reglab/statecodes huggingface dataset:
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-35. "Regulatory Action Level Event"

Sec. 35. As used in this chapter, "regulatory action level event" means any of the following events:
(1) The filing of an RBC report by the insurer that indicates that the insurer's total adjusted capital is:
(A) greater than or equal to its authorized control level RBC; but
(B) less than its regulatory action level RBC.
(2) The notification by the commissioner to an insurer of an adjusted RBC report that indicates that the insurer's total adjusted capital is:
(A) greater than or equal to its authorized control level RBC; but
(B) less than its regulatory action level RBC;
unless the insurer challenges the adjusted RBC report under section 44 of this chapter.
(3) The notification by the commissioner to the insurer that the commissioner has, after a hearing under section 44 of this chapter, rejected the insurer's challenge to an adjusted RBC report.
(4) The failure of the insurer to file an RBC report by the filing date, unless the insurer:
(A) has provided an explanation for the failure that is satisfactory to the commissioner; and
(B) has cured the failure not more than ten (10) days after the March 1 filing date.
(5) The failure of the insurer to submit an RBC plan to the commissioner within the period prescribed in section 31 of this chapter.
(6) Notification by the commissioner to the insurer under section 33 of this chapter, unless the insurer challenges the notification under section 44 of this chapter.
(7) The notification by the commissioner to the insurer that the commissioner has, after a hearing under section 44 of this chapter, rejected the challenge to a determination by the commissioner under section 33 of this chapter.
(8) Notification by the commissioner to the insurer that the insurer has failed to adhere to its RBC plan or revised RBC plan, but only if:
(A) the failure has a substantial adverse effect on the ability of the insurer to eliminate the company action level event in accordance with its RBC plan or revised RBC plan; and
(B) the commissioner has so stated in the notification;
unless the insurer challenges the determination under section 44 of this chapter.
(9) The notification by the commissioner to the insurer that the commissioner has, after a hearing under section 44 of this chapter, rejected the insurer's challenge to the determination made under subdivision (8).
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-36. Action by Commissioner After Regulatory Action Level Event

Sec. 36. If a regulatory action level event occurs, the commissioner shall:
(1) require the insurer to prepare an RBC plan or, if applicable, a revised RBC plan;
(2) perform such examination or analysis as the commissioner considers necessary of the assets, liabilities, and operations of the insurer, including a review of the insurer's RBC plan or revised RBC plan; and
(3) after the examination or analysis, issue a corrective order specifying the corrective actions that the commissioner determines are required, taking into account relevant factors with respect to the insurer, based upon the commissioner's examination or analysis of the assets, liabilities, and operations of the insurer, including the results of any sensitivity tests undertaken under the RBC instructions.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-37. Timing for Submission of Rbc Plan or Revised Rbc Plan After Regulatory Action Level Event

Sec. 37. The RBC plan or revised RBC plan must be submitted:
(1) not more than forty-five (45) days after the regulatory action level event;
(2) not later than forty-five (45) days after the notification to the insurer that the commissioner has, after a hearing under section 44 of this chapter, rejected the insurer's challenge to an adjusted RBC report; or
(3) not more than forty-five (45) days after the notification to the insurer that the commissioner has, after a hearing under section 44 of this chapter, rejected the insurer's challenge to an adjusted RBC plan.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-38. Consultants to Commissioner

Sec. 38. (a) The commissioner may retain actuaries, investment experts, and other consultants that the commissioner determines to be necessary to:
(1) review the insurer's RBC plan or revised RBC plan;
(2) examine or analyze the assets, liabilities, and operations of the insurer; and
(3) formulate the corrective order with respect to the insurer.
(b) The reasonable costs and expenses relating to consultants shall be paid by the affected insurer or another party, as directed by the commissioner.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-39. "Authorized Control Level Event"

Sec. 39. As used in this chapter, "authorized control level event" means any of the following events:
(1) The filing of an RBC report by an insurer that indicates that the insurer's total adjusted capital is:
(A) greater than or equal to its mandatory control level RBC; but
(B) less than its authorized control level RBC.
(2) The notification by the commissioner to the insurer of an adjusted RBC report that indicates that the insurer's total adjusted capital is:
(A) greater than or equal to its mandatory control level RBC; but
(B) less than its authorized control level RBC;
unless the insurer challenges the adjusted RBC report under section 44 of this chapter.
(3) Notification by the commissioner to the insurer that the commissioner has, after a hearing under section 44 of this chapter, rejected the insurer's challenge to an adjusted RBC report.
(4) The failure of the insurer to respond, in a manner satisfactory to the commissioner, to a corrective order, unless the insurer has challenged the corrective order under section 44 of this chapter.
(5) The failure of the insurer to respond, in a manner satisfactory to the commissioner, to a corrective order if, after a challenge and a hearing under section 44 of this chapter, the commissioner has:
(A) rejected the challenge; or
(B) modified the corrective order.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-40. Action by Commissioner After Authorized Control Level Event

Sec. 40. (a) If an authorized control level event occurs with respect to an insurer, the commissioner shall:
(1) take the actions required under section 36 of this chapter regarding an insurer; or
(2) if the commissioner considers it to be in the best interests of:
(A) the policyholders and creditors of the insurer; and
(B) the public;
take any action necessary to cause the insurer to be placed under regulatory control under IC 27-9.
(b) An authorized control level event is sufficient grounds for the commissioner to:
(1) determine, under IC 27-9-2-1, that an insurer has committed or engaged in, or is about to commit or engage in, an act, a practice, or a transaction that would subject the insurer to a delinquency proceeding under IC 27-9-3-1 or IC 27-9-3-6; and
(2) serve upon the insurer, under IC 27-9-2-1, orders reasonably necessary to correct, eliminate, or remedy the conduct, condition, or ground.
The commissioner has the rights, powers, and duties with respect to the insurer that are set forth in IC 27-9.
(c) If the commissioner takes action under subsection (a)(2), the insurer is entitled to the protections of IC 27-9-2 pertaining to summary proceedings.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-41. "Mandatory Control Level Event"

Sec. 41. As used in this chapter, "mandatory control level event" means any of the following events:
(1) The filing of an RBC report that indicates that the insurer's total adjusted capital is less than its mandatory control level RBC.
(2) Notification by the commissioner to the insurer of an adjusted RBC report that indicates that the insurer's total adjusted capital is less than its mandatory control level RBC unless the insurer challenges the adjusted RBC report under section 44 of this chapter.
(3) Notification by the commissioner to the insurer that the commissioner has, after a hearing under section 44 of this chapter, rejected the insurer's challenge to an adjusted RBC report.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-42. Action by Commissioner After Mandatory Control Level Event With Respect to Life or Health Insurer or Fraternal Benefit Society

Sec. 42. (a) If a mandatory control level event occurs with respect to a life insurer, a health insurer, or a fraternal benefit society, the commissioner shall take the actions necessary to place the insurer under regulatory control under IC 27-9.
(b) A mandatory control level event is sufficient grounds for the commissioner to take action against a life insurer, a health insurer, or a fraternal benefit society under IC 27-9, and the commissioner has the rights, powers, and duties with respect to the insurer that are set forth in IC 27-9.
(c) If the commissioner takes action against a life insurer, a health insurer, or a fraternal benefit society under an adjusted RBC report, the insurer is entitled to the protections of IC 27-9-2 pertaining to summary proceedings.
(d) The commissioner may forego action under subsections (a) through (c) for not more than ninety (90) days after the mandatory control level event if the commissioner finds there is a reasonable expectation that the mandatory control level event may be eliminated within the ninety (90) day period.
As added by P.L.186-1996, SEC.1. Amended by P.L.276-2013, SEC.27.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-42.1. Action by Commissioner After Mandatory Control Level Event With Respect to Health Maintenance Organization or Limited Service Health Maintenance Organization

Sec. 42.1. (a) If a mandatory control level event occurs with respect to a health maintenance organization or a limited service health maintenance organization, the commissioner shall take the action necessary to place the health maintenance organization or limited service health maintenance organization under regulatory control under IC 27-13.
(b) A mandatory control level event is sufficient grounds for the commissioner to take action against a health maintenance organization or a limited service health maintenance organization under IC 27-13 and the commissioner has the rights, powers, and duties with respect to the health maintenance organization or limited service health maintenance organization that are set forth in IC 27-13.
(c) If the commissioner takes action against a health maintenance organization or a limited service health maintenance organization under an adjusted RBC report, the health maintenance organization or limited service health maintenance organization is entitled to the protections under IC 27-9-2 pertaining to summary proceedings.
(d) The commissioner may forego action under subsections (a) through (c) for not more than ninety (90) days after the mandatory control level event if the commissioner finds that there is a reasonable expectation that the mandatory control level event may be eliminated within the ninety (90) day period.
As added by P.L.51-2002, SEC.9.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-43. Action by Commissioner After Mandatory Control Level Event With Respect to Property and Casualty Insurer

Sec. 43. (a) If a mandatory control level event occurs with respect to a property and casualty insurer, the commissioner:
(1) shall take the actions necessary to place the insurer under regulatory control under IC 27-9; or
(2) in the case of an insurer that is not writing business and that is running off its existing business, may allow the insurer to continue its run-off under the supervision of the commissioner.
(b) A mandatory control level event is sufficient grounds for the commissioner to take action against a property and casualty insurer under IC 27-9, and the commissioner has the rights, powers, and duties with respect to the insurer that are set forth in IC 27-9.
(c) If the commissioner takes action against a property and casualty insurer under an adjusted RBC report, the insurer is entitled to the protections of IC 27-9-2 pertaining to summary proceedings.
(d) The commissioner may forego action for not more than ninety (90) days after the mandatory control level event if the commissioner finds there is a reasonable expectation that the mandatory control level event may be eliminated within the ninety (90) day period.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-44. Confidential Department Hearing

Sec. 44. (a) The insurer has the right to a confidential departmental hearing, on the record, upon the occurrence of any of the following:
(1) Notification to an insurer by the commissioner of an adjusted RBC report.
(2) Notification to an insurer by the commissioner under section 32(b) of this chapter.
(3) Notification to an insurer by the commissioner that:
(A) the insurer has failed to adhere to its RBC plan or revised RBC plan; and
(B) the insurer's failure has a substantial adverse effect on the ability of the insurer to eliminate the company action level event with respect to the insurer in accordance with its RBC plan or revised RBC plan.
(4) Notification to an insurer by the commissioner of a corrective order with respect to the insurer.
(b) At a confidential hearing under this section, the insurer may challenge any determination or action by the commissioner.
(c) An insurer must notify the commissioner of the insurer's request for a hearing under this section not more than five (5) days after the notification by the commissioner under subsection (a). Upon receiving the insurer's request for a hearing, the commissioner shall set a date for the hearing. The date set by the commissioner must be:
(1) at least ten (10); and
(2) not more than thirty (30);
days after the date of the insurer's request.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-45. Confidential Information

Sec. 45. (a) Because they contain information that might be damaging to an insurer if made available to the insurer's competitors, the following are declared confidential for purposes of IC 5-14-3-4 and are not subject to inspection and copying by the public under IC 5-14-3-3:
(1) An RBC report filed with the commissioner under this chapter, to the extent that the information in the report is not required to be provided in a publicly available annual statement schedule.
(2) An RBC plan filed with the commissioner under this chapter, including:
(A) the results or report of any examination or analysis of an insurer performed under the plan; and
(B) any corrective order issued by the commissioner under the examination or analysis.
(b) The information described in subsection (a):
(1) must be kept confidential by the commissioner;
(2) shall not be made public; and
(3) is not:
(A) subject to subpoena;
(B) subject to discovery in a private civil action; or
(C) admissible in evidence in a private civil action;
other than by the commissioner and then only for the purpose of enforcement actions taken by the commissioner under this chapter or another provision of this title.
(c) The commissioner, or a person receiving documents, materials, or other information while acting under the authority of the commissioner, is not permitted or required to testify in a private civil action concerning confidential information described in subsection (a).
(d) The commissioner may disclose documents, materials, and other information, including the information described in subsection (a), to:
(1) other state, federal, and international regulatory agencies;
(2) the NAIC and affiliates and subsidiaries of the NAIC; and
(3) state, federal, and international law enforcement authorities;
if the recipient agrees to maintain the confidential and privileged status of the documents, materials, and other information.
(e) The commissioner:
(1) may receive documents, materials, and other information, including confidential and privileged documents, materials, and information, from:
(A) other state, federal, and international regulatory agencies;
(B) the NAIC and affiliates and subsidiaries of the NAIC; and
(C) other state, federal, and international law enforcement authorities; and
(2) shall maintain as confidential or privileged all documents, materials, and other information received with notice or the understanding that the documents, materials, and information are confidential or privileged under the law of the jurisdiction that is the source of the documents, materials, and information.
(f) Any applicable privilege or claim of confidentiality in documents, materials, or information described in this section is not waived as a result of the disclosure or receipt of the documents, materials, or information by the commissioner under this section.
As added by P.L.186-1996, SEC.1. Amended by P.L.276-2013, SEC.28.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-46. Comparison of Insurer's Total Adjusted Capital to Rbc Levels

Sec. 46. (a) The comparison of an insurer's total adjusted capital to any of its RBC levels is a regulatory tool that may indicate the need for possible corrective action with respect to the insurer and it is not intended as a means to rank insurers generally. Except as provided in subsection (b), the action of an insurer, an insurance producer, a broker, or other person engaged in any manner in the insurance business, in:
(1) making, publishing, disseminating, circulating, or placing before the public; or
(2) causing, directly or indirectly to be made, published, disseminated, circulated, or placed before the public, in a newspaper, magazine, or other publication, or in the form of a notice, circular, pamphlet, letter, or poster, or over any radio or television station, or in any other way;
an advertisement, an announcement, or a statement containing an assertion, a representation, or a statement regarding the RBC level of an insurer or any component derived in the calculation of the RBC level of an insurer is misleading and is prohibited.
(b) If:
(1) a materially false statement with respect to the comparison regarding an insurer's total adjusted capital to an RBC level of the insurer or an inappropriate comparison of any other amount to the insurer's RBC levels is published in any written publication; and
(2) the insurer is able to demonstrate to the commissioner with substantial proof the:
(A) falsity; or
(B) inappropriateness;
of the statement;
the insurer may publish an announcement in a written publication if the sole purpose of the announcement is to rebut the materially false statement.
As added by P.L.186-1996, SEC.1. Amended by P.L.178-2003, SEC.31.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-47. Use of Documents Referred to in Chapter

Sec. 47. (a) The:
(1) RBC instructions;
(2) RBC reports;
(3) adjusted RBC reports;
(4) RBC plans; and
(5) revised RBC plans;
referred to in this chapter are intended solely for use by the commissioner in monitoring the solvency of insurers and the need for possible corrective action with respect to insurers.
(b) The instructions, reports, and plans referred to in subsection (a) shall not be:
(1) used by the commissioner for ratemaking;
(2) considered or introduced as evidence in a rate proceeding; or
(3) used by the commissioner to calculate or derive any elements of an appropriate premium level or rate of return for any line of insurance that an insurer or an affiliate is authorized to write.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-48. Chapter Supplements Other Indiana Law

Sec. 48. This chapter is supplemental to other provisions of Indiana law and does not preclude or limit any other powers or duties of the commissioner under other provisions of Indiana law, including IC 27-9.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-49. Submission of Rbc Report by Foreign Insurer

Sec. 49. (a) Upon the written request of the commissioner, a foreign insurer shall submit to the commissioner an RBC report as of the last day of the calendar year most recently ended. The foreign insurer shall submit the report on or before:
(1) the date on which a domestic insurer would be required to file an RBC report under this chapter; or
(2) fifteen (15) days after the foreign insurer receives the request;
whichever occurs later.
(b) Upon the written request of the commissioner, a foreign insurer shall promptly submit to the commissioner a copy of any RBC plan that the foreign insurer has filed with the insurance commissioner of any other state.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-50. Filing of Rbc Plan by Foreign Insurer

Sec. 50. (a) If:
(1) an event that is:
(A) a company action level event;
(B) a regulatory action level event; or
(C) an authorized control level event;
occurs with respect to a foreign insurer as determined under the RBC statute applicable in the state of domicile of the insurer (or, if no RBC statute is in force in that state, under this chapter); and
(2) the insurance commissioner of the state of domicile of the foreign insurer fails to require the foreign insurer to file an RBC plan in the manner specified under that state's RBC statute (or, if no RBC statute is in force in that state, under sections 31 through 35 of this chapter);
the commissioner may require the foreign insurer to file an RBC plan with the commissioner.
(b) In a situation described in subsection (a), the failure of the foreign insurer to file an RBC plan with the commissioner is grounds for the commissioner to order the insurer to cease and desist from writing new insurance business in Indiana.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-51. Liquidation of Property of Foreign Insurer

Sec. 51. If:
(1) a mandatory control level event occurs with respect to a foreign insurer; and
(2) no domiciliary receiver has been appointed with respect to the foreign insurer under the rehabilitation and liquidation statute applicable in the state of domicile of the foreign insurer;
the commissioner may apply to the Marion County circuit court with respect to the liquidation of property of the foreign insurer that is found in Indiana. The occurrence of the mandatory control level event is adequate grounds for the application.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-52. Effective Notice

Sec. 52. (a) A notice by the commissioner to an insurer that may result in regulatory action under this chapter, if transmitted by registered or certified mail, is effective when the notice is put in the mail.
(b) A transmission by the commissioner to an insurer under this chapter other than a notice described in subsection (a) is effective upon the insurer's receipt of the transmission.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-53. Immunity From Liability

Sec. 53. There is no liability on the part of, and no cause of action shall arise against:
(1) the commissioner;
(2) the department; or
(3) any employee or agent of the department;
for any action taken in the exercise of their powers and the performance of duties under this chapter.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-54. Severability of Chapter Provisions

Sec. 54. The provisions of this chapter are severable in the manner provided in IC 1-1-1-8. If:
(1) any provision of this chapter; or
(2) the application of this chapter to any person or circumstance;
is held invalid, that determination shall not affect the provisions or applications of this chapter that can be given effect without the invalid provision or application.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 36. Risk Based Capital Requirements › 27-1-36-56. Excess Capital

Sec. 56. (a) An excess of capital over the amount produced by the:
(1) risk based capital requirements contained in this chapter; and
(2) formulas, schedules, and instructions referred to in this chapter;
is desirable in the business of insurance. Therefore, insurers should seek to maintain capital above the RBC levels required by this chapter.
(b) Additional capital is used and useful in the insurance business and helps to secure an insurer against various risks that are:
(1) inherent in or affecting the business of insurance; and
(2) not accounted for or only partially measured by the risk based capital requirements contained in this chapter.
As added by P.L.186-1996, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37. Health Provider Contracts › 27-1-37-0.2. "Affiliate" Defined

Sec. 0.2. As used in this chapter, "affiliate" means any person who, directly or indirectly through one (1) or more intermediaries, controls, is controlled by, or is under common control with, the person to whom affiliation is attributed.
As added by P.L.198-2021, SEC.16.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37. Health Provider Contracts › 27-1-37-1. "Emergency" Defined

Sec. 1. As used in this chapter, "emergency" means a medical condition that arises suddenly and unexpectedly and manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent lay person who possesses an average knowledge of health and medicine to:
(1) place an individual's health in serious jeopardy;
(2) result in serious impairment to the individual's bodily functions; or
(3) result in serious dysfunction of a bodily organ or part of the individual.
As added by P.L.197-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37. Health Provider Contracts › 27-1-37-1.5. "Health Carrier" Defined

Sec. 1.5. (a) As used in this chapter, "health carrier" means an entity:
(1) that is subject to IC 27 and the administrative rules adopted under IC 27; and
(2) that enters into a contract to:
(A) provide health care services;
(B) deliver health care services;
(C) arrange for health care services; or
(D) pay for or reimburse any of the costs of health care services.
(b) The term includes the following:
(1) An insurer, as defined in IC 27-1-2-3(x), that issues a policy of accident and sickness insurance, as defined in IC 27-8-5-1(a).
(2) A health maintenance organization, as defined in IC 27-13-1-19.
(3) An administrator (as defined in IC 27-1-25-1(a)) that is licensed under IC 27-1-25.
(4) A state employee health plan offered under IC 5-10-8.
(5) A short term insurance plan (as defined by IC 27-8-5.9-3).
(6) Any other entity that provides a plan of health insurance, health benefits, or health care services.
(c) The term does not include:
(1) an insurer that issues a policy of accident and sickness insurance;
(2) a limited service health maintenance organization (as defined in IC 27-13-34-4); or
(3) an administrator;
that only provides coverage for, or processes claims for, dental or vision care services.
As added by P.L.198-2021, SEC.17.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37. Health Provider Contracts › 27-1-37-2. "Health Maintenance Organization" Defined

Sec. 2. As used in this chapter, "health maintenance organization" means a person that undertakes to provide or arrange for the delivery of health care services to individuals on a prepaid basis, except for the individual's responsibility for copayments or deductibles. The term includes a limited service health maintenance organization. The term does not include a staff-model health maintenance organization that employs a group of providers and that requires the providers to provide health care services solely to individuals who are entitled to coverage under a contract with the staff-model health maintenance organization or an affiliate of the staff-model health maintenance organization.
As added by P.L.197-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37. Health Provider Contracts › 27-1-37-3. "Health Provider Contract" Defined

Sec. 3. As used in this chapter, "health provider contract" means an agreement with a provider or a health provider facility relating to terms and conditions of reimbursement for health care services provided to an individual under:
(1) an employee welfare benefit plan (as defined in 29 U.S.C. 1002 et seq.);
(2) a policy of accident and sickness insurance (as defined in IC 27-8-5-1);
(3) a contract with a health maintenance organization;
(4) a self-insurance program established under IC 5-10-8-7(b); or
(5) a prepaid health care delivery plan entered into under IC 5-10-8-7(c).
As added by P.L.197-2001, SEC.1. Amended by P.L.198-2021, SEC.18.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37. Health Provider Contracts › 27-1-37-3.2. "Health Provider Facility" Defined

Sec. 3.2. As used in this chapter, "health provider facility" means any of the following:
(1) A hospital, as defined in IC 16-18-2-179(a).
(2) A hospital system.
(3) An affiliate of a hospital or hospital system.
As added by P.L.198-2021, SEC.19.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37. Health Provider Contracts › 27-1-37-3.5. "Hospital System" Defined

Sec. 3.5. As used in this chapter, "hospital system" means:
(1) a parent corporation of at least one (1) hospital and any entity affiliated with the parent corporation through ownership, governance, or membership; or
(2) a hospital and any entity affiliated with the hospital through ownership, governance, or membership.
As added by P.L.198-2021, SEC.20.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37. Health Provider Contracts › 27-1-37-4. "Person" Defined

Sec. 4. (a) As used in this chapter, "person" means an individual, an agency, a political subdivision, a partnership, a corporation, an association, or any other entity.
(b) The term does not include a health care provider described in IC 16-18-2-163(a)(1), IC 16-18-2-163(a)(2), IC 16-18-2-163(a)(3), or IC 16-18-2-163(a)(4).
As added by P.L.197-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37. Health Provider Contracts › 27-1-37-6. Requiring Provider to Provide Health Care Services

Sec. 6. (a) Except as provided in subsection (b), a person may not require a provider, as a condition of entering into a health provider contract for the provision of health care services other than health care services to enrollees of a health maintenance organization, to provide health care services to enrollees of a health maintenance organization.
(b) A person may require a provider, as a condition of entering into a health provider contract for the provision of health care services other than health care services to enrollees of a health maintenance organization, to provide health care services to enrollees of a health maintenance organization:
(1) in an emergency; or
(2) upon referral.
(c) If a person requires a provider to provide health care services to enrollees of a health maintenance organization under subsection (b), the person:
(1) shall reimburse the provider at rates established under the health provider contract; and
(2) may not require the provider to comply with the terms and conditions of the health maintenance organization.
As added by P.L.197-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37. Health Provider Contracts › 27-1-37-7. Applicability; Prohibition on Preventing Disclosure of Health Care Service Claims Data; Violation an Unfair or Deceptive Act

Sec. 7. (a) This section applies to health provider contracts entered into or renewed after June 30, 2020.
(b) A health provider contract, including a contract with a pharmacy benefit manager or a health facility, may not contain a provision that prohibits the disclosure of health care service claims data to:
(1) employers providing the coverage; or
(2) beginning July 1, 2021, another person for use in the all payer claims data base established by IC 27-1-44.5.
However, any disclosure of claims data must comply with health privacy laws, including the federal Health Insurance Portability and Accountability Act (HIPAA) (P.L. 104-191).
(c) A violation of this section constitutes an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4.
As added by P.L.50-2020, SEC.5. Amended by P.L.93-2020, SEC.10; P.L.198-2021, SEC.21.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37. Health Provider Contracts › 27-1-37-8. Prohibited Contract Provisions; Severable and Void; Investigative Demand by Attorney General

Sec. 8. (a) This section applies to a health provider contract entered into, amended, or renewed after June 30, 2021.
(b) A health provider contract, including a contract with a pharmacy benefit manager, may not contain a provision that does any of the following:
(1) Limits the ability of either the health carrier or the health provider facility to disclose the allowed amount and fees of services to any insured (as defined in IC 27-8-5.8-3) or enrollee (as defined in IC 27-13-1-12), or to the treating health provider facility or physician of the insured or enrollee.
(2) Limits the ability of either the health carrier or the health provider facility to disclose out-of-pocket costs to an insured (as defined in IC 27-8-5.8-3) or an enrollee (as defined in IC 27-13-1-12).
(c) Any provision of a health provider contract that includes a provision described in subsection (b) in violation of this section is severable and the provision in violation is null and void. The remaining provisions of the health provider contract, excluding the provision in violation of this section, remain in effect and are enforceable.
(d) The attorney general may issue a civil investigative demand to obtain information from a party of, or pertaining to, a health provider contract and compliance of this section.
As added by P.L.198-2021, SEC.22.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.1. Termination of Health Provider Contracts › 27-1-37.1-1. "Health Maintenance Organization"

Sec. 1. As used in this chapter, "health maintenance organization" means a person that undertakes to provide or arrange for the delivery of health care services to individuals on a prepaid basis, except for the individual's responsibility for copayments or deductibles. The term includes a limited service health maintenance organization. The term does not include a staff-model health maintenance organization that employs a group of providers and that requires the providers to provide health care services solely to individuals who are entitled to coverage under a contract with the staff-model health maintenance organization or an affiliate of the staff-model health maintenance organization.
As added by P.L.196-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.1. Termination of Health Provider Contracts › 27-1-37.1-2. "Health Provider Contract"

Sec. 2. As used in this chapter, "health provider contract" means an agreement with a provider relating to terms and conditions of reimbursement for health care services provided to an individual under:
(1) an employee welfare benefit plan (as defined in 29 U.S.C. 1002 et seq.);
(2) a policy of accident and sickness insurance (as defined in IC 27-8-5-1);
(3) a contract with a health maintenance organization;
(4) a self-insurance program established under IC 5-10-8-7(b); or
(5) a prepaid health care delivery plan entered into under IC 5-10-8-7(c).
As added by P.L.196-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.1. Termination of Health Provider Contracts › 27-1-37.1-3. "Person"

Sec. 3. (a) As used in this chapter, "person" means an individual, an agency, a political subdivision, a partnership, a corporation, an association, or any other entity that enters into a health provider contract with a provider.
(b) The term does not include a health care provider described in IC 16-18-2-163(a)(1), IC 16-18-2-163(a)(2), IC 16-18-2-163(a)(3), or IC 16-18-2-163(a)(4).
As added by P.L.196-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.1. Termination of Health Provider Contracts › 27-1-37.1-4. "Provider"

Sec. 4. As used in this chapter, "provider" means:
(1) a physician licensed under IC 25-22.5;
(2) a dentist licensed under IC 25-14;
(3) an advanced practice registered nurse licensed under IC 25-23;
(4) a chiropractor licensed under IC 25-10;
(5) a podiatrist licensed under IC 25-29;
(6) an optometrist licensed under IC 25-24; or
(7) a clinical psychologist licensed under IC 25-33.
As added by P.L.196-2001, SEC.1. Amended by P.L.129-2018, SEC.40.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.1. Termination of Health Provider Contracts › 27-1-37.1-5. Notice of Amendment of Contract

Sec. 5. A person who enters into a health provider contract with a provider shall provide written notice to the provider of any amendment to the health provider contract not less than forty-five (45) days before the proposed effective date of the amendment.
As added by P.L.196-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.1. Termination of Health Provider Contracts › 27-1-37.1-6. Termination of Contract Without Penalty

Sec. 6. (a) Subject to subsection (b), a provider who receives notice under section 5 of this chapter may terminate the health provider contract without penalty by informing the person with whom the health care provider contracts that the provider chooses not to approve the amendment.
(b) Notice under subsection (a) must be:
(1) given not later than fifteen (15) days after the provider receives notice under section 5 of this chapter; and
(2) in writing.
As added by P.L.196-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.1. Termination of Health Provider Contracts › 27-1-37.1-7. Effective Date of Termination

Sec. 7. The termination of a contract under section 6 of this chapter is effective:
(1) ninety (90) days after the person with whom the provider contracts receives written notice from the provider that the provider does not approve the amendment; or
(2) on a date earlier than the date described in subdivision (1), if agreed to by the person with whom the provider contracts and the provider.
As added by P.L.196-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.1. Termination of Health Provider Contracts › 27-1-37.1-8. Compliance With Proposed Amendment Not Required

Sec. 8. If a person with whom a provider contracts receives notice from a provider under section 6 of this chapter, the person with whom a provider contracts may not require the provider to comply with the proposed amendment.
As added by P.L.196-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.1. Termination of Health Provider Contracts › 27-1-37.1-9. Notification to Patient That Provider's Contract Terminated

Sec. 9. Except in an emergency, a provider who elects to terminate a health provider contract under this section shall, before providing services to a patient who is covered by the contract, notify the patient that the provider's contract has been or will be terminated.
As added by P.L.196-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.1. Termination of Health Provider Contracts › 27-1-37.1-10. Contrary Contract Provisions Void

Sec. 10. Except as provided in section 7(2) of this chapter, a health provider contract provision that is contrary to this chapter is void.
As added by P.L.196-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.1. Termination of Health Provider Contracts › 27-1-37.1-11. Chapter Inapplicable to Compliance With State or Federal Laws

Sec. 11. This chapter does not apply to an amendment to a health provider contract that is required to comply with a state or federal law.
As added by P.L.196-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.2. Health Insurance Educator › 27-1-37.2-1. "Health Benefit Plan" Defined

Sec. 1. As used in this chapter, "health benefit plan" means coverage for health care services provided under:
(1) a policy of accident and sickness insurance (as defined in IC 27-8-5-1);
(2) a contract with a health maintenance organization under IC 27-13; or
(3) any other benefit program that provides payment, reimbursement, or indemnification for the costs of health care except:
(A) worker's compensation or similar insurance; or
(B) benefits provided under a certificate of exemption issued by the worker's compensation board under IC 22-3-2-5.
As added by P.L.258-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.2. Health Insurance Educator › 27-1-37.2-3. "Health Insurance Educator" Defined

Sec. 3. As used in this chapter, "health insurance educator" refers to the health insurance educator appointed under section 6 of this chapter.
As added by P.L.258-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.2. Health Insurance Educator › 27-1-37.2-8. Duties; Prohibitions

Sec. 8. (a) The health insurance educator shall do the following:
(1) Assist health benefit plan consumers in making informed choices regarding health benefit plans by providing information about the following:
(A) The purchase, or enrollment in, a health benefit plan.
(B) The manner in which to resolve a dispute with a health benefit plan.
(C) The method of filing a claim under a health benefit plan.
(D) The availability of resources useful to a health benefit plan consumer.
(E) Consumer rights and responsibilities under a health benefit plan.
(F) Comparative information about health benefit plans to consumers and purchasers of health benefit plans.
(G) Other matters that may further a health benefit plan consumer's knowledge of health insurance benefit plans.
(2) Apply to obtain funds through federal grants and any other source. Any funds obtained shall be used to fulfill the purposes described in subdivision (1).
(b) Notwithstanding subsection (a)(1), the health insurance educator shall not:
(1) recommend a particular company, insurance producer, or product; or
(2) interpret or advise an individual regarding a particular contract or disputed claim that is subject to the federal Employee Retirement Income Security Act (29 U.S.C. 1001 et seq.).
As added by P.L.258-2001, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.3. Third Party Rights and Responsibilities Under Health Care Contracts › 27-1-37.3-0.1. Application of Chapter

Sec. 0.1. The addition of this chapter by P.L.55-2008 applies to a health care contract that is entered into, amended, or renewed after June 30, 2008.
As added by P.L.220-2011, SEC.425.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.3. Third Party Rights and Responsibilities Under Health Care Contracts › 27-1-37.3-1. Application of Definitions

Sec. 1. Unless otherwise specified in this chapter, the definitions in IC 27-8-11-1 apply throughout this chapter.
As added by P.L.55-2008, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.3. Third Party Rights and Responsibilities Under Health Care Contracts › 27-1-37.3-2. "Affiliate"

Sec. 2. As used in this chapter, "affiliate" has the meaning set forth in IC 27-1-25-1.
As added by P.L.55-2008, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.3. Third Party Rights and Responsibilities Under Health Care Contracts › 27-1-37.3-3. "Contractor"

Sec. 3. As used in this chapter, "contractor" refers to a person with a primary business purpose of entering into health care contracts with providers.
As added by P.L.55-2008, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.3. Third Party Rights and Responsibilities Under Health Care Contracts › 27-1-37.3-4. "Covered Individual"

Sec. 4. As used in this chapter, "covered individual" means an individual who is entitled to coverage under a health plan.
As added by P.L.55-2008, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.3. Third Party Rights and Responsibilities Under Health Care Contracts › 27-1-37.3-5. "Health Plan"

Sec. 5. (a) As used in this chapter, "health plan" means a plan through which coverage is provided for health care services through insurance, prepayment, reimbursement, or otherwise. The term includes the following:
(1) An employee welfare benefit plan (as defined in 29 U.S.C. 1002 et seq.).
(2) A policy of accident and sickness insurance (as defined in IC 27-8-5-1).
(3) An individual contract (as defined in IC 27-13-1-21) or a group contract (as defined in IC 27-13-1-16).
(b) The term does not include the following:
(1) Accident-only, credit, Medicare supplement, long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Worker's compensation or similar insurance.
(4) Automobile medical payment insurance.
(5) A specified disease policy issued as an individual policy.
(6) A short term insurance plan that:
(A) may be renewed for the greater of:
(i) thirty-six (36) months; or
(ii) the maximum period permitted under federal law;
(B) has a term of not more than three hundred sixty-four (364) days; and
(C) has an annual limit of at least two million dollars ($2,000,000).
(7) A policy that provides a stipulated daily, weekly, or monthly payment to an insured during hospital confinement, without regard to the actual expense of the confinement.
As added by P.L.55-2008, SEC.1. Amended by P.L.288-2019, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 37.3. Third Party Rights and Responsibilities Under Health Care Contracts › 27-1-37.3-6. "Health Care Contract"

Sec. 6. As used in this chapter, "health care contract" means a contract between a person and a provider specifying the rights and responsibilities of the:
(1) person; and
(2) provider;
in relation to payment for and delivery of health care services to a covered individual.
As added by P.L.55-2008, SEC.1.