiana at which a dialysis treatment provider provides dialysis treatment.(b) As used in this section, "contracted dialysis facility" means a dialysis facility that has entered into an agreement with a particular insurer under section 3 of this chapter.(c) Notwithstanding section 1 of this chapter, as used in this section, "insured" refers only to an insured who requires dialysis treatment.(d) As used in this section, "insurer" includes the following:(1) An administrator licensed under IC 27-1-25.(2) An agent of an insurer.(e) As used in this section, "non-contracted dialysis facility" means a dialysis facility that has not entered into an agreement with a particular insurer under section 3 of this chapter.(f) An insurer shall not require an insured, as a condition of coverage or reimbursement, to:(1) if the nearest dialysis facility is located within thirty (30) miles of the insured's home, travel more than thirty (30) miles from the insured's home to obtain dialysis treatment; or(2) if the nearest dialysis facility is located more than thirty (30) miles from the insured's home, travel a greater distance than the distance to the nearest dialysis facility to obtain dialysis treatment;regardless of whether the insured chooses to receive dialysis treatment at a contracted dialysis facility or a non-contracted dialysis facility.As added by P.L.111-2008, SEC.4.
IN Code § 27-8-11-11 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-11. Insurer Payment to Insured for Service Rendered by Noncontracted Provider; Requirements

Sec. 11. (a) As used in this section, "noncontracted provider" means a provider that has not entered into an agreement with an insurer under section 3 of this chapter.(b) After September 30, 2009, if an insurer makes a payment to an insured for a health care service rendered by a noncontracted provider, the insurer shall include with the payment instrument written notice to the insured that includes the following:(1) A statement specifying the claims covered by the payment instrument.(2) The name and address of the provider submitting each claim.(3) The amount paid by the insurer for each claim.(4) Any amount of a claim that is the insured's responsibility.(5) A statement in at least 24 point bold type that:(A) instructs the insured to use the payment to pay the noncontracted provider if the insured has not paid the noncontracted provider in full;(B) specifies that paying the noncontracted provider is the insured's responsibility; and(C) states that the failure to make the payment violates the law and may result in collection proceedings or criminal penalties.As added by P.L.144-2009, SEC.2.
IN Code § 27-8-11-12 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-12. Right to Provide Prescription Cost Information; Point of Sale Cost Limit; Pharmacist May Not Be Required to Collect Higher Copayment

Sec. 12. (a) As used in this section, "drug" means a prescription drug.(b) As used in this section, "insurer" refers to an insurer that provides coverage for drugs. The term includes a person that administers drug benefits on behalf of an insurer.(c) As used in this section, "pharmacy" refers to a pharmacist or pharmacy that has entered into an agreement with an insurer under section 3 of this chapter.(d) A pharmacy or pharmacist shall have the right to provide an insured with information concerning the amount of the insured's cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be proscribed by an insurer from discussing this information or from selling to the insured a more affordable alternative if an affordable alternative is available.(e) An insurer that covers prescription drugs may not include a provision that requires an insured 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 insurer at the point of sale.This subsection does not prohibit the adjudication of claims in accordance with an accident and sickness insurance policy issued or administered by an insurer. The insured is not liable for any additional charges or entitled to any credits as a result of the adjudicated claim.(f) The insurer or a pharmacy benefits manager may not require a pharmacy or pharmacist to collect a higher copayment for a prescription drug from an insured than the insurer or pharmacy benefits manager allows the pharmacy or pharmacist to retain.As added by P.L.209-2018, SEC.12. Amended by P.L.114-2020, SEC.20.
IN Code § 27-8-11-13 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 11. Accident and Sickness Insurance─reimbursement Agreements|27-8-11-13. Fully Credentialed Provider Reimbursement; Requirements

Sec. 13. (a) A fully credentialed provider shall be reimbursed for eligible services provided at any in-network hospital if the following conditions are met:(1) The provider submits the documentation required by the insurer to be loaded under the provider group or hospital.(2) The provider, provider group, or hospital is a network provider with the insurer.(3) The services are provided in accordance with all terms and conditions of the provider's, group provider's, or hospital's agreement or contract with the insurer.(4) Prior authorization is obtained in accordance with IC 27-1-37.5 when required by the insurer for an eligible service.(b) The insurer shall reimburse the provider or hospital for services described in subsection (a) at the rates determined by the contract between the provider and the insurer.(c) An insurer is not required to credential a provider. However, if:(1) a provider is employed by a hospital that is part of the hospital's network that is covered by the insurer; and(2) the provider meets the insurer's credentialing requirements;the insurer shall reimburse the provider for any reimbursable services from the date that the provider was employed by the hospital.As added by P.L.50-2020, SEC.8.
IN Code § 27-8-12-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 12. Long Term Care Insurance|27-8-12-1. "Applicant" Defined

Sec. 1. As used in this chapter, "applicant" means:(1) an individual who applies for long term care insurance through an individual insurance policy; or(2) a prospective holder of a certificate issued under a group long term care insurance policy.As added by P.L.275-1987, SEC.1.
IN Code § 27-8-12-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 12. Long Term Care Insurance|27-8-12-2. "Certificate" Defined

Sec. 2. As used in this chapter, "certificate" means a document issued to a member of the group covered under a group insurance policy, which policy has been delivered or issued for delivery in Indiana, to signify that the individual named in the certificate is covered under the policy.As added by P.L.275-1987, SEC.1.
IN Code § 27-8-12-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 12. Long Term Care Insurance|27-8-12-3. "Certificate Holder" Defined

Sec. 3. As used in this chapter, "certificate holder" means an individual to whom a certificate is issued.As added by P.L.275-1987, SEC.1.