reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-5 - Benefits payable, losses covered or premiums payable

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 5.
ADVERTISEMENTS OF BENEFITS PAYABLE, LOSSES COVERED OR
				  PREMIUMS PAYABLE.
(a) Deceptive Words,
				Phrases or Illustrations. Words, phrases or illustrations shall not be used in
				a manner which misleads or has the capacity and tendency to deceive as to the
				extent of any policy benefit payable, loss covered or premium payable. An
				advertisement relating to any policy benefit payable, loss covered or premium
				payable shall be sufficiently complete and clear as to avoid deception or the
				capacity and tendency to deceive.
Explanation:
(i) The
				words and phrases "all", "full", "complete", "comprehensive", "unlimited", "up
				to", "as high as", "this policy will pay your hospital and surgical bills" or
				"this policy will replace your income" or similar words or phrases shall not be
				used so as to exaggerate any benefit beyond the terms of the policy, but may be
				used only in such manner as fairly to describe such benefit.
(ii) A policy covering only one disease or a
				list of specified diseases shall not be advertised so as to imply coverage
				beyond the terms of the policy. Synonymous terms shall not be used to refer to
				any disease so as to imply broader coverage than is the fact.
(iii) The benefits of a policy which pays
				varying amounts for the same loss occurring under different conditions, or
				which pays benefits only when a loss occurs under certain conditions, shall not
				be advertised without disclosing the limited conditions under which the
				benefits referred to are provided by the policy.
(iv) Phrases such as "this policy pays $1,800
				for hospital room and board expenses" are incomplete without indicating the
				maximum daily benefit and the maximum time limit for hospital room and board
				expenses.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-9 - Statistics in advertising

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 9.
USE OF STATISTICS. An advertisement relating to the dollar
				  amounts of claims paid, the number of persons insured, or similar statistical
				  information relating to any insurer or policy shall not be used unless it
				  accurately reflects all of the relevant facts. Such an advertisement shall not
				  imply that such statistics are derived from the policy advertised unless such
				  is the fact.
Interpretation of Section B 6
[this
				  section]
If the term "loss ratio" is quoted, it should be based on (a)
				  premiums received and benefits paid, or (b) premiums earned and losses
				  incurred.
An advertisement representing the dollar amounts of claims
				  paid must also indicate the period over which such claims have been paid.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-10 - Offers of inspection of policy or premium refund

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 10.
INSPECTION OF POLICY. An offer in an advertisement of free
				  inspection of policy or offer of a premium refund is not a cure for misleading
				  or deceptive statements contained in such advertisement. Furthermore, if such
				  an offer is made, it must provide for a minimum of ten (10) days after delivery
				  in which one may return the policy to the agent or company and receive a refund
				  of any premiums paid.
Interpretation of Section B 7
[this
				  section]
No comment believed necessary.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-11 - Disclosure of plan or combination of policies referred to

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 11.
IDENTIFICATION OF PLAN OR NUMBER OF POLICIES.
(a) When a choice of the amount of benefits
				is referred to, an advertisement shall disclose that the amount of benefits
				provided depends upon the plan selected and that the premium will vary with the
				amount of the benefits.
(b) When an
				advertisement refers to various benefits which may be contained in two or more
				policies, other than group master policies, the advertisement shall disclose
				that such benefits are provided only through a combination of such policies.
Interpretation of Section B 8
[this
				  section]
No comment believed necessary.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-12 - References to other policies and competitors

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 12.
DISPARAGING COMPARISONS AND STATEMENTS. An advertisement
				  shall not directly or indirectly make unfair or incomplete comparisons of
				  policies or benefits or otherwise falsely disparage competitors, their
				  policies, services or business methods.
Interpretation of Section B 9
[this
				  section]
No comment believed necessary.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-13 - Advertising beyond jurisdiction of licensing

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 13.
JURISDICTIONAL LICENSING. An advertisement which is intended
				  to be seen or heard beyond the limits of the jurisdiction in which the insurer
				  is licensed shall not imply licensing beyond those limits.
Interpretation of Section B 10
[this
				  section]
An advertisement which contains testimonials from persons who
				  reside in a state in which the insurer is not licensed or which refers to
				  claims of persons residing in states in which the insurer is not licensed
				  implies licensing in those states and therefore is in violation of this Section
				  unless the advertisement otherwise states.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-14 - Disclosure of identity of insurer

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 14.
IDENTITY OF INSURER. The identity of the insurer shall be
				  made clear in all of its advertisments. An advertisement shall not use a trade
				  name, service mark, slogan, symbol or other device which has the capacity and
				  tendency to mislead or deceive as to the true identity of the insurer.
Interpretation of Section B 11
[this
				  section]
This section prohibits the use of the name of an agency or "
				  _____ Underwriters" " _____ Plan" in type, size and location so as to have the
				  capacity and tendency to mislead or deceive as to the true identity of the
				  insurer.
This Section does not prohibit the use of the initials, the
				  trade name or a portion of the corporate name of the insurer unless such use
				  has the capacity and tendency to mislead or deceive as to the true identity of
				  the insurer, in which event the insurer should set forth its full name and its
				  home or principal office, i.e., city and state.
This Section prohibits an insurer from using an address so as
				  to mislead or deceive as to its true identity or licensing status.
This Section prohibits an insurer from using envelopes or
				  stationery which has imprinted thereon any name, service mark, slogan, symbol
				  or other device which has the capacity or tendency to mislead or deceive as to
				  imply that the insured or the policy advertised is connected with a
				  governmental agency such as the Social Security Administration or the Veterans
				  Administration.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-15 - Group or quasi-group implications

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 15.
GROUP OR QUASI-GROUP IMPLICATIONS. An advertisement of a
				  particular policy shall not state or imply that prospective policyholders
				  become group or quasi-group members and as such enjoy special rates or
				  underwriting privileges, unless such is the fact.
Interpretation of Section B 12
[this
				  section]
This Section prohibits the use of representations to any
				  segment of individuals that a particular policy or coverage is available only
				  to that, or similar segment of individuals as preferred risks, when actually
				  such policy or coverage is available to eligible members of the public at
				  large. There is no prohibition against advertising that a policy or coverage is
				  available to only a particular segment of individuals such as professional men,
				  business men, etc., as preferred risks when in actual underwriting practice
				  such is the fact.
This Section prohibits the solicitation of a particular class
				  such as governmental employees by the use of advertisements which state or
				  imply that their occupational status entitles them to reduced rates on a group
				  or other basis when in fact the policy being advertised is sold only on an
				  individual basis at regular rates.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-16 - Introductory, initial or special offers

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 16.
INTRODUCTORY, INITIAL OR SPECIAL OFFERS.
(a) An advertisement shall not state or imply
				that a particular policy or combination of policies is an introductory, initial
				or special offer and that the applicant will receive advantages by accepting
				the offer, unless such is the fact. If an enrollment date by which one must
				accept an introductory, initial or special offer is provided, such offer shall
				not be repeated for six (6) months.
(b) No insurer may use a mail order
				solicitation form that requires the recipient to refuse the policy by signing
				said form and returning it to the insurer.
Interpretation of Section B 13
[this
				  section]
This Section prohibits any statements or implication to the
				  effect that only a specific number of policies will be sold or that a time is
				  fixed for the discontinuance of the sale of the particular policy advertised
				  because of special advantages available in the policy, unless such is the
				  fact.
This Section prohibits any statements or implication in the
				  same advertising media to the effect that only a specific number of policies
				  will be sold, or that a time is fixed for the discontinuance of the sale of the
				  particular policy advertised because of special advantages available in the
				  policy, or that an individual will receive special advantages by enrolling
				  within an open enrollment period or by a deadline date, unless such is the
				  fact.
An applicant should be able to determine from the advertising
				  the cost of his insurance. If the insurer charges an initial premium that
				  differs from the renewal premium on the same mode, both the initial and renewal
				  premium must be shown in the advertisement together with any increase in rate
				  or reduction in coverage because of age.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-17 - Third-party approval or endorsement

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 17.
APPROVAL OR ENDORSEMENT BY THIRD PARTIES.
(a) An advertisement shall not state or imply
				that an insurer or a policy has been approved or an insurer's financial
				condition has been examined and found to be satisfactory by a governmental
				agency, unless such is the fact.
(b) An advertisement shall not state or imply
				that an insurer or a policy has been approved or endorsed by an individual,
				group of individuals, society, association or other organization, unless such
				is the fact.
Interpretation of Section B 14(a)
[subsection (a) of
				  this section]
The word "approved" shall not be interpreted so as to permit
				  an insurer to state or imply in an advertisement that a governmental agency has
				  endorsed or recommended the insurer, its policies or its financial
				  condition.
This Section does not prohibit an insurer from reproducing a
				  portion of a filed report of examination of such insurer, conducted by one or
				  more insurance departments, provided the portion reproduced is not taken out of
				  context and thereby rendered untrue or misleading.
Interpretation of Section B 14(b)
[subsection (b) of
				  this section]
This Section requires current and valid endorsements. It
				  would prohibit representations that a policy or plan of an insurer is a
				  community health plan or program unless such policy or plan has been adopted by
				  the particular community government for the residents of that community or has
				  been so designated by law.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-18 - Statements of services and settlement policies

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 18.
SERVICE FACILITIES. An advertisement shall not contain untrue
				  statements with respect to the time within which claims are paid or statements
				  which imply that claim settlements will be liberal or generous beyond the terms
				  of the policy. An advertisement promising cost savings derived from elimination
				  of the agent shall also indicate that no direct personal service may be
				  expected, if such is the fact.
Interpretation of Section B 15
[this
				  section]
No comment believed necessary.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-19 - Statements about insurer

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-4-1-4
Sec. 19.
STATEMENTS ABOUT AN INSURER. An advertisement shall not
				  contain statements which are untrue in fact or by implication misleading with
				  respect to the insurer's assets, corporate structure, financial standing, age
				  or relative position in the insurance business.
Interpretation of Section B 16
[this
				  section]
Among other things, this Section prohibits insurers which
				  have been organized for only a brief period of time from advertising that they
				  are "old" or from making similar untrue representations.
Illustrations of a "Home Office" building should not be used
				  in a manner which will be misleading with respect to the actual size and
				  magnitude of the insurer's business.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 18 - Accident and Sickness Insurance-Advertising › Section 18-20 - Records; certificate of compliance

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-4-1-4
Sec. 20.
Section C.
				ENFORCEMENT PROCEDURES.
(1) Advertising File:
				Each insurer shall maintain at its home or principal office a complete file
				containing every printed, published or prepared advertisement of individual
				policies and typical printed, published or prepared advertisements of blanket,
				franchise and group policies hereafter disseminated in this or any other state
				whether or not licensed in such other state, with a notation attached to each
				such advertisement which shall indicate the manner and extent of distribution
				and the form number of any policy advertised. Such file shall be subject to
				regular and periodical inspection by this Department. All such advertisements
				shall be maintained in said file for a period of not less than three
				years.
(2) Certificate of
				Compliance: Each insurer required to file an annual statement which is now or
				which hereafter becomes subject to the provisions of this rule must file with
				this Department together with its annual statement, a certificate executed by
				an authorized officer of the insurer wherein it is stated that to the best of
				his knowledge, information and belief the advertisements which were
				disseminated by the insurer during the preceding statement year complied or
				were made to comply in all respects with the provisions of the insurance laws
				of this state as implemented and interpreted by this rule
[ 760 IAC
				1-18 ]
. It is requested that the chief executive officer of each such
				insurer to which this rule
[ 760 IAC 1-18 ]
is addressed
				acknowledge its receipt and indicate its intention to comply therewith.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 19 - Group Accident and Sickness Insurance-Succeeding Carrier Requirements › Section 19-1 - Authority to promulgate rule; purpose of rule

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-8-5
Sec. 1.
AUTHORITY AND PURPOSES. This regulation
[ 760 IAC
				  1-19 ]
is issued pursuant to the authority set out at I.C. 1971,
				  27-1-3-7.
Many Indiana citizens have purchased coverage under group
				  disability policies which contain pre-existing conditions limitations. If the
				  policy holder replaces an existing group disability policy issued by a
				  succeeding carrier, pre-existing conditions limitations in the new policy may
				  cause unfair hardship on the insureds. The purpose of this regulation
[
				  760 IAC 1-19 ]
is to eliminate this hardship.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 19 - Group Accident and Sickness Insurance-Succeeding Carrier Requirements › Section 19-2 - Pre-existing condition limitations

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-8-5
Sec. 2.
LIMITATIONS. In the case of persons insured under a prior
				  carrier's group disability policy at the date of change in coverage to a
				  succeeding carrier's group disability policy containing a pre-existing
				  conditions limitation, during the period of time the limitation applies under
				  the new policy, the level of benefits shall be the lesser of
(a) the benefits of the new plan determined
				without application of the pre-existing conditions limitation; or
(b) the benefits of the prior plan.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 19 - Group Accident and Sickness Insurance-Succeeding Carrier Requirements › Section 19-3 - Effective date of rule

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7; IC 27-8-5
Sec. 3.
APPLICATION. All group disability policies issued on or after
				  the effective date of this regulation
[ 760 IAC 1-19 ]
must
				  contain policy provisions consistent with Sec. II
[
				  760 IAC
				  1-19-2 ]
of this regulation.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 21 - Medical Malpractice Insurance › Section 21-2 - Definitions

Current through July 10, 2024
Authority: IC 34-18-5-4
Affected: IC 12-15-18-3; IC 12-24-1-3; IC 12-25; IC 16-28; IC
				  25-14-1-1.5; IC 25-14-1-3; IC 25-22.5; IC 25-29-1-13; IC 34-18
Sec. 2.
The following definitions and those contained in IC 34-18-2
				  apply throughout this rule:
(1)
				"Ancillary provider" means all health care providers as defined in IC
				34-18-2-14, except the following:
(A)
				Physicians.
(B) Nursing
				homes.
(C) Hospitals.
(D) Psychiatric hospitals.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 21 - Medical Malpractice Insurance › Section 21-2.5 - Insurance policy as proof of financial responsibility

Current through July 10, 2024
Authority: IC
				  34-18-3-7;
				  IC
				  34-18-5-2; IC
				  34-18-5-4;
				  IC
				  34-18-6-6
Affected: IC 27-1; IC
				  27-4-5-2;
				  IC
				  34-18-2-14;
				  IC 34-18-3; IC 34-18-4; IC
				  34-18-15-4;
				  IC 34-18-17
Sec. 2.5.
(a) A
				health care provider may use a policy of insurance issued by any of the
				following types of insurer as proof of financial responsibility:
(1) An insurance company holding a
				certificate of authority from the department under IC 27-1-6 or IC
				27-1-17.
(2) A risk retention group
				domiciled in Indiana or a foreign risk retention group registered with the
				department.
(3) An insurer that
				does not hold a certificate of authority from the department through one (1) of
				the following:
(A) A surplus lines transaction
				under IC 27-1-15.8.
(B) An
				industrial insured transaction under IC
				27-4-5-2(a)(8).
(4) A captive insurer registered
				with the department under IC
				27-1-2-2.3.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 21 - Medical Malpractice Insurance › Section 21-3 - Establishment of financial responsibility by health care provider by means other than insurance

Current through July 10, 2024
Authority: IC
				  34-18-5-4
Affected: IC
				  34-18-4-1
Sec. 3.
(a) A health
				care provider desiring to establish financial responsibility under IC
				34-18-4-1
				by a means other than insurance may do so by submitting, to the commissioner,
				the following:
(1) An agreement in writing, in
				a form and manner prescribed by the commissioner, to pay any final judgment or
				agreed settlement arising from claims of malpractice in accordance with the
				limits on liability set forth in IC
				34-18-4-1(1).
(2) Filing and maintaining with the
				commissioner cash or surety bonds from a company acceptable to the
				commissioner, in accordance with the limits on liability set forth in IC
				34-18-4-1(1)
				 for each year in which financial
				responsibility is established by a means other than insurance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 21 - Medical Malpractice Insurance › Section 21-4 - Retention of deposit during liability

Current through July 10, 2024
Authority: IC
				  34-18-5-4
Affected: IC
				  34-18-4-1;
				  IC
				  34-18-4-2
Sec. 4.
If a health care provider that has established financial
				  responsibility, in the manner set forth in section 3 of this rule:
(1) ceases practice;
(2) establishes financial responsibility by
				means of insurance; or
(3) decides
				that he or she no longer wishes to establish financial responsibility under IC
				34-18; any cash or surety bond filed with the commissioner shall remain on
				deposit until liability ceases to exist.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 21 - Medical Malpractice Insurance › Section 21-5 - Financial responsibility of hospital or psychiatric hospital

Current through July 10, 2024
Authority: IC
				  34-18-5-4
Affected: IC 12-25; IC 16-21-2; IC
				  34-18-4-1;
				  IC
				  34-18-5-3
Sec. 5.
A hospital or psychiatric hospital may establish financial
				  responsibility for itself and its officers, agents, and employees by
				  submitting, to the commissioner, all of the following at least sixty (60) days
				  before the requested effective date of coverage with the PCF:
(1) An agreement in writing, in a form and
				manner prescribed by the commissioner, to pay any final judgment or agreed
				settlement arising from claims of malpractice subject to the limits on
				liability set forth in IC
				34-18-4-1(1)(A)(i)
				 and IC
				34-18-4-1(1)(A)(ii).
(2) An agreement in writing that the hospital
				or psychiatric hospital will establish and maintain a claims management and
				risk management program. The program shall include, at a minimum, the
				following:
(A) Procedures satisfactory to the
				commissioner for the prompt investigation of each malpractice claim reported to
				the hospital or psychiatric hospital to determine the following:
(i) Whether malpractice liability
				exists.
(ii) Its cause.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 21 - Medical Malpractice Insurance › Section 21-6 - Financial reserves

Current through July 10, 2024
Authority: IC
				  34-18-5-4
Affected: IC 5-14-3; IC
				  34-18-9-3
Sec. 6.
A health care provider that establishes financial
				  responsibility by a means other than insurance must maintain reserves adequate
				  to cover the possible loss and expected litigation costs in conjunction with
				  any claim submitted against that health care provider. Such reserves must be
				  established within sixty (60) days after a claim is reported. Upon the request
				  of the department, the health care provider shall provide an actuarial opinion
				  that states the health care provider has adequate reserves for its potential
				  liabilities under generally accepted standards of actuarial practice. Any
				  information received by the department regarding claim reserves is confidential
				  under IC 5-14-3 and IC
				  34-18-9-3.
				  The department shall request not more than one (1) report in a twelve (12)
				  month period unless the department receives information that indicates a
				  financial issue.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 21 - Medical Malpractice Insurance › Section 21-7 - Cash deposits

Current through July 10, 2024
Authority: IC
				  34-18-5-4
Affected: IC
				  34-18-4-1
Sec. 7.
Cash deposited by a health care provider under IC
				  34-18-4-1(2)
				   and this rule may be deposited in an
				  interest-bearing account in any bank located in Indiana. Such a deposit must be
				  in a joint account under the control of the commissioner and the health care
				  provider. The health care provider may withdraw accrued interest from the
				  account.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 21 - Medical Malpractice Insurance › Section 21-8 - Payment into patient's compensation fund; annual surcharge for ancillary provider

Current through July 10, 2024
Authority: IC
				  34-18-5-4
Affected: IC 27-1-6; IC 27-1-17; IC
				  27-7-10-14;
				  IC
				  34-18-5-2; IC
				  34-18-5-3
Sec. 8.
The annual surcharge for an ancillary provider or independent
				  ancillary provider shall be as follows:
(1) An ancillary provider who is not an
				independent ancillary provider that purchases insurance as proof of financial
				responsibility shall pay one hundred percent (100%) of the premium charged by
				the insurer.
(2) An ancillary
				provider who is not an independent ancillary provider that establishes
				financial responsibility by means other than insurance under section 3 of this
				rule shall pay an amount equal to one hundred percent (100%) of the premium
				that would be charged to the ancillary provider by IRMIA. The payment must be
				made each year under IC
				34-18-5-3
				within thirty (30) days after qualification.
(3) An independent ancillary provider's
				surcharge shall be calculated at the following percentage of the published
				surcharge for a specialty class 1 physician:
(A) Twenty percent (20%) for each
				dentist.
(B) One hundred thirty
				percent (130%) for each dentist - oral surgery.
(C) Twelve and one-half percent (12.5%) for
				each psychologist.
(D) Ninety-two
				and one-half percent (92.5%) for each podiatrist - no surgery.
(E) One hundred forty-five percent (145%) for
				each podiatrist - surgery.
(F)
				Twelve and one-half percent (12.5%) for each optometrist.
(G) Thirty-five percent (35%) for each nurse
				practitioner.
(H) One hundred fifty
				percent (150%) for each nurse midwife.
(I) Forty-five percent (45%) for each
				certified registered nurse anesthetist.
(J) Thirty-five percent (35%) for each
				physician assistant.
(K)
				Thirty-five percent (35%) for each clinical nurse specialist.
(L) Forty-five percent (45%) for each
				anesthesiologist assistant.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 21 - Medical Malpractice Insurance › Section 21-8.5 - Payment into patient's compensation fund; annual surcharge for nursing homes

Current through July 10, 2024
Authority: IC
				  34-18-3-7;
				  IC
				  34-18-5-2; IC
				  34-18-5-4;
				  IC
				  34-18-6-6
Affected: IC
				  34-18-5-2; IC
				  34-18-5-3
Sec. 8.5.
A nursing home shall calculate its surcharge rate on a form
				  prescribed by the department. The calculation shall include the
				  following:
(1) The actual number and
				type of beds licensed by the state department of health.
(2) A per bed charge for for-profit
				facilities as follows:
(A) Eighty-one dollars
				and sixty-one cents ($81.61) for each comprehensive nursing care bed.
(B) Thirty-seven dollars and sixty-seven
				cents ($37.67) for each residential nursing care bed.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 21 - Medical Malpractice Insurance › Section 21-10 - Scope of coverage

Current through July 10, 2024
Authority: IC 34-18-5-4
Affected: IC 16-21-2; IC 34-18-2-14; IC 34-18-2-24.5; IC
				  34-18-5-2; IC 34-18-5-3; IC 34-18-5-4
Sec. 10.
(a) A
				hospital's or psychiatric hospital's coverage with the PCF is limited to
				facilities identified in the hospital's or psychiatric hospital's application
				for licensure to operate as facilities operated under the hospital or
				psychiatric hospital license. Each hospital or psychiatric hospital shall
				identify on the surcharge calculation worksheet prescribed by the department
				all of the:
(1) facilities operated under the
				license; and
(2) classes of
				employees intended to be included in the coverage.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 21 - Medical Malpractice Insurance › Section 21-12 - Severability

Current through July 10, 2024
Authority: IC
				  34-18-3-7;
				  IC
				  34-18-5-2; IC
				  34-18-5-4;
				  IC
				  34-18-6-6
Affected: IC 16-28; IC
				  34-18-5-2; IC
				  34-18-5-3
Sec. 12.
If:
(1) any section
				or portion of a section of this rule; or
(2) its applicability to any person or
				circumstance; is held invalid by a court, the remainder of the rule or the
				applicability of the provision to other persons or circumstances shall not be
				affected.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 23 - Accident and Sickness Insurance-Claim Forms › Section 23-1 - Authority to promulgate rule; effective date

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-8-5.5-2
Sec. 1.
By authority vested in the Insurance Commissioner under the
				  terms of I.C. 27-8-5.5-2 which became law in this state effective June 1, 1977,
				  the following regulation
[ 760 IAC 1-23 ]
is to become
				  effective on September 1, 1977. This action is predicated upon the need to
				  establish uniformity of reporting data by providers of health care or treatment
				  for the processing of health care and health insurance
				  benefits.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 23 - Accident and Sickness Insurance-Claim Forms › Section 23-2 - Approved forms

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5.5-2
Sec. 2.
All accident and sickness insurers, hospitals, medical and
				  dental service corporations, and other prepayment organizations must accept
				  forms approved by this Department for the administration of benefit
				  payments.
It is the opinion of the Commissioner that the interests of
				  the insuring public would be best served by adoption of forms developed for
				  nationwide use by national health care provider organizations, health insurers
				  and other prepayment organizations. Accordingly, the following forms are hereby
				  adopted and approved for use in this state:
ATTENDING DENTIST'S STATEMENT - ADS (75), (Exhibit 1),
				  developed under the auspices of the American Dental Association by its Task
				  Force representing dental insurance underwriters.
HEALTH INSURANCE CLAIM FORM - 6-74, (Exhibit II), developed
				  under the auspices of an
[sic.]
approved by the American
				  Medical Association by its WORK GROUP on attending physician's billing and
				  insurance reporting forms representing health insurers.
UNIFORM HOSPITAL BILLING FORM - UB-82 HCFA-1450, (Exhibit
				  III), developed under the auspices of the Health Care Financing Administration
				  of the Department of Health and Human Services.
LONG-TERM DISABILITY INCOME - APS-LT/P&T DIS (75),
				  (Exhibit IV), developed by the Standard Forms Committee of the Health Insurance
				  Association of American Council on Consumer and Professional Relations and
				  approved by the American Medical Association Committee on Health Care
				  Financing.
VISION INSURANCE CLAIM FORM - VICF (75), (Exhibit V),
				  developed by the Standard Forms Committee of the Health Insurance Association
				  of American Council on Consumer and Professional Relations and approved by the
				  American Optometric Association.
EXHIBIT I
Click
				  here to view Image
EXHIBIT II
Click
				  here to view Image
Click
				  here to view Image
EXHIBIT III
Click
				  here to view Image
EXHIBIT IV
Click
				  here to view Image
Click
				  here to view Image
EXHIBIT V
Click
				  here to view Image
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 23 - Accident and Sickness Insurance-Claim Forms › Section 23-3 - Modification of forms

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-8-5.5-2
Sec. 3.
Statements, instructions, or reports, such as those which
				  are normally completed by claimants and policyholders, and needed in the
				  administration of benefit payments, but not requiring information from
				  providers, may be included on the reverse side of any of the approved forms.
				  The approved forms shall not be changed by the addition of data elements or
				  questions; however, the name and/or identifying symbol of the insuring or
				  prepayment organization and/or the group policyholder and/or the professional
				  organization furnishing the form, may be imprinted in the space
				  provided.
Unneeded data elements or sections may be deleted and the
				  space closed-up, except as follows:
Unneeded elements in the "PATIENT AND INSURED (SUBSCRIBER)
				  INFORMATION" section of the Health Insurance Claim Form-(6-74), (Exhibit II)
[
				  760 IAC 1-23-2
				  ]
, may be deleted and the space closed; however, unneeded items in the
				  "PHYSICIAN OR SUPPLIER INFORMATION" section must be shaded-out so that the
				  dimensions of this section and the sequence of the elements are not altered.
				  Further, this section must be positioned on an 8 1/2 × 11 sheet of paper so
				  that the forms of two or more insuring or prepayment organizations may be
				  completed together by the insertion of carbon paper between
				  them.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 23 - Accident and Sickness Insurance-Claim Forms › Section 23-4 - Additional information; approval of non-standard forms

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5.5-2
Sec. 4.
This regulation does not prohibit an insurer, service
				  corporation or prepayment organization from requesting additional information
				  from a provider of health care or treatment when such information is necessary
				  for the proper administration of determining benefit payments. Further, if an
				  insurer or prepayment organization needs a provider report form which differs
				  in some respects from its approved counterpart, such forms shall be submitted
				  to the Insurance Department for approval along with the reasons for the
				  deviations.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 23 - Accident and Sickness Insurance-Claim Forms › Section 23-5 - Revision of approved forms

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-8-5.5-2
Sec. 5.
It is anticipated that reporting forms herein adopted for use
				  in this state will require periodic revision resulting in new editions. In such
				  event, the new editions will be acceptable for use in this state; provided, (1)
				  such have been approved by the appropriate health care or treatment provider
				  groups and organization as set forth in Section 2
[
				  760 IAC 1-23-2 ]
of this Regulation, and (2) such new editions have been filed with
				  this Department.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 24 - Life Insurance Solicitation › Section 24-1 - Authority to promulgate rule; effective date

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7
Sec. 1.
Authority. By authority vested in the Insurance Commissioner
				  under the terms of I.C. 27-1-3-7, the following regulation is to become
				  effective six (6) months after the promulgation of this regulation
[
				  760 IAC 1-24 ]
.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 24 - Life Insurance Solicitation › Section 24-2 - Purpose of rule

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7
Sec. 2.
Purpose.
(A) The
				purpose of this regulation
[ 760 IAC 1-24 ]
is to require
				insurers to deliver to purchasers of life insurance information which will
				improve the buyer's ability to select the most appropriate plan of life
				insurance for his needs, improve the buyer's understanding of the basic
				features of the policy which has been purchased or which is under consideration
				and improve the ability of the buyer to evaluate the relative costs of similar
				plans of life insurance.
(B) This
				regulation
[ 760 IAC 1-24 ]
does not prohibit the use of
				additional material which is not in violation of this regulation
[ 760
				IAC 1-24 ]
or any other state statute or regulation.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 24 - Life Insurance Solicitation › Section 24-3 - Applicability of rule

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7
Sec. 3.
Scope.
(A) Except as
				hereafter exempted, this regulation
[ 760 IAC 1-24 ]
shall
				apply to any solicitation, negotiation or procurement of life insurance
				occurring within this state. This regulation
[ 760 IAC 1-24
				]
shall apply to any issuer of life insurance contracts including
				fraternal benefit societies.
(B)
				Unless otherwise specifically included, this regulation
[ 760 IAC 1-24
				]
shall not apply to:
(1)
				Annuities
(2) Credit life
				insurance
(3) Group life
				insurance
(4) Life insurance
				policies issued in connection with pension and welfare plans as defined by and
				which are subject to the federal Employee Retirement Income Security Act of
				1974 (ERISA).
(5) Variable life
				insurance under which the death benefits and cash values vary in accordance
				with unit values of investments held in a separate account.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 24 - Life Insurance Solicitation › Section 24-4 - Definitions

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7
Sec. 4.
Definitions. For the purpose of this regulation
[ 760
				  IAC 1-24 ]
, the following definitions shall apply:
(A) Buyer's Guide. A Buyer's Guide is a
				document which contains, and is limited to, the language contained in the
				Appendix
[
				760 IAC
				1-24-9 ]
to this regulation or language
				approved by the Commissioner of Insurance.
(B) Cash Dividend. A Cash Dividend is the
				current illustrated dividend which can be applied toward payment of the gross
				premium.
(C) Equivalent Level
				Annual Dividend. The Equivalent Level Annual Dividend is calculated by applying
				the following steps:
(1) Accumulate the annual
				cash dividends at five percent interest compounded annually to the end of the
				tenth and twentieth policy years.
(2) Divide each accumulation of Step (1)
[subsection (C)(1) of this section]
by an interest factor that
				converts it into one equivalent level annual amount that, if paid at the
				beginning of each year, would accrue to the values in Step (1)
[subsection (C)(1) of this section]
over the respective periods
				stipulated in Step (1)
[subsection (C)(1) of this section]
. If
				the period is ten years, the factor is 13.207 and if the period is twenty
				years, the factor is 34.719.
(3)
				Divide the results of Step (2)
[subsection (C)(2) of this
				section]
by the number of thousands of the Equivalent Level Death
				Benefit to arrive at the Equivalent Level Annual Dividend.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 24 - Life Insurance Solicitation › Section 24-5 - Disclosure requirements

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7
Sec. 5.
Disclosure Requirements.
(A) The insurer shall provide, to all
				prospective purchasers, a Buyer's Guide and a Policy Summary prior to accepting
				the applicant's initial premium or premium deposit, unless the policy for which
				application is made contains an unconditional refund provision of at least ten
				days or unless the Policy Summary contains such an unconditional refund offer,
				in which event the Buyer's Guide and Policy Summary must be delivered with the
				policy or prior to delivery of the policy.
(B) The insurer shall provide a Buyer's Guide
				and a Policy Summary to any prospective purchaser upon request.
(C) In the case of policies whose Equivalent
				Level Death Benefit does not exceed $5,000, the requirement for providing a
				Policy Summary will be satisfied by delivery of a written statement containing
				the information described in Section 4(G), items 2, 3, 4, 5a, 5b, 6, 7, 10, and
				11
[
				760 IAC 1-24-4(G)(2), (G)(3), (G)(4),
				(G)(5)(a), (G)(5)(b), (G)(6), (G)(7), (G)(10), and
				(G)(11) ]
.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 24 - Life Insurance Solicitation › Section 24-6 - File of forms used; presentation to prospective purchaser; annual premium defined

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7
Sec. 6.
General Rules.
(A)
				Each insurer shall maintain at its home office or principal office, a complete
				file containing one copy of each form authorized by the insurer for use
				pursuant to this regulation. Such file shall contain one copy of each
				authorized form for a period of three years following the date of its last
				authorized use.
(B) An agent shall
				inform the prospective purchaser, prior to commencing a life insurance sales
				presentation, that he is acting as a life insurance agent and inform the
				prospective purchaser of the full name of the insurance company whish he is
				representing to the buyer. In sales situations in which an agent is not
				involved, the insurer shall identify its full name.
(C) Terms such as financial planner,
				investment advisor, financial consultant, or financial counseling shall not be
				used in such a way as to imply that the insurance agent is generally engaged in
				an advisory business in which compensation is unrelated to sales unless such is
				actually the case.
(D) Any
				reference to policy dividends must include a statement that dividends are not
				guaranteed.
(E) A system or
				presentation which does not recognize the time value of money through the use
				of appropriate interest adjustments shall not be used for comparing the cost of
				two or more life insurance policies. Such a system may be used for the purpose
				of demonstrating the cash-flow pattern of a policy if such presentation is
				accompanied by a statement disclosing that the presentation does not recognize
				that, because of interest, a dollar in the future has less value than a dollar
				today.
(F) A presentation of
				benefits shall not display guaranteed and non-guaranteed benefits combined in a
				single sum unless the guaranteed portion is shown separately in close proximity
				thereto.
(G) A statement regarding
				the use of the Life Insurance Cost Indexes shall include an explanation to the
				effect that the indexes are useful only for the comparison of the relative
				costs of two or more similar policies.
(H) A Life Insurance Cost Index which
				reflects dividends or an Equivalent Level Annual Dividend shall be accompanied
				by a statement that it is based on the company's current dividend scale and is
				not guaranteed.
(I) For the
				purposes of this regulation
[ 760 IAC 1-24 ]
, the annual
				premium for a basic policy or rider, for which the company reserves the right
				to change the premium, shall be the maximum annual premium.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 24 - Life Insurance Solicitation › Section 24-7 - Failure to deliver buyer's guide or policy summary

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7
Sec. 7.
Failure to Comply. Failure of an insurer to provide or
				  deliver a Buyer's Guide, or a Policy Summary as provided in Section 5
[
				  760 IAC
				  1-24-5 ]
shall constitute an omission which
				  misrepresents the benefits, advantages, conditions or terms of an insurance
				  policy.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 24 - Life Insurance Solicitation › Section 24-8 - Effective date of rule

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7
Sec. 8.
Effective Date. This rule
[ 760 IAC 1-24 ]
shall apply to all solicitations of life insurance which commence on
				  or after promulgation six (6) months subsequent to promulgation of the
				  regulation.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 32 - Blended Mortality Tables › Section 32-1 - Authority to promulgate rule

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7; IC 27-1-12-7; IC 27-1-12-10
Sec. 1.
This rule
[ 760 IAC 1-32 ]
is promulgated by
				  the commissioner of insurance pursuant to IC 27-1-3-7, IC 27-1-12-7(dd)(8F),
				  and IC 27-1-12-10(2)(a)(iii) of the Indiana insurance laws.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 32 - Blended Mortality Tables › Section 32-2 - Purpose of rule

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-12-7
Sec. 2.
The purpose of this rule
[ 760 IAC 1-32 ]
is
				  to permit individual life insurance policies to provide the same cash surrender
				  values and paid-up nonforfeiture benefits to both men and women and, for
				  policies providing the same cash surrender values and paid-up nonforfeiture
				  benefits to both men and women, to permit minimum valuation standards which are
				  the same for both men and women.