reglab/housing_qa huggingface dataset:
IN Code § 5-10-8-16.5 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-16.5. Post-Mastectomy Coverage

Sec. 16.5. (a) As used in this section, "covered individual" means an individual who is entitled to coverage under a state employee health plan.(b) As used in this section, "mastectomy" means the removal of all or part of a breast for reasons that are determined by a licensed physician to be medically necessary.(c) A state employee health plan that provides coverage for a mastectomy must provide coverage as required under 29 U.S.C. 1185b, including coverage for:(1) prosthetic devices; and(2) reconstructive surgery incident to a mastectomy including:(A) all stages of reconstruction of the breast on which the mastectomy has been performed; and(B) surgery and reconstruction of the other breast to produce symmetry;in the manner determined by the attending physician and the covered individual to be appropriate.(d) In addition to the coverage required by 29 U.S.C. 1185b, a state employee health plan that provides coverage for a mastectomy must provide coverage for:(1) custom fabricated breast prostheses; and(2) one (1) additional breast prosthesis per breast affected by the mastectomy.(e) Coverage required under this section is subject to:(1) the deductible and coinsurance provisions applicable to a mastectomy; and(2) all other terms and conditions applicable to other benefits.(f) A state employee health plan must provide to a covered individual, when the individual's coverage under the state employee health plan begins and annually thereafter, written notice of the coverage required under this section. Notice that is sent by the state employee health plan that meets the requirements set forth in 29 U.S.C. 1185b constitutes compliance with this subsection.(g) The coverage required under this section applies to a state employee health plan that provides coverage for a mastectomy, regardless of whether an individual who:(1) underwent a mastectomy; and(2) is covered under the state employee health plan;was covered under the state employee health plan at the time of the mastectomy.(h) Except as provided in subsection (d), this section does not require a state employee health plan to provide coverage related to postmastectomy care that exceeds the coverage required for postmastectomy care under federal law.As added by P.L.67-2020, SEC.1.
IN Code § 5-10-8-18 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-18. Prescription Drug Coverage

Sec. 18. (a) The definitions in section 17 of this chapter apply throughout this section.(b) This section applies to a state employee health plan that uses a formulary, cost sharing, or utilization review for prescription drug coverage.(c) A state employee health plan shall not remove a prescription drug from the state employee health plan's formulary, change the cost sharing requirements that apply to a prescription drug, or change the utilization review requirements that apply to a prescription drug unless the state employee health plan does at least one (1) of the following:(1) At least sixty (60) days before the removal or change is effective, send written notice of the removal or change to each covered individual for whom the prescription drug has been prescribed during the preceding twelve (12) month period.(2) At the time a covered individual for whom the prescription drug has been prescribed during the preceding twelve (12) month period requests a refill of the prescription drug, provide to the covered individual:(A) written notice of the removal or change; and(B) a sixty (60) day supply of the prescription drug under the terms that applied before the removal or change.As added by P.L.19-2016, SEC.2.
IN Code § 5-10-8-19 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-19. Prior Authorization

Sec. 19. A self-insurance program established under section 7(b) of this chapter to provide health care coverage shall comply with the prior authorization requirements that apply to a health plan under IC 27-1-37.5.As added by P.L.77-2018, SEC.1.
IN Code § 5-10-8-20 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-20. Right to Provide Prescription Cost Information; Point of Sale Cost Limit; Pharmacist May Not Be Required to Collect Higher Copayment

Sec. 20. (a) As used in this section, "covered individual" means an individual entitled to coverage under a state employee plan.(b) As used in this section, "drug" means a prescription drug.(c) As used in this section, "pharmacy" refers to a pharmacist or pharmacy that has entered into an agreement with a state employee plan to provide drugs to individuals covered under a state employee plan.(d) As used in this section, "state employee plan" refers to the following that provide coverage for drugs:(1) A self-insurance program established under section 7(b) of this chapter to provide group health coverage.(2) A contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter.The term includes a person that administers drug benefits on behalf of a state employee plan.(e) A pharmacy or pharmacist shall have the right to provide a covered individual with information concerning the amount of the covered individual's cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be proscribed by a pharmacy benefits manager from discussing this information or from selling to the covered individual a more affordable alternative if an affordable alternative is available.(f) A pharmacy benefits manager that covers prescription drugs may not include a provision that requires a covered individual 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 pharmacy benefits manager at the point of sale.This subsection does not prohibit the adjudication of claims in accordance with the state employee plan administered by a pharmacy benefits manager. The covered individual is not liable for any additional charges or entitled to any credits as a result of the adjudicated claim.(g) The state employee plan or a pharmacy benefits manager may not require a pharmacy or pharmacist to collect a higher copayment for a prescription drug from a covered individual than the state employee plan or pharmacy benefits manager allows the pharmacy or pharmacist to retain.As added by P.L.209-2018, SEC.1. Amended by P.L.114-2020, SEC.1.
IN Code § 5-10-8-21 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-21. Coverage for Anatomical Gifts, Transplantation, or Related Health Care Services

Sec. 21. (a) As used in this section, "covered individual" means an individual who:(1) is entitled to coverage under a state employee health plan; and(2) has a disability (as defined 42 U.S.C. 12102).(b) As used in this section, "state employee health plan" means either of the following that provides coverage for anatomical gifts, transplantation, or related health care services:(1) A self-insurance program established under section 7(b) of this chapter to provide group health coverage.(2) A contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter.The term includes a person that administers coverage under a state employee health plan.(c) A state employee health plan shall not deny coverage for anatomical gifts, transplantation, or related health care services under the state employee health plan based solely on the disability of the covered individual.As added by P.L.2-2019, SEC.1.
IN Code § 5-10-8-22 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-22. Coverage for Chronic Pain Management

Sec. 22. (a) 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.(b) 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; and(5) osteopathic manipulative treatment.(c) As used in this section, "covered individual" means an individual entitled to coverage under a state employee health plan.(d) As used in this section, "state employee health plan" means the following:(1) A self-insurance program established under section 7(b) of this chapter.(2) A contract for prepaid health care services entered into under section 7(c) of this chapter.The term does not include a dental plan.(e) A state employee health plan must provide coverage for medically necessary chronic pain management prescribed by a covered individual's treating practitioner.(f) 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 state employee health plan.As added by P.L.149-2019, SEC.1.
IN Code § 5-10-8-22.5 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-22.5. Amount Paid for Prescription Drug to Be Counted Against Deductible

Sec. 22.5. (a) As used in this section, "covered individual" means an individual who is entitled to coverage under a state employee health plan.(b) As used in this section, "state employee health plan" means the following:(1) A self-insurance program established under section 7(b) of this chapter.(2) A contract for prepaid health services under section 7(c) of this chapter.(c) A state employee health plan shall implement a procedure to allow a covered individual to submit a claim to offset the covered individual's deductible for the cost of a purchase by the covered individual of a prescription drug that:(1) is covered under the state employee health plan; and(2) was purchased by the covered individual without submitting at the point of purchase the claim through the state employee health plan.(d) If a covered individual submits a claim to the state employee health plan in accordance with the procedure established under subsection (c), the state employee health plan shall verify the purchase described under subsection (c) and count the amount paid by the covered individual for the purchased covered prescription drug against the covered individual's deductible.As added by P.L.114-2020, SEC.2.
IN Code § 5-10-8-23 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-23. Reimbursement for Emergency Medical Services

Sec. 23. (a) As used in this section, "covered individual" means an individual who is entitled to coverage under a state employee health plan.(b) 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.(c) As used in this section, "state employee health plan" means either of the following that provides coverage for emergency medical services:(1) A self-insurance program established under section 7(b) of this chapter to provide group health coverage.(2) A contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter.(d) A state employee health plan that provides coverage for emergency medical services must at least provide reimbursement, subject to applicable deductible and coinsurance, for a covered individual 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 was transported.(e) If multiple emergency medical services provider organizations qualify and submit a claim for reimbursement under this section for an encounter, the state employee health plan:(1) may only reimburse, subject to applicable deductible and coinsurance, under this section for one (1) claim per patient encounter; and(2) shall reimburse, subject to applicable deductible and coinsurance, the claim submitted by the emergency medical services provider organization that performed or provided the majority of advanced life support services for the patient.(f) The state personnel 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 restrict the state employee health plan from providing coverage beyond the requirements in this section.As added by P.L.115-2020, SEC.1.
IN Code § 5-10-8-24 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8. Group Insurance for Public Employees|5-10-8-24. Coverage for Pediatric Neuropsychiatric Disorders

Sec. 24. (a) As used in this section, "state employee health plan" means the following:(1) A self-insurance program established under section 7(b) of this chapter.(2) A contract for prepaid health services entered into under section 7(c) of this chapter.(b) A state employee health plan 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.(c) 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 state employee health plan.As added by P.L.130-2020, SEC.1.
IN Code § 5-10-8.1-1 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.1. State Employee Health Benefits; Provider Payment|5-10-8.1-1. "Administrator" Defined

Sec. 1. As used in this chapter, "administrator" means:(1) the state personnel department;(2) an entity with which the state contracts to administer health coverage under IC 5-10-8-7(b); or(3) a prepaid health care delivery plan with which the state contracts under IC 5-10-8-7(c).As added by P.L.162-2001, SEC.1.
IN Code § 5-10-8.1-2 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.1. State Employee Health Benefits; Provider Payment|5-10-8.1-2. "Clean Claim" Defined

Sec. 2. As used in this chapter, "clean claim" means a claim submitted by a provider for payment under a health benefit plan that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment.As added by P.L.162-2001, SEC.1.
IN Code § 5-10-8.1-3 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.1. State Employee Health Benefits; Provider Payment|5-10-8.1-3. "Covered Individual" Defined

Sec. 3. As used in this chapter, "covered individual" means an individual who is:(1) covered under a self-insurance program established under IC 5-10-8-7(b) to provide group health coverage; or(2) entitled to services under a contract for health services entered into or renewed under IC 5-10-8-7(c).As added by P.L.162-2001, SEC.1.
IN Code § 5-10-8.1-4 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.1. State Employee Health Benefits; Provider Payment|5-10-8.1-4. "Health Benefit Plan" Defined

Sec. 4. As used in this chapter, "health benefit plan" means a self-insurance program established to provide group health coverage as described in IC 5-10-8-7(b), or a contract for health services as described in IC 5-10-8-7(c).As added by P.L.162-2001, SEC.1.
IN Code § 5-10-8.1-5 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.1. State Employee Health Benefits; Provider Payment|5-10-8.1-5. "Provider" Defined

Sec. 5. As used in this chapter, "provider" has the meaning set forth in IC 27-8-11-1.As added by P.L.162-2001, SEC.1.
IN Code § 5-10-8.1-6 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.1. State Employee Health Benefits; Provider Payment|5-10-8.1-6. Notice of Deficiencies in Claims

Sec. 6. (a) The administrator shall pay or deny each clean claim in accordance with section 7 of this chapter.(b) An administrator shall notify a provider of any deficiencies in a submitted claim not more than:(1) thirty (30) days for a claim that is filed electronically; or(2) forty-five (45) days for a claim that is filed on paper;and describe any remedy necessary to establish a clean claim.(c) Failure of an administrator to notify a provider as required under subsection (b) establishes the submitted claim as a clean claim.As added by P.L.162-2001, SEC.1. Amended by P.L.137-2002, SEC.1.
IN Code § 5-10-8.1-7 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.1. State Employee Health Benefits; Provider Payment|5-10-8.1-7. Payment or Denial of Claims; Interest

Sec. 7. (a) The administrator shall pay or deny each clean claim as follows:(1) If the claim is filed electronically, not more than thirty (30) days after the date the claim is received by the administrator.(2) If the claim is filed on paper, not more than forty-five (45) days after the date the claim is received by the administrator.(b) If:(1) the administrator fails to pay or deny a clean claim in the time required under subsection (a); and(2) the administrator subsequently pays the claim;the administrator shall pay the provider that submitted the claim interest on the health benefit plan allowable amount of the claim paid under this section.(c) Interest paid under subsection (b):(1) accrues beginning:(A) thirty-one (31) days after the date the claim is filed under subsection (a)(1); or(B) forty-six (46) days after the date the claim is filed under subsection (a)(2); and(2) stops accruing on the date the claim is paid.(d) In paying interest under subsection (b), the administrator shall use the same interest rate as provided in IC 12-15-21-3(7)(A).As added by P.L.162-2001, SEC.1.
IN Code § 5-10-8.1-8 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.1. State Employee Health Benefits; Provider Payment|5-10-8.1-8. Permitted Forms

Sec. 8. A provider shall submit only the following forms for payment by an administrator:(1) CMS-1500.(2) CMS-1450 (UB-04).(3) American Dental Association (ADA) claim form.As added by P.L.162-2001, SEC.1. Amended by P.L.208-2018, SEC.1.
IN Code § 5-10-8.5-0.1 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.5. Retirement Medical Benefits Account|5-10-8.5-0.1. Application of Certain Amendments to Chapter

Sec. 0.1. The amendments made to section 18 of this chapter by P.L.124-2008 apply to premiums paid after July 31, 2007, for individual or group health coverage for a retired participant and the spouse and dependents of a retired participant.As added by P.L.220-2011, SEC.69.
IN Code § 5-10-8.5-1 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.5. Retirement Medical Benefits Account|5-10-8.5-1. Application of Chapter

Sec. 1. (a) Except as provided in this section, this chapter applies to an individual who is one (1) of the following:(1) An employee of the executive, legislative, or judicial branch of state government.(2) A state elected or appointed officer.(3) A member of the general assembly.(4) An elected officer paid by the state.(5) An officer paid by the state under IC 33-23-5-10, IC 33-38-5-7, or IC 33-39-6-2.(b) An individual described in subsection (a) other than the following is a participant in the retirement medical benefits account:(1) A conservation officer of the department of natural resources.(2) An employee of the state excise police.(3) An employee of the state police department, other than the following:(A) An employee of the state police department who waived coverage under a common and unified plan of self-insurance under IC 5-10-8-6 before July 1, 2011.(B) An employee of the state police department who makes an election under IC 5-10-8.5-9.5.(C) An employee of the state police department who makes an election under IC 5-10-8.5-9.6.As added by P.L.44-2007, SEC.1. Amended by P.L.229-2011, SEC.70.
IN Code § 5-10-8.5-2 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.5. Retirement Medical Benefits Account|5-10-8.5-2. "Account"

Sec. 2. As used in this chapter, "account" refers to the retirement medical benefits account established by section 11 of this chapter.As added by P.L.44-2007, SEC.1.
IN Code § 5-10-8.5-4 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.5. Retirement Medical Benefits Account|5-10-8.5-4. "Department"

Sec. 4. As used in this chapter, "department" refers to the state personnel department established under IC 4-15-2.2.As added by P.L.44-2007, SEC.1. Amended by P.L.6-2012, SEC.27.
IN Code § 5-10-8.5-5 (2021)
2021 Indiana Code|Title 5. State and Local Administration|Article 10. Public Employee Benefits|Chapter 8.5. Retirement Medical Benefits Account|5-10-8.5-5. "Employer"

Sec. 5. As used in this chapter, "employer" means the following:(1) For an elected officer, appointed officer, or employee of the executive branch of state government who is a participant in the retirement medical benefits account, the state, including any board, commission, department, division, authority, institution, establishment, facility, or governmental unit under the supervision of the state, having a payroll in relation to persons it immediately employs.(2) For a member of the general assembly or an employee of the legislative branch of state government:(A) the president pro tempore of the senate, for a member or an employee of the senate;(B) the speaker of the house, for a member or an employee of the house of representatives; or(C) the personnel subcommittee of the legislative council, for an employee of the legislative services agency.(3) For:(A) a justice;(B) a judge;(C) a prosecuting attorney;(D) an officer described under section 1(a)(5) of this chapter; or(E) an employee of the judicial branch of state government, including an employee of any board, commission, department, division, authority, institution, establishment, facility, or governmental unit under the supervision of the judicial branch, having a payroll in relation to persons it immediately employs;the Indiana supreme court.As added by P.L.44-2007, SEC.1. Amended by P.L.229-2011, SEC.71.