reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 9 - Open Enrollment › Section 9-1 - Open enrollment

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 issuer
				shall:
(1) deny or condition the issuance or
				effectiveness of any Medicare supplement policy or certificate available for
				sale in this state; or
(2)
				discriminate in the pricing of the policy or certificate; because of the health
				status, claims experience, receipt of health care, or medical condition of an
				applicant in the case of an application for a policy or certificate that is
				submitted before or during the six (6) month period beginning with the first
				day of the first month in which an individual is both at least sixty-five (65)
				years of age and enrolled for benefits under Medicare Part B. Each Medicare
				supplement policy and certificate currently available from an insurer shall be
				made available to all applicants who qualify under this subsection without
				regard to age.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 9 - Open Enrollment › Section 9-2 - Guaranteed issue for eligible persons

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.
(a) As used
				in this section, "eligible person" means an individual described in any of the
				following:
(1) An individual enrolled under an
				employee welfare benefit plan that:
(A)
				provides health benefits that supplement the benefits under Medicare and the
				plan:
(i) terminates; or
(ii) implements a material reduction of
				supplemental health benefits to the individual; or
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 10 - Standards for Claims Payment › Section 10-1 - Claims payment

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 comply with Section 1882(c)(3) of the Social Security Act (as enacted by
				Section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA)
				1987, Pub. L. No. 100-203 ) by doing the following:
(1) Accepting a notice from a Medicare
				carrier on dually assigned claims submitted by participating physicians and
				suppliers as a claim for benefits in place of any other claim form otherwise
				required and making a payment determination on the basis of the information
				contained in that notice.
(2)
				Notifying the participating physician or supplier and the beneficiary of the
				payment determination.
(3) Paying
				the participating physician or supplier directly.
(4) Furnishing, at the time of enrollment,
				each enrollee with a card listing the policy name, number, and a central
				mailing address to which notices from a Medicare carrier may be sent.
(5) Paying user fees for claim notices that
				are transmitted electronically or otherwise.
(6) Providing to the Secretary of Health and
				Human Services, at least annually, a central mailing address to which all
				claims may be sent by Medicare carriers.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 11 - Loss Ratio Standards and Refund or Credit of Premium › Section 11-1 - Loss ratio standards and refund or credit of premium

Current through July 10, 2024
Authority: IC
				  27-8-13-10;
				  IC
				  27-8-13-12
Affected: IC
				  27-8-13-1
Sec. 1.
(a) Loss
				ratio standards are as follows:
(1) A Medicare
				supplement policy form or certificate form shall not be delivered or issued for
				delivery unless the policy form or certificate form can be expected, as
				estimated for the entire period for which rates are computed to provide
				coverage, to return to policyholders and certificate holders in the form of
				aggregate benefits (not including anticipated refunds or credits) provided
				under the policy form or certificate form at least either of the following:
(A) Seventy-five percent (75%) of the
				aggregate amount of premiums earned in the case of group policies.
(B) Sixty-five percent (65%) of the aggregate
				amount of premiums earned in the case of individual policies, calculated on the
				basis of incurred claims experience or incurred health care expenses where
				coverage is provided by a health maintenance organization on a service rather
				than reimbursement basis and earned premiums for the period and in accordance
				with accepted actuarial principles and practices. Incurred health care expenses
				where coverage is provided by a health maintenance organization shall not
				include the following:
(i) Home office and
				overhead costs.
(ii) Advertising
				costs.
(iii) Commissions and other
				acquisition costs.
(iv)
				Taxes.
(v) Capital costs.
(vi) Administrative costs.
(vii) Claims processing costs.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 12 - Filing and Approval of Policies and Certificates and Premium Rates › Section 12-1 - Filing and approval of policies and certificates and premium rates

Current through July 10, 2024
Authority: IC 27-8-13-9; IC 27-8-13-10; IC 27-8-13-10.1; IC
				  27-8-13-12
Affected: IC 27-8-13-1
Sec. 1.
(a) An issuer
				shall not deliver or issue for delivery a policy or certificate to a resident
				of this state unless the policy form or certificate form has been filed with
				and approved by the commissioner of the department of insurance in accordance
				with filing requirements and procedures prescribed by the commissioner of the
				department of insurance.
(b) An
				issuer shall file any riders or amendments to policy or certificate forms to
				delete outpatient prescription drug benefits as required by the Medicare
				Prescription Drug, Improvement, and Modernization Act of 2003 only with the
				commissioner in the state in which the policy or certificate was
				issued.
(c) An issuer shall not use
				or change premium rates for a Medicare supplement policy or certificate unless
				the rates, rating schedule, and supporting documentation have been filed with
				and approved by the commissioner of the department of insurance in accordance
				with the filing requirements and procedures prescribed by the commissioner of
				the department of insurance.
(d)
				Except as provided in subsection (e), an issuer shall not file for approval
				more than one (1) form of a policy or certificate of each type for each
				standard Medicare supplement benefit plan.
(e) An issuer may offer, with the approval of
				the commissioner of the department of insurance, up to four (4) additional
				policy forms or certificate forms of the same type for the same standard
				Medicare supplement benefit plan, one (1) for each of the following cases:
(1) The inclusion of new or innovative
				benefits.
(2) The addition of
				either:
(A) direct response or agent marketing
				methods; or
(B) guaranteed issue or
				underwritten coverage.
(3) The offering of coverage to individuals
				eligible for Medicare by reason of disability.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 13 - Permitted Compensation Arrangements › Section 13-1 - Permitted compensation arrangements

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
				or other entity may provide commission or other compensation to an agent or
				other representative for the sale of a Medicare supplement policy or
				certificate only if the first year commission or other first year compensation
				is no more than two hundred percent (200%) of the commission or other
				compensation paid for selling or servicing the policy or certificate in the
				second year or period.
(b) The
				commission or other compensation provided in subsequent (renewal) years must be
				the same as that provided in the second year or period and must be provided for
				no fewer than five (5) renewal years.
(c) No issuer or other entity shall provide
				compensation to its agents or other producers, and no agent or producer shall
				receive compensation greater than the renewal compensation payable by the
				replacing issuer on renewal policies or certificates if an existing policy or
				certificate is replaced.
(d) No
				issuer or other entity shall provide to its agents or other producers, and no
				agent or producer shall receive:
(1)
				compensation for the sale of a Medicare supplement policy or certificate that
				differs from the compensation for the sale of any other Medicare supplement
				policy or certificate because of the level, type, or nature of benefits;
				or
(2) compensation for the sale of
				any Medicare supplement policy or certificate to a person that differs from the
				compensation that applies to the sale of any Medicare supplement policy or
				certificate to any other person because of the age, health status, claims
				experience, receipt of health care, or medical condition of that
				person.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 14 - Required Disclosure Provisions › Section 14-1 - Required disclosure provisions

Current through July 10, 2024
Authority: IC 27-8-13
Affected: IC 27-8-13-1
Sec. 1.
(a) General
				provisions are as follows:
(1) Medicare
				supplement policies and certificates shall include a renewal or continuation
				provision. The language or specifications of the provision shall be consistent
				with the type of contract issued. The provision shall:
(A) be appropriately captioned;
(B) appear on the first page of the policy;
				and
(C) include any:
(i) reservation by the issuer of the right to
				change premiums; and
(ii) automatic
				renewal premium increases based on the policyholder's age.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 16 - Filing Requirements for Advertising › Section 16-1 - Filing requirements for advertising

Current through July 10, 2024
Authority: IC
				  27-8-13-10
Affected: IC
				  27-8-13-18
Sec. 1.
An issuer shall file a copy of any Medicare supplement
				  advertisement intended for use in this state whether through written, radio, or
				  television media to the commissioner of the department of insurance of this
				  state.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 17 - Standards for Marketing › Section 17-1 - Marketing

Current through July 10, 2024
Authority: IC
				  27-8-13-10;
				  IC
				  27-8-13-16
Affected: IC
				  27-4-1-4;
				  IC
				  27-8-13-1
Sec. 1.
(a) An
				issuer, directly or through its producers, shall do the following:
(1) Establish marketing procedures to assure
				that any comparison of policies by its agents or other producers will be fair
				and accurate.
(2) Establish
				marketing procedures to assure excessive insurance is not sold or
				issued.
(3) Establish marketing
				procedures which set forth a mechanism or formula for determining whether a
				replacement policy or certificate is truly in the best interest of the
				applicant.
(4) Display prominently
				by type, stamp, or other appropriate means, on the first page of the policy,
				the following:
"Notice to buyer: This policy may not cover all of your
				  medical expenses.".
(5)
				Inquire and otherwise make every reasonable effort to identify whether a
				prospective applicant or enrollee for Medicare supplement insurance already has
				accident and sickness insurance and the types and amounts of any such
				insurance.
(6) Establish auditable
				procedures for verifying compliance with this subsection.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 18 - Recommended Purchase and Excessive Insurance › Section 18-1 - Appropriateness of recommended purchase and excessive insurance; reporting of multiple policies

Current through July 10, 2024
Authority: IC 27-8-13-9; IC 27-8-13-10; IC 27-8-13-10.1; IC
				  27-8-13-12
Affected: IC 27-8-13
Sec. 1.
(a) In
				recommending the purchase or replacement of any Medicare supplement policy or
				certificate, an agent shall make reasonable efforts to determine the
				appropriateness of a recommended purchase or replacement.
(b) Any sale of a Medicare supplement policy
				or certificate that will provide an individual more than one (1) Medicare
				supplement policy or certificate is prohibited, except that an agent may sell a
				replacement policy or certificate in accordance with
				760 IAC
				3-15-1 provided that the replacement policy or
				certificate is not made effective any sooner than is necessary to provide
				continuous benefits for preexisting conditions.
(c) An issuer shall not issue a Medicare
				supplement policy or certificate to an individual enrolled in Medicare Part C
				unless the effective date of the coverage is after the termination date of the
				individual's Part C coverage.
(d)
				An insurer that issues a Medicare supplement policy or certificate to any
				individual who has one (1) policy or certificate then in effect, except as
				permitted by subsection (b), shall, at the request of the insured, either:
(1) refund the premiums; or
(2) pay any claims on the policy or
				certificate; whichever is greater.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 19 - Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods, and Probation Periods › Section 19-1 - Prohibition against preexisting conditions, waiting periods, elimination periods, and probationary periods in replacement policies or 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) If a
				Medicare supplement policy or certificate replaces another Medicare supplement
				policy or certificate, the replacing issuer shall waive any time periods
				applicable to preexisting conditions, waiting periods, elimination periods, and
				probationary periods in the new Medicare supplement policy or certificate to
				the extent such time was spent under the original policy.
(b) If a Medicare supplement policy or
				certificate replaces another Medicare supplement policy or certificate which
				has been in effect for at least six (6) months, the replacing policy shall not
				provide any time period applicable to preexisting conditions, waiting periods,
				elimination periods, and probationary periods.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 19.1 - Prohibition Against Use of Genetic Information and Requests for Genetic Testing › Section 19.1-1 - Prohibition against discrimination, use of genetic information, and requests for genetic testing

Current through July 10, 2024
Authority: IC 27-8-13
Affected: IC
				  27-8-13-1
Sec. 1.
(a) This
				section applies to all policies with policy years beginning on or after May 21,
				2009.
(b) The following definitions
				apply for purposes of this section only:
(1)
				"Family member" means, with respect to an individual, any other individual who
				is a first-degree, second-degree, third-degree, or fourth-degree relative of
				the individual.
(2) "Genetic
				information" means, with respect to any individual, information about the
				following:
(A) The individual's genetic
				tests.
(B) The genetic tests of
				family members of the individual.
(C) The manifestation of a disease or
				disorder in family members of the individual.
(D) Any request for, or receipt of, genetic
				services.
(E) Any participation in
				clinical research that includes genetic services by the individual or any
				family member of the individual.
Any reference to genetic information concerning an individual
				  or family member of an individual who is a pregnant woman, includes genetic
				  information of any fetus carried by the pregnant woman, or with respect to an
				  individual or family member utilizing an assisted reproductive technology,
				  includes genetic information of any embryo legally held by the individual or
				  family member. The term shall not include information about the sex or age of
				  any individual.
(3) "Genetic services" means a genetic test,
				genetic counseling (including obtaining, interpreting, or assessing genetic
				information), or genetic education.
(4) "Genetic test" means an analysis of human
				DNA, RNA, chromosomes, proteins, or metabolites that detect genotypes,
				mutations, or chromosomal changes. The term does not include an analysis of
				proteins or metabolites that:
(A) does not
				detect genotypes, mutations, or chromosomal changes; or
(B) is directly related to a manifested
				disease, disorder, or pathological condition that could reasonably be detected
				by a health care professional with appropriate training and expertise in the
				field of medicine involved.
(5) "Issuer of a Medicare supplement policy"
				includes a third party administrator or other person acting for or on behalf of
				the issuer.
(6) "Underwriting
				purposes" includes the following:
(A) Rules
				for, or determination of, eligibility (including enrollment and continued
				eligibility) for benefits under the policy.
(B) The computation of premium or
				contribution amounts under the policy.
(C) The application of any preexisting
				condition exclusion under the policy.
(D) Other activities related to the creation,
				renewal, or replacement of a contract of health insurance or health
				benefits.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 20 - Separability › Section 20-1 - Separability

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.
If any provision of this article or the application thereof
				  to any person or circumstance is for any reason held to be invalid, the
				  remainder of the article 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 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 1 - General Provisions › Section 1-1 - Applicability and scope

Current through July 10, 2024
Authority: IC
				  27-19-1-4
Affected: IC
				  27-19-1-4
Sec. 1.
This article applies to all application organizations,
				  navigators, programs, and providers defined under this article.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 2 - Definitions › Section 2-1 - Definitions

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1
Affected: IC 12-8-1.5-2; IC 12-10; IC 12-15-44.5; IC 12-17.6;
				  IC 16-28; IC 27-1-1; IC 27-19-2; IC 27-19-4-1
Sec. 1.
The definitions set forth in IC 27-19-2 and the following
				  definitions apply throughout this article:
(1) "Application organization" means a
				navigator described in Section 1311(i) of PPACA (42 U.S.C.
				18031(i)) , a certified
				application counselor organization described in
				45 CFR
				155.225 issued pursuant to PPACA, or any
				other federal assistance program under PPACA, or an entity that employs
				personnel to assist individuals with application for and enrollment in a QHP
				through a health benefit exchange or in a public health insurance program. An
				application organization does not include:
(A) An entity that makes presumptive
				eligibility determinations concerning an individual's eligibility for
				enrollment in a public health insurance program unless such entity also assists
				individuals with the full application for and enrollment in a public health
				insurance program or QHP through a health benefit exchange.
(B) A state agency, division, or subdivision
				thereof.
(C) An entity that only
				performs one (1) or both of the following two (2) functions:
(i) Provides assistance with application for
				and enrollment in a public health insurance program to individuals who may be
				eligible for Medicaid nursing home care.
(ii) Provides individuals with general
				information concerning the application process for enrollment in a QHP through
				a health benefit exchange or in a public health insurance program but does not
				assist individuals with application for or enrollment in a QHP through a health
				benefit exchange or in a public health insurance program.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 3 - Certification, Registration, and Duties › Section 3-1 - Certification and registration requirement

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1; IC 27-19-4-11
Affected: IC 27-1-15.6; IC 27-1-15.7; IC 27-19-4-11
Sec. 1.
(a) A person
				shall not assist individuals with application for and enrollment in a QHP
				through a health benefit exchange or in a public health insurance program or
				otherwise function as a navigator or application organization unless the
				individual is certified as a navigator or the entity is registered as an
				application organization under this rule.
(b) A person that is a navigator described in
				Section 1311(i) of PPACA (42
				U.S.C. 18031(i)) , a
				certified application counselor described in
				45 CFR
				155.225 issued pursuant to PPACA, or any
				other federal assistance personnel under PPACA, shall:
(1) continue to carry out all duties and
				functions under PPACA while applying to be certified as a navigator or
				registered as an application organization under this rule;
(2) obtain certification as a navigator or
				registration as an application organization in a timely manner as determined by
				the commissioner in consultation with the secretary; and
(3) continue to carry out all duties and
				functions under PPACA while acting as a certified navigator or registered
				application organization.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 3 - Certification, Registration, and Duties › Section 3-2 - Certification and registration application

Current through July 10, 2024
Authority: IC
				  27-19-1-4
Affected: IC
				  27-19-1-4; IC
				  27-19-4-1
Sec. 2.
(a) An
				application for navigator certification or application organization
				registration shall be completed on a form prescribed by the commissioner in
				consultation with the secretary.
(b) An individual applying for navigator
				certification and an individual applying for application organization
				registration on behalf of an entity must declare under penalty of denial,
				suspension, or revocation of the certification or registration that the
				statements made in the application are true, correct, and complete to the best
				of the individual's knowledge and belief.
(c) All individuals applying for navigator
				certification shall submit a criminal background check to the department, in a
				manner determined
[sic, by the]
commissioner in consultation
				with the secretary, by either of the following two (2) methods:
(1) The associated application organization
				performs the criminal background check of the navigator and submits the
				background check results to the department.
(2) The applicant obtains the criminal
				background check and submits the criminal background check results to the
				department.
The criminal background check shall be dated no more than
				  thirty (30) days prior to the application submission date.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 3 - Certification, Registration, and Duties › Section 3-3 - Certification and registration fees

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1
Affected: IC
				  27-19-1-4; IC
				  27-19-4-1
Sec. 3.
(a) All
				resident individuals and entities applying for certification or registration
				under this rule shall submit a nonrefundable fifty dollar ($50) application
				fee, and an electronic processing fee if submitted electronically, with the
				initial certification or registration application.
(b) All nonresident individuals and entities
				applying for certification or registration under this rule shall submit a
				nonrefundable one hundred dollar ($100) application fee, and an electronic
				processing fee if submitted electronically, with the initial certification or
				registration application.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 3 - Certification, Registration, and Duties › Section 3-4 - Precertification education

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1; IC 27-19-4-11
Affected: IC 27-19-4-11
Sec. 4.
(a) A
				resident or nonresident individual applying for navigator certification shall
				complete navigator precertification education offered by an approved navigator
				precertification education provider, as described in
				760 IAC 4-8, prior to taking the
				navigator certification examination.
(b) The precertification education shall
				provide instructions regarding the following:
(1) The functions of a health benefit
				exchange and public health insurance programs.
(2) The duties and responsibilities of a
				navigator.
(3) The insurance laws
				of Indiana that apply to the functions of a navigator with respect to a health
				benefit exchange.
(4) Rules related
				to public health insurance programs, including the following:
(A) Eligibility requirements.
(B) Renewal and redetermination
				rules.
(C) Appeal
				policies.
(5) The
				obligations of a navigator related to confidentiality and security of
				information and conflicts of interest.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 3 - Certification, Registration, and Duties › Section 3-5 - Certification examination

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-11
Affected: IC
				  27-19-4-11
Sec. 5.
(a) A
				resident or nonresident individual applying for navigator certification shall:
(1) submit a nonrefundable examination fee,
				as determined by the commissioner in consultation with the secretary;
				and
(2) pass a written examination,
				as prescribed by the commissioner in consultation with the secretary, by
				correctly answering seventy percent (70%) of the examination
				questions.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 3 - Certification, Registration, and Duties › Section 3-6 - Certification and registration renewal and continuing education

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1
Affected: IC 27-19-1-4; IC 27-19-4-1
Sec. 6.
(a) A
				resident and nonresident navigator's certification or application
				organization's registration shall remain in effect for one (1) year from the
				last day of the month of original certification or registration, unless
				canceled, suspended, or revoked under this article. The annual certification or
				registration renewal shall be completed no later than the last day of the month
				of original certification or registration.
(b) The navigator certification or
				application organization registration renewal shall consist of a renewal
				application and nonrefundable renewal fee, as prescribed by the commissioner in
				consultation with the secretary, and, for navigators, continuing education as
				provided under this rule.
(c) All
				resident navigators and application organizations shall submit a nonrefundable
				fifty dollar ($50) renewal application fee, and an electronic processing fee if
				submitted electronically, with the renewal application.
(d) All nonresident navigators and
				application organizations shall submit a nonrefundable one hundred dollar
				($100) renewal application fee, and an electronic processing fee if submitted
				electronically, with the renewal application.
(e) All certification and registration
				renewal applications must be made under oath or affirmation.
(f) No less than sixty (60) days prior to the
				navigator certification or application organization registration expiration
				date, the department, or its duly authorized agent, may notify, by business
				electronic mail, the certified navigator or registered application organization
				of the requirement to renew with the department.
(g) A certified navigator or registered
				application organization's failure to receive a business electronic mail
				notification of renewal due to failure to submit to the department a valid
				business electronic mail address, or for any other reason, shall not:
(1) constitute an error on the part of the
				department; or
(2) exonerate or
				otherwise excuse the navigator or application organization from completing the
				annual certification or registration renewal requirements under this
				rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 3 - Certification, Registration, and Duties › Section 3-7 - Duties

Current through July 10, 2024
Authority: IC 27-19-1-4
Affected: IC 27-19-1-4
Sec. 7.
(a) An
				application organization or navigator shall carry out, at a minimum, the
				following duties:
(1) Maintain expertise in
				eligibility, enrollment, and program specifications related to QHPs available
				on the health benefit exchange and public health insurance programs.
(2) Provide information and assistance to an
				individual in a fair, accurate, and impartial manner. Information provided
				regarding QHPs must acknowledge all QHPs available to the individual on the
				health benefit exchange.
(3)
				Provide referrals to the department for any person who has a grievance,
				complaint, or question regarding a navigator, application organization,
				program, provider, or the certification, registration, or renewal procedures
				provided in this article or IC 27-19.
(4) Provide referrals to the appropriate
				person for any individual who has a grievance, complaint, or question regarding
				their QHP or public health insurance program coverage.
(5) Provide assistance in a manner that is
				culturally and linguistically appropriate to the needs of the individuals being
				assisted and ensure accessibility to individuals with disabilities in
				accordance with the federal Americans with Disabilities Act and Section 504 of
				the federal Rehabilitation Act.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 4 - Navigator Association › Section 4-1 - Navigator association and verification

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1
Affected: IC 27-19-1-4; IC 27-19-4-1
Sec. 1.
(a) An
				application organization that employs or contracts with one (1) or more
				navigators to perform the functions of a navigator shall verify that each
				navigator is certified and has not committed any acts that would be grounds for
				certification denial, suspension, or revocation under IC 27-19-4 or this
				article.
(b) An application
				organization shall notify the department no later than thirty (30) days
				following a navigator addition to or removal from the application organization
				by sending notification to the department in a manner specified by the
				commissioner in consultation with the secretary.
(c) If an application organization revokes a
				navigator's association due to a violation of IC 27-19-4 or this article, the
				application organization shall do the following no later than thirty (30) days
				following the revocation:
(1) Submit a written
				report to the department, in a manner specified by the commissioner, detailing
				the revocation circumstances.
(2)
				Provide a copy of the written report to the navigator.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 5 - Conflict of Interest Policy › Section 5-1 - Conflict of interest policy

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1
Affected: IC 27-19-1-4; IC 27-19-4-1
Sec. 1.
(a) The
				commissioner shall, in consultation with the secretary, develop a conflict of
				interest policy concerning actual or potential conflicts of interest affecting
				navigators or application organizations.
(b) A conflict of interest includes a
				conflict of loyalty or a financial interest, which are defined as follows:
(1) A conflict of loyalty exists when a
				navigator or application organization has, directly or indirectly, through
				business or family, an interest or relationship with a third party that
				prohibits or inhibits, or potentially prohibits or inhibits, the navigator or
				application organization from exercising independent judgment in the best
				interests of individuals the person assists or may assist with application for
				and enrollment in a QHP through a health benefit exchange or in a public health
				insurance program. A conflict of loyalty does not exist solely because a
				navigator or application organization is employed by a hospital that owns or is
				owned, in whole or in part, by an issuer.
(2) A financial interest exists if, as a
				result of an individual's health plan selection at issue, a navigator or
				application organization receives or may receive any consideration,
				compensation, or financial benefit, either directly or indirectly, from a third
				party as a condition of assisting individuals with application for and
				enrollment in a particular health plan as follows:
(A) A person that receives consideration,
				compensation, or financial benefit from a health insurance issuer (as defined
				in Section 2791 of the federal Public Health Service Act (42 U.S.C. 300gg-91) )
				in connection with application for and enrollment of an individual in a health
				plan is prohibited from serving as a navigator or application organization when
				receipt of such consideration, compensation, or financial benefit requires or
				otherwise influences the person to direct the individual towards a particular
				health plan.
(B) A navigator or
				application organization receiving grant funding through the federal navigator
				grant program provided under Section 1311(i)(6) of PPACA does not have a
				prohibited financial interest by reason of that compensation.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 5 - Conflict of Interest Policy › Section 5-2 - Privacy and security agreement

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1
Affected: IC 24-4.9-1; IC 27-19-1-4; IC 27-19-4-1
Sec. 2.
(a) The
				commissioner shall, in consultation with the secretary, develop a privacy and
				security agreement for navigators and application organizations pursuant to
				this rule.
(b) Navigators and
				application organizations shall maintain and protect all personal information
				received from individuals when assisting such individuals with application for
				and enrollment in a QHP through a health benefit exchange or in a public health
				insurance program with reasonable operational, administrative, technical, and
				physical safeguards to ensure its confidentiality and to prevent unauthorized
				or inappropriate access, use, or disclosure of such personal
				information.
(c) Navigators and
				application organizations shall follow all state and federal laws governing the
				privacy and security of personal information received from individuals whom
				they are assisting with application for and enrollment in a QHP through a
				health benefit exchange or in a public health insurance program.
(d) Navigators and application organizations
				shall comply with the following safeguards to maintain and protect the
				confidentiality of personal information:
(1)
				Personal information shall only be disclosed to those individuals or entities
				authorized by law or by the individual to whom the personal information
				belongs.
(2) When disclosing
				personal information to authorized individuals or entities, reasonable efforts
				shall be made to limit disclosure of the personal information to the minimum
				necessary personal information needed to accomplish the intended purpose of
				such disclosure.
(3) Personal
				information shall be protected against any reasonably anticipated threats or
				hazards to the confidentiality of such personal information.
(4) Personal information shall be protected
				against any reasonably anticipated uses or disclosures that are not permitted
				or required by law.
(5) Personal
				information shall be securely destroyed or disposed of in an appropriate and
				reasonable manner that results in the personal information being illegible and
				unusable.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 6 - Other Reporting Requirements › Section 6-1 - Other reporting requirements

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1
Affected: IC 27-19-1-4; IC 27-19-4-1
Sec. 1.
(a) In
				addition to reporting and disclosure requirements established under this
				article or IC 27-19, a navigator or application organization shall comply with
				the reporting requirements established under this rule.
(b) A navigator shall inform the department,
				on a form provided by the department, of a change in any of the following no
				later than thirty (30) days after the change occurs:
(1) Legal name.
(2) Residential, business, or mailing
				address.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 7 - Enforcement and Hearing and Appeals › Section 7-1 - Enforcement

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-3
Affected: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-3
Sec. 1.
(a) For
				purposes of this section, "permanently revoke" means that:
(1) the navigator's certification or
				application organization's registration shall never be reinstated or reissued;
				and
(2) the former navigator or
				application organization, after the permanent revocation, is not eligible to
				submit a navigator or application organization application to the
				department.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 7 - Enforcement and Hearing and Appeals › Section 7-2 - Hearings and appeals

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1
Affected: IC 4-21.5; IC 27-19-1-4; IC 27-19-4-1
Sec. 2.
(a) If the
				commissioner:
(1) denies an initial or renewal
				application for navigator certification or application organization
				registration;
(2) files an
				enforcement action under section 1 of this rule against a navigator or
				application organization for a violation of IC 27-19-4 or this
				article;
(3) denies, suspends, or
				revokes the approval of a navigator precertification education program under
				760 IAC 4-8;
(4) denies, suspends, or revokes the approval
				of a navigator precertification education program instructor or program
				director under
				760 IAC 4-8; or
(5) denies approval of a navigator continuing
				education course of study or the provider disagrees with the number of hours
				assigned to the navigator continuing education course of study;
the department shall provide written notice of the reason for
				  the action to the affected person.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 8 - Navigator Precertification Education Program Requirements › Section 8-1 - Approval of navigator precertification education program

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-11
Affected: IC
				  27-19-4-11
Sec. 1.
(a) A
				program shall not provide navigator precertification education unless the
				program is certified as a navigator precertification education
				program.
(b) Approval of a
				navigator precertification education program shall require the following:
(1) Submission of an application to the
				department on a form provided by the department.
(2) Payment of a nonrefundable application
				fee as determined by the commissioner.
(3) Approval by the commissioner.
(4) Compliance with the qualifications set
				forth under section 2 of this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 8 - Navigator Precertification Education Program Requirements › Section 8-2 - Qualifications and requirements for navigator precertification education program

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-11
Affected: IC
				  27-19-4-11
Sec. 2.
(a) To
				qualify as a navigator precertification education program for purposes of IC
				27-19-4-11 and this article, a
				program shall meet all of the following criteria:
(1) The navigator precertification education
				program shall be conducted or developed by an:
(A) insurance trade association;
(B) accredited college or
				university;
(C) educational
				organization; or
(D) application
				organization;
that is approved by the commissioner under this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 8 - Navigator Precertification Education Program Requirements › Section 8-3 - Qualifications for approved instructor

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-11
Affected: IC
				  27-19-4-11
Sec. 3.
(a) An
				approved instructor shall do the following:
(1) Hold a high school diploma.
(2) Have any of the following:
(A) A valid teaching certificate for two (2)
				or more years.
(B) Two (2) or more
				years of managerial, supervisory, or teaching experience in the insurance or
				health care industries.
(C) An
				active navigator certification in good standing with the department.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 8 - Navigator Precertification Education Program Requirements › Section 8-4 - Renewal for approved instructor

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-11
Affected: IC
				  27-19-4-11
Sec. 4.
(a) Approval
				of a qualified instructor is valid for two (2) years from the date of the
				approval by the commissioner of the instructor's most recent application for
				approval as an instructor.
(b) An
				approved instructor who desires to renew instructor approval shall submit to
				the commissioner no more than sixty (60) days prior to the expiration of the
				instructor's qualification, the following:
(1)
				A renewal application on a form provided by the department.
(2) A nonrefundable renewal fee as determined
				by the commissioner.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 8 - Navigator Precertification Education Program Requirements › Section 8-5 - Qualifications for approved program director

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-11
Affected: IC
				  27-19-4-11
Sec. 5.
(a) An
				approved program director shall do the following:
(1) Hold a high school diploma.
(2) Have any of the following:
(A) Two (2) or more years of experience as an
				instructor or educational administrator in the insurance or healthcare
				industries.
(B) Six (6) or more
				years of experience in the insurance or healthcare industries with a minimum of
				two (2) years in insurance or healthcare management.
(C) An active navigator certification in good
				standing with the department.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 8 - Navigator Precertification Education Program Requirements › Section 8-6 - Renewal for approved program director

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-11
Affected: IC
				  27-19-4-11
Sec. 6.
(a) Approval
				of a qualified program director under section 5 of this rule is valid for two
				(2) years from the date of the commissioner's approval of the program
				director's most recent application for approval as a program
				director.
(b) An approved program
				director who desires to renew approval shall submit to the commissioner no more
				than sixty (60) days prior to the expiration of the program director's
				approval, the following:
(1) A renewal
				application on a form provided by the department.
(2) A nonrefundable renewal fee as determined
				by the commissioner.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 8 - Navigator Precertification Education Program Requirements › Section 8-7 - Enforcement

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1; IC 27-19-4-11
Affected: IC 27-19-4-11
Sec. 7.
(a) As used
				in this section, "material misrepresentation" means a false or misleading
				statement of fact or the omission of any fact that, if known to the
				commissioner, would be cause to suspend, revoke, or refuse to grant approval
				under this rule, or that would otherwise render such program, instructor, or
				program director ineligible for the approval for which application was
				made.
(b) The commissioner may
				deny, suspend, or revoke the approval of a program or the approval of an
				instructor or program director if the commissioner finds that the program,
				instructor, or program director has made a material misrepresentation on the
				application for program approval, on the application for instructor approval,
				or on the application for program director approval.
(c) The commissioner may:
(1) suspend or revoke the certification of a
				program that does not maintain reasonable standards, as determined by the
				commissioner; or
(2) disqualify an
				approved instructor who is currently qualified under section 3 of this rule to
				render instruction in a navigator program from rendering the instruction if the
				annual passing percentage of individuals, who receive instruction from the
				approved instructor and take the navigator certification examination, is less
				than forty-five percent (45%).