reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-13 - Order of benefits for dependent child/parents not separated or divorced

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 13.
(a) For a
				dependent child whose parents are:
(1)
				married; or
(2) living together,
				whether or not they have ever married; the benefits of the plan of the parent
				whose birthday falls earlier in a calendar year is
[sic., are]
the primary.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-14 - Order of benefits for dependent child/separated or divorced parents

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 14.
(a) For a
				dependent child whose parents are divorced or separated or do not live
				together, whether or not they have ever been married, this subsection applies:
(1) If there is no court decree allocating
				responsibility for the child's health care expenses or health care coverage,
				the order of benefits for the child are as follows:
(A) The plan of the custodial
				parent.
(B) The plan of the spouse
				of the custodial parent.
(C) The
				plan of the noncustodial parent.
(D) The plan of the spouse of the
				noncustodial parent.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-15 - Order of benefits for active/inactive employee

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 15.
The benefits of a plan that covers a person as:
(1) an active employee, meaning an employee
				who is neither laid off nor retired; or
(2) that employee's dependent; is the primary
				plan. The plan covering that same person as a retired or laid off employee or
				as a dependent of a retired or laid off employee is the secondary plan. If the
				other plan does not have this provision, and if, as a result, the plans do not
				agree on the order of benefits, this section is ignored. This section does not
				apply if section 12(d) of this rule can determine the order of
				benefits.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-15.5 - Order of benefits under COBRA or continuation coverage

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 15.5.
If a person whose coverage is provided under COBRA or under
				  a right of continuation under state or other federal law is covered under
				  another plan, the plan covering the person as:
(1) an employee, member, subscriber, or
				retiree; or
(2) a dependent of an
				employee, member, subscriber, or retiree; is the primary plan, and the plan
				covering that same person under COBRA or under a right of continuation under
				state or other federal law is the secondary plan. If the other plan does not
				have this rule and as a result the plans do not agree on the order of benefit,
				this rule is ignored. This section does not apply if the rule in section 12(d)
				of this rule can determine the order of benefits.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-16 - Order of benefits for longer/shorter length of coverage

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 16.
(a) If the
				provisions of sections 12 through 15.5 of this rule do not determine the order
				of benefits, the benefits of the plan that covered the person for the:
(1) longer period of time is the primary
				plan; and
(2) shorter period of
				time is the secondary plan.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-17 - Secondary plan procedures; total allowable expenses

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 17.
In determining the amount to be paid by the secondary plan
				  on a claim, should the plan wish to coordinate benefits, the secondary plan
				  shall calculate the benefits it would have paid on the claim in the absence of
				  other health coverage and apply that calculated amount to any allowable expense
				  under its plan that is unpaid by the primary plan. The secondary plan:
(1) may reduce its payment by the amount so
				that, when combined with the amount paid by the primary plan, the total
				benefits paid or provided by all plans for the claim do not exceed one hundred
				percent (100%) of the total allowable expense for that claim; and
(2) shall credit to its plan deductible any
				amounts it would have credited to its deductible in the absence of other health
				care coverage.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-18 - Reasonable cash values of services

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 18.
A secondary plan which provides benefits in the form of
				  services may recover the reasonable cash value of providing the services from
				  the primary plan, to the extent that benefits for the services are covered by
				  the primary plan and have not already been paid or provided by the primary
				  plan. Nothing in this section shall be interpreted to require a plan to
				  reimburse a covered person in cash for the value of services provided by a plan
				  which provides benefits in the form of services.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-19 - Excess and other nonconforming provisions

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 19.
(a) A plan
				with order of benefit determination provisions that comply with this rule
				(complying plan) may coordinate its benefits with a plan that is "excess" or
				"always secondary", or that uses order of benefit determination provisions that
				are inconsistent with those contained in this rule (noncomplying plan) on the
				following basis:
(1) If the complying plan is
				the:
(A) primary plan, it shall pay or provide
				its benefits on a primary basis; or
(B) secondary plan, it shall, nevertheless,
				pay or provide its benefits first, but the amount of the benefits payable shall
				be determined as if the complying plan were the secondary plan. In such a
				situation, the payment shall be the limit of the complying plan's
				liability.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-20 - Allowable expense

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 20.
Terms such as:
(1)
				"usual, customary, and reasonable", "usual and prevailing", or "reasonable and
				customary" may be substituted for the term "usual, reasonable, and customary";
				and
(2) "medical care" or "dental
				care" may be substituted for "health care"; to describe the coverages to which
				the coordination of benefits provisions apply.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-21 - Subrogation

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 21.
The coordination of benefits concept clearly differs from
				  that of subrogation. Provisions for one may be included in health care benefits
				  contracts without compelling the inclusion or exclusion of the
				  other.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-21.2 - Notice to covered persons

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 21.2.
A plan shall, in its explanation of benefits provided to
				  covered persons, include the language, "If you are covered by more than one
				  health benefit plan, you should file all your claims with each plan.".
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-21.6 - Failure to agree

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 21.6.
If the plans cannot agree on the order of benefits within
				  thirty (30) calendar days after the plans have received all of the information
				  needed to pay the claim, the plans shall:
(1) immediately pay the claim in equal
				shares; and
(2) determine their
				relative liabilities following payment; except that no plan shall be required
				to pay more than it would have paid had it been the primary plan.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 38.1 - Group Coordination of Benefits › Section 38.1-22 - Effectiveness

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-8-5-19
Sec. 22.
A group contract which provides health care benefits and was
				  issued before the effective date of this rule shall be brought into compliance
				  with this rule by the later of:
(1)
				the next anniversary date or renewal date of the group contract; or
(2) the expiration of any applicable
				collectively bargained contract pursuant to which it was written.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 39 - AIDS Questioning, Testing and Coverage › Section 39-1 - Authority

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7; IC 27-1-3-19; IC 27-1-12-13; IC
				  27-8-5-1
Sec. 1.
This rule ( 760 IAC 1-39 ) is promulgated by the insurance
				  commissioner of the department of insurance of the state of Indiana pursuant to
				  IC
				  27-1-3-7 of
				  the Indiana insurance law.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 39 - AIDS Questioning, Testing and Coverage › Section 39-3 - Definitions

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-1-3-19;
				  IC
				  27-1-12-13;
				  IC
				  27-8-5-1
Sec. 3.
The following definitions apply throughout this rule:
(1) "AIDS" means acquired immune deficiency
				syndrome.
(2) "Commissioner" means
				the commissioner of the Indiana department of insurance.
(3) "HIV" means human immunodeficiency
				virus.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 39 - AIDS Questioning, Testing and Coverage › Section 39-4 - Application questions

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-1-3-19;
				  IC
				  27-1-12-13;
				  IC
				  27-8-5-1
Sec. 4.
In its applications for coverage, an insurer may ask any
				  questions of a medically specific nature that are necessary to render a fully
				  informed underwriting determination based upon sound actuarial principles
				  concerning whether to accept or rate a particular risk, subject to the
				  following conditions:
(1) No question
				in an application for health or life insurance coverage shall be directed
				towards determining the applicant's sexual orientation.
(2) No question shall be used which is
				designed to establish the sexual orientation of the applicant.
(3) Questions relating to the applicant
				having:
(A) HIV; or
(B) been diagnosed as having HIV; are
				permissible if they are factual, objective, and designed to establish the
				existence of the condition.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 39 - AIDS Questioning, Testing and Coverage › Section 39-5 - Testing requirements and protocol

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-1-3-19;
				  IC
				  27-1-12-13;
				  IC
				  27-8-5-1
Sec. 5.
An insurer may require a potential insured to submit to any
				  medical tests, at the insurer's expense, the purpose of which is to determine
				  infection with HIV, subject to the following conditions:
(1) The test is necessary to render a fully
				informed underwriting determination based upon sound actuarial principles
				concerning whether to accept or rate a particular risk.
(2) Whenever an applicant is requested to
				take a test to determine HIV infection in connection with an application for
				insurance, the use of such a test must be revealed to the applicant and his or
				her written consent obtained. No adverse underwriting decision shall be made on
				the basis of such a positive test unless an established test protocol has been
				followed.
(3) The following test
				protocol is established and must be the basis of an adverse underwriting
				determination:
(A) Two (2) positive ELISA
				tests.
(B) One (1) Western Blot
				test, which is not negative, must be obtained from the same sample b from tests
				conducted by a qualified laboratory.
Notwithstanding, the commissioner may approve an alternative
				  screening and confirmatory test protocol that utilizes a screening and
				  confirmatory test approved by the federal Food and Drug Administration for
				  detecting the presence of HIV or HIV antibodies that is no less accurate than
				  ELISA and Western Blot protocol.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 39 - AIDS Questioning, Testing and Coverage › Section 39-6 - Underwriting and rating determinations

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-1-3-19;
				  IC
				  27-1-12-13;
				  IC
				  27-8-5-1
Sec. 6.
An insurer may make an underwriting or a rating determination
				  based upon questions asked pursuant to section 4 of this rule and upon tests
				  required pursuant to section 5 of this rule, subject to the following
				  conditions:
(1) Sexual orientation may
				not be used in the underwriting process or in the determination of
				insurability.
(2) Insurance support
				organizations shall be directed by insurers not to investigate, directly or
				indirectly, the sexual orientation of an applicant or a beneficiary.
(3) Neither the marital status, the living
				arrangements, the occupation, the gender, the medical history, the beneficiary
				designation, nor the zip code or other territorial classification of an
				applicant may be used to establish, or aid in establishing, the applicant's
				sexual orientation.
(4) For
				purposes of rating an applicant for health and life insurance, an insurer may
				impose territorial rates, but only if the rates are based on sound actuarial
				principles or are related to actual or reasonably anticipated
				experience.
(5) No adverse
				underwriting decision shall be made because medical records or a report from an
				insurance support organization shows that the applicant has demonstrated
				concern about HIV by seeking testing or counseling from health care
				professionals. This subsection does not apply to an applicant seeking treatment
				or diagnosis for a specific condition.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 39 - AIDS Questioning, Testing and Coverage › Section 39-7 - Limitations and exclusions prohibited

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC
				  27-1-3-19;
				  IC
				  27-1-12-13;
				  IC
				  27-8-5-1
Sec. 7.
In the event an insurer determines to accept a risk, it must
				  do so without limitations or exclusions solely of the coverage for HIV, AIDS,
				  or a related condition, as follows:
(1) No maximum dollar amount of coverage,
				which is limited solely to HIV, AIDS, or a related condition, shall be included
				in any policy or certificate.
(2)
				No exclusion of coverage, which is limited solely to HIV, AIDS, or a related
				condition, shall be included in any policy or certificate.
This section shall not apply to those policies that provide
				  coverage only for specified diseases.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 39 - AIDS Questioning, Testing and Coverage › Section 39-8 - Departmental approval of policy

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7; IC 27-1-3-19; IC 27-1-12-13; IC
				  27-8-5-1
Sec. 8.
No group or individual life or health insurance policy which
				  is not in compliance with 760 IAC 1-39 will be approved by the department of
				  insurance of the state of Indiana for issue in this state on or after the
				  effective date of 760 IAC 1-39. As of the effective date of 760 IAC 1-39,
				  approval is withdrawn from all group and individual life and health insurance
				  policies approved prior to the effective date which do not meet the
				  requirements set forth in 760 IAC 1-39.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 39 - AIDS Questioning, Testing and Coverage › Section 39-9 - Separability

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-3-7; IC 27-1-3-19; IC 27-1-12-13; IC
				  27-8-5-1
Sec. 9.
If any provisions of this rule
[ 760 IAC 1-39 ]
or the application thereof to any person or circumstance is for any
				  reason held to be invalid, the remainder of the rule and the application of
				  such provision to other persons or circumstances shall not be affected thereby.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-1 - Authority

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-15.5-4; IC 27-1-15.5-19
Sec. 1.
The following rule
[ 760 IAC 1-40 ]
applicable to pre-licensing education requirements is promulgated
				  under the authority of IC 27-1-15.5-4 and IC 27-1-15.5-19.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-2 - Purpose

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-15.5
Sec. 2.
The purpose of this rule
[ 760 IAC 1-40 ]
is
				  to prescribe a course of study to be completed by each applicant prior to
				  taking the written licensing examination; to establish the requirements for
				  certification of an individual who seeks to be qualified as an instructor or
				  director of a registered insurance agent program of study; and to adopt the
				  reasonable and necessary forms to carry out the stated purposes of this rule
[ 760 IAC 1-40 ]
and those set forth in IC 27-1-15.5.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-3 - Definitions

Current through July 10, 2024
Authority: IC 27-1-3-7
Affected: IC 27-1-15.5
Sec. 3.
As used in this rule or any form adopted pursuant to this
				  rule:
(a) "Approved instructor" means
				a person who has met the qualifications as prescribed in
				760 IAC
				1-40-5
[section 5 of this
				rule]
.
(b) A registered
				insurance agent program means a course of studies which:
(1) is taught by an approved
				instructor;
(2) presents all course
				materials as designated in the pertinent section of
				760 IAC
				1-40-6
[section 6 of this rule]
;
				and
(3) has been approved by the
				commissioner.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-3.1 - Renewal of commissioner approval for a registered program

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-15.5
Sec. 3.1.
(a) The
				commissioner's approval for a registered agent program is valid for three (3)
				years from the date of approval of the agent program's most recent registration
				application.
(b) In order to renew
				the commissioner's approval for a registered agent program, the qualified
				program director shall submit no later than sixty (60) days prior to the
				expiration of the agent program's valid approval, the following:
(1) An application to renew the
				commissioner's approval.
(2) A
				renewal fee.
(3) If the program
				material has been modified, altered, or changed from the program material
				indicated and approved at the time of the registered agent program's most
				recent registration application, the modified, altered, or changed material
				must be submitted with the application for review. If the program material is
				the same as that which was approved at the time of the registered agent
				program's most recent registration application, the renewal application shall
				identify the program material and indicate that it is the same that has been
				previously approved.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-4 - Qualifications for program director

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-15.5
Sec. 4.
(a) To
				qualify as a program director an individual must meet the following criteria:
(1) hold a high school diploma; and
(2) acquired the following experience:
(A) two or more years of experience as an
				instructor of insurance or an educational administrator; or
(B) six or more years of experience in the
				insurance industry with two years in insurance management; or
(C) earned the designation of CLU, CPCU,
				FLMI, CIC or CHFC.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-4.1 - Renewal for program director

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-15.5
Sec. 4.1.
(a)
				Qualification of a program director is valid for three (3) years from the date
				of the commissioner's approval of the program director's most recent
				application to qualify as a program director.
(b) A qualified program director who desires
				to renew qualification to be a program director shall submit to the
				commissioner no later than sixty (60) days prior to the expiration of the
				program director's qualification, the following:
(1) An application for renewal of approval as
				a program director.
(2) A renewal
				fee.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-5 - Qualifications for approved instructor

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-15.5
Sec. 5.
(a) An
				approved instructor must meet the following criteria:
(1) hold a high school diploma; and
(2) acquired the following experience:
(A) a valid teaching certificate for two (2)
				or more years; or
(B) two (2) or
				more years of managerial, supervisory or teaching experience in the insurance
				industry; or
(C) earned the
				designation of CLU, CPCU, FLMI, CIC or CHFC.
(b) No person may qualify as an approved
				instructor who:
(1) has been convicted of a
				crime involving moral turpitude; or
(2) has had his/her insurance agents license
				suspended or revoked in Indiana or in any other state; or
(3) at the time of application, has
				outstanding any fines imposed by the commissioner for insurance related
				disciplinary offenses; or
(4) is on
				the most recent tax warrant list supplied to the commissioner by the department
				of state revenue.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-5.1 - Renewal for approved instructor

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-15.5
Sec. 5.1.
(a)
				Qualification of an approved instructor is valid for three (3) years from the
				date of the approval by the commissioner of the instructor's most recent
				application to qualify as an instructor.
(b) An approved instructor who desires to
				renew qualification to be an instructor shall submit to the commissioner no
				later than sixty (60) days prior to the expiration of the instructor's
				qualification, the following:
(1) An
				application for renewal of approval as an instructor.
(2) A renewal fee.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-6 - Educational requirements

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-15.5-4
Sec. 6.
(a)
(1) To qualify as a registered insurance
				agent program for life insurance pre-licensing education, the program shall
				include instruction in the following areas of study and for each of these
				areas, shall provide not less than the smaller of the below designated number
				of hours of instruction:
I. Introduction to Life Insurance
5-7 Hours
* Function of Life Insurance
* Life Insurance and Annuities
* Life Insurance Classifications
* Forms of Life Insurance
* Kinds of Policies
* Registered Products
* New Developments in Policies
II. Life Insurance as a Contract
5-7 Hours
* General Provisions
* Non-forfeiture Values
* Dividends
* Optional Provisions
III. Special Life Policies
5-7 Hours
* Mortgage Redemption
* Family Maintenance
* Family Income
* Modified Whole Life
* Universal Life
IV. Special Annuities
2-3 Hours
* Joint and Survivor
* Variable
* Guaranteed for Period Certain
V. Ethics, Insurance Laws and Regulations
4-6 Hours
* Indiana Insurance Laws and Regulations
* Registered Products Regulations
* Ethical Practices in Sales and Marketing
* Code of Professional Conduct
TOTAL HOURS
24 Hours
(2)
				Nothing in this section shall preclude a registered insurance agent program
				from offering additional or supplemental materials or instruction in the area
				of life insurance, provided, however, that the program continues to meet the
				requirements set forth in part (1) of this section
[subdivision
				(1)]
.
(3) A certificate of
				pre-licensing course completion may be accepted only if the applicant and the
				instructor certify to the commissioner that:
(1) the applicant has satisfactorily
				completed the minimum required course studies totaling not less than
				twenty-four (24) hours; and
(2) the
				applicant has been present in a structured setting with an approved instructor
				for not less than a total of twenty-four (24) hours.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-7 - Time, place of course offering

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-15.5
Sec. 7.
(a) The
				director of a registered insurance agent program may determine the hours and
				location where its program may be offered, provided, however, that all such
				times and locations shall be reported to the commissioner not less than 15 days
				before the beginning of the course.
(b) The commissioner may refuse to accept a
				certificate of course completion:
(1) unless
				on the form provided by the commissioner, the approved instructor and the
				applicant certify under penalties of perjury that the applicant has received
				the minimum required hours of instruction at the location and times indicated
				on the application; or
(2) if,
				after notice and opportunity for hearing, the commissioner finds that an
				applicant has completed fewer than the minimum number of hours of instruction
				or that the instruction was received at a location or at a time or place other
				than that reported to the commissioner under part (a) of this section
[subsection (a) of this section]
.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-7.1 - Certificates of course completion

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-15.5
Sec. 7.1.
The commissioner shall make available to approved registered
				  agent programs, certificates of course completion as follows:
(1) The minimum number of certificates of
				course completion which an approved registered agent program shall be issued at
				one (1) time is ten (10). An approved registered agent program may be issued
				any number of certificates of course completion more than the minimum as per
				request.
(2) Certificates of course
				completion issued to an approved registered agent program shall not be
				transferrable from the approved registered agent program to which the
				certificates of course completion were issued.
(3) Once issued, unused certificates of
				course completion shall not be returnable to the commissioner, nor shall a
				refund be available.
(4) Unused
				certificates of course completion issued to a registered agent program shall be
				valid only so long as the registered agent program to which the certificates of
				course completion were issued retains the commissioner's approval as set forth
				in sections 3 and 3.1 of this rule.
(5) An approved registered agent program
				shall issue only one (1) certificate of course completion per individual per
				actual completion. Renewals of certificate or course completion shall not be
				accepted.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-8 - Enforcement

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-15.5
Sec. 8.
(a) The
				commissioner may after notice and opportunity for a hearing, withhold, suspend,
				or revoke the registration of a program or the approval of an instructor or
				director if the commissioner finds that the director or instructor has made a
				material misrepresentation on the application for program approval, on the
				application for program director approval, or on the certificate of
				pre-licensing course completion.
(b) The commissioner may, after notice and
				opportunity for a hearing, deny, suspend, or revoke the license of an applicant
				or agent if the commissioner finds that the applicant or agent has made a
				material misrepresentation on the certificate of pre-licensing course
				completion.
(c) As used in this
				section, the term "material misrepresentation" means a false or misleading
				statement of fact or the omission of any fact which if known to the
				commissioner, would be cause to suspend, revoke, or refuse to grant approval or
				certification under this rule, or which would otherwise render such person or
				organization ineligible for the approval or certification for which application
				was made.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-9 - Fees

Current through July 10, 2024
Authority: IC 27-1-15.5-7.7
Affected: IC 27-1-15.5-7.7
Sec. 9.
(a) All
				certificates of completion shall be purchased by the agent education program
				director from the commissioner at the cost of five dollars ($5) each. The
				program director shall be reimbursed by each applicant for the cost of the
				certificate of completion.
(b) The
				submission of a certificate of completion shall constitute certification by the
				program director that the five dollar ($5) application fee has been paid to the
				commissioner. No copy or reproduction of an original authorized certificate of
				completion shall be valid without the prior written approval of the
				commissioner upon verification that the application fee has been paid.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 40 - Agent Prelicensing Study Program › Section 40-10.1 - Forms

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-15.5
Sec. 10.1.
The commissioner shall prepare and distribute such forms and
				  certificates which, is
[sic.]
his discretion, are reasonable or
				  necessary to carry out the requirements of this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 41 - Insurance Administrators › Section 41-1 - Authority for rule

Current through July 10, 2024
Authority: IC 27-1-25-14
Affected: IC 27-1-25-11
Sec. 1.
This rule ( 760 IAC 1-41 ) is promulgated by the commissioner
				  of insurance pursuant to IC 27-1-25-11 and IC 27-1-25-14.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 41 - Insurance Administrators › Section 41-2 - Financial statement

Current through July 10, 2024
Authority: IC 27-1-25-14
Affected: IC 27-1-25-11
Sec. 2.
Each application for issuance of a certificate of
				  registration or renewal of a certificate of registration shall be accompanied
				  by the applicant's current financial statement. A financial statement, for
				  purposes of this rule, consists of a financial statement that is prepared in a
				  manner consistent with generally accepted accounting principles (GAAP) and is
				  accompanied by either an opinion by an independent accounting firm or a
				  statement by an officer of the entity being registered as an administrator,
				  representing that the financial statement was prepared in a manner consistent
				  with GAAP and accurately reflects the financial condition of the entity. The
				  financial statement must reflect a positive net worth in order to be acceptable
				  as proof of the applicant's financial responsibility.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 41 - Insurance Administrators › Section 41-3 - Certificate of registration; date of issue, expiration and renewal

Current through July 10, 2024
Authority: IC 27-1-25-14
Affected: IC 27-1-25
Sec. 3.
(a) Every
				administrator who has complied with the requirements of Indiana Code Chapter
				27-1-25 and this rule shall be issued a certificate of registration. A
				certificate of registration issued to a first-time applicant shall be effective
				as of the date of approval of the application and shall expire on the next
				following June 30.
(b) All
				certificates of registration will expire on June 30 of each year and must be
				renewed on an annual basis. Applications for renewal of registration, on forms
				approved by the commissioner, will be mailed to all current certificate holders
				at the last address as shown in the commissioner's records, no later than March
				1 of each year. Applications for renewal along with any other required
				documents must be received no later than May 1. Renewal certificates will be
				issued on July 1 of each year.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 41 - Insurance Administrators › Section 41-5 - Effective date

Current through July 10, 2024
Authority: IC 27-1-25-14
Affected: IC 27-1-25-11
Sec. 5.
This rule shall become effective on March 1, 1990, and shall
				  apply to any new applicant for a certificate of registration making application
				  on or after that date. For administrators holding a certificate of registration
				  prior to the effective date, this rule shall apply no sooner than the
				  administrators' 1990 renewal date.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 46 - Registration of Utilization Review Agents › Section 46-1 - Authority

Current through July 10, 2024
Authority: IC
				  27-8-17-20
Affected: IC
				  27-8-17-20
Sec. 1.
This rule is adopted and promulgated by the department of
				  insurance under IC
				  27-8-17-20.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 46 - Registration of Utilization Review Agents › Section 46-2 - Definitions

Current through July 10, 2024
Authority: IC
				  27-8-17-20
Affected: IC 27-8-17
Sec. 2.
The definitions in IC 27-8-17 shall apply to all provisions
				  contained in this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 46 - Registration of Utilization Review Agents › Section 46-3 - Certification of utilization review agents

Current through July 10, 2024
Authority: IC
				  27-8-17-20
Affected: IC 4-21.5; IC
				  27-8-17-19
Sec. 3.
(a) An
				application for certification of a utilization review agent must be filed with
				the department of insurance at 311 West Washington Street, Suite 300,
				Indianapolis, Indiana 46204. Initial applications must be filed on or before
				February 28, 1993.
(b) The
				application must be submitted on a utilization review agent application form
				that can be obtained from the department of insurance. The application form is
				adopted by reference, and a copy may be obtained from the Department of
				Insurance, 311 West Washington Street, Suite 300, Indianapolis, Indiana
				46204.
(c) The completed
				application form shall be accompanied by a description of the utilization
				review plan that shall summarize the following information:
(1) Procedures established for appeal of an
				adverse determination. These procedures must comply with section 6 of this
				rule.
(2) Procedures established
				for handling complaints by enrollees, patients, or health care providers. These
				procedures must comply with section 9 of this rule.
(3) Policies and procedures that ensure that
				all applicable state and federal laws to protect the confidentiality of medical
				records are followed. These procedures must comply with section 8 of this
				rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 46 - Registration of Utilization Review Agents › Section 46-4 - General standards of utilization review

Current through July 10, 2024
Authority: IC
				  27-8-17-20
Affected: IC 27-8-17
Sec. 4.
The utilization review plan, including appeal requirements,
				  shall be conducted in accordance with standards or guidelines developed with
				  input from appropriate health care providers and approved by a physician. The
				  utilization review plan shall include the following components:
(1) Written procedures for:
(A) Notification of the utilization review
				agent's determinations provided to the enrollee, a person acting on behalf of
				the enrollee, or the enrollee's provider of record as addressed in section 5 of
				this rule.
(B) Appeal of an adverse
				determination and a copy of any forms used during the appeal process, as
				required by section 6 of this rule.
(C) Receiving or redirecting toll free
				telephone calls during normal business hours and after hour calls, either in
				person or by recording, and assurance that a toll free number will be
				maintained forty (40) hours per week during normal business hours as addressed
				in section 7 of this rule.
(D)
				Reviewing, including the following:
(i) Any
				form used during the review process.
(ii) Time frames that shall be met during the
				review.
(E) Handling of
				written complaints by enrollees, patients, or health care providers, as
				addressed in section 9(a) of this rule.
(F) Determining if health care providers
				utilized by the utilization review agent are licensed.
(G) Orientation and training of personnel who
				perform utilization review.
(H)
				Assuring that patient-specific information obtained during the process of
				utilization review, as addressed in section 8 of this rule, will be:
(i) kept confidential in accordance with
				applicable federal and state laws;
(ii) used for purposes of utilization review,
				quality assurance, discharge planning, and catastrophic case
				management;
(iii) shared with only
				those agencies (such as the claims administrator) that have authority to
				receive such information; and
(iv)
				summary data shall not be considered confidential if it does not provide
				sufficient information to allow for identification of individual
				patients.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 46 - Registration of Utilization Review Agents › Section 46-5 - Notice of determinations made by utilization review agents

Current through July 10, 2024
Authority: IC
				  27-8-17-20
Affected: IC
				  27-8-17-11
Sec. 5.
In making a determination on whether to certify an admission,
				  a utilization review agent shall comply with all provisions contained in IC
				  27-8-17-11.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 46 - Registration of Utilization Review Agents › Section 46-6 - Appeal of adverse determination of utilization review agents

Current through July 10, 2024
Authority: IC
				  27-8-17-20
Affected: IC
				  27-8-17-12
Sec. 6.
A utilization review agent shall comply with all provisions
				  of IC
				  27-8-17-12 in
				  establishing an appeal procedure for adverse determinations.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 46 - Registration of Utilization Review Agents › Section 46-7 - Utilization review agent's telephone access

Current through July 10, 2024
Authority: IC
				  27-8-17-20
Affected: IC
				  27-8-17-9
Sec. 7.
(a) A
				utilization review agent shall have personnel available by toll free telephone
				at least forty (40) hours per week during normal business hours.
(b) A utilization review agent must have a
				telephone system capable of accepting, recording, or providing instructions to
				incoming calls during other than normal business hours and shall respond to
				such calls not later than two (2) working days after the date on which the call
				was received.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 46 - Registration of Utilization Review Agents › Section 46-8 - Confidentiality

Current through July 10, 2024
Authority: IC
				  27-8-17-20
Affected: IC 27-8-17
Sec. 8.
(a) A
				utilization review agent shall preserve the confidentiality of individual
				medical records to the extent required by state and federal laws.
(b) To assure confidentiality, a utilization
				review agent must, when contacting a health care provider's office or hospital,
				provide its certification number and the caller's name to the provider's named
				utilization review representative in the health care provider's
				office.
(c) Medical records and
				patient-specific information shall be maintained by the utilization review
				agent in a secure area with access limited to utilization review personnel
				only.
(d) Information generated and
				obtained by the utilization review agent in the course of utilization review
				shall be retained for at least two (2) years if the information relates to a
				case for which an adverse decision was made at any point or if the information
				relates to a case that may be reopened.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 46 - Registration of Utilization Review Agents › Section 46-9 - Complaints and information

Current through July 10, 2024
Authority: IC
				  27-8-17-20
Affected: IC 27-8-17
Sec. 9.
(a) Within a
				reasonable time period, upon receipt of a written complaint alleging a
				violation of this section or IC 27-8-17 by a utilization review agent, from an
				enrollee's health care provider, a person acting on behalf of the enrollee, or
				the enrollee, the commissioner or a designated department of insurance
				representative shall investigate the complaint and furnish a written response
				to the complainant and the utilization review agent named. The response will
				not identify in any manner, the patient or patients without written consent.
				This response must include the following:
(1)
				A statement of the original complaint.
(2) A copy of any written response by the
				utilization review agent. The written response should not contain privileged
				medical records. If it is necessary to refer to medical records, they shall be
				separately forwarded with the response and clearly marked as privileged medical
				records.
(3) A statement of the
				findings of the commissioner or a designated department of insurance
				representative and an explanation of the basis of such findings.
(4) Corrective actions, if any, on the part
				of the utilization review agent that the commissioner or a designated
				department of insurance representative finds appropriate.
(5) A time frame in which any corrective
				actions should be completed. The utilization review agent will provide evidence
				of corrective action within the specified time frame to the commissioner or a
				designated department of insurance representative.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 46 - Registration of Utilization Review Agents › Section 46-10 - Administrative violations

Current through July 10, 2024
Authority: IC
				  27-8-17-20
Affected: IC
				  27-8-17-17
Sec. 10.
If the commissioner, through the commissioner's designated
				  representative, believes that a utilization review agent may have violated, or
				  is violating, this section or IC 27-8-17, the commissioner's designated
				  representative shall comply with IC
				  27-8-17-17
				  in investigating the complaint and, where appropriate, in imposing sanctions
				  against the utilization review agent.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 46 - Registration of Utilization Review Agents › Section 46-11 - Fees

Current through July 10, 2024
Authority: IC
				  27-8-17-9;
				  IC
				  27-8-17-20
Affected: IC
				  27-8-17-10
Sec. 11.
(a) The fee
				for initial application for certification as a utilization review agent is one
				hundred fifty dollars ($150).
(b)
				The annual renewal fee for a certificate as a utilization review agent is one
				hundred dollars ($100).
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 48 - Standards for Accelerated Benefit Provisions of Individual and Group Life Insurance Policies and Required Disclosure › Section 48-1 - Purpose; scope

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-12; IC 27-8-12
Sec. 1.
(a) This
				rule sets forth the standards for accelerated benefit provisions of individual
				and group life insurance policies and provides required standards of
				disclosure.
(b) This rule applies
				to all accelerated benefit provisions of individual and group life insurance
				policies issued or delivered in Indiana on or after the effective date of this
				rule, except those policies subject to IC 27-8-12.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 48 - Standards for Accelerated Benefit Provisions of Individual and Group Life Insurance Policies and Required Disclosure › Section 48-2 - Definitions

Current through July 10, 2024
Authority: IC
				  27-1-3-7
Affected: IC 27-1-12
Sec. 2.
(a) As used
				in this rule, "accelerated benefits" refers to those benefits under a life
				insurance contract that:
(1) are payable to a
				policy owner or certificate holder, during the lifetime of the insured, in
				anticipation of death or upon the occurrence of specified life threatening or
				catastrophic conditions as defined by the policy or rider;
(2) reduce the death benefit otherwise
				payable under the life insurance contract; and
(3) are payable upon the occurrence of a
				single qualifying event that results in the payment of a benefit amount fixed
				at the time of acceleration.