reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 53 - Standards for Companies Deemed to be in Hazardous Financial Condition › Section 53-5 - Order of the commissioner

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  4-21.5-4-3;
				  IC
				  4-21.5-4-4; IC
				  27-1-1-1; IC
				  27-9-2-1
Sec. 5.
(a) If the
				commissioner determines that the continued operation of the insurer licensed to
				transact business in this state may be hazardous to the policyholders or the
				general public, then the commissioner may, in addition to any other action the
				commissioner may take under IC
				27-9-2-1(b)
				 or any other statute or rule, issue an order
				requiring the insurer to do the following:
(1) Reduce the total amount of present and
				potential liability for policy benefits by reinsurance.
(2) Reduce, suspend, or limit the volume of
				business being accepted or renewed.
(3) Reduce general insurance and commission
				expenses by specified methods.
(4)
				Increase the insurer's capital and surplus.
(5) Suspend or limit the declaration and
				payment of dividends by an insurer to its stockholders or to its
				policyholders.
(6) File reports in
				a form acceptable to the commissioner concerning the market value of an
				insurer's assets.
(7) Limit or
				withdraw from certain investments or discontinue certain investment practices
				to the extent the commissioner deems necessary.
(8) Document the adequacy of premium rates in
				relation to the risks insured.
(9)
				File, in addition to regular annual statements, interim financial reports on
				the form adopted by the NAIC or in such format as promulgated by the
				commissioner.
(10) Correct
				corporate governance practice deficiencies and adopt and utilize governance
				practices acceptable to the commissioner.
(11) Provide a business plan to the
				commissioner in order to continue to transact business in the state.
(12) Notwithstanding any other provision of
				law limiting the frequency or amount of premium rate adjustments, adjust rates
				for any non-life insurance product written by the insurer that the commissioner
				considers necessary to improve the financial condition of the insurer.
If the insurer is a foreign insurer, the order of the
				  commissioner may be limited to the extent provided by statute.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 53 - Standards for Companies Deemed to be in Hazardous Financial Condition › Section 53-6 - Review of order

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 4-21.5-3; IC
				  27-1-1-1
Sec. 6.
Any order or decision of the commissioner shall be subject to
				  judicial review as permitted by IC 4-21.5-3 at the instance of any party to the
				  proceedings whose interests are substantially affected.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 53 - Standards for Companies Deemed to be in Hazardous Financial Condition › Section 53-7 - Separability

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-1-1-1
Sec. 7.
If any provision of this rule or the application thereof to
				  any person or circumstance is for any reason held to be invalid, the remainder
				  of the rule and the application of such provision to other persons or
				  circumstances shall not be affected thereby.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 55 - Life and Accident and Health Insurers; Reinsurance Agreements › Section 55-1 - Authority

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC
				  27-6-10-15
Affected: IC 27-6-10
Sec. 1.
This rule is adopted and promulgated pursuant to IC
				  27-1-3-7
				  and IC
				  27-6-10-15.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 55 - Life and Accident and Health Insurers; Reinsurance Agreements › Section 55-2 - Preamble

Current through July 10, 2024
Authority: IC 27-1-3-7; IC 27-6-10-15
Affected: IC 27-1-20-21; IC 27-6-10; IC 27-9-2-1
Sec. 2.
(a) The
				department of insurance recognizes that licensed insurers routinely enter into
				reinsurance agreements that yield legitimate relief to the ceding insurer from
				strain to surplus.
(b) However, it
				is improper for a licensed insurer, in the capacity of ceding insurer, to enter
				into reinsurance agreements for the principal purpose of producing significant
				surplus aid for the ceding insurer, typically on a temporary basis, while not
				transferring all of the significant risks inherent in the business being
				reinsured. In substance or effect, the expected potential liability to the
				ceding insurer remains basically unchanged by the reinsurance transaction,
				notwithstanding certain risk elements in the reinsurance agreement, such as
				catastrophic mortality or extraordinary survival. The terms of such agreements
				referred to in this subsection and described in section 4 of this rule violate:
(1) IC 27-1-20-21 relating to financial
				statements which do not properly reflect the financial condition of the ceding
				insurer;
(2)760 IAC 1-56 relating
				to reinsurance reserve credits, thus resulting in a ceding insurer improperly
				reducing liabilities or establishing assets for reinsurance ceded;
				and
(3) IC
				27-9-2-1
				relating to creating a situation that may be hazardous to policyholders and the
				people of this state.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 55 - Life and Accident and Health Insurers; Reinsurance Agreements › Section 55-3 - Scope

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC
				  27-6-10-15
Affected: IC 27-6-10
Sec. 3.
This rule shall apply to all domestic life and accident and
				  health insurers and to all other licensed life and accident and health insurers
				  who are not subject to a substantially similar regulation in their domiciliary
				  state. This rule shall also similarly apply to licensed property and casualty
				  insurers with respect to their accident and health business. This rule shall
				  not apply to assumption reinsurance, yearly renewable term reinsurance, or
				  certain nonproportional reinsurance such as stop loss or catastrophe
				  reinsurance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 55 - Life and Accident and Health Insurers; Reinsurance Agreements › Section 55-5 - Written agreements

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC
				  27-6-10-15
Affected: IC 27-6-10
Sec. 5.
(a) No
				reinsurance agreement or amendment to any agreement may be used to reduce any
				liability or to establish any asset in any financial statement filed with the
				department of insurance unless the agreement, amendment, or a binding letter of
				intent has been duly executed by both parties no later than the "as of date" of
				the financial statement.
(b) In the
				case of a letter of intent, a reinsurance agreement or an amendment to a
				reinsurance agreement must be executed within a reasonable period of time, not
				exceeding ninety (90) days from the execution date of the letter of intent, in
				order for credit to be granted for the reinsurance ceded.
(c) The reinsurance agreement shall contain
				provisions which provide in substance or effect:
(1) that the agreement shall constitute the
				entire agreement between the parties with respect to the business being
				reinsured thereunder and that there are no understandings between the parties
				other than as expressed in the agreement; and
(2) any change or modification to the
				agreement shall be null and void unless made by amendment to the agreement and
				signed by both parties.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 55 - Life and Accident and Health Insurers; Reinsurance Agreements › Section 55-6 - Existing agreements

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC
				  27-6-10-15
Affected: IC 27-6-10
Sec. 6.
Insurers subject to this rule shall reduce to zero (0) by
				  December 31, 1994, any reserve credits or assets established with respect to
				  reinsurance agreements entered into prior to the effective date of this rule
				  which, under the provisions of this rule, would not be entitled to recognition
				  of such reserve credits or assets, provided, however, that such reinsurance
				  agreements shall have been in compliance with laws or rules in existence
				  immediately preceding the effective date of this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-1 - Authority

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC 27-6-10.1-5
Affected: IC
				  27-1-3-7;
				  IC 27-6-10.1-5
Sec. 1.
This rule is promulgated pursuant to the authority granted
				  by IC
				  27-1-3-7
				  and IC 27-6-10.1-5.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-2 - Purpose

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 2.
The purpose of this rule is to set forth rules and
				  procedural requirements which the commissioner of the department of insurance
				  deems necessary to carry out the provisions of IC 27-6-10.1. The actions and
				  information required by this rule are hereby declared to be necessary and
				  appropriate in the public interest and for the protection of the ceding
				  insurers in this state.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-3 - Severability

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC
				  27-6-10-15
Affected: IC 27-6-10
Sec. 3.
If any provision of this rule or its application to any
				  person or circumstance is held invalid, such determination shall not affect
				  other provisions or applications of this rule which can be given effect without
				  the invalid provision or application, and to that end the provisions of this
				  rule are severable.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-4 - Reinsurer licensed in Indiana

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC 27-6-10.1-5
Affected: IC 27-6-10.1-2
Sec. 4.
Under IC 27-6-10.1-2, the commissioner of the department of
				  insurance shall allow credit for reinsurance ceded by a domestic insurer to
				  assuming insurers that were licensed in this state as of the date of the ceding
				  insurer's statutory financial statement in which credit for reinsurance is
				  claimed.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-5 - Accredited reinsurers

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC 27-6-10.1-5
Affected: IC 27-6-10.1-2
Sec. 5.
(a) Under IC
				27-6-10.1-2, the commissioner of the department of insurance shall allow credit
				for reinsurance ceded by a domestic insurer to an assuming insurer that is
				accredited as a reinsurer in this state as of the date of the ceding insurer's
				statutory financial statement in which credit for reinsurance is claimed. An
				accredited reinsurer is one that:
(1) files a
				properly executed Form AR-1, as established in section 15 of this rule, as
				evidence of its submission to this state's jurisdiction and to this state's
				authority to examine its books and records;
(2) files with the commissioner of the
				department of insurance a certified copy of a letter or a certificate of
				authority or of compliance as evidence that it is licensed to transact
				insurance or reinsurance in at least one (1) state or, in the case of a United
				States branch of an alien assuming insurer, is entered through and licensed to
				transact insurance or reinsurance in at least one (1) state;
(3) files annually with the commissioner of
				the department of insurance a copy of its annual statement filed with the
				department of insurance of its state of domicile or, in the case of an alien
				assuming insurer, with the state through which it is entered and in which it is
				licensed to transact insurance or reinsurance, and a copy of its most recent
				audited financial statement; and
(4) maintains a surplus as regards
				policyholders in an amount not less than twenty million dollars ($20,000,000)
				and whose accreditation has not been denied by the commissioner of the
				department of insurance within ninety (90) days of its submission or, in the
				case of companies with a surplus as regards policyholders of less than twenty
				million dollars ($20,000,000), whose accreditation has been approved by the
				commissioner of the department of insurance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-6 - Reinsurer domiciled and licensed in another state

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC 27-6-10.1-5
Affected: IC 27-6-10.1-2
Sec. 6.
(a) Under IC
				27-6-10.1-2, the commissioner of the department of insurance shall allow credit
				for reinsurance ceded by a domestic insurer to an assuming insurer that, as of
				the date of the ceding insurer's statutory financial statement in which credit
				for reinsurance is claimed:
(1) is domiciled
				and licensed in (or, in the case of a United States branch of an alien assuming
				insurer, is entered through and licensed in) a state that employs standards
				regarding credit for reinsurance substantially similar to those applicable
				under this rule;
(2) maintains a
				surplus as regards policyholders in an amount not less than twenty million
				dollars ($20,000,000); and
(3)
				files a properly executed Form AR-1 with the commissioner of the department of
				insurance as evidence of its submission to the state's authority to examine its
				books and records.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-8 - Credit reinsurance required by law

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 8.
Under IC 27-6-10.1-3, the commissioner of the department of
				  insurance shall allow credit for reinsurance ceded by a domestic insurer to an
				  assuming insurer not meeting the requirements of IC 27-6-10.1-2, but only with
				  respect to the insurance of risks located in jurisdictions where such
				  reinsurance is required by the applicable law or regulation of that
				  jurisdiction. As used in this section, "jurisdiction" means any state,
				  district, or territory of the United States and any lawful national
				  government.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-9 - Reduction from liability for reinsurance ceded to an unauthorized assuming insurer

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 9.
(a) Under IC
				27-6-10.1-3, the commissioner of the department of insurance shall allow a
				reduction from liability for reinsurance ceded by a domestic insurer to an
				assuming insurer not meeting the requirements of IC 27-6-10.1-2 in an amount
				not exceeding the liabilities carried by the ceding insurer. Such reduction
				shall be in the amount of funds held by or on behalf of the ceding insurer,
				including funds held in trust for the exclusive benefit of the ceding insurer,
				under a reinsurance contract with such assuming insurer as security for the
				payment of obligations thereunder. Such security must be held in the United
				States subject to withdrawal solely by, and under the exclusive control of, the
				ceding insurer or, in the case of a trust, held in a qualified United States
				financial institution as defined in IC 27-6-10.1-4.
(b) The security required by subsection (a)
				may be in the form of any of the following:
(1) Cash.
(2) Securities listed by the Securities
				Valuation Office of the National Association of Insurance Commissioners,
				including those deemed exempt from filing as defined by the Purposes and
				Procedures Manual of the Securities Valuation Office, and qualifying as
				admitted assets.
(3) Clean,
				irrevocable, unconditional, and evergreen letters of credit issued or confirmed
				by a qualified United States institution, as defined in IC 27-6-10.1-3,
				effective no later than December 31 of the year for which filing is being made,
				and in the possession of the ceding company on or before the filing date of its
				annual statement. Letters of credit meeting applicable standards of issuer
				acceptability as of the dates of their issuance (or confirmation) shall,
				notwithstanding the issuing (or confirming) institutions' subsequent failure to
				meet applicable standards of issuer acceptability, continue to be acceptable as
				security until their expiration, extension, renewal, modification, or
				amendment, whichever first occurs.
(4) Any other form of security acceptable to
				the commissioner of the department of insurance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-10 - Trust agreements qualified under section 9 of this rule

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC 27-6-10.1-5
Affected: IC 27-6-10.1-4
Sec. 10.
(a) The
				following definitions apply throughout this section:
(1) "Beneficiary" means the entity for whose
				sole benefit the trust has been established and any successor of the
				beneficiary by operation of law. If a court of law appoints a successor in
				interest to the named beneficiary, then the named beneficiary includes and is
				limited to the court appointed domiciliary receiver (including conservator,
				rehabilitator, or liquidator).
(2)
				"Grantor" means the entity that has established a trust for the sole benefit of
				the beneficiary. When established in conjunction with a reinsurance agreement,
				the grantor is the unlicensed, unaccredited assuming insurer.
(3) "Obligations", as used in subsection
				(b)(11), means the following:
(A) Reinsured
				losses and allocated loss expenses paid by the ceding insurer, but not
				recovered from the assuming insurer.
(B) Reserves for the following:
(i) Reinsured losses reported and
				outstanding.
(ii) Reinsured losses
				incurred but not reported.
(iii)
				Allocated reinsured loss expenses and unearned premiums.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-11 - Letters of credit qualified under section 9 of this rule

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC 27-6-10.1-5
Affected: IC 27-6-10.1-4
Sec. 11.
(a) The
				letter of credit must be clean, irrevocable, and unconditional and issued or
				confirmed by a qualified United States financial institution as defined in IC
				27-6-10.1-4. The letter of credit shall:
(1)
				contain an issue date and date of expiration;
(2) stipulate that the beneficiary need only
				draw a sight draft under the letter of credit and present it to obtain funds
				and that no other document need be presented; and
(3) indicate that it is not subject to any
				condition or qualifications outside of the letter of credit.
In addition, the letter of credit itself shall not contain
				  reference to any other agreements, documents, or entities, except as provided
				  in subsection (i)(1). As used in this section, "beneficiary" means the domestic
				  insurer for whose benefit the letter of credit has been established and any
				  successor of the beneficiary by operation of law. If a court of law appoints a
				  successor in interest to the named beneficiary, then the named beneficiary
				  includes, and is limited to, the court appointed domiciliary receiver
				  (including conservator, rehabilitator, or liquidator).
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-12 - Other security

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC
				  27-6-10-15
Affected: IC 27-6-10
Sec. 12.
A ceding insurer may take credit for unencumbered funds
				  withheld by the ceding insurer in the United States subject to withdrawal
				  solely by the ceding insurer and under its exclusive control.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-13 - Reinsurance contract

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC 27-6-10.1-5
Affected: IC 27-6-10.1; IC 27-9
Sec. 13.
Credit will not be granted, nor an asset or reduction from
				  liability allowed, to a ceding insurer for reinsurance effected with assuming
				  insurers meeting the requirements of section 4, 5, 6, 7, 7.5, 7.8, or 9 of this
				  rule or otherwise in compliance with IC 27-6-10.1-2 after the adoption of this
				  rule unless the reinsurance agreement includes the following:
(1) A proper insolvency clause, which
				stipulates that reinsurance is payable directly to the liquidator or successor
				without diminution regardless of the status of the ceding company, under IC
				27-9.
(2) A provision under IC
				27-6-10.1-3, whereby the assuming insurer, if an unauthorized assuming insurer
				has:
(A) submitted to the jurisdiction of an
				alternative dispute resolution panel or court of competent jurisdiction within
				the United States;
(B) agreed to
				comply with all requirements necessary to give such court or panel
				jurisdiction;
(C) designated an
				agent upon whom service of process may be effected; and
(D) agreed to abide by the final decision of
				such court or panel.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-14 - Contracts affected

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC
				  27-6-10-15
Affected: IC 27-6-10
Sec. 14.
All new and renewal reinsurance transactions entered into
				  after December 31, 2013, shall conform to the requirements of this rule if
				  credit is to be given to the ceding insurer for such reinsurance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-15 - Certificate of assuming insurer, form AR-1

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC
				  27-6-10-15
Affected: IC 27-6-10
Sec. 15.
Form AR-1, Certificate of Assuming Insurer, shall be as
				  follows:
FORM AR-1
Click
				  here to view Image
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 56 - Credit for Reinsurance › Section 56-16 - Certificate of certified reinsurer, form CR-1

Current through July 10, 2024
Authority: IC
				  27-1-3-7;
				  IC
				  27-6-10-15
Affected: IC 27-6-10
Sec. 16.
Form CR-1, Certificate of Certified Reinsurer, shall be as
				  follows:
FORM CR-1
Click here to view
				  Image
Click here to view
				  Image
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 57 - Actuarial Opinion and Memorandum › Section 57-1 - Authority

Current through July 10, 2024
Authority: IC
				  27-1-12.8-21
Affected: IC
				  27-1-12-10
Sec. 1.
This rule is promulgated pursuant to the authority granted
				  by IC
				  27-1-12-10.1
[IC
				  27-1-12-10.1 was
				  repealed by
				  P.L.
				  276-2013,
				  SECTION
				  6, effective July 1, 2013.]
.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 57 - Actuarial Opinion and Memorandum › Section 57-2 - Purpose

Current through July 10, 2024
Authority: IC
				  27-1-12.8-21
Affected: IC
				  27-1-12.8-21
Sec. 2.
The purpose of this rule is to prescribe the
				  following:
(1) Guidelines and
				standards for statements of actuarial opinion that are to be submitted in
				accordance with IC
				27-1-12-10.1
[IC
				27-1-12-10.1 was
				repealed by
				P.L.
				276-2013,
				SECTION
				6, effective July 1, 2013.]
and for
				memoranda in support thereof.
(2)
				Rules applicable to the appointment of an appointed
				actuary.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 57 - Actuarial Opinion and Memorandum › Section 57-3 - Scope

Current through July 10, 2024
Authority: IC
				  27-1-12.8-21
Affected: IC
				  27-11-8-2
Sec. 3.
(a) This rule
				shall apply to:
(1) all life insurance
				companies and fraternal benefit societies doing business in this
				state;
(2) all life insurance
				companies and fraternal benefit societies that are authorized to reinsure life
				insurance, annuities, or accident and health insurance business in this state;
				and
(3) any annual statement filed
				with the commissioner after the effective date of this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 57 - Actuarial Opinion and Memorandum › Section 57-4 - Definitions

Current through July 10, 2024
Authority: IC
				  27-1-12.8-21
Affected: IC
				  27-1-20-21
Sec. 4.
The following definitions apply throughout this rule, IC
				  27-1-12-10
[IC
				  27-1-12-10
				  was repealed by
				  P.L.
				  276-2013,
				  SECTION
				  5, effective July 1, 2013.]
, and IC
				  27-1-12-10.1
[IC
				  27-1-12-10.1 was
				  repealed by
				  P.L.
				  276-2013,
				  SECTION
				  6, effective July 1, 2013.]
:
(1) "Actuarial opinion" means the opinion of
				an appointed actuary regarding the adequacy of the reserves and related
				actuarial items based on an asset adequacy test in accordance with section 8 of
				this rule and with presently accepted actuarial standards.
(2) "Actuarial Standards Board" means the
				board established by the American Academy of Actuaries to develop and
				promulgate standards of actuarial practice.
(3) "Annual statement" means the statement
				required by IC
				27-1-20-21
				to be filed by the company with the department annually.
(4) "Appointed actuary" means any individual
				who meets the requirements of section 5(c) of this rule.
(5) "Asset adequacy analysis" means an
				analysis that meets the requirements of section 5(d) of this rule. The term
				includes cash flow testing, sensitivity testing, or applications of risk
				theory.
(6) "Commissioner" means
				the commissioner of the department of insurance.
(7) "Company" means a life insurance company,
				fraternal benefit society, or reinsurer subject to this rule.
(8) "Department" means the department of
				insurance.
(9) "NAIC" means the
				National Association of Insurance Commissioners.
(10) "Noninvestment grade bonds" means bonds
				designated as Class 3, 4, 5, or 6 by the NAIC securities valuation
				office.
(11) "Qualified actuary"
				means any individual who meets the requirements of section 5(b) of this
				rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 57 - Actuarial Opinion and Memorandum › Section 57-5 - General requirements

Current through July 10, 2024
Authority: IC
				  27-1-12.8-21
Affected: IC
				  27-1-12-10
Sec. 5.
(a)
				Requirements for the submission of statement of actuarial opinion shall be as
				follows:
(1) A statement entitled "Statement
				of Actuarial Opinion" that meets the requirements of section 8 of this rule and
				is rendered by an appointed actuary shall be included on or attached to page 1
				of the annual statement of any company.
(2) The commissioner may grant an extension
				of the date for submission of the statement of actuarial opinion upon written
				request by a company.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 57 - Actuarial Opinion and Memorandum › Section 57-6 - Required opinions

Current through July 10, 2024
Authority: IC
				  27-1-12.8-21
Affected: IC
				  27-1-12.8-21
Sec. 6.
In accordance with IC
				  27-1-12-10.1
[IC
				  27-1-12-10.1 was
				  repealed by
				  P.L.
				  276-2013,
				  SECTION
				  6, effective July 1, 2013.]
, every
				  company doing business in this state shall annually submit a statement of
				  actuarial opinion in accordance with section 8 of this rule for each year
				  beginning with the year in which this rule becomes effective.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 57 - Actuarial Opinion and Memorandum › Section 57-8 - Statement of actuarial opinion based on an asset adequacy analysis

Current through July 10, 2024
Authority: IC
				  27-1-12.8-21
Affected: IC
				  27-1-12.8-21
Sec. 8.
(a) The
				statement of actuarial opinion based on an asset adequacy analysis required by
				IC
				27-1-12-10.1
[IC 27-1-1210.1 was repealed by
				P.L.
				276-2013,
				SECTION
				6, effective July 1, 2013.]
shall
				consist of the following:
(1) An opening
				paragraph.
(2) A scope
				paragraph.
(3) A reliance
				paragraph.
(4) An opinion
				paragraph.
(5) One (1) or more
				additional paragraphs will be needed in individual company cases as follows:
(A) If the appointed actuary considers it
				necessary to state a qualification of his or her opinion.
(B) If the appointed actuary must disclose
				the method or aggregation for reserves of different products or lines of
				business for asset adequacy analysis.
(C) If the appointed actuary must disclose
				reliance upon any portion of the assets supporting the Asset Valuation Reserve
				(AVR), Interest Maintenance Reserve (IMR), or other mandatory or voluntary
				statement of reserves for asset adequacy analysis.
(D) If the appointed actuary must disclose an
				inconsistency in the method of analysis or basis of asset allocation used at
				the prior opinion date with that used for this opinion.
(E) If the appointed actuary must disclose
				whether additional reserves of the prior opinion date are released as of this
				opinion date, and the extent of the release.
(F) If the appointed actuary chooses to add a
				paragraph briefly describing the assumptions that form the basis for the
				actuarial opinion.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-1 - Authority

Current through July 10, 2024
Authority: IC
				  27-8-28-20; IC
				  27-13-10-13; IC
				  27-13-35-1
Affected: IC 27-8-28; IC 27-13-10
Sec. 1.
This rule is adopted and promulgated pursuant to the
				  authority granted by IC
				  27-8-28-20, IC
				  27-13-10-13,
				  and IC 2713-35-1.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-2 - Purpose

Current through July 10, 2024
Authority: IC
				  27-8-28-20; IC
				  27-13-10-13
Affected: IC
				  27-8-28-19;
				  IC
				  27-13-8-2;
				  IC 27-13-10
Sec. 2.
The purpose of this rule is to prescribe the following for
				  insurers and health maintenance organizations:
(1) The form for filing information with the
				commissioner, as required by IC
				27-8-28-19
				and IC
				27-13-8-2(a).
(2) Requirements for notifying enrollees of
				grievance procedures.
(3)
				Requirements for filing, investigating, and resolving grievances and
				appeals.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-3 - Definitions

Current through July 10, 2024
Authority: IC
				  27-8-28-20; IC
				  27-13-10-13; IC
				  27-13-35-1
Affected: IC
				  27-8-28-3;
				  IC
				  27-13-1-12;
				  IC
				  27-13-1-32;
				  IC
				  27-13-10-7
Sec. 3.
The definitions in IC 27-8-28 and IC 27-13 shall apply for
				  purposes of this rule, in addition to the following:
(1) "Enrollee", as defined in IC
				27-13-1-12,
				includes "subscriber" as defined in IC
				27-13-1-32
				and "covered individual" as defined in IC
				27-8-28-3.
(2) "Grievance" means the following:
(A) For a health maintenance organization and
				a limited service health maintenance organization, any dissatisfaction
				expressed by or on behalf of an enrollee of a health maintenance organization
				or a limited service health maintenance organization regarding the:
(i) availability, delivery, appropriateness,
				or quality of health care services;
(ii) handling or payment of claims for health
				care services; or
(iii) matters
				pertaining to the contractual relationship between:
(AA) an enrollee and a health maintenance
				organization or a limited service health maintenance organization; or
(BB) a group or individual contract holder
				and a health maintenance organization or a limited service health maintenance
				organization; and for which the enrollee has a reasonable expectation that
				action will be taken to resolve or reconsider the matter that is the subject of
				dissatisfaction.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-4 - Reports

Current through July 10, 2024
Authority: IC
				  27-8-28-20; IC
				  27-13-10-13; IC
				  27-13-35-1
Affected: IC
				  27-8-28-19;
				  IC
				  27-13-8-2
Sec. 4.
On or before March 1 of each year, an insurer, a health
				  maintenance organization, and a limited service health maintenance organization
				  must submit electronically to the department a grievance procedure report for
				  the preceding calendar year on the form set forth in section 14 of this rule. A
				  health maintenance organization and a limited service health maintenance
				  organization may submit the information required by IC
				  27-13-8-2(a)(2)
				   and IC
				  27-13-8-2(a)(3)
				   concurrent with this filing.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-5 - Grievance register

Current through July 10, 2024
Authority: IC
				  27-8-28-20; IC
				  27-13-10-13; IC
				  27-13-35-1
Affected: IC 27-8-28; IC
				  27-13-10-3
Sec. 5.
(a) An
				insurer, a health maintenance organization, and a limited service health
				maintenance organization shall maintain written records that document certain
				information about all grievances received during a calendar year (the grievance
				register).
(b) The grievance
				register shall contain, at a minimum, the following information for each
				grievance:
(1) A general description of the
				basis for the grievance using the categories in block 3 of the grievance
				procedures report set forth in section 14 of this rule.
(2) Date received.
(3) Date investigated or reviewed.
(4) Date resolved.
(5) Description of resolution.
(6) Date appeal, if any, was
				received.
(7) Date of appeals
				hearing or review.
(8) Date appeal
				was resolved.
(9) Description of
				resolution of the appeal.
(10) Name
				of enrollee and enrollee's representative, if any, who filed, or upon whose
				behalf was filed, the grievance.
(11) Names and titles of all persons who
				investigated, reviewed, and resolved the grievance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-6 - Establishment of grievance procedures; filing with and review by commissioner

Current through July 10, 2024
Authority: IC
				  27-8-28-20; IC
				  27-13-10-13; IC
				  27-13-35-1
Affected: IC
				  27-8-28-17;
				  IC 27-13-2; IC 27-13-10; IC
				  27-13-34-8;
				  IC
				  27-13-39-3
Sec. 6.
(a) An
				insurer, a health maintenance organization, and a limited service health
				maintenance organization shall establish and maintain grievance
				procedures.
(b) A copy of the
				grievance procedures, including all forms used in filing and reviewing
				grievances, shall be included with any application for a certificate of
				authority submitted to the department.
(c) Any material modifications to the
				grievance procedures subsequent to the submission of the application shall be
				filed with the commissioner not more than fifteen (15) days after the adoption
				of the modification.
(d) The
				grievance procedures shall require the following:
(1) A health maintenance organization must
				provide written or oral acknowledgment of a grievance or appeal no more than
				three (3) business days after receipt. Insurers must provide written or oral
				acknowledgment of a grievance or appeal no more than five (5) business days
				after receipt. The acknowledgment must include the name, address, and telephone
				number of an individual to contact regarding the grievance and the date the
				grievance was filed.
(2)
				Investigation of any grievance or appeal in accordance with written procedures
				and the requirements of section 10 of this rule.
(3) Documentation of the substance of the
				grievance and all actions taken by the insurer or health maintenance
				organization regarding the grievance or appeal, including notification,
				acknowledgment, investigation, and resolution.
(4) Written notification to the enrollee of:
(A) resolution of the grievance or
				appeal;
(B) the right to appeal the
				resolution;
(C) information about
				how, when, and where to appeal the resolution; and
(D) the right to further remedies allowed by
				law, in the case of an appeal of a grievance resolution.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-7 - Notice to enrollees

Current through July 10, 2024
Authority: IC
				  27-8-28-20; IC
				  27-13-10-13; IC
				  27-13-35-1
Affected: IC 27-8-28; IC
				  27-13-7-5;
				  IC
				  27-13-9-4;
				  IC 27-13-10; IC 27-13-39
Sec. 7.
(a) An
				insurer and a health maintenance organization shall provide the following to
				each enrollee:
(1) Information about health
				care services covered by the insurer or health maintenance organization,
				including the following:
(A) A description of
				covered services, including any services subject to a network
				restriction.
(B) A description of
				any limitations on payment for or coverage of health care services, including
				definitions of commonly used terms.
(C) Criteria used to determine whether to
				deny coverage.
(D) A description of
				exclusions from coverage.
(E) An
				explanation of any limitation on coverage for experimental treatments,
				procedures, drugs, or devices, including the following:
(i) A description of the process used to
				determine any limitation.
(ii) A
				description of the criteria the insurer or the health maintenance organization
				uses to determine whether a treatment, procedure, drug, or device is
				experimental.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-8 - Toll free telephone number

Current through July 10, 2024
Authority: IC
				  27-13-10-13; IC
				  27-13-35-1
Affected: IC
				  27-13-9-4;
				  IC
				  27-13-10-5
Sec. 8.
(a) An
				insurer and a health maintenance organization shall establish a toll free
				telephone number through which grievances and appeals may be filed and
				information about grievance procedures obtained.
(b) An individual who is knowledgeable about
				the insurer's or the health maintenance organization's grievance procedures and
				any applicable state laws and regulations must be available to respond to calls
				received at the toll free telephone number at least forty (40) normal business
				hours per week. The toll free telephone number must be answered by an answering
				machine or similar device at all other times.
(c) Any messages left through the toll free
				telephone number must be returned on the following business day by a qualified
				individual.
(d) The toll free
				telephone number must accept grievances in English and the languages of the
				major population groups served by the health maintenance organization.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-9 - Filing grievances

Current through July 10, 2024
Authority: IC
				  27-8-28-20; IC
				  27-13-10-13; IC
				  27-13-35-1
Affected: IC 27-8-28; IC 27-13-10
Sec. 9.
(a) A
				grievance may be filed with an insurer or a health maintenance organization
				orally, including by telephone, or in writing, including by facsimile or
				electronic means of communication.
(b) A grievance may be filed with a limited
				service health maintenance organization, in writing, including by facsimile or
				electronic means of communication.
(c) A grievance is considered to be filed on
				the day and time it is first received orally or in writing by the insurer,
				health maintenance organization, or limited service health maintenance
				organization.
(d) A grievance may
				be filed by an enrollee, or a representative of an enrollee, including a health
				care provider acting on behalf of an enrollee.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-10 - Standards for timely review and resolution of grievances

Current through July 10, 2024
Authority: IC
				  27-8-28-20; IC
				  27-13-10-13; IC
				  27-13-35-1
Affected: IC 27-8-28; IC
				  27-13-10-7;
				  IC
				  27-13-10-8
Sec. 10.
(a) Minimum
				standards for timely review and resolution of grievances filed with an insurer
				or a health maintenance organization are as follows:
(1) A health maintenance organization shall
				provide oral or written acknowledgment of a filed grievance to an enrollee not
				more than three (3) business days after the grievance is filed. An insurer
				shall provide oral or written acknowledgment of a filed grievance to an
				enrollee or an enrollee's representative not more than five (5) business days
				after the grievance is filed.
(2) A
				health maintenance organization shall resolve a grievance not more than twenty
				(20) business days after the grievance is filed. An insurer shall resolve a
				grievance not more than twenty (20) business days after the insurer receives
				all information reasonably necessary to complete the review.
(3) Written notification to an enrollee of
				the resolution of a grievance not more than five (5) business days after the
				resolution.
(4) The time period
				set forth in subdivision (2) may be extended if an insurer or a health
				maintenance organization is unable to resolve a grievance within the specified
				time period due to circumstances beyond the insurer's or the health maintenance
				organization's control. An enrollee must be notified in writing of the reason
				for the delay not more than nineteen (19) business days after the grievance is
				filed. The insurer or the health maintenance organization shall issue a written
				notification of the resolution of the grievance not more than ten (10) business
				days after the notification to the enrollee of the delay.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-11 - Grievance resolution notice

Current through July 10, 2024
Authority: IC
				  27-13-10-13; IC
				  27-13-35-1
Affected: IC
				  27-13-10-7
Sec. 11.
The written notification of resolution required by section
				  10(a) and 10(c) of this rule shall contain the following:
(1) A statement of the insurer's or the
				health maintenance organization's understanding of the enrollee's
				grievance.
(2) A description of the
				resolution reached by the insurer or the health maintenance organization stated
				in clear terms and the contract basis or medical rationale for the resolution
				stated in sufficient detail for the enrollee to respond further to the
				insurer's or the health maintenance organization's position.
(3) A reference to the evidence or
				documentation used as the basis for the resolution.
(4) A statement of the procedures governing
				an appeal, including how to file an appeal.
(5) In the case of a resolution of an appeal
				of a grievance resolution, a notice of the enrollee's right to further remedies
				allowed by law.
(6) The department,
				address, and telephone number through which an enrollee may contact a qualified
				representative to obtain more information about the resolution of the grievance
				or the right to and procedures governing an appeal or further remedies allowed
				by law.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 59 - HMO Grievance Procedures › Section 59-12 - Appeal of a grievance resolution

Current through July 10, 2024
Authority: IC 27-8-28; IC
				  27-13-10-13; IC
				  27-13-35-1
Affected: IC 27-8-28; IC 27-8-17; IC
				  27-13-10-8
Sec. 12.
(a) The
				health maintenance organization shall appoint a panel of individuals who have
				sufficient experience, knowledge, and training to appropriately resolve an
				appeal. If the grievance involves the proposal, refusal, or delivery of a
				health care procedure, treatment, or service, the panel must include at least
				one (1) individual who:
(1) has knowledge in
				the medical condition, procedure, or treatment at issue;
(2) is in the same licensed profession as the
				health care provider who proposed, refused, or delivered the health care
				procedure, treatment, or service that is the basis of the underlying grievance;
				and
(3) is not involved, in any
				manner, in the matter that is the basis of the underlying grievance or have a
				direct business relationship with the enrollee or the health care provider who
				proposed, refused, or delivered the health care procedure, treatment, or
				service that is the basis of the underlying grievance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 60 - Physician Specialty Classes › Section 60-1 - Authority

Current through July 10, 2024
Authority: IC
				  34-18-5-2
Affected: IC
				  34-18-5-2
Sec. 1.
This rule is adopted and promulgated pursuant to the
				  authority granted by IC
				  34-18-5-2.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 60 - Physician Specialty Classes › Section 60-1.1 - Definitions

Current through July 10, 2024
Authority: IC 34-18-5-2
Affected: IC 34-18-5-2
Sec. 1.1.
(a) The
				following definitions apply throughout this rule:
(1) "Advanced trauma procedures" include the
				following:
(A) Tracheostomy.
(B) Cranial burr holes.
(C) Resuscitative thoracotomy.
(D) Resuscitative endovascular balloon
				occlusion of the aorta.
(E)
				Extracorporeal membrane oxygenation.
(F) Lateral canthotomy.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 60 - Physician Specialty Classes › Section 60-4 - Doctors of osteopathy

Current through July 10, 2024
Authority: IC
				  34-18-5-2
Affected: IC
				  34-18-5-2
Sec. 4.
Doctors of osteopathy classified by ISO Codes 84*** shall be
				  included in the same rating class as the corresponding doctor of medicine
				  specialty identified by ISO Codes 80***.