reglab/statecodes huggingface dataset:
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-19.5. Federal Drug Pricing Program

Sec. 19.5. (a) This section:
(1) applies to a Medicaid managed care organization (as defined in 42 U.S.C. 1396b(m)); and
(2) does not apply to the state Medicaid program when Medicaid provides reimbursement for covered outpatient drugs (as defined in 42 U.S.C. 1396r-8(k)) on a fee for service basis.
(b) As used in this section, "340B covered entity" means an entity authorized to participate in the federal 340B Drug Pricing Program under Section 340B(a)(4) of the federal Public Health Service Act (42 U.S.C. 256b(a)(4)) and includes any pharmacy under contract with the entity to dispense drugs on behalf of the entity.
(c) The following provisions may not be contained in a contract between a pharmacy benefit manager and a 340B covered entity:
(1) A reimbursement rate for a prescription drug that would diminish the 340B benefit to a 340B covered entity.
(2) A fee or adjustment that is not imposed on a pharmacy that is not a 340B covered entity.
(3) A fee or adjustment amount that exceeds the fee or adjustment amount imposed on a pharmacy that is not a 340B covered entity.
(4) Any provision that prevents or interferes with an individual's choice to receive a prescription drug from a 340B covered entity, including the administration of the drug.
(5) Any provision that excludes a 340B covered entity from pharmacy benefit manager networks based on the 340B covered entity's participation in the federal 340B Drug Pricing Program.
(6) Any provision that discriminates against a 340B covered entity.
A violation of this subsection by a pharmacy benefit manager constitutes an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4.
(d) For contracts between a pharmacy benefit manager and a 340B covered entity that are entered into, amended, or renewed after June 30, 2021, a provision that violates subsection (c) is considered void and unenforceable.
As added by P.L.196-2021, SEC.23.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-20. Acts of the Commissioner; Confidentiality

Sec. 20. (a) The commissioner shall do the following:
(1) Prescribe an application for use in applying for a license to operate as a pharmacy benefit manager.
(2) Adopt rules under IC 4-22-2 to establish the following:
(A) Pharmacy benefit manager licensing requirements.
(B) Licensing fees.
(C) A license application.
(D) Financial standards for pharmacy benefit managers.
(E) Reporting requirements described in section 21 of this chapter.
(F) The time frame for the resolution of an appeal under section 22 of this chapter.
(b) The commissioner may do the following:
(1) Charge a license application fee and renewal fees established under subsection (a)(2) in an amount not to exceed five hundred dollars ($500) to be deposited in the department of insurance fund established by IC 27-1-3-28.
(2) Examine or audit the books and records of a pharmacy benefit manager one (1) time per year to determine if the pharmacy benefit manager is in compliance with this chapter.
(3) Adopt rules under IC 4-22-2 to:
(A) implement this chapter; and
(B) specify requirements for the following:
(i) Prohibited market conduct practices.
(ii) Data reporting in connection with violations of state law.
(iii) Maximum allowable cost list compliance and enforcement requirements, including the requirements of sections 22 and 23 of this chapter.
(iv) Prohibitions and limits on pharmacy benefit manager practices that require licensure under IC 25-22.5.
(v) Pharmacy benefit manager affiliate information sharing.
(vi) Lists of health plans administered by a pharmacy benefit manager in Indiana.
(c) Financial information and proprietary information submitted by a pharmacy benefit manager to the department is confidential.
As added by P.L.68-2020, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-21. Annual Reporting Requirements; Trade Secrets

Sec. 21. (a) Beginning June 1, 2021, and annually thereafter, a pharmacy benefit manager shall submit a report containing data from the immediately preceding calendar year to the commissioner. The commissioner shall determine what must be included in the report and consider the following information to be included in the report:
(1) The aggregate amount of all rebates that the pharmacy benefit manager received from all pharmaceutical manufacturers for:
(A) all insurers; and
(B) each insurer;
with which the pharmacy benefit manager contracted during the immediately preceding calendar year.
(2) The aggregate amount of administrative fees that the pharmacy benefit manager received from all pharmaceutical manufacturers for:
(A) all insurers; and
(B) each insurer;
with which the pharmacy benefit manager contracted during the immediately preceding calendar year.
(3) The aggregate amount of retained rebates that the pharmacy benefit manager received from all pharmaceutical manufacturers and did not pass through to insurers with which the pharmacy benefit manager contracted during the immediately preceding calendar year.
(4) The highest, lowest, and mean aggregate retained rebate for:
(A) all insurers; and
(B) each insurer;
with which the pharmacy benefit manager contracted during the immediately preceding calendar year.
(b) A pharmacy benefit manager that provides information under this section may designate the information as a trade secret (as defined in IC 24-2-3-2). Information designated as a trade secret under this subsection must not be published unless required under subsection (c).
(c) Disclosure of information designated as a trade secret under subsection (b) may be ordered by a court of Indiana for good cause shown or made in a court filing.
As added by P.L.68-2020, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-22.5. Aggregated Information From Pharmacy Benefit Manager Reports

Sec. 22.5. Aggregated information compiled from reports submitted by pharmacy benefit managers to the insurance commissioner under section 22 of this chapter is not confidential except for information that would reveal a specific pharmacy benefit manager's proprietary information.
As added by P.L.114-2020, SEC.15.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-22.6. Filing Complaints With Department of Insurance

Sec. 22.6. (a) If a pharmacy benefit manager denies an appeal under section 22(a)(2) of this chapter, the appealing contracted pharmacy, pharmacy services administrative organization, or group purchasing organization may file a complaint with the department not later than thirty (30) days from the date of the denial. The department may request additional information from either party as necessary to resolve a complaint.
(b) If a contracted pharmacy or pharmacy services administrative organization believes that its contract with a pharmacy benefit manager contains an unlawful contractual provision regarding reimbursement rates, the contracted pharmacy or pharmacy services administrative organization may file a complaint with the department.
(c) A pharmacy benefit manager that receives written notice of a complaint filed under this section shall promptly conduct an investigation of the matters alleged in the complaint. Not later than twenty (20) business days after the date of the complaint, the pharmacy benefit manager shall provide to the department and the complaining party a written report containing the following information:
(1) The specific actions taken by the pharmacy benefit manager with respect to:
(A) the appeal, for a complaint filed under subsection (a); or
(B) the contract, for a complaint filed under subsection (b).
(2) A good faith estimate of the time required for a resolution of the complaint.
(d) If a pharmacy believes that its contract with a pharmacy services administrative organization contains an unlawful contractual provision regarding reimbursement rates, the pharmacy may file a complaint with the department.
(e) The department shall establish a process for complaints filed under this section.
As added by P.L.196-2021, SEC.25.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-23. Drug Price Data

Sec. 23. (a) For every drug for which the pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the pharmacy benefit manager shall make available to a contracted pharmacy services administrative organization to make available to the pharmacies, or to a pharmacy if the pharmacy benefit manager contracts directly with a pharmacy, in a manner established by the department by administrative rule described in subsection (b) the following:
(1) Information identifying the national drug pricing compendia or sources used to obtain the drug price data.
(2) The comprehensive list of drugs subject to maximum allowable cost and the actual maximum allowable cost for each drug.
(b) The department shall adopt rules under IC 4-22-2 concerning the manner in which a pharmacy benefit manager shall communicate the following to contracted pharmacy services administrative organizations:
(1) Drug price data should be used to establish drug reimbursements by pharmacy benefit managers as described in subsection (a)(1).
(2) The comprehensive list of drugs described in subsection (a)(2).
(c) The department may, concerning a maximum allowable cost list, consider whether a drug is:
(1) obsolete;
(2) temporarily unavailable;
(3) to be included on a drug shortage list; or
(4) unable to be lawfully substituted.
As added by P.L.68-2020, SEC.1. Amended by P.L.32-2021, SEC.80.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-24. Information Necessary for Appeal

Sec. 24. (a) For every drug for which a pharmacy benefit manager establishes a maximum allowable cost to determine reimbursement for the drug product, the pharmacy benefit manager shall make available to the department, upon request of the department, information that is needed to resolve an appeal.
(b) If the pharmacy benefit manager fails to promptly make available to the department the information as required in subsection (a), the department shall consider the appeal granted in favor of the appealing pharmacy.
As added by P.L.68-2020, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-25. Party's Right to Audit; Amounts Paid; Consideration

Sec. 25. (a) A party that has contracted with a pharmacy benefit manager to provide services may, at least one (1) time in a calendar year, request an audit of compliance with the contract. The audit may include full disclosure of rebate amounts secured on prescription drugs, whether product specific or general rebates, that were provided by a pharmaceutical manufacturer and any other revenue and fees derived by the pharmacy benefit manager from the contract. A contract may not contain provisions that impose unreasonable fees or conditions that would severely restrict a party's right to conduct an audit under this subsection.
(b) A pharmacy benefit manager shall disclose, upon request from a party that has contracted with a pharmacy benefit manager, to the party the actual amounts paid by the pharmacy benefit manager to any pharmacy.
(c) A pharmacy benefit manager shall provide notice to a party contracting with the pharmacy benefit manager of any consideration that the pharmacy benefit manager receives from a pharmacy manufacturer for any name brand dispensing of a prescription when a generic or biologically similar product is available for the prescription.
(d) The commissioner may establish a procedure to release information from an audit performed by the department to a party that has requested an audit under this section in a manner that does not violate confidential or proprietary information laws.
(e) Any provision of a contract entered into, issued, or renewed after June 30, 2020, that violates this section is unenforceable.
As added by P.L.68-2020, SEC.1. Amended by P.L.32-2021, SEC.81.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-26. Disclosure of Contract With Another Party

Sec. 26. A person or entity that has contracted with a pharmacy benefit manager for the performance of services described in section 12(a) of this chapter is entitled to full disclosure from the pharmacy benefit manager of the terms of a contract between the pharmacy benefit manager and any other person or entity within the same network concerning the performance of the services described in section 12(a) of this chapter, including:
(1) the purchase price for prescription drugs within the same network and set by a contract entered into by the pharmacy benefit manager; and
(2) the amount of any rebate provided in connection with the purchase of prescription drugs within the same network by a contract entered into by the pharmacy benefit manager.
As added by P.L.68-2020, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-27. Contracts of Pharmacy Services Administrative Organizations

Sec. 27. A pharmacy services administrative organization shall, upon request, fully disclose to an independent pharmacy on whose behalf the pharmacy services administrative organization acts the terms of a contract between the pharmacy services administrative organization and any other person or entity concerning the actions taken by the pharmacy services administrative organization on behalf of the independent pharmacy.
As added by P.L.68-2020, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-27.5. Pharmacist May Not Be Required to Collect Higher Copayment for Prescription Drug

Sec. 27.5. A pharmacy benefit manager may not require a pharmacy or pharmacist to collect a higher copayment for a prescription drug from a customer than the pharmacy benefit manager allows the pharmacy or pharmacist to retain.
As added by P.L.114-2020, SEC.16. Amended by P.L.32-2021, SEC.82.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-28. Violation of Chapter

Sec. 28. (a) A violation of this chapter is an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4.
(b) The department may also adopt rules under IC 4-22-2 to set forth fines for a violation under this chapter.
As added by P.L.68-2020, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 24.5. Pharmacy Benefit Managers › 27-1-24.5-29. Report

Sec. 29. (a) At least every six (6) months, a pharmacy benefit manager shall provide a report to the department.
(b) A report under subsection (a) must include the:
(1) overall aggregate amount charged to a health plan for all pharmaceutical claims processed by the pharmacy benefit manager; and
(2) overall aggregate amount paid to pharmacies for claims processed by the pharmacy benefit manager.
(c) Upon request, the department shall make a report received under subsection (a) available to the members of the general assembly in an electronic format under IC 5-14-6.
As added by P.L.166-2023, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-2. Written Agreements

Sec. 2. (a) An administrator may act only if there is a written agreement between the administrator and an insurer. This agreement must conform to the requirements of this chapter, which apply to the functions performed by the administrator.
(b) An agreement between an administrator and an insurer must be retained by both parties as part of their official records for a period of not less than five (5) years after the termination of the agreement.
(c) When a policy is issued to a trustee, a copy of the trust agreement and all amendments to it must be:
(1) furnished by the administrator to the insurer with which the administrator has a written agreement; and
(2) retained as part of the official records of the administrator for a period of not less than five (5) years after the termination of the trust.
(d) The written agreement required under subsection (a) must:
(1) include a statement of functions that the administrator will perform on behalf of the insurer;
(2) specify the lines, classes, or types of coverage that the administrator is authorized to administer on behalf of the insurer; and
(3) contain provisions concerning the standard of underwriting required by the insurer.
(e) The commissioner may require any written agreement executed by an administrator and an insurer to be filed with the department at the time the administrator applies for a license under this chapter. The commissioner may require any written agreement executed subsequent to the original issue of the license to the administrator to be filed with the department at the time the administrator is applying for renewal of the license.
(f) An administrator or insurer may, with written notice, terminate a written agreement for cause as provided in the written agreement. The insurer may suspend the underwriting authority of the administrator during the pendency of a dispute regarding the cause for termination of the written agreement. The insurer shall fulfill lawful obligations with respect to coverage affected by the written agreement, regardless of a dispute described in this subsection.
As added by Acts 1980, P.L.168, SEC.2. Amended by Acts 1982, P.L.165, SEC.2; P.L.160-2003, SEC.5.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-3. Presumptions as to Payment of Premiums and Claims

Sec. 3. (a) If an insurer utilizes the services of an administrator:
(1) premiums or charges for coverage paid by or on behalf of the covered individual are considered to have been received by the insurer when paid to the administrator; and
(2) claims or return premiums paid by the insurer to the administrator are not considered to have been paid to the covered individual or claimant until the payment is received by the covered individual or claimant.
(b) This section does not limit the rights of an insurer against an administrator resulting from the failure of the administrator to make payments to the insurer, covered individuals, or claimants.
As added by Acts 1980, P.L.168, SEC.2. Amended by P.L.26-1991, SEC.19; P.L.160-2003, SEC.6.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-5. Advertising

Sec. 5. An administrator may use advertising relating to the business underwritten by an insurer only to the extent that the advertising has been approved in writing by that insurer before the advertising is used.
As added by Acts 1980, P.L.168, SEC.2. Amended by P.L.160-2003, SEC.8.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-5.5. Insurer Responsibilities

Sec. 5.5. (a) If an insurer uses the services of an administrator, the insurer is responsible for:
(1) determining the:
(A) benefits;
(B) premium rates;
(C) underwriting criteria; and
(D) claims payment procedures;
that apply to the coverage; and
(2) securing reinsurance.
(b) An insurer shall provide to an administrator, with the written agreement required under section 2 of this chapter:
(1) the rules that the administrator must follow in administering the coverage, as determined under subsection (a); and
(2) the responsibilities of the administrator as to administering the coverage.
(c) An insurer that uses the services of an administrator has sole responsibility for the competent administration of benefit programs provided by the insurer.
(d) If an administrator administers benefits for more than one hundred (100) covered individuals on behalf of an insurer, the insurer shall, not less than semiannually, review the operations of the administrator. At least one (1) of the semiannual reviews must be an onsite audit of the operations of the administrator.
As added by P.L.160-2003, SEC.9.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-6. Fiduciary Status of Administrator; Fiduciary Accounts

Sec. 6. (a) An administrator is a fiduciary in collecting or returning premiums or charges for the insurer with whom it has a written agreement for administrative services.
(b) Funds collected by the administrator shall be immediately remitted to the person entitled to the funds or deposited in a fiduciary account, which shall be established and maintained by the administrator in a federally insured or state insured financial institution.
(c) The administrator shall maintain records clearly showing the deposits and withdrawals from the fiduciary account for each insurer with whom it has a written agreement for administrative services. The administrator shall furnish to the insurer:
(1) upon the insurer's request, copies of the required records; and
(2) at intervals specified in the written agreement, a periodic accounting of transactions performed by the administrator pertaining to the business underwritten by the insurer.
(d) Subject to the written agreement required by section 2 of this chapter, withdrawals from the fiduciary account shall only be made for the following:
(1) Remittance to an insurer entitled to the funds.
(2) Deposit in an account maintained in the name of the insurer with whom the administrator has a written agreement.
(3) Transfer to and deposit in a claims paying account, with claims to be paid as required under section 7 of this chapter.
(4) Payment to a group policyholder for remittance to the insurer entitled to the funds.
(5) Payment to the administrator for its commission, fees, or charges.
(6) Remittance of return premiums to the person entitled to the funds.
(e) An administrator may not pay any claim with money withdrawn from a fiduciary account established under subsection (b) in which premiums or charges are deposited.
As added by Acts 1980, P.L.168, SEC.2. Amended by Acts 1982, P.L.165, SEC.4; P.L.26-1991, SEC.20; P.L.160-2003, SEC.10.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-7. Payment of Claims

Sec. 7. All claims paid by an administrator from funds collected on behalf of an insurer shall be paid:
(1) by draft or check; or
(2) via electronic payment;
as authorized by the insurer.
As added by Acts 1980, P.L.168, SEC.2. Amended by Acts 1982, P.L.165, SEC.5; P.L.160-2003, SEC.11; P.L.130-2020, SEC.5.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-8. Administrator Compensation

Sec. 8. (a) An administrator may not enter into an agreement or understanding with an insurer if the effect of the agreement or understanding is to make the amount of a:
(1) commission;
(2) fee; or
(3) charge;
that is payable to the administrator contingent on savings effected in the adjustment, settlement, and payment of losses covered by the insurer's obligations.
(b) This section does not prevent an administrator from receiving performance based compensation for providing hospital auditing services or other auditing services.
As added by Acts 1980, P.L.168, SEC.2. Amended by P.L.26-1991, SEC.21; P.L.160-2003, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-9. Delivery of Written Communications

Sec. 9. Policies, certificates, booklets, termination notices, or other written communications delivered by an insurer to an administrator for delivery to its covered individuals shall be delivered by the administrator promptly after receipt of instructions from the insurer to do so.
As added by Acts 1980, P.L.168, SEC.2. Amended by P.L.160-2003, SEC.13.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-10. Notice of Relationship; Statement of Premiums or Charges

Sec. 10. (a) An administrator having a written agreement with an insurer shall provide written notice, which must first be approved by the insurer, to covered persons advising them of the relationship among the administrator, the covered person, and the insurer.
(b) When the administrator collects premiums or charges, the administrator shall state separately the amount of any premium or charge for coverage specified by the insurer to the person paying the premium or charge. Additional charges may not be made for a service to the extent that the charge for the service has been paid by the insurer.
(c) The administrator shall disclose to the insurer:
(1) charges;
(2) fees; and
(3) commissions;
received by the administrator in connection with the provision of administrative services for the insurer, including fees or commissions paid by insurers that provide reinsurance.
As added by Acts 1980, P.L.168, SEC.2. Amended by Acts 1982, P.L.165, SEC.6; P.L.160-2003, SEC.14.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-11. Repealed

As added by Acts 1980, P.L.168, SEC.2. Amended by P.L.267-1987, SEC.4; P.L.192-1991, SEC.1; P.L.26-1991, SEC.22; P.L.1-1992, SEC.146. Repealed by P.L.160-2003, SEC.28.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-12.3. Resident Administrator Annual Filings

Sec. 12.3. (a) An administrator that is licensed under section 11.1 of this chapter shall, not later than July 1 of each year unless the commissioner grants an extension of time for good cause, file a report for the previous calendar year that complies with the following:
(1) The report must contain financial information reflecting a positive net worth prepared in accordance with section 11.1(b)(4) of this chapter.
(2) The report must be in the form and contain matters prescribed by the commissioner.
(3) The report must be verified by at least two (2) officers of the administrator.
(4) The report must include the complete names and addresses of insurers with which the administrator had a written agreement during the preceding fiscal year.
(5) The report must be accompanied by a filing fee in an amount determined by the commissioner.
The commissioner shall collect a filing fee paid under subdivision (5) and deposit the fee into the department of insurance fund established by IC 27-1-3-28.
(b) The commissioner shall review a report filed under subsection (a) not later than September 1 of the year in which the report is filed. Upon completion of the review, the commissioner shall:
(1) issue a certification to the administrator:
(A) indicating that:
(i) the financial statement reflects a positive net worth; and
(ii) the administrator is currently licensed and in good standing; or
(B) noting deficiencies found in the report; or
(2) update the centralized insurance producer license registry described in IC 27-1-15.6-7:
(A) indicating that the administrator is solvent and in compliance with this chapter; or
(B) noting deficiencies found in the report.
As added by P.L.160-2003, SEC.17. Amended by P.L.173-2007, SEC.18; P.L.234-2007, SEC.192; P.L.11-2011, SEC.21; P.L.124-2018, SEC.50.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-13. Public Documents; Confidentiality; Financial Information

Sec. 13. (a) Except as provided by section 4(b) of this chapter, and except that all provisions of the written agreement between the administrator and an insurer shall be treated by the commissioner as confidential and shall not be open to any member of the public for inspection or copying, all documents submitted to the commissioner under this chapter are public documents:
(1) when filed by the commissioner; or
(2) thirty (30) days after their receipt by the department.
(b) Any financial information concerning an administrator submitted by an administrator to the commissioner must remain confidential and is not open to any member of the public for inspection or copying. However, the commissioner may use the financial information in a proceeding under section 12.4 of this chapter.
As added by Acts 1980, P.L.168, SEC.2. Amended by Acts 1982, P.L.165, SEC.7; P.L.192-1991, SEC.2; P.L.160-2003, SEC.19.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-15. Violations; Offense; Notice

Sec. 15. (a) An administrator acting without a license issued under this chapter commits a Class C infraction.
(b) The commissioner shall notify the prosecuting attorney or the attorney general of Indiana of violations under subsection (a).
As added by Acts 1980, P.L.168, SEC.2. Amended by P.L.160-2003, SEC.20.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25. Insurance Administrators › 27-1-25-16. Presumption of Control

Sec. 16. (a) A presumption of control arising under section 1(e) of this chapter may be rebutted by a showing made in the manner provided under IC 27-1-23-3(k) that control does not exist in fact.
(b) In the absence of a presumption that control exists in fact, the commissioner may determine that control exists in fact after:
(1) providing notice and an opportunity to be heard under IC 4-21.5 to all interested parties; and
(2) making specific findings of fact to support the determination.
As added by P.L.160-2003, SEC.21.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25.1. Certain Insurer Responsibilities › 27-1-25.1-2. "Insurer"

Sec. 2. As used in this chapter, "insurer" has the meaning set forth in IC 27-1-25-1(l).
As added by P.L.160-2003, SEC.22.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25.1. Certain Insurer Responsibilities › 27-1-25.1-3. "Person"

Sec. 3. As used in this chapter, "person" refers to a person described in IC 27-1-25-1(a)(15).
As added by P.L.160-2003, SEC.22.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 25.1. Certain Insurer Responsibilities › 27-1-25.1-4. Insurer Responsibility for Actions of Affiliate

Sec. 4. The insurer with which a person is affiliated is responsible for:
(1) the acts of the person; and
(2) providing the person's books and records to the commissioner.
As added by P.L.160-2003, SEC.22.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 26. Policy Language Simplification › 27-1-26-1. Definitions

Sec. 1. As used in this chapter:
(a) "Commissioner" refers to the insurance commissioner.
(b) "Company" or "insurer" means a life or health insurance company, fraternal benefit society, prepaid health plan, dental care plan, vision care plan, pharmaceutical plan, health maintenance organization, and all similar type organizations.
(c) "Department" refers to the insurance department.
(d) "Policy" or "policy form" means:
(1) Any policy, contract, plan, or agreement of life or health insurance, including credit life insurance and credit health insurance, to be issued in Indiana by a company subject to this chapter.
(2) Any certificate, contract, or policy issued by a fraternal benefit society.
(3) Any certificate issued under a group insurance policy to be issued for delivery in Indiana.
(e) "Text" means all printed matter except the following:
(1) The name and address of the insurer.
(2) The name, number, or title of the policy.
(3) The table of contents or index.
(4) Captions and subcaptions.
(5) Specification pages.
(6) Schedules or tables.
(7) Language that is drafted to conform to the requirements of federal law, regulation, or federal agency interpretation.
(8) Language required by a collectively bargained agreement.
(9) Medical terminology.
(10) Words that are defined in the policy.
As added by Acts 1981, P.L.245, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 26. Policy Language Simplification › 27-1-26-2. Policies and Forms Not Subject to Chapter

Sec. 2. (a) This chapter does not apply to:
(1) A policy that is security subject to federal jurisdiction.
(2) A group policy, other than a group credit life insurance policy or a group credit health insurance policy.
(3) A group annuity contract that serves as a funding vehicle for pension, profit-sharing, or deferred compensation plans.
(4) A form used in connection with a policy issued for delivery on a form approved or permitted to be issued for delivery in Indiana.
As added by Acts 1981, P.L.245, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 26. Policy Language Simplification › 27-1-26-3. Minimum Requirements

Sec. 3. Except as otherwise provided in this chapter, a policy issued for delivery in Indiana must meet the following minimum requirements:
(1) The text achieves a minimum score of forty (40) on the Flesch reading ease test or an equivalent score on a comparable test approved by the commissioner as provided by section 6 of this chapter.
(2) It is printed, except for specification pages, schedules, and tables, in not less than ten (10) point type, one (1) point leaded.
(3) The style, arrangement, and overall appearance of the policy give no undue prominence to any portion of the text of the policy or to any endorsements or riders.
(4) It must contain a table of contents or an index of the principal sections of the policy if:
(A) the policy has three thousand (3,000) or more words; or
(B) the policy has three (3) or more pages.
As added by Acts 1981, P.L.245, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 26. Policy Language Simplification › 27-1-26-4. Non-English Language Policies

Sec. 4. A non-English language policy that is issued for delivery in Indiana is in compliance with this chapter if the insurer issuing the policy certifies that the policy if translated into English would comply with section 3 of this chapter.
As added by Acts 1981, P.L.245, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 26. Policy Language Simplification › 27-1-26-5. Flesch Reading Ease Score; Procedure to Determine; Rules of Construction

Sec. 5. (a) The following procedure shall be used in determining the Flesch reading ease score:
(1) First, a sample of the text of the policy shall be chosen for analysis:
(A) For policy forms containing ten thousand (10,000) or less words of text, the entire policy form shall be analyzed.
(B) For policy forms containing ten thousand and one (10,001) or more words of text, two (2) samples of two hundred (200) words from each page, with each sample separated by at least twenty (20) lines, may be analyzed instead of the entire form.
(2) Second, the number of words and sentences in the text shall be counted and the total number of words shall be divided by the total number of sentences. The figure obtained shall be multiplied by a factor of one and fifteen thousandths (1.015).
(3) Third, the total number of syllables shall be counted and divided by the total number of words. The figure obtained shall be multiplied by a factor of eighty-four and six tenths (84.6).
(4) Fourth, the sum of the figures computed under subdivisions (2) and (3) when subtracted from two hundred six and eight hundred thirty-five thousandths (206.835) equals the Flesch reading ease score for the policy form.
(b) For the purposes of subsections (a)(2) through (4), the following rules of construction shall be used:
(1) A contraction, hyphenated word, or numbers and letters, when separated by spaces, shall be treated as one (1) word.
(2) A unit of words ending with a period, semicolon, or colon, but excluding headings and captions, shall be counted as a sentence.
(3) The term "syllable" means a unit of spoken language consisting of one (1) or more letters of a word as divided by a dictionary approved by the commissioner.
(4) When a dictionary approved by the commissioner shows two (2) or more equally acceptable pronunciations of a word, the pronunciation containing fewer syllables may be used.
As added by Acts 1981, P.L.245, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 26. Policy Language Simplification › 27-1-26-6. Reading Ease; Alternative Tests

Sec. 6. The commissioner may approve the use of any other reading ease test as an alternative to the Flesch reading ease test if it is comparable in result to the Flesch reading ease test.
As added by Acts 1981, P.L.245, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 26. Policy Language Simplification › 27-1-26-7. Certificate of Insurer to Accompany Policy Filed With Department; Contents; Additional Information

Sec. 7. (a) A policy filed with the department must be accompanied by a certificate signed by an officer of the insurer stating that:
(1) the policy meets the minimum reading ease score on the test used; or
(2) the score for the policy is lower than the minimum required but should be approved in accordance with section 9 of this chapter.
(b) To confirm the accuracy of a certification under subsection (a), the commissioner may require the submission of additional information to verify the certification.
As added by Acts 1981, P.L.245, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 26. Policy Language Simplification › 27-1-26-8. Separate Test Scores Permitted for Riders, Endorsements, Applications, and Other Forms

Sec. 8. At the option of an insurer, riders, endorsements, applications, and other forms made a part of the policy may be scored separately.
As added by Acts 1981, P.L.245, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 26. Policy Language Simplification › 27-1-26-9. Policies With Failing Scores; Issuance for Delivery Authorized Upon Certain Findings

Sec. 9. The commissioner may authorize a policy to be issued for delivery in Indiana with a score lower than the score required by section 3 of this chapter if he finds that the lower score:
(1) will provide a more accurate reflection of the readability of a policy form;
(2) is necessary because of the nature of a particular policy form or type or class of policy forms; or
(3) is caused by policy language that is drafted to conform to the requirements of Indiana law, regulation, or agency interpretation.
As added by Acts 1981, P.L.245, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 26. Policy Language Simplification › 27-1-26-10. Compliance With Other Laws

Sec. 10. A policy form meeting the requirements of this chapter shall be approved notwithstanding the requirements of any other law that specifies the contents of policies, only if the policy form provides the policyholders and claimants with protection as favorable as they are entitled to under that law.
As added by Acts 1981, P.L.245, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 26. Policy Language Simplification › 27-1-26-12. Application of Chapter

Sec. 12. This chapter applies to all policy forms filed after June 30, 1982. A policy may not be issued for delivery in Indiana after June 30, 1985, unless approved by the commissioner or permitted to be issued under this chapter. A policy that has been approved or permitted to be issued under this chapter before July 1, 1985, and that meets the standards of this chapter does not need to be refiled for approval on July 1, 1985, but may continue being issued in Indiana upon filing with the commissioner a list of those forms, identified by form number, and accompanied by a certificate for each form as provided by section 7 of this chapter.
As added by Acts 1981, P.L.245, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 27. Public Adjusters › 27-1-27-1. Definitions

Sec. 1. (a) The definitions set forth in this section apply throughout this chapter.
(b) "Contract" refers to a contract between a public adjuster and an insured under which:
(1) the public adjuster agrees to provide services for the insured in the adjustment of an insurance claim; and
(2) the insured agrees to compensate the public adjuster for those services.
(c) "Firm" includes any corporation, partnership, association, joint stock company, or individual.
(d) "Independent adjuster" has the meaning set forth in IC 27-1-28-6.
(e) "Insured" means a person covered by an insurance policy.
(f) "Person" means an individual, a corporation, a limited liability company, a partnership, or any other legal entity.
(g) "Public adjuster" includes the following:
(1) A person that, for compensation or reward, renders advice or assistance to an insured in the adjustment of a claim or claims for loss or damages under any policy of insurance covering real or personal property.
(2) A person that advertises, solicits business, or holds itself out to the public as an adjuster of claims described in subdivision (1).
(h) The term "public adjuster" does not include the following:
(1) An attorney at law admitted to practice in Indiana who adjusts insurance losses in the course of the practice of the attorney's profession.
(2) An officer, regular salaried employee, or other representative of:
(A) an insurer; or
(B) an attorney in fact of any reciprocal insurer or Lloyd's underwriter licensed to do business in Indiana;
who adjusts losses arising under an employer's or principal's own policies.
(3) An adjustment bureau or association owned and maintained by insurers to adjust or investigate losses of the insurers, or any regular salaried employee who devotes substantially all the employee's time to the business of an adjustment bureau or association described in this subdivision.
(4) Any of the following:
(A) A licensed insurance producer.
(B) An authorized insurer.
(C) An officer or employee of an authorized insurer who adjusts losses for the insurer.
(D) An insurance producer or representative of a farm mutual insurance company operating under IC 27-5.1.
(5) Any independent adjuster representing an insurer.
As added by P.L.257-1983, SEC.1. Amended by P.L.129-2003, SEC.6; P.L.178-2003, SEC.28; P.L.226-2023, SEC.3.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 27. Public Adjusters › 27-1-27-1.5. Prohibited Public Adjuster Actions

Sec. 1.5. A public adjuster shall not:
(1) file an insurance claim with:
(A) an insurer; or
(B) an agent, employee, or representative of an insurer;
on behalf of an insured person;
(2) act in any manner in relation to claims for personal injury or automobile liability;
(3) bind the insured in the settlement of claims; or
(4) perform:
(A) the role of a roofing contractor;
(B) the role of an appraiser; or
(C) any other role;
with respect to the subject of a claim at the same time that the public adjuster is providing advice or assistance to an insured in the adjustment of the claim.
As added by P.L.226-2023, SEC.4.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 27. Public Adjusters › 27-1-27-2. Certificate of Authority Required

Sec. 2. (a) No individual or corporation shall act within Indiana as a public adjuster, or receive, directly or indirectly, compensation or reward for services rendered in the adjustment of any claim or claims under the types of insurance policies set forth in section 1(g) of this chapter, unless the individual, or it, is the holder of a certificate of authority to act as such public adjuster issued by the commissioner of insurance of the state of Indiana pursuant to this chapter.
(b) Any individual or corporation who, or which, shall have received from the commissioner of insurance a public adjuster's certificate of authority shall be styled and be known as a "Certified Public Adjuster".
As added by P.L.257-1983, SEC.1. Amended by P.L.226-2023, SEC.5.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 27. Public Adjusters › 27-1-27-3. Certificates of Authority; Issuance; Prerequisites

Sec. 3. (a) The commissioner of insurance shall issue resident and nonresident public adjusters' certificates of authority to each person who:
(1) has complied with the requirements of this chapter, including the payment of fees, the completion of the examination, and, in the case of a nonresident applicant, the service of process designation;
(2) is at least eighteen (18) years of age; and
(3) has not been convicted of:
(A) an act which would constitute a ground for disciplinary sanction under section 7.1 of this chapter; or
(B) a felony that has a direct bearing on his ability to practice competently.
A certificate of authority may be issued to a corporation that has one (1) or more officers, directors, or employees who have been issued public adjusters' certificates of authority. However, a corporation may practice public adjusting only through its officers, directors, or employees who have been issued certificates under this chapter.
(b) The commissioner of insurance may issue a resident certificate of authority only to an applicant who is a bona fide resident of Indiana.
(c) The commissioner may issue a nonresident certificate of authority only to a nonresident of Indiana who holds an equivalent resident certificate of authority or a license issued under the laws of any other state, any territorial possession of the United States, or any foreign country.
As added by P.L.257-1983, SEC.1. Amended by P.L.146-2015, SEC.25.