reglab/statecodes huggingface dataset:
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44. Electronic Posting of Documents › 27-1-44-2. Electronic Posting of Policy or Endorsement

Sec. 2. A standard property and casualty insurance policy or endorsement that does not contain personally identifiable information may be:
(1) mailed or electronically delivered (as provided in IC 27-1-43) to the insured; or
(2) posted on the insurer's Internet web site.
As added by P.L.119-2014, SEC.2.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44. Electronic Posting of Documents › 27-1-44-3. Requirements for Electronic Posting of Policy or Endorsement

Sec. 3. An insurer that elects to post a property and casualty insurance policy or endorsement on the insurer's Internet web site under section 2 of this chapter shall comply with all the following:
(1) The policy or endorsement must remain accessible as long as the policy is in force.
(2) After the expiration of the policy or endorsement, the insurer shall:
(A) archive the expired policy or endorsement for at least five (5) years; and
(B) make the expired policy or endorsement available upon request.
(3) The policy or endorsement must be posted in a manner that enables the insured to print and save the policy or endorsement using programs or applications that are widely available on the Internet and free of charge.
(4) The insurer provides to the insured the following information in, or in addition to, each declaration page provided at issuance and each renewal of the policy or endorsement:
(A) A description of the specific policy or endorsement forms purchased by the insured.
(B) A method by which the insured may obtain, upon request and without charge, a paper copy of the policy or endorsement.
(C) The Internet web site address at which the policy or endorsement is posted.
(5) The insurer provides written or electronic notice, in the format preferred by the insured, of the following:
(A) Any change to the policy or endorsement form.
(B) The insured's right to obtain, upon request and without charge:
(i) a paper copy of the change to the policy or endorsement form; and
(ii) the Internet web site address at which the policy or endorsement is posted.
As added by P.L.119-2014, SEC.2.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-0.2. "Administrator"

Sec. 0.2. As used in this chapter, "administrator" means the entity that contracts with the department to create, operate, and maintain the data base.
As added by P.L.195-2021, SEC.1.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-0.4. "Advisory Board"

Sec. 0.4. As used in this chapter, "advisory board" means the all payer claims data base advisory board established under IC 27-1-44.6-5.
As added by P.L.195-2021, SEC.2.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-1.2. "Executive Director"

Sec. 1.2. As used in this chapter, "executive director" means the individual who is responsible for overseeing the operations of the data base as an employee of the department.
As added by P.L.195-2021, SEC.3.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-2. "Health Payer"

Sec. 2. As used in this chapter, "health payer" includes the following:
(1) Medicare.
(2) Medicaid or a managed care organization (as defined in IC 12-7-2-126.9) that has contracted with Medicaid to provide services to a Medicaid recipient.
(3) An insurer that issues a policy of accident and sickness insurance (as defined in IC 27-8-5-1), except for the following types of coverage:
(A) Accident only, credit, dental, vision, long term care, or disability income insurance.
(B) Coverage issued as a supplement to liability insurance.
(C) Automobile medical payment insurance.
(D) A specified disease policy.
(E) A policy that provides indemnity benefits not based on any expense incurred requirements, including a plan that provides coverage for:
(i) hospital confinement, critical illness, or intensive care; or
(ii) gaps for deductibles or copayments.
(F) Worker's compensation or similar insurance.
(G) A student health plan.
(H) A supplemental plan that always pays in addition to other coverage.
(4) A health maintenance organization (as defined in IC 27-13-1-19).
(5) A pharmacy benefit manager (as defined in IC 27-1-24.5-12).
(6) An administrator (as defined in IC 27-1-25-1).
(7) A multiple employer welfare arrangement (as defined in IC 27-1-34-1).
(8) An employee benefit plan that is subject to the federal Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.), including a third party administrator of an employee benefit plan.
(9) A state employee health plan (as defined in IC 5-10-8-6.7(a)).
(10) Any other person identified by the commissioner for participation in the data base described in this chapter.
As added by P.L.50-2020, SEC.6. Amended by P.L.32-2021, SEC.84; P.L.195-2021, SEC.4; P.L.165-2022, SEC.6; P.L.190-2023, SEC.19.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-3. Issue of Request for Information by Department; Requirements; Deadline

Sec. 3. (a) Before July 1, 2020, the department shall issue a request for information in compliance with IC 5-23-4.5 concerning the creation, operation, and maintenance of a data base.
(b) The request for information must include the following questions:
(1) How the person would collect all relevant claims data for the data base from a health payer in a manner that would minimize technical barriers for a health payer to submit a claim.
(2) How the person would promote and encourage self-funded plans to voluntarily submit claims data for inclusion in the data base.
(3) What funding sources the person would seek to offset costs to implement and maintain the data base.
(4) How the person would make data from the data base available, including what sufficient fee would need to be assessed, to researchers, companies, and other interested parties in analyzing the data.
(5) How the person would ensure the following:
(A) That data is submitted and released in a machine readable format.
(B) That the data from the data base is used in an ethical manner.
(C) That the data is not personally identifiable and is properly secured and maintained, and that the person complies with federal and state health care privacy laws.
(6) How the person would establish a public web portal for individuals to quickly and easily compare prices for the full spectrum of medical billing codes as well as check quality ratings of providers.
(7) What threshold should be set for health payers to submit data for the data base.
(8) How the person would work with other states and relevant stakeholders to either:
(A) use a data language that is already available; or
(B) facilitate the establishment of a common data language to be used by states for the data.
(9) Whether any changes to state law would increase the functionality and effectiveness of the data base and recommendations of the statutes and necessary changes.
(10) Any other questions the department determines are relevant to the implementation of a robust and transparent data base.
(c) The department shall set the deadline for submissions of the request for information under this section that may be not later than November 30, 2020.
As added by P.L.50-2020, SEC.6.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-4. Request to Create, Operate, and Maintain Data Base; Requirements; Publication of Decision; Contract; Ensure Compliance of Privacy Laws

Sec. 4. (a) After December 31, 2021, the department shall issue a request for an entity that is not a state agency or political subdivision to create, operate, and maintain the data base under this chapter. In addition to the requirements of IC 5-22-9, the request for proposals must include the considerations contained in the request for information under section 3 of this chapter.
(b) The request for proposals must state that the data base's purpose is to facilitate the following:
(1) Identifying health care needs and informing health care policy.
(2) Comparing costs between various treatment settings and approaches.
(3) Providing information to consumers and purchasers of health care.
(4) Improving the quality and affordability of patient health care and health care coverage.
(c) The department shall publish the department's decision concerning the submissions not later than April 1, 2022, on the department's Internet web site.
(d) If the department accepts a submission for the request for proposals, the department shall enter into a contract with the person to act as administrator of the data base and develop the data base.
(e) The administrator shall ensure that the data base is secure and compliant with the federal Health Insurance Portability and Accountability Act (HIPAA).
As added by P.L.50-2020, SEC.6. Amended by P.L.195-2021, SEC.5.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-5. Submission of Required Data by Health Payers

Sec. 5. A health payer shall begin submitting the required data in a format specified by the administrator of the data base not later than three (3) months from the first day the department declares the data base to be fully operational.
As added by P.L.50-2020, SEC.6. Amended by P.L.195-2021, SEC.6; P.L.190-2023, SEC.20.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-7. Duties of Administrator

Sec. 7. The administrator, with input from the executive director and the advisory board:
(1) shall ensure the security of the data;
(2) shall protect the privacy of the data in compliance with state and federal law;
(3) shall incorporate and utilize publicly available data other than administrative claims data if necessary to measure and analyze a significant health care quality, safety, or cost issue that cannot be adequately measured with administrative claims data alone;
(4) shall ensure uniform data collection and determine the data elements to be collected, the reporting formats for data submitted, and the use and reporting of any data submitted, which shall align with national, regional, and other uniform all payer claims data bases' standards where possible;
(5) may audit the accuracy of all data submitted;
(6) shall collect, aggregate, distribute, and publicly report performance data on cost, utilization, and pricing in a manner accessible for consumers, public and private purchasers, providers, and policymakers;
(7) may share data nationally or help develop a multistate effort if recommended by the advisory board; and
(8) may share data for research and publication purposes if approved by the advisory board.
As added by P.L.195-2021, SEC.7.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-8. Data Base Requirements

Sec. 8. The data base must do the following:
(1) Provide an online, public web portal that is free to use and allows the public to view the average negotiated charges by each health carrier for specific health care services provided by an individual health care provider, as well as the quality metrics for facilities and providers for specific health care services. Facilities and providers include hospitals, physician groups, ambulatory outpatient surgical centers, physical therapy offices, imaging centers, laboratories, infusion clinics, pharmacies, and any other location providing health care services.
(2) Be available to the public as a resource to insurers, consumers, employers, providers, purchasers of health care, and state agencies to allow for continuous review of health care utilization, expenditures, and quality and safety performance in the state.
(3) Be available to state agencies and private entities in the state that are engaged in efforts to improve health care, subject to rules adopted by the department.
(4) Be presented to allow for comparisons of geographic, demographic, and economic factors and institutional size.
(5) Present data in a consumer friendly manner.
As added by P.L.195-2021, SEC.8.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-9. Duties of Executive Director

Sec. 9. (a) The executive director shall do the following:
(1) Report to the governor and, in an electronic format under IC 5-14-6, to the general assembly not later than September 1 of each year on the following:
(A) The status of the operations of the data base.
(B) The financial stability of the data base.
(C) The status of efforts to obtain funding for the data base.
(2) Seek to establish agreements or requests with the federal Centers for Medicare and Medicaid Services to obtain their health claims data.
(3) Maximize private and federal funding opportunities, including private and federal grants, and the use of fees for the costs of implementing and operating the data base.
(4) Establish a fee formula for data licensing and claims data collection and release.
(5) Ensure privacy and security of the data collected.
(6) Provide leadership and coordination of public and private health care quality and performance measurements to ensure efficiency, cost effectiveness, transparency, and informed choice by consumers and public and private purchasers.
(7) Seek to establish agreements for voluntary reporting of health care claims data from health payers that are not subject to mandatory reporting requirements in order to ensure availability of the most comprehensive and systemwide data on health care costs and quality.
(8) Determine the data to be collected from health payers and the method of collection, including mandatory and voluntary reporting of health care and health quality data.
(9) Determine the measures necessary to implement the reporting requirements in a manner that is cost effective and reasonable for data sources and timely, relevant, and reliable for consumers, public and private purchasers, providers, and policymakers.
(10) Determine the reports and data to be made available to the public, with recommendations from the advisory board, in order to accomplish the purposes of this chapter, including conducting studies and reporting the results of the studies.
(b) The executive director may contract with third parties to collect and process the health care data collected under this chapter.
As added by P.L.195-2021, SEC.9.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-10. Health Care Data Privacy

Sec. 10. The collection, storage, and release of health care data and other information under this chapter is subject to the federal Health Insurance Portability and Accountability Act (42 U.S.C. 201 et seq.), as amended.
As added by P.L.195-2021, SEC.10.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.5. All Payer Claims Data Base › 27-1-44.5-11. Adoption of Rules

Sec. 11. (a) Except as provided in subsection (c), the department shall adopt rules under IC 4-22-2 to implement this chapter. The rules must include a requirement that health payer data sources submit necessary information to the administrator. Rules enacted under this subsection must cover all health payer data sources as follows:
(1) The department shall adopt rules that apply to health payers regulated under IC 27.
(2) The office of the secretary of family and social services shall adopt rules that apply to health payers regulated under IC 12.
(b) The department shall adopt provisional rules under IC 4-22-2-37.1 establishing a fee formula for data licensing and the collection and release of claims data.
(c) The department may adopt rules under IC 4-22-2 concerning the:
(1) requirement that health payers submit required data under section 5 of this chapter; and
(2) establishment of a fee formula for data licensing, collection, and release of claims described in section 9 of this chapter.
(d) The department may impose a civil penalty on a health payer that is required to submit information under this chapter and fails to comply. A civil penalty collected under this section must be deposited in the department of insurance fund created by IC 27-1-3-28.
As added by P.L.195-2021, SEC.11. Amended by P.L.190-2023, SEC.21; P.L.225-2023, SEC.2; P.L.249-2023, SEC.81.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.6. All Payer Claims Data Base Advisory Board › 27-1-44.6-1. "Administrator"

Sec. 1. As used in this chapter, "administrator" has the meaning in IC 27-1-44.5-0.2.
As added by P.L.195-2021, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.6. All Payer Claims Data Base Advisory Board › 27-1-44.6-2. "Advisory Board"

Sec. 2. As used in this chapter, "advisory board" refers to the all payer claims data base advisory board established under section 5 of this chapter.
As added by P.L.195-2021, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.6. All Payer Claims Data Base Advisory Board › 27-1-44.6-3. "Data Base"

Sec. 3. As used in this chapter, "data base" refers to the all payer claims data base established under IC 27-1-44.5.
As added by P.L.195-2021, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.6. All Payer Claims Data Base Advisory Board › 27-1-44.6-4. "Executive Director"

Sec. 4. As used in this chapter, "executive director" has the meaning in IC 27-1-44.5-1.2.
As added by P.L.195-2021, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.6. All Payer Claims Data Base Advisory Board › 27-1-44.6-5. Establishment of All Payer Claims Data Base Advisory Board

Sec. 5. The all payer claims data base advisory board is established to:
(1) provide executive director candidate recommendations to the department for consideration. A candidate may only be considered if the candidate:
(A) has subject matter expertise in setting up an all payer claims data base; and
(B) is not affiliated with the administrator;
(2) advise the executive director and administrator in the administration of the all payer claims data base under IC 27-1-44.5; and
(3) ensure the integrity, security, and privacy of the all payer claims data base's operations.
As added by P.L.195-2021, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.6. All Payer Claims Data Base Advisory Board › 27-1-44.6-6. Membership

Sec. 6. (a) The advisory board consists of the following members, appointed by the governor:
(1) One (1) individual representing the Indiana Hospital Association.
(2) One (1) individual who is a physician or surgeon and is not employed by or contracted to predominantly provide health care services at a hospital licensed under IC 16-21-2 or a hospital system.
(3) One (1) individual representing a small employer that purchases a group health plan for its employees.
(4) One (1) individual representing a large employer that purchases a group health plan for its employees.
(5) One (1) individual representing a self-insured employer.
(6) One (1) individual from a firm that processes claims for health plans.
(7) One (1) individual representing a domestic insurance company that issues policies of accident and sickness insurance (as defined in IC 27-8-5-1).
(8) One (1) individual representing pharmacists or an affiliate society.
(9) The executive director.
Individuals appointed to represent an employer under subdivisions (3), (4), and (5) may not represent an employer who is a health care facility or provider or a supplier or broker of health plans.
(b) The advisory board consists of the following nonvoting advisory members:
(1) The commissioner of the department or a designee of the commissioner.
(2) The secretary of family and social services or a designee of the secretary.
(3) The commissioner of the Indiana department of health or a designee of the commissioner.
(4) Two (2) members of the senate, who may not be members of the same political party, appointed by the president pro tempore of the senate with the advice of the minority leader of the senate.
(5) Two (2) members of the house of representatives, who may not be members of the same political party, appointed by the speaker of the house of representatives with the advice of the minority leader of the house of representatives.
As added by P.L.195-2021, SEC.12. Amended by P.L.56-2023, SEC.243.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.6. All Payer Claims Data Base Advisory Board › 27-1-44.6-7. Appointment and Terms of Members

Sec. 7. (a) The initial appointment of members beginning July 1, 2021, must be made not later than August 1, 2021.
(b) For the initial appointment of the eight (8) members appointed to the advisory board by the governor under section 6(a)(1) through 6(a)(8) of this chapter, four (4) members will serve for a term of two (2) years and four (4) members will serve for a term of four (4) years. For all subsequent appointments by the governor under section 6(a)(1) through 6(a)(8) of this chapter and all appointments made under section 6(b) of this chapter, members will serve for a term of four (4) years. Members may be reappointed.
(c) Subject to subsection (e), the executive director is a permanent member of the advisory board.
(d) Each appointed member serves until the member's successor is appointed and qualified. A vacancy must be filled by appointment of the governor for the unexpired term.
(e) A member may be removed from the advisory board for good cause.
As added by P.L.195-2021, SEC.12. Amended by P.L.137-2021, SEC.32.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.6. All Payer Claims Data Base Advisory Board › 27-1-44.6-8. Meetings; Quorum

Sec. 8. The advisory board must meet at least two (2) times per calendar year. A majority of the members of the advisory board constitutes a quorum.
As added by P.L.195-2021, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.6. All Payer Claims Data Base Advisory Board › 27-1-44.6-9. Reimbursement; per Diem

Sec. 9. (a) Each member of the advisory board who is not a state employee is entitled to the minimum financial compensation per diem provided by IC 4-10-11-2.1(b). Such a member is also entitled to reimbursement for traveling expenses and other expenses actually incurred in connection with the member's duties, as provided in the state travel policies and procedures established by the Indiana department of administration and approved by the budget agency.
(b) Each member of the advisory board who is a state employee but who is not a member of the general assembly is entitled to reimbursement for traveling expenses and other expenses actually incurred in connection with the member's duties, as provided in the state travel policies and procedures established by the Indiana department of administration and approved by the budget agency.
(c) Each member of the advisory board who is a member of the general assembly is entitled to receive the same per diem, mileage, and travel allowances paid to legislative members of interim study committees established by the legislative council. Per diem, mileage, and travel allowances paid under this subsection shall be paid from appropriations made to the legislative council or the legislative services agency.
(d) Membership on the advisory board does not constitute the holding of a public office.
As added by P.L.195-2021, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 44.6. All Payer Claims Data Base Advisory Board › 27-1-44.6-10. Duties of Advisory Board

Sec. 10. (a) The advisory board may make recommendations to the executive director and administrator regarding the data base that:
(1) include specific strategies to measure and collect data related to health care safety and quality, utilization, health outcomes, and cost;
(2) focus on data elements that foster quality improvement and peer group comparisons;
(3) facilitate value based, cost effective purchasing of health care services by public and private purchasers and consumers;
(4) result in usable and comparable information that allows public and private health care purchasers, consumers, and data analysts to identify and compare health plans, health insurers, health care facilities, and health care providers regarding the provision of safe, cost effective, high quality health care services;
(5) use and build upon existing data collection standards and methods to establish and maintain the data base in a cost effective and efficient manner;
(6) are designed to measure the following performance domains:
(A) safety;
(B) timeliness;
(C) effectiveness;
(D) efficiency;
(E) equity; and
(F) patient centeredness;
(7) incorporate and utilize claims, eligibility, and other publicly available data to the extent it is the most cost effective method of collecting data to minimize the cost and administrative burden on data sources;
(8) include recommendations about whether to include data on the uninsured;
(9) discuss the harmonization of the data base with other state, regional, and federal efforts concerning all payer claims data bases;
(10) discuss the harmonization of the data base with federal legislation concerning all payer claims data bases;
(11) discuss a limit on the number of times the executive director and administrator may require submission of the required data elements;
(12) discuss a limit on the number of times the executive director and administrator may change the required data elements for submission in a calendar year considering administrative costs, resources, and time required to fulfill the requests;
(13) discuss compliance with the federal Health Insurance Portability and Accountability Act (42 U.S.C. 201 et seq.), as amended, and other proprietary information related to collection and release of data;
(14) discuss comparing Indiana's health insurance premium rates, Medicaid reimbursement rates, and Medicare reimbursement rates with all other states; and
(15) discuss auditing and comparing Indiana's health insurance reimbursement claim denials with all other states.
(b) The advisory board shall make recommendations to the executive director regarding how the ongoing oversight of the operations of the data base should function, including where the data base should be housed.
(c) Any recommendations or actions by the advisory board are subject to the approval of the commissioner.
As added by P.L.195-2021, SEC.12. Amended by P.L.203-2023, SEC.20.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 45. Health Facility Compensation › 27-1-45-1.5. "Emergency Services"

Sec. 1.5. As used in this chapter, "emergency services" means services that are:
(1) furnished by a provider qualified to furnish emergency services; and
(2) needed to evaluate or stabilize an emergency medical condition.
As added by P.L.93-2020, SEC.11.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 45. Health Facility Compensation › 27-1-45-2. "Facility"

Sec. 2. (a) As used in this chapter, "facility" means an institution in which health care services are provided to individuals. The term includes:
(1) hospitals and other licensed ambulatory surgical centers; and
(2) ambulatory outpatient surgical centers.
(b) The term does not include the following:
(1) A private mental health institution licensed under IC 12-25.
(2) A Medicare certified, freestanding rehabilitation hospital.
As added by P.L.93-2020, SEC.11.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 45. Health Facility Compensation › 27-1-45-3. "In Network Provider"

Sec. 3. As used in this chapter, "in network provider" means a provider that is required under a network plan to provide health care services to covered individuals at not more than a preestablished rate or amount of compensation.
As added by P.L.93-2020, SEC.11.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 45. Health Facility Compensation › 27-1-45-4. "Network Plan"

Sec. 4. As used in this chapter, "network plan" means a plan under which providers are required by contract to provide health care services to covered individuals at not more than a preestablished rate or amount of compensation.
As added by P.L.93-2020, SEC.11.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 45. Health Facility Compensation › 27-1-45-5. "Practitioner"

Sec. 5. (a) As used in this chapter, "practitioner" means the following:
(1) An individual:
(A) who holds:
(i) an unlimited license, certificate, or registration;
(ii) a limited or probationary license, certificate, or registration;
(iii) a temporary license, certificate, registration, or permit;
(iv) an intern permit; or
(v) a provisional license;
issued by the board (as defined in IC 25-0.5-11-1) regulating the profession in question; and
(B) who provides professional health care services to individuals in a facility.
(2) An entity that:
(A) is owned by, or employs; or
(B) performs billing for professional health care services rendered by;
an individual described in subdivision (1).
(b) The term does not include the following:
(1) A dentist licensed under IC 25-14.
(2) An optometrist licensed under IC 25-24.
(3) A provider facility.
As added by P.L.93-2020, SEC.11. Amended by P.L.202-2021, SEC.8.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 45. Health Facility Compensation › 27-1-45-7. Exception to Good Faith Estimate Requirement

Sec. 7. (a) This section is effective beginning January 1, 2022.
(b) A facility or a practitioner is not required to provide the good faith estimate if the health care service to be provided to the covered individual is scheduled to be performed within five (5) business days after the health care service is ordered.
As added by P.L.93-2020, SEC.11. Amended by P.L.202-2021, SEC.9; P.L.165-2022, SEC.7.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 45. Health Facility Compensation › 27-1-45-9. Civil Penalty; Fund

Sec. 9. (a) The insurance commissioner may, after notice and hearing under IC 4-21.5, impose on the provider facility a civil penalty of not more than one thousand dollars ($1,000) for each violation of this chapter.
(b) A civil penalty collected under this section shall be deposited in the department of insurance fund established by IC 27-1-3-28.
As added by P.L.93-2020, SEC.11.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 45. Health Facility Compensation › 27-1-45-10. Compliance With Federal Requirements

Sec. 10. The requirements of this chapter do not apply to a facility or practitioner that:
(1) is required to comply with; and
(2) is in compliance with;
45 CFR Part 149, Subparts E and G, as may be enforced and amended by the federal Department of Health and Human Services.
As added by P.L.165-2022, SEC.9. Amended by P.L.190-2023, SEC.22.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 45.5. Indiana Public Employers' Plan › 27-1-45.5-1. "Ipep"

Sec. 1. As used in this chapter, "IPEP" refers to the Indiana Public Employers' Plan, Inc., which was originally incorporated under the name Indiana Employers' Compensation Plan, Inc., as a domestic nonprofit corporation on December 11, 1989.
As added by P.L.117-2021, SEC.4.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 45.5. Indiana Public Employers' Plan › 27-1-45.5-3. Application for Certificate of Authority; Application Deadline

Sec. 3. (a) Before December 31, 2026, IPEP shall apply to the insurance commissioner for a certificate of authority to transact the business of insurance in Indiana as a domestic tax exempt reciprocal insurance company.
(b) The bylaws or articles of incorporation prepared by IPEP for purposes of IPEP's conversion to a domestic tax exempt reciprocal insurance company must require that the board of the domestic tax exempt reciprocal insurance company be made up of at least seven (7) individuals.
(c) IPEP, in converting to a domestic tax exempt reciprocal insurance company, must meet the requirements and conditions for the formation of a domestic tax exempt reciprocal insurance company set forth in IC 27-1-6, including an examination under IC 27-1-6-17.
As added by P.L.117-2021, SEC.4. Amended by P.L.226-2023, SEC.17.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 45.5. Indiana Public Employers' Plan › 27-1-45.5-4. Domestic Tax Exempt Reciprocal Insurance Company

Sec. 4. (a) After:
(1) receiving a certificate of authority from the insurance commissioner to transact the business of insurance in Indiana as a domestic tax exempt reciprocal insurance company; and
(2) making any changes in structure and legal status necessary or beneficial to the conversion of IPEP from a domestic nonprofit corporation into a domestic tax exempt reciprocal insurance company;
IPEP shall begin transacting the business of insurance as a domestic tax exempt reciprocal insurance company.
(b) All of the following apply on the date on which IPEP begins transacting the business of insurance as a domestic tax exempt reciprocal insurance company:
(1) All powers, duties, agreements, and liabilities that IPEP had as a domestic nonprofit corporation immediately before the date are transferred to the domestic tax exempt reciprocal insurance company as the successor entity.
(2) All records and property that IPEP had as a domestic nonprofit corporation immediately before the date, including all funds under the control or supervision of IPEP, are transferred to the domestic tax exempt reciprocal insurance company as the successor entity.
(3) Any amounts owed to IPEP immediately before the date are considered to be owed to the domestic tax exempt reciprocal insurance company as the successor entity.
(4) A reference to IPEP in a statute, rule, or other document is considered a reference to the domestic insurance company as the successor entity.
(5) All powers, duties, agreements, and liabilities of IPEP immediately before the date with respect to bonds issued by IPEP in connection with any trust agreement or indenture securing the bonds are transferred to the domestic tax exempt reciprocal insurance company as the successor entity. The rights of the trustee under any trust agreement or indenture and the rights of the bondholders of IPEP remain unchanged despite the transfer of the powers, duties, agreements, and liabilities of IPEP to the domestic tax exempt reciprocal insurance company as the successor entity.
As added by P.L.117-2021, SEC.4.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-0.5. Provision of Information by Certain Health Plans

Sec. 0.5. Nothing in this chapter prohibits:
(1) a self-funded health benefit plan that complies with the federal Employee Retirement Income Security Act (ERISA) of 1974 (29 U.S.C. 1001 et seq.); or
(2) a:
(A) self-insurance program established to provide group health coverage as described in IC 5-10-8-7(b); or
(B) contract for health services as described in IC 5-10-8-7(c);
from providing information requested by a practitioner or provider facility under this chapter.
As added by P.L.93-2020, SEC.12. Amended by P.L.11-2023, SEC.88.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-1. "Covered Individual"

Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to be provided health care services according to a health carrier's network plan.
As added by P.L.93-2020, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-1.5. "Episode of Care"

Sec. 1.5. As used in this chapter, "episode of care" means the medical care ordered to be provided for a specific medical procedure, condition, or illness.
As added by P.L.93-2020, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-2. "Good Faith Estimate"

Sec. 2. As used in this chapter, "good faith estimate" means a reasonable estimate of the price each provider anticipates charging for an episode of care for nonemergency health care services that:
(1) is made by a provider under this chapter upon the request of the individual for whom the nonemergency health care service has been ordered; and
(2) is not binding upon the provider.
As added by P.L.93-2020, SEC.12. Amended by P.L.202-2021, SEC.11.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-3. "Health Carrier"

Sec. 3. (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.93-2020, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-4. "In Network"

Sec. 4. As used in this chapter, "in network", when used in reference to a provider, means that the health care services provided by the provider are subject to a health carrier's network plan.
As added by P.L.93-2020, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-5. "Network"

Sec. 5. (a) As used in this chapter, "network" means a group of provider facilities and practitioners that:
(1) provide health care services to covered individuals; and
(2) have agreed to, or are otherwise subject to, maximum limits on the prices for the health care services to be provided to the covered individuals.
(b) The term includes the following:
(1) A network described in subsection (a) that is established pursuant to a contract between an insurer providing coverage under a group health policy and:
(A) individual provider facilities and practitioners;
(B) a preferred provider organization; or
(C) an entity that employs or represents providers, including:
(i) an independent practice association; and
(ii) a physician-hospital organization.
(2) A health maintenance organization, as defined in IC 27-13-1-19.
As added by P.L.93-2020, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-6. "Network Plan"

Sec. 6. As used in this chapter, "network plan" means a plan of a health carrier that:
(1) requires a covered individual to receive; or
(2) creates incentives, including financial incentives, for a covered individual to receive;
health care services from one (1) or more providers that are under contract with, managed by, or owned by the health carrier.
As added by P.L.93-2020, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-7. "Nonemergency Health Care Service"

Sec. 7. As used in this chapter, "nonemergency health care service" means a discrete service or series of services ordered by a practitioner for an episode of care for the purpose of:
(1) diagnosis;
(2) prevention;
(3) treatment;
(4) cure; or
(5) relief;
of a physical, mental, or behavioral health condition, illness, injury, or disease that is not provided on an emergency or urgent care basis.
As added by P.L.93-2020, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-8. "Practitioner"

Sec. 8. (a) As used in this chapter, "practitioner" means:
(1) an individual who holds:
(A) an unlimited license, certificate, or registration;
(B) a limited or probationary license, certificate, or registration;
(C) a temporary license, certificate, registration, or permit;
(D) an intern permit; or
(E) a provisional license;
issued by the board (as defined in IC 25-0.5-11-1) regulating the profession in question; or
(2) an entity that:
(A) is owned by, or employs; or
(B) performs billing for professional health care services rendered by;
an individual described in subdivision (1).
(b) The term does not include the following:
(1) A dentist licensed under IC 25-14.
(2) An optometrist licensed under IC 25-24.
(3) A provider facility.
As added by P.L.93-2020, SEC.12. Amended by P.L.202-2021, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-8.5. "Price"

Sec. 8.5. As used in this chapter, "price" means the negotiated rate between the:
(1) provider facility and practitioner; and
(2) covered individual's primary health carrier.
As added by P.L.93-2020, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-10. "Provider Facility"

Sec. 10. (a) As used in this chapter, "provider facility" means any of the following:
(1) A hospital licensed under IC 16-21-2.
(2) An ambulatory outpatient surgical center licensed under IC 16-21-2.
(3) A birthing center licensed under IC 16-21-2.
(4) Except for an urgent care facility, a facility that provides diagnostic services to the medical profession or the general public, including outpatient facilities.
(5) A laboratory where clinical pathology tests are carried out on specimens to obtain information about the health of a patient.
(6) A facility where radiologic and electromagnetic images are made to obtain information about the health of a patient.
(7) An infusion center that administers intravenous medications.
(b) The term does not include the following:
(1) A private mental health institution licensed under IC 12-25.
(2) A Medicare certified, freestanding rehabilitation hospital.
As added by P.L.93-2020, SEC.12. Amended by P.L.9-2022, SEC.49; P.L.36-2022, SEC.11; P.L.179-2022(ss), SEC.43.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-10.5. "Urgent Care Facility"

Sec. 10.5. (a) As used in this chapter, "urgent care facility" means a freestanding health care facility that offers episodic, walk-in care for the treatment of acute, but not life threatening, health conditions.
(b) The term does not include an emergency department of a hospital or a nonprofit or government operated health clinic.
As added by P.L.93-2020, SEC.12.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-11. Right of Individual to Request Good Faith Estimate From Provider Facility; Duty of Provider Facility to Provide Estimate; Required Contents

Sec. 11. (a) This section does not:
(1) apply to an individual who is a Medicaid recipient; or
(2) limit the authority of a legal representative of the patient.
(b) An individual for whom a nonemergency health care service has been ordered, scheduled, or referred may request from the provider facility in which the nonemergency health care service will be provided a good faith estimate of the price that will be charged for the nonemergency health care service.
(c) A provider facility that receives a request from an individual under subsection (b) shall, not more than five (5) business days after receiving relevant information from the individual, provide to the individual a good faith estimate of:
(1) the price that the provider facility in which the health care service will be performed will charge for:
(A) the use of the provider facility to care for the individual for the nonemergency health care service;
(B) the services rendered by the employed or contracted staff of the provider facility in connection with the nonemergency health care service; and
(C) medication, supplies, equipment, and material items to be provided to or used by the individual while the individual is present in the provider facility in connection with the nonemergency health care service; and
(2) the price charged for the services of all practitioners, support staff, and other persons who provide professional health services:
(A) who may provide services to or for the individual during the individual's presence in the provider facility for the nonemergency health care service; and
(B) for whose services the individual will be charged separately from the charge of the provider facility.
(d) The price that must be included in a good faith estimate under this section includes all services under subsection (c)(1) or (c)(2) for imaging, laboratory services, diagnostic services, therapy, observation services, and other services expected to be provided to the individual for the episode of care.
(e) A provider facility shall ensure that a good faith estimate states that:
(1) an estimate provided under this section is not binding on the provider facility;
(2) the price the provider facility charges the individual may vary from the estimate based on the individual's medical needs; and
(3) the estimate provided under this section is only valid for thirty (30) days.
(f) A provider facility may not charge a patient for information provided under this section.
As added by P.L.93-2020, SEC.12. Amended by P.L.202-2021, SEC.13.
2023 Indiana Code › Title 27. Insurance › Article 1. Department of Insurance › Chapter 46. Provider Facility Good Faith Estimates › 27-1-46-12. In Network Good Faith Estimates; Out of Network Good Faith Estimates

Sec. 12. (a) If:
(1) the individual who requests a good faith estimate from a provider facility under this chapter and has been verified as a covered individual with respect to a network plan; and
(2) the provider facility from which the individual requests the good faith estimate is in network with respect to the same network plan;
the good faith estimate that the provider facility provides to the individual under this chapter must be based on the price to which the provider facility and any practitioners referred to in section 11(c)(2) of this chapter have agreed as in network providers.
(b) If the individual who requests a good faith estimate from a provider facility under this chapter:
(1) is not a covered individual with respect to any network plan; or
(2) is not a covered individual with respect to a network plan with respect to which the provider facility is in network;
the good faith estimate that the provider facility provides to the individual under this chapter must be based on the price that the provider facility and any practitioners referred to in section 11(c)(2) of this chapter charge for the nonemergency health care services in the absence of any network plan.
As added by P.L.93-2020, SEC.12.