reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-35 - Minimum benefit standards for qualifying policies, certificates, and riders

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-10-12; IC
				  12-15-2
Sec. 35.
No long term care insurance policy, certificate, or rider
				  may be advertised, solicited, or issued for delivery in this state as a
				  qualified long term care insurance policy, certificate, or rider that does not
				  meet the minimum benefit standards in this section and that has not been
				  approved by the commissioner of the department of insurance as a qualified long
				  term care insurance policy, certificate, or rider. These minimum standards do
				  not preclude the inclusion of other provisions or benefits which are not
				  inconsistent with these standards. These standards are in addition to all other
				  requirements of this article. In order to qualify for participation in the
				  Indiana long term care program, a long term care insurance policy, certificate,
				  or rider shall meet the following:
(1)
				Provide that maximum benefits be available in dollars and not in days of
				care.
(2) Include a provision of
				inflation protection that satisfies at least one (1) of the following criteria:
(A) The policy or certificate covers at least
				seventy-five percent (75%) of the average daily private pay rate.
(B) The policy or certificate provides for
				automatic increases in the per diem dollar level in accordance with either the
				consumer price index or at five percent (5%) each year over the previous year
				for each year that the contract is in force.
(C) For policyholders or certificate holders
				seventy-five (75) years of age or greater at time of purchase, the policy or
				certificate provides for automatic increases in the per diem dollar level at
				five percent (5%) each year that the contract is in force.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-36 - Required policy, certificate, and rider provisions

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 36.
All qualified policies, certificates, and riders shall meet
				  the following requirements:
(1) Have
				premiums:
(A) based on the issue age of the
				applicant; or
(B) level for the
				life of the policy or certificate.
Nothing in this subdivision shall preclude an issuer from
				  reducing premiums of a policy or certificate or using a policy form or
				  certificate form in which the premiums are no longer required to be paid after
				  a specified period of time.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-36.1 - Minimum benefit standards and required policy and certificate provisions for integrated policies

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 36.1.
No long term care insurance policy or certificate may be
				  advertised, solicited, or issued for delivery in this state as a qualified
				  integrated policy or certificate that does not meet the minimum benefit
				  standards and required policy and certificate provisions in this section and
				  that has not been approved by the commissioner of the department as a qualified
				  long term care insurance policy or certificate. These minimum standards do not
				  preclude the inclusion of other provisions or benefits that are not
				  inconsistent with these standards. These standards are in addition to all other
				  requirements of this article. In order to qualify for participation in the
				  Indiana long term care program, an integrated policy or certificate must meet
				  the following:
(1) Contain a maximum
				benefit amount equivalent to at least three hundred sixty-five (365) times the
				minimum daily nursing facility benefit defined in subdivision (3)(A).
(2) Offer a maximum benefit amount option
				equivalent to three hundred sixty-five (365) times the minimum daily nursing
				facility benefit defined in subdivision (3)(A). Issuers may offer other benefit
				amount options in addition to this minimum benefit amount option.
(3) At a minimum, upon the initial effective
				date, provide the following:
(A) A daily
				nursing facility benefit of at least seventy-five percent (75%) of the average
				daily private pay rate in nursing facilities rounded to the next highest five
				dollar ($5) or ten dollar ($10) increment. No policy or certificate shall pay
				benefits in excess of the actual charges.
(B) A daily home and community based benefit
				of at least fifty percent (50%) of the daily nursing facility benefit contained
				in the policy or certificate. No policy or certificate shall pay benefits in
				excess of the actual charges.
(C)
				The daily home and community based benefit shall not exceed the daily nursing
				facility benefit.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-36.2 - Minimum benefit standards and required policy and certificate provisions for long term care facility policies

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 36.2.
No long term care insurance policy or certificate may be
				  advertised, solicited, or issued for delivery in this state as a qualified long
				  term care facility policy or certificate that does not meet the minimum benefit
				  standards and required policy and certificate provisions in this section, and
				  that has not been approved by the commissioner of the department of insurance
				  as a qualified long term care insurance policy or certificate. These minimum
				  standards do not preclude the inclusion of other provisions or benefits that
				  are not inconsistent with these standards. These standards are in addition to
				  all other requirements of this article. In order to qualify for participation
				  in the Indiana long term care program, a long term care facility policy or
				  certificate must meet the following:
(1) Contain a maximum benefit amount
				equivalent to at least three hundred sixty-five (365) times the minimum daily
				nursing facility benefit defined in subdivision (3).
(2) Offer a maximum benefit amount option
				equivalent to three hundred sixty-five (365) times the minimum daily nursing
				facility benefit defined in subdivision (3). Issuers may offer other benefit
				amount options in addition to this minimum benefit amount option.
(3) At a minimum, upon the initial effective
				date, provide a daily nursing facility benefit of at least seventy-five percent
				(75%) of the average daily private pay rate in nursing facilities rounded to
				the next highest five dollar ($5) or ten dollar ($10) increment. No policy or
				certificate shall pay benefits in excess of the actual charges.
(4) If issued on an expense incurred basis,
				provide daily nursing facility benefits that are equal to at least seventy-five
				percent (75%) of the per diem cost incurred by the insured.
(5) Issuers may include benefits for
				residential care facilities, as defined in section 31.1 of this rule, in a long
				term care facility policy or certificate. Policies and certificates that
				include residential care facility benefits must:
(A) provide a daily residential care facility
				benefit of at least seventy-five percent (75%) and no more than the daily
				nursing facility benefit contained in the policy or certificate;
(B) if issued on an expense incurred basis,
				provide a daily residential care facility benefit that does not exceed
				seventy-five percent (75%) of the per diem cost incurred by the insured;
				and
(C) include a provision that
				policy or certificate benefits can be used to purchase care in a nursing
				facility or a residential care facility.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-36.3 - Minimum benefit standards and required policy and certificate provisions for qualified riders

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 36.3.
(a) No
				long term care insurance rider may be advertised, solicited, or issued for
				delivery in this state as a qualified rider which does not meet the minimum
				benefit standards and required provisions in this section, and which has not
				been approved by the commissioner of the department of insurance as a qualified
				rider.
(b) An issuer may only
				attach a qualified rider to a qualified long term care policy sold by the same
				issuer.
(c) A qualified rider,
				which provides home and community based services, must provide benefits, at a
				minimum, but not be limited to, the following:
(1) Home health nursing.
(2) Home health aide services.
(3) Attendant care.
(4) Respite care.
(5) Adult day care services.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-37.1 - Reporting requirements

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 37.1.
Unless otherwise noted, the following requirements refer to
				  issuer documentation and reporting requirements for qualified policies and
				  certificates:
(1) The reporting
				requirements shall adhere to the specifications put forth in the Partnership
				for Long Term Care Insurance Uniform Data Set (UDS) Manual. A printed copy of
				the Indiana Long Term Care Program reporting requirements and documentation
				shall be provided, upon request, by OMPP. Reports shall adhere to the most
				recent UDS specifications, including, but not limited to:
(A) reporting frequencies;
(B) file structures;
(C) file triggers and formats;
(D) field definitions; and
(E) state specific requirements as noted in
				the Indiana Long Term Care Program section of the state specific appendices of
				the UDS manual.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-37.2 - Reporting of insurance producer data

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 37.2.
Issuers of qualified policies or certificates shall submit
				  insurance producer sales data to OMPP two (2) times per year for purposes of
				  creating and maintaining a directory of insurance producers for consumers. The
				  format, time frame of reporting periods, and due date for data will be
				  specified by OMPP.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-37.3 - Reporting of sales data

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 37.3.
Issuers of qualified policies or certificates shall submit
				  Indiana sales data for qualified and nonqualified long term care insurance
				  policies or certificates annually to OMPP. The format and time frame for
				  reporting this data will be specified by OMPP.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-38.1 - Determining asset protection

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 38.1.
(a) Total
				asset protection for an individually owned qualified policy or certificate is
				earned when:
(1) the policy or certificate
				includes a maximum benefit equal to or greater than the state-set dollar amount
				in force on the original effective date of the policy or certificate;
(2) the policy or certificate includes an
				inflation protection benefit of five percent (5%) compounded
				annually;
(3) the maximum benefit
				was not reduced by the request of the policyholder or certificate holder during
				the term of the policy or certificate; and
(4) all of the qualified policy or
				certificate benefits have been exhausted.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-39 - Reporting on asset protection

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 39.
(a) Each
				issuer shall send an asset protection report at least quarterly, with a copy
				sent to OMPP, to each policyholder or certificateholder who has received any
				benefits since the last asset protection report sent to the policyholder or
				certificateholder. Each asset protection report shall include the following
				information and shall appear in a format prescribed by OMPP:
(1) The amount of asset protection for which
				the policyholder or certificateholder had qualified prior to the quarter
				covered by the report.
(2) The
				total benefits paid by the issuer for services rendered during the
				quarter.
(3) A statement of the
				amount of benefits paid by the issuer for services rendered during the quarter
				which qualify for asset protection.
(4) A summary total of the amount paid to
				date under the policy or certificate that qualifies for asset
				protection.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-40 - Preparing a service summary

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 40.
(a) Each
				issuer shall prepare a service summary at the client's request specifically for
				the policyholder or certificateholder applying for Medicaid. The issuer shall
				also prepare a service summary when the policyholder or certificateholder has
				exhausted his or her benefits under the policy or certificate or when the
				policy or certificate ceases to be in force for a reason other than the death
				of the policyholder or certificateholder, whichever occurs first. The issuer
				shall send the service summary to the policyholder or certificateholder, with a
				copy sent to OMPP, within thirty (30) days of the date of final payment of
				qualifying insurance benefits by the issuer.
(b) The service summary shall include the
				following and shall appear in a format prescribed by OMPP:
(1) The specific qualified policy or
				certificate.
(2) The total benefits
				paid for services rendered to date.
(3) The amount qualifying for asset
				protection.
This service summary is separate and in addition to the
				  information requirement described in section 38 of this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-41 - Plan of action

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 41.
(a) Each
				issuer shall, prior to qualification by the department of insurance, submit to
				OMPP a plan for complying with the information maintenance and documentation
				requirements set forth in sections 37.1 and 38 of this rule. No policy or
				certificate shall be qualified until OMPP has approved the issuer's
				documentation plan for the policy or certificate. The documentation plan will
				include the following:
(1) The location where
				records will be kept. Records required for purposes of the Indiana long term
				care program must be available at no more than three (3) locations, each of
				which shall be easily accessible to OMPP serving as representative of the
				department of insurance.
(2) The
				issuer shall agree to give OMPP access to all information described in section
				38 of this rule on an aggregate basis for all policyholders or
				certificateholders and on an individual basis for all policyholders or
				certificateholders who have ever received any benefits. Access to information
				on persons who have not applied for Medicaid is required in order to determine
				if an issuer's system for documenting asset protection is functioning
				correctly. The OMPP shall have the final decision concerning the frequency of
				access to the data and the size of samples for auditing or other
				purposes.
(3) The name, job title,
				address, and telephone number of the person primarily responsible for the
				maintenance of the information required and for acting as liaison with OMPP and
				the department of insurance concerning the information.
(4) Methods for determining when insurance
				benefits or prepaid benefits qualify for asset protection, including the
				following:
(A) Documentation of the insured
				event.
(B) Description of
				services.
(C) Documentation of
				charges and benefits paid.
(D)
				Documentation of plans of care, when required.
(5) Description of electronic and manual
				systems which will be used in maintaining the required information.
(6) Information that will be retained which
				is needed to comply with this rule.
(7) Copies of forms and descriptions of
				standard procedures for maintaining and reporting the information required,
				including the specific electronic medium that will be used to report required
				information and a description of the relevant files.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-43 - Separability

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 43.
If any provision of this rule or the application thereof to
				  any person or circumstance is for any reason held to be invalid or
				  unenforceable, 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 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 21 - Opt Out of Interstate Insurance Product Regulation Compact › Section 21-1 - Definitions

Current through July 10, 2024
Authority: IC
				  27-8-31-8
Affected: IC
				  27-8-31-3
Sec. 1.
The following definitions apply throughout this rule:
(1) "Commission" means the interstate
				insurance product regulation commission established by IC
				27-8-31-3.
(2) "Commissioner" means the commissioner of
				the department of insurance.
(3)
				"Legislature" means the Indiana general assembly.
(4) "Long-term care uniform standards" means
				a standard adopted by the commission for long-term care insurance products
				under IC 27-8-31-8.
(5) "State" means the state of
				Indiana.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 21 - Opt Out of Interstate Insurance Product Regulation Compact › Section 21-2 - Opt out

Current through July 10, 2024
Authority: IC
				  27-8-31-8
Affected: IC
				  27-8-31-8
Sec. 2.
(a) The
				commissioner has balanced, has considered, and finds that the conditions in the
				state and needs of the citizens of the state outweigh the following factors:
(1) The intent of the legislature to
				participate in, and the benefits of, an interstate agreement to establish
				national uniform consumer protections for long-term care uniform
				standards.
(2) The presumption that
				long-term care uniform standards adopted by the commission provide reasonable
				protections to consumers of the long-term care product.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 1 - General Provisions › Section 1-1 - Applicability and scope

Current through July 10, 2024
Authority: IC 27-8-13-10
Affected: IC 27-8-13-1
Sec. 1.
(a) Except as
				otherwise specifically provided in
				760 IAC
				3-5,
				760 IAC
				3-10,
				760
				IAC 3-11,
				760 IAC
				3-14,
				760 IAC
				3-18, and
				760
				IAC 3-19, this article shall apply to the following:
(1) All Medicare supplement policies
				delivered or issued for delivery in this state on or after the effective date
				of this regulation.
(2) All
				certificates issued under group Medicare supplement policies which certificates
				have been delivered or issued for delivery in this state.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-1 - Applicability

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 1.
The definitions in this rule apply throughout this article.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-1.2 - "1990 Standardized Medicare supplement benefit plan", "1990 Standardized benefit plan", or "1990 plan" defined

Current through July 10, 2024
Authority: IC 27-8-13
Affected: IC
				  27-8-13-1
Sec. 1.2.
"1990 Standardized Medicare supplement benefit plan", "1990
				  Standardized benefit plan", or "1990 plan" means a group or individual policy
				  of Medicare supplement insurance issued on or after January 1, 1992, and with
				  an effective date for coverage prior to June 1, 2010. The term includes
				  Medicare supplement insurance policies renewed on or after that date that are
				  not replaced by the insurer at the request of the insured.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-1.4 - "2010 Standardized Medicare supplement benefit plan", "2010 Standardized benefit plan", or "2010 plan" defined

Current through July 10, 2024
Authority: IC 27-8-13
Affected: IC
				  27-8-13-1
Sec. 1.4.
"2010 Standardized Medicare supplement benefit plan", "2010
				  Standardized benefit plan", or "2010 plan" means a group or individual policy
				  of Medicare supplement insurance issued with an effective date for coverage on
				  or after June 1, 2010.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-2 - "Applicant" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 2.
"Applicant" means:
(1) in the case of an individual Medicare
				supplement policy, the person who seeks to contract for insurance benefits;
				or
(2) in the case of a group
				Medicare supplement policy, the proposed certificate holder.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-2.5 - "Bankruptcy" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 2.5.
As used in this rule, "bankruptcy" means when a Medicare
				  Advantage organization that is not an issuer has:
(1) filed, or has had filed against it, a
				petition for declaration of bankruptcy; and
(2) ceased doing business in
				Indiana.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-3 - "Certificate" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 3.
"Certificate" means any certificate delivered or issued for
				  delivery in this state under a group Medicare supplement policy.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-4 - "Certificate form" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 4.
"Certificate form" means the form on which the certificate
				  is delivered or issued for delivery by the issuer.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-4.5 - "Continuous period of creditable coverage" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 4.5.
As used in this rule, "continuous period of creditable
				  coverage" means the period during which an individual was covered by creditable
				  coverage, if during the period of the coverage the individual had no breaks in
				  coverage greater than sixty-three (63) days.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-4.6 - "Creditable coverage" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC 27-8-13-1
Sec. 4.6.
(a) As used
				in this rule, "creditable coverage" means, with respect to an individual,
				coverage of the individual provided under any of the following:
(1) A group health plan.
(2) Health insurance coverage.
(3) Part A or Part B of Title XVIII of the
				Social Security Act (Medicare).
(4)
				Title XIX of the Social Security Act (Medicaid), other than coverage consisting
				solely of benefits under Section 1928.
(5) Chapter 55 of Title 10, United States
				Code (CHAMPUS).
(6) A medical care
				program of the Indian Health Service or of a tribal organization.
(7) A state health benefits risk
				pool.
(8) A health plan offered
				under Chapter 89 of Title 5, United States Code (Federal Employees Health
				Benefits Program).
(9) A public
				health plan as defined in federal regulation.
(10) A health benefit plan under Section 5(e)
				of the Peace Corps Act (22 United States Code
				2504(e)) .
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-4.7 - "Employee welfare benefit plan" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC 27-8-13-1
Sec. 4.7.
As used in this rule, "employee welfare benefit plan" means
				  a plan, fund, or program of employee benefits as defined in
				  29
				  U.S.C. 1002 (Employee Retirement Income
				  Security Act).
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-4.8 - "Insolvency" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 4.8.
As used in this rule, "insolvency" means when an issuer,
				  licensed to transact the business of insurance in Indiana, has had a final
				  order of liquidation entered against it with a finding of insolvency by a court
				  of competent jurisdiction in the issuer's state of domicile.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-5 - "Issuer" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 5.
"Issuer" means insurance companies, fraternal benefit
				  societies, prepaid health care delivery plans, health care service plans,
				  health maintenance organizations, and any other entity delivering or issuing
				  for delivery in this state Medicare supplement policies or certificates.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-6 - "Medicare" or "Medicare program" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 6.
"Medicare" or "Medicare program" means the "Health Insurance
				  for the Aged Act", Title XVIII of the Social Security Amendments of 1965, as
				  then constituted or later amended.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-6.1 - "Medicare Advantage" defined

Current through July 10, 2024
Authority: IC 27-8-13-9; IC 27-8-13-10; IC
				  27-8-13-10.1
Affected: IC 27-8-13-1
Sec. 6.1.
As used in this rule, "Medicare Advantage" has the meaning
				  set forth in
				  42 U.S.C.
				  1395w-28.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-6.2 - "Medicare Advantage plan" defined

Current through July 10, 2024
Authority: IC 27-8-13-9; IC 27-8-13-10; IC
				  27-8-13-10.1
Affected: IC 27-8-13-1
Sec. 6.2.
As used in this rule, "Medicare Advantage plan" has the
				  meaning set forth in
				  42 U.S.C.
				  1395w-28.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-6.3 - "Medicare Advantage supplemental plan" defined

Current through July 10, 2024
Authority: IC 27-8-13
Affected: IC
				  27-8-13-1
Sec. 6.3.
"Medicare Advantage supplemental plan" means a policy that
				  is advertised, marketed, or designed primarily to cover out-of-pocket costs
				  under a Medicare Advantage plan.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-7 - "Medicare supplement policy" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC 27-8-13-1
Sec. 7.
"Medicare supplement policy" means a group or individual
				  policy of accident and sickness insurance or a subscriber contract of hospital
				  and medical service associations or health maintenance organizations, other
				  than:
(1) a policy issued pursuant to
				a contract under Section 1876 of the Social Security Act (42 U.S.C.
				1395 et seq.); or
(2) an issued policy under a demonstration
				project specified in
				42
				U.S.C. 1395ss(g)(1); that is
				advertised, marketed, or designed primarily as a supplement to reimbursements
				under Medicare for the hospital, medical, or surgical expenses of persons
				eligible for Medicare. The term does not include Medicare Advantage plans
				established under Medicare Part C, Outpatient Prescription Drug plans
				established under Medicare Part D, or any health care prepayment plan that
				provides benefits pursuant to an agreement under Section 1833(a)(1)(A) of the
				Social Security Act.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-8 - "Policy form" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 8.
"Policy form" means the form on which the policy is
				  delivered or issued for delivery by the issuer.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-8.5 - "Pre-Standardized Medicare supplement benefit plan", "Pre-Standardized benefit plan", or "PreStandardized plan" defined

Current through July 10, 2024
Authority: IC 27-8-13
Affected: IC
				  27-8-13-1
Sec. 8.5.
"Pre-Standardized Medicare supplement benefit plan",
				  "Pre-Standardized benefit plan", or "Pre-Standardized plan" means a group or
				  individual policy of Medicare supplement insurance issued prior to January 1,
				  1992.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 2 - Definitions › Section 2-9 - "Secretary" defined

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 9.
As used in this rule, "Secretary" means the Secretary of the
				  United States Department of Health and Human Services.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 3 - Policy Definitions and Terms › Section 3-1 - Policy definitions and terms

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 1.
(a) No policy
				or certificate may be advertised, solicited, or issued for delivery in this
				state as a Medicare supplement policy or certificate unless such policy or
				certificate contains definitions or terms that conform to the requirements of
				this article.
(b) "Accident",
				"accidental injury", or "accidental means" means to employ "result" language
				and shall not include words that establish an accidental means test or use
				words such as "external, violent, visible wounds" or similar words of
				description or characterization and as follows:
(1) The definition shall not be more
				restrictive than the following: "Injury or injuries for which benefits are
				provided means accidental bodily injury sustained by the insured person, which
				is the direct result of an accident, independent of disease or bodily infirmity
				or any other cause, and occurs while insurance coverage is in
				force.".
(2) The definition may
				provide that injuries shall not include injuries for which benefits are
				provided or available under any workers' compensation, employer's liability or
				similar law, or motor vehicle no-fault plan, unless prohibited by
				law.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 4 - Policy Provisions › Section 4-1 - Policy provisions

Current through July 10, 2024
Authority: IC 27-8-13
Affected: IC 27-8-13-1
Sec. 1.
(a) Except
				for permitted preexisting condition clauses as described in
				760
				IAC 3-5-1(b)(1)(A),
				760
				IAC 3-5-1(b)(1)(B), and
				760
				IAC 3-6-1(b), no policy or
				certificate shall be advertised, solicited, or issued for delivery in this
				state as a Medicare supplement policy if the policy or certificate contains
				limitations or exclusions on coverage that are more restrictive than those of
				Medicare.
(b) No Medicare
				supplement policy or certificate may use waivers to exclude, limit, or reduce
				coverage or benefits for specifically named or described preexisting diseases
				or physical conditions.
(c) No
				Medicare supplement policy or certificate in force in the state shall contain
				benefits that duplicate benefits provided by Medicare.
(d) Subject to
				760
				IAC 3-5-1(b)(3)  through
				760
				IAC 3-5-1(b)(7),
				760
				IAC 3-5-1(b)(9),
				760
				IAC 3-6-1(b)(3), and
				760
				IAC 3-6-1(b)(4), a Medicare
				supplement policy with benefits for outpatient prescription drugs in existence
				before January 1, 2006, shall be renewed for current policyholders who do not
				enroll in Part D at the option of the policyholder.
(e) A Medicare supplement policy with
				benefits for outpatient prescription drugs shall not be issued after December
				31, 2005.
(f) After December 31,
				2005, a Medicare supplement policy with benefits for outpatient prescription
				drugs may not be renewed after the policyholder enrolls in Medicare Part D
				unless:
(1) the policy is modified to
				eliminate outpatient prescription coverage for expenses of outpatient
				prescription drugs incurred after the effective date of the individual's
				coverage under a Part D plan; and
(2) premiums are adjusted to reflect the
				elimination of outpatient prescription drug coverage at the time of Medicare
				Part D enrollment, accounting for any claims paid, if applicable.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 6 - Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery after December 31, 1991, and with an Effective Date for Coverage Prior to June 1, 2010 › Section 6-1 - Benefit standards for policies or certificates issued or delivered after December 31, 1991, and with an effective date for coverage prior to June 1, 2010

Current through July 10, 2024
Authority: IC 27-8-13
Affected: IC 27-8-13-1
Sec. 1.
(a) The
				following standards are applicable to all Medicare supplement policies or
				certificates delivered or issued for delivery in this state after December 31,
				1991, and prior to June 1, 2010. No policy or certificate may be:
(1) advertised;
(2) solicited;
(3) delivered; or
(4) issued for delivery; in this state as a
				Medicare supplement policy or certificate unless the policy or certificate
				complies with the benefit standards in this section.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 6.1 - Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or after June 1, 2010 › Section 6.1-1 - Benefit standards for 2010 Standardized Medicare supplement benefit plan policies or certificates issued for delivery with an effective date for coverage on or after June 1, 2010

Current through July 10, 2024
Authority: IC 27-8-13
Affected: IC 27-8-13-1
Sec. 1.
(a) The
				following standards are applicable to all Medicare supplement policies or
				certificates delivered or issued for delivery in this state with an effective
				date of coverage on or after June 1, 2010. No policy or certificate may be:
(1) advertised;
(2) solicited;
(3) delivered; or
(4) issued for delivery; in this state as a
				Medicare supplement policy or certificate unless the policy or certificate
				complies with the benefit standards in this section. Benefit plan standards
				applicable to Medicare supplement policies and certificates with an effective
				date of coverage before June 1, 2010, remain subject to the requirements of
				760
				IAC 3-6-1.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 7 - Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery After December 31, 1991, and Prior to June 1, 2010 › Section 7-1 - Standard Medicare supplement benefit plans for 1990 Standardized Medicare supplement benefit plan policies or certificates issued for delivery after December 31, 1991, and prior to June 1, 2010

Current through July 10, 2024
Authority: IC 27-8-13-9; IC 27-8-13-10; IC
				  27-8-13-10.1
Affected: IC 27-8-13-1
Sec. 1.
(a) An issuer
				shall make available to each prospective policyholder and certificate holder a
				policy form or certificate form containing only the basic core benefits as
				defined in
				760
				IAC 3-6-1(c).
(b) No groups, packages, or combinations of
				Medicare supplement benefits other than those listed in this section shall be
				offered for sale in this state, except as may be permitted in
				760 IAC
				3-8.
(c)
				Benefit plans shall be uniform in structure, language, designation, and format
				to the standard benefit Plans A through J listed in this section and conform to
				the definitions in
				760 IAC 3-2 and
				760 IAC
				3-3. Each benefit shall:
(1) be structured in accordance with the
				format provided in
				760
				IAC 3-6-1(c)  through
				760
				IAC 3-6-1(d); and
(2) list the benefits in the order shown in
				subsection (e).
As used in this section, "structure, language, and format"
				  means style, arrangement, and overall content of a benefit.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 7.1 - Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or after June 1, 2010 › Section 7.1-1 - Standard Medicare supplement benefit plans for 2010 Standardized Medicare supplement benefit plan policies or certificates issued for delivery with an effective date for coverage on or after June 1, 2010

Current through July 10, 2024
Authority: IC 27-8-13
Affected: IC 27-8-13-1
Sec. 1.
(a) An issuer
				shall make available to each prospective policyholder and certificate holder a
				policy form or certificate form containing only the basic core benefits as
				defined in
				760
				IAC 3-6-1(c).
(b) If an issuer makes available any of the
				additional benefits described in
				760
				IAC 3-6.1-1(d)  or offers
				standardized benefit Plans K or L, then the issuer shall make available to each
				prospective policyholder and certificate holder, in addition to a policy form
				or certificate form with only the basic core benefits as described in
				760
				IAC 3-6.1-1(c), a policy form or
				certificate form containing either standardized benefit Plan C or standardized
				benefit Plan F.
(c) No groups,
				packages, or combinations of Medicare supplement benefits other than those
				listed in this section shall be offered for sale in this state, except as may
				be permitted in
				760 IAC
				3-8.
(d)
				Benefit plans shall be uniform in structure, language, designation, and format
				to the standard benefit plans listed in this section and conform to the
				definitions in
				760 IAC 3-2 and
				760 IAC
				3-3. Each benefit shall:
(1) be structured in accordance with the
				format provided in
				760
				IAC 3-6-1(c)  through
				760
				IAC 3-6-1(d); and
(2) list the benefits in the order shown in
				subsection (f).
As used in this section, "structure, language, and format"
				  means style, arrangement, and overall content of a benefit.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 7.2 - Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or after January 1, 2020 › Section 7.2-1 - Standard Medicare supplement benefit plans for 2020 Medicare supplement benefit plan policies or certificates issued for delivery to individuals newly eligible for Medicare on or after January 1, 2020

Current through July 10, 2024
Authority: IC 27-8-13
Affected: IC 27-8-13-1
Sec. 1.
(a) The
				standards and requirements set forth in
				760
				IAC 3-7.1-1 apply to all Medicare supplement policies
				or certificates delivered or issued for delivery to individuals newly eligible
				for Medicare on or after January 1, 2020, with the following exceptions:
(1) Standardized Medicare supplement benefit
				Plan C is redesignated as Plan D and shall provide the benefits contained in
				760
				IAC 3-7.1-1(f)(3), but shall not
				provide coverage for one hundred percent (100%) or any portion of the Medicare
				Part B deductible.
(2) Standardized
				Medicare supplement benefit Plan F is redesignated as Plan G and shall provide
				the benefits contained in
				760
				IAC 3-7.1-1(f)(5), but shall not
				provide coverage for one hundred percent (100%) or any portion of the Medicare
				Part B deductible.
(3) Standardized
				Medicare supplement benefit Plan F with high deductible is redesignated as Plan
				G with high deductible and shall provide the benefits contained in
				760
				IAC 3-7.1-1(f)(6), but shall not
				provide coverage for one hundred percent (100%) or any portion of the Medicare
				Part B deductible. The Medicare Part B deductible paid by the beneficiary shall
				be considered an out-of-pocket expense in meeting the annual high
				deductible.
(4) Standardized
				Medicare supplement benefit Plans C, F, and F with high deductible may not be
				offered to individuals newly eligible for Medicare on or after January 1,
				2020.
(5) Reference to Plans C or F
				contained in
				760
				IAC 3-7.1-1(b)  is deemed a reference
				to Plans D or G for purposes of this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 8 - Medicare Select Policies and Certificates › Section 8-1 - Medicare select policies and certificates

Current through July 10, 2024
Authority: IC
				  27-8-13-9;
				  IC
				  27-8-13-10;
				  IC
				  27-8-13-10.1
Affected: IC
				  27-8-13-1
Sec. 1.
(a) This
				section shall apply to Medicare select policies and certificates as defined in
				this section.
(b) No policy or
				certificate may be advertised as a Medicare select policy or certificate unless
				it meets the requirements of this section.
(c) The following definitions apply
				throughout this section:
(1) "Complaint" means
				any dissatisfaction expressed by an individual concerning a Medicare select
				issuer or its network providers.
(2) "Grievance" means dissatisfaction
				expressed in writing by an individual insured under a Medicare select policy or
				certificate with the:
(A)
				administration;
(B) claims
				practices; or
(C) provision of
				services; concerning a Medicare select issuer or its network providers.
(3) "Medicare select
				issuer" means an issuer offering, or seeking to offer, a Medicare select policy
				or certificate.
(4) "Medicare
				select policy" or "Medicare select certificate" means, respectively, a Medicare
				supplement policy or certificate that contains restricted network
				provisions.
(5) "Network provider"
				means a provider of health care, or a group of providers of health care, that
				has entered into a written agreement with the issuer to provide benefits
				insured under a Medicare select policy.
(6) "Restricted network provision" means any
				provision which conditions the payment of benefits, in whole or in part, on the
				use of network providers.
(7)
				"Service area" means the geographic area approved by the commissioner of the
				department of insurance within which an issuer is authorized to offer a
				Medicare select policy.