February 15, 2013
SENATE BILL No. 551
_____
DIGEST OF SB 551
(Updated February 13, 2013 7:37 pm - DI 104)
Citations Affected: IC 12-15; IC 27-1; IC 27-4; IC 27-8; IC 27-19;
noncode.
Synopsis: Federal health care reform. Defines populations that may be
subject to Medicaid resource requirements. Eliminates resource
requirements in determining Medicaid eligibility for specified
populations. Authorizes the office of Medicaid policy and planning
(office) to negotiate with the United States Department of Health and
Human Services (HHS) to establish a block grant system for providing
services under the Medicaid program, including expanding coverage
to specified individuals. Specifies conditions that must be included in
the negotiations. Requires the office to apply to HHS for an amendment
to the state Medicaid plan to require Medicaid recipients to participate
in cost sharing. Provides for implementation of the federal Patient
Protection and Affordable Care Act with respect to a health benefit
exchange in Indiana. Specifies requirements for health plans issued
through a health benefit exchange. Requires a navigator or an assister
to be certified or registered before providing services with respect to a
health benefit exchange. Provides for dissolution of the Indiana
comprehensive health insurance association. Requires the office to
present specified information to the health finance commission
(commission) before August 1, 2013. Requires the department of
insurance, the office of the secretary of family and social services, and
the state department of health to prepare a report for the commission
concerning the establishment and implementation of an exchange in
Indiana and concerning the definition of "essential health benefits".
Effective: Upon passage; July 1, 2013.
Miller Patricia
, Kenley
, Tallian,
Charbonneau
January 14, 2013, read first time and referred to Committee on Health and Provider
Services.
February 14, 2013, amended, reported favorably _ Do Pass; reassigned to Committee on
Appropriations.
February 15, 2013
First Regular Session 118th General Assembly (2013)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in
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Additions: Whenever a new statutory provision is being enacted (or a new constitutional
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NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in
this style type or
this style type reconciles conflicts
between statutes enacted by the 2012 Regular Session of the General Assembly.
SENATE BILL No. 551
A BILL FOR AN ACT to amend the Indiana Code concerning
health.
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: IC 12-15-2-3.5; (13)SB0551.1.1. -->
SECTION 1. IC 12-15-2-3.5 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2013]: Sec. 3.5. An individual:
(1) who is:
(A) at least sixty-five (65) years of age; or
(B) disabled, as determined by the Supplemental Security
Income program; and
(2) whose income and resources do not exceed those levels
established by the Supplemental Security Income program;
is eligible to receive Medicaid assistance if the individual's family
income does not exceed one hundred percent (100%) of the federal
income poverty level for the same size family.
SOURCE: IC 12-15-2-13; (13)SB0551.1.2. -->
SECTION 2. IC 12-15-2-13, AS AMENDED BY P.L.218-2007,
SECTION 9, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 13. (a) A pregnant woman:
(1) who is not described in 42 U.S.C. 1396a(a)(10)(A)(i); and
(2) whose family income does not exceed the income level
established in subsection (b);
is eligible to receive Medicaid.
(b) A pregnant woman described in this section is eligible to receive
Medicaid, subject to subsections (c) and (d) and 42 U.S.C. 1396a et
seq., if her family income does not exceed two hundred percent (200%)
of the federal income poverty level for the same size family.
(c) Medicaid made available to a pregnant woman described in this
section is limited to medical assistance for services related to
pregnancy, including prenatal, delivery, and postpartum services, and
to other conditions that may complicate pregnancy.
(d) Medicaid is available to a pregnant woman described in this
section for the duration of the pregnancy and for the sixty (60) day
postpartum period that begins on the last day of the pregnancy, without
regard to any change in income of the family of which she is a member
during that time.
(e) The office may apply a resource standard in determining the
eligibility of a pregnant woman described in this section. This
subsection expires December 31, 2013.
SOURCE: IC 12-15-2-14; (13)SB0551.1.3. -->
SECTION 3. IC 12-15-2-14 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 14. (a) An individual:
(1) who is less than nineteen (19) years of age;
(2) who is not described in 42 U.S.C. 1396a(a)(10)(A)(I); and
(3) whose family income does not exceed the income level
established in subsection (b);
is eligible to receive Medicaid.
(b) An individual described in this section is eligible to receive
Medicaid, subject to 42 U.S.C. 1396a et seq., if the individual's family
income does not exceed one hundred fifty percent (150%) of the
federal income poverty level for the same size family.
(c) The office may apply a resource standard in determining the
eligibility of an individual described in this section. This subsection
expires December 31, 2013.
SOURCE: IC 12-15-2-17; (13)SB0551.1.4. -->
SECTION 4. IC 12-15-2-17, AS AMENDED BY P.L.196-2011,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 17.
(a) Beginning January 1, 2014, the office
may apply this section only to the following Medicaid applicants or
Medicaid recipients:
(1) An individual whose eligibility for Medicaid does not
require a determination of income by the office.
(2) An individual who is at least sixty-five (65) years of age
when age is a condition of eligibility.
(3) An individual whose eligibility is being determined on the
basis of being blind or disabled, or on the basis of being
treated as blind or disabled.
(4) An individual who requests coverage for long term care
services and supports for the purpose of being evaluated for
an eligibility group under which long term care services or
supports are covered, including the following:
(A) Nursing facility services.
(B) Nursing facility level of care services provided in an
institution.
(C) Home and community based services.
(D) Home health services.
(E) Personal care services.
(5) An individual applying for Medicare cost sharing
assistance.
(a) (b) Except as provided in subsections (b) (c) and (d), (e), if an
applicant for or a recipient of Medicaid:
(1) establishes one (1) irrevocable trust that has a value of not
more than ten thousand dollars ($10,000), exclusive of interest,
and is established for the sole purpose of providing money for the
burial of the applicant or recipient;
(2) enters into an irrevocable prepaid funeral agreement having a
value of not more than ten thousand dollars ($10,000); or
(3) owns a life insurance policy with a face value of not more than
ten thousand dollars ($10,000) and with respect to which
provision is made to pay not more than ten thousand dollars
($10,000) toward the applicant's or recipient's funeral expenses;
the value of the trust, prepaid funeral agreement, or life insurance
policy may not be considered as a resource in determining the
applicant's or recipient's eligibility for Medicaid.
(b) (c) Subject to subsection (d), (e), if an applicant for or a
recipient of Medicaid establishes an irrevocable trust or escrow under
IC 30-2-13, the entire value of the trust or escrow may not be
considered as a resource in determining the applicant's or recipient's
eligibility for Medicaid.
(c) (d) Except as provided in IC 12-15-3-7, if an applicant for or a
recipient of Medicaid owns resources described in subsection (a) (b)
and the total value of those resources is more than ten thousand dollars
($10,000), the value of those resources that is more than ten thousand
dollars ($10,000) may be considered as a resource in determining the
applicant's or recipient's eligibility for Medicaid.
(d) (e) In order for a trust, an escrow, a life insurance policy, or a
prepaid funeral agreement to be exempt as a resource in determining
an applicant's or a recipient's eligibility for Medicaid under this section,
the applicant or recipient must designate the office or the applicant's or
recipient's estate to receive any remaining amounts after delivery of all
services and merchandise under the contract as reimbursement for
Medicaid assistance provided to the applicant or recipient after
fifty-five (55) years of age. The office may receive funds under this
subsection only to the extent permitted by 42 U.S.C. 1396p. The
computation of remaining amounts shall be made as of the date of
delivery of services and merchandise under the contract and must be
the excess, if any, derived from:
(1) growth in principal;
(2) accumulation and reinvestment of dividends;
(3) accumulation and reinvestment of interest; and
(4) accumulation and reinvestment of distributions;
on the applicant's or recipient's trust, escrow, life insurance policy, or
prepaid funeral agreement over and above the seller's current retail
price of all services, merchandise, and cash advance items set forth in
the applicant's or recipient's contract.
SOURCE: IC 12-15-2.3-10; (13)SB0551.1.5. -->
SECTION 5. IC 12-15-2.3-10 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 10. (a) If a woman
described in section 1 of this chapter:
(1) is determined to be presumptively eligible for Medicaid under
this chapter; and
(2) appoints, in writing, an agent of a qualified entity under
section 4 of this chapter as the woman's authorized representative
for purposes of completing all aspects of the Medicaid application
process;
the county office shall conduct any face-to-face interview that is
necessary to determine the woman's eligibility for Medicaid with the
woman's authorized representative.
(b) This section expires December 31, 2013.
SOURCE: IC 12-15-3-1; (13)SB0551.1.6. -->
SECTION 6. IC 12-15-3-1, AS AMENDED BY P.L.196-2011,
SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 1. (a) Except as provided in subsections (b) and
(c) and section 7 of this chapter, an applicant for or recipient of
Medicaid is ineligible for assistance if the total cash value of money,
stock, bonds, and life insurance owned by:
(1) the applicant or recipient is more than one thousand five
hundred dollars ($1,500) for assistance to the aged, blind, or
disabled; or
(2) the applicant or recipient and the applicant's or recipient's
spouse is more than two thousand two hundred fifty dollars
($2,250) for medical assistance to the aged, blind, or disabled.
(b) In the case of an applicant who is an eligible individual, a
Holocaust victim's settlement payment received by the applicant or the
applicant's spouse may not be considered when calculating the total
cash value of money, stock, bonds, and life insurance owned by the
applicant or the applicant's spouse.
(c) In the case of an individual who:
(1) resides in a nursing facility or another medical institution; and
(2) has a spouse who does not reside in a nursing facility or
another medical institution;
the total cash value of money, stock, bonds, and life insurance that may
be owned by the couple to be eligible for the program is determined
under IC 12-15-2-24.
(d) This section expires December 31, 2013.
SOURCE: IC 12-15-3-1.5; (13)SB0551.1.7. -->
SECTION 7. IC 12-15-3-1.5 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2013]: Sec. 1.5. (a) Beginning January 1, 2014, the office shall
determine eligibility for a Medicaid applicant or Medicaid
recipient who is aged, blind, or disabled under IC 12-15-2-3.5.
(b) If an individual:
(1) resides in a nursing facility or another medical institution;
and
(2) has a spouse who does not reside in a nursing facility or
another medical institution;
the total cash value of money, stock, bonds, and life insurance that
may be owned by the couple to be eligible for Medicaid is
determined under IC 12-15-2-24.
SOURCE: IC 12-15-3-2; (13)SB0551.1.8. -->
SECTION 8. IC 12-15-3-2, AS AMENDED BY P.L.196-2011,
SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 2. (a) Except as provided in section 7 of this
chapter, if the parent of an applicant for or a recipient of assistance to
the blind or disabled who is less than eighteen (18) years of age owns
money, stock, bonds, and life insurance whose total cash value is more
than one thousand five hundred dollars ($1,500), the amount of the
excess shall be added to the total cash value of money, stock, bonds,
and life insurance owned by the applicant or recipient to determine the
recipient's eligibility for Medicaid under section 1 of this chapter.
(b) However, a Holocaust victim's settlement payment received by
the parent of an applicant for or a recipient of assistance may not be
added to the total cash value of money, stock, bonds, and life insurance
owned by the applicant or recipient to determine the recipient's
eligibility for Medicaid under section 1 of this chapter.
(c) This section expires December 31, 2013.
SOURCE: IC 12-15-3-3; (13)SB0551.1.9. -->
SECTION 9. IC 12-15-3-3, AS AMENDED BY P.L.196-2011,
SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 3. (a) Except as provided in section 7 of this
chapter, if the parents of an applicant for or a recipient of assistance to
the blind or disabled who is less than eighteen (18) years of age own
money, stock, bonds, and life insurance whose total cash value is more
than two thousand two hundred fifty dollars ($2,250), the amount of the
excess shall be added to the total cash value of money, stock, bonds,
and life insurance owned by the applicant or recipient to determine the
recipient's eligibility for Medicaid under section 1 of this chapter.
(b) This section expires December 31, 2013.
SOURCE: IC 12-15-44.2-9; (13)SB0551.1.10. -->
SECTION 10. IC 12-15-44.2-9, AS AMENDED BY P.L.160-2011,
SECTION 9, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 9. (a) An individual is eligible for participation in
the plan if the individual meets the following requirements:
(1) The individual is at least eighteen (18) years of age and less
than sixty-five (65) years of age.
(2) The individual is a United States citizen and has been a
resident of Indiana for at least twelve (12) months.
(3) The individual has an annual household income of not more
than the following:
(A) Effective through December 31, 2013, two hundred
percent (200%) of the federal income poverty level.
(B) Beginning January 1, 2014, one hundred thirty-three
percent (133%) of the federal income poverty level, based on
the adjusted gross income provisions set forth in Section
2001(a)(1) of the federal Patient Protection and Affordable
Care Act.
(4) Effective through December 31, 2013, the individual is not
eligible for health insurance coverage through the individual's
employer.
(5) Effective through December 31, 2013, the individual has:
(A) not had health insurance coverage for at least six (6)
months; or
(B) had coverage under the Indiana comprehensive health
insurance association (IC 27-8-10) within the immediately
preceding six (6) months and the coverage no longer
applies under IC 27-8-10-0.5.
(b) The following individuals are not eligible for the plan:
(1) An individual who participates in the federal Medicare
program (42 U.S.C. 1395 et seq.).
(2) A pregnant woman for purposes of pregnancy related services.
(3) An individual who is otherwise eligible for medical assistance.
(c) The eligibility requirements specified in subsection (a) are
subject to approval for federal financial participation by the United
States Department of Health and Human Services.
SOURCE: IC 12-15-46-1; (13)SB0551.1.11. -->
SECTION 11. IC 12-15-46-1, AS ADDED BY P.L.6-2012,
SECTION 95, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 1. (a) As used in this section, "family planning
services" does not include the performance of abortions or the use of
a drug or device intended to terminate fertilization.
(b) As used in this section, "fertilization" means the joining of a
human egg cell with a human sperm cell.
(c) As used in this section, "state plan amendment" refers to an
amendment to Indiana's Medicaid State Plan as authorized by Section
1902(a)(10)(A)(ii)(XXI) of the federal Social Security Act (42 U.S.C.
1315).
(d) Before January 1, 2012, 2014, the office shall do the following:
(1) Apply to the United States Department of Health and Human
Services for approval of a state plan amendment to expand the
population eligible for family planning services and supplies as
permitted by Section 1902(a)(10)(A)(ii)(XXI) of the federal
Social Security Act (42 U.S.C. 1315). In determining what
population is eligible, for this expansion, the state must
incorporate the following:
(A) Inclusion of women and men.
(B) Setting income eligibility at one hundred thirty-three
percent (133%) of the federal income poverty level.
(C) Adopting presumptive eligibility for services to this
population.
(2) Consider the inclusion of additional:
(A) medical diagnosis; and
(B) treatment services;
that are provided for family planning services in a family planning
setting for the population designated in subdivision (1) in the state
plan amendment.
(e) The office shall report concerning its proposed state plan
amendment to the select joint commission on Medicaid oversight
established by IC 2-5-26-3 during the commission's 2011 interim
meetings. The select joint commission on Medicaid oversight shall
review the proposed state plan amendment and may make an advisory
recommendation to the office concerning the proposed state plan
amendment.
(f) (e) The office may adopt rules under IC 4-22-2 to implement this
section.
(g) This section expires January 1, 2016.
SOURCE: IC 12-15-46-3; (13)SB0551.1.12. -->
SECTION 12. IC 12-15-46-3 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 3. (a) The office of the
secretary has the authority to negotiate with the United States
Department of Health and Human Services for amendments to the
state Medicaid plan or for any Medicaid waivers necessary to
establish a block grant system for providing services under the
Medicaid program, including providing coverage for individuals
described in 42 U.S.C. 1396a(a)(10)(A)(i)(VIII).
(b) A waiver or state plan amendment negotiated under this
section must include the following:
(1) Allow the office to withdraw from participating in a
program negotiated under this section at any time.
(2) Include federal financial participation at least at the levels
specified in the federal Patient Protection and Affordable
Care Act.
(3) Include, when appropriate, consumer driven principles.
(4) Include coverage for preventative care services provided
at no cost to the recipient and allow incentives for increasing
preventative care for recipients.
(5) Allow for personal responsibility requirements.
(6) Require a recipient to make out-of-pocket payments
related to coverage for health care expenses provided under
the program.
(7) Require a health care account to be used to pay the
recipient's out-of-pocket health care expenses associated with
health care coverage provided as part of the recipient's
participation in the program described in this section.
(8) Include health care initiatives designed to promote the
general health and well being of recipients and encourage an
understanding of the cost and quality of care.
(c) The office of the secretary may not implement a waiver or
Medicaid state plan amendment negotiated under this section until
the office of the secretary has developed a sustainable financing
plan for the Medicaid state plan amendment or waiver.
SOURCE: IC 12-15-46-5; (13)SB0551.1.13. -->
SECTION 13. IC 12-15-46-5 IS ADDED TO THE INDIANA
CODE AS A
NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2013]:
Sec. 5. (a) The office shall apply to the
United States Department of Health and Human Services for an
amendment to the state Medicaid plan to require Medicaid
recipients to participate in cost sharing, as allowable under federal
law.
( b) The office may not implement the state plan amendment
described in this section until the office files an affidavit with the
governor attesting that the state plan amendment applied for
under this section has been approved by the United States
Department of Health and Human Services. The office shall file the
affidavit under this subsection not later than five (5) days after the
office is notified that the state plan amendment described in this
section has been approved.
(c) The office may adopt rules under IC 4-22-2 necessary to
implement this section.
SOURCE: IC 27-1-3-7; (13)SB0551.1.14. -->
SECTION 14. IC 27-1-3-7 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 7. (a) The department
may promulgate rules and regulations for any of the following
enumerated purposes:
(1) For the conduct of the work of the department.
(2) Prescribing the methods and standards to be used in making
the examinations and prescribing the forms of reports of the
several insurance companies to which IC 27-1 is applicable.
(3) Defining what is a safe or an unsafe manner and a safe or an
unsafe condition for conducting business by any insurance
company to which IC 27-1 is applicable.
(4) For the establishment of safe and sound methods for the
transaction of business by such insurance companies and for the
purpose of safeguarding the interests of policyholders, creditors,
and shareholders respecting the withdrawal or payment of funds
by any life insurance company in times of emergency. Any rule or
regulation promulgated under this subdivision may apply to one
(1) or more insurance companies as the department may
determine.
(5) For the administration and termination of the affairs of any
such insurance company which is in involuntary liquidation or
whose business and property have been taken possession of by the
department for the purpose of rehabilitation, liquidation,
conservation, or dissolution under IC 27-1.
(6) For the regulation of the solicitation or use of proxies, in
general and as they concern consents or authorizations, in respect
of securities issued by any domestic stock company for the
purpose of protecting investors by prescribing the form of proxies,
including such consents or authorizations, and by requiring
adequate disclosure of information relevant to such proxies,
including such consents or authorizations, and relevant to the
business to be transacted at any meeting of shareholders with
respect to which such proxies, including such consents or
authorizations, may be used, which regulations may, in general,
conform to those prescribed by the National Association of
Insurance Commissioners.
(7) For regulation related to a health benefit exchange
established under the federal Patient Protection and
Affordable Care Act (P.L. 111-148), as amended by the
federal Health Care and Education Reconciliation Act of 2010
(P.L. 111-152), and operating in Indiana.
(b) The department may adopt a rule under IC 4-22-2 to provide
reasonable simplification of the terms and coverage of individual and
group Medicare supplement accident and sickness insurance policies
and individual and group Medicare supplement subscriber contracts in
order to facilitate public understanding and comparison and to
eliminate provisions contained in those policies or contracts which may
be misleading or confusing in connection either with the purchase of
those coverages or with the settlement of claims and to provide for full
disclosure in the sale of those coverages.
SOURCE: IC 27-1-3-10.5; (13)SB0551.1.15. -->
SECTION 15. IC 27-1-3-10.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 10.5. (a) As used in this
section, "confidential information" means information that has been
designated as confidential by statute, rule, or regulation issued under
a statute.
(b) The commissioner may not:
(1) disclose; or
(2) subject to subpoena;
financial information regarding material transactions disclosed by an
insurer under IC 27-2-18.
(c) The commissioner may not disclose any information, including
any document or report received from:
(1) the National Association of Insurance Commissioners; or
(2) an insurance department of another state;
if the information is designated as confidential information in the other
jurisdiction.
(d) The commissioner may share confidential information with:
(1) the National Association of Insurance Commissioners; or
(2) an insurance department of another state;
on the condition that the National Association of Insurance
Commissioners and the other state agree to maintain the same level of
confidentiality that is provided to the information under Indiana law.
(e) The commissioner may share confidential information
related to a health benefit exchange established under the federal
Patient Protection and Affordable Care Act (P.L. 111-148), as
amended by the federal Health Care and Education Reconciliation
Act of 2010 (P.L. 111-152), with the health benefit exchange if the
health benefit exchange:
(1) agrees to maintain the same level of confidentiality that is
provided to the confidential information under Indiana law;
and
(2) complies with all applicable confidentiality requirements
under federal law.
SOURCE: IC 27-4-1-4; (13)SB0551.1.16. -->
SECTION 16. IC 27-4-1-4, AS AMENDED BY P.L.67-2011,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 4. (a) The following are hereby defined as unfair
methods of competition and unfair and deceptive acts and practices in
the business of insurance:
(1) Making, issuing, circulating, or causing to be made, issued, or
circulated, any estimate, illustration, circular, or statement:
(A) misrepresenting the terms of any policy issued or to be
issued or the benefits or advantages promised thereby or the
dividends or share of the surplus to be received thereon;
(B) making any false or misleading statement as to the
dividends or share of surplus previously paid on similar
policies;
(C) making any misleading representation or any
misrepresentation as to the financial condition of any insurer,
or as to the legal reserve system upon which any life insurer
operates;
(D) using any name or title of any policy or class of policies
misrepresenting the true nature thereof; or
(E) making any misrepresentation to any policyholder insured
in any company for the purpose of inducing or tending to
induce such policyholder to lapse, forfeit, or surrender the
policyholder's insurance.
(2) Making, publishing, disseminating, circulating, or placing
before the public, or causing, directly or indirectly, to be made,
published, disseminated, circulated, or placed before the public,
in a newspaper, magazine, or other publication, or in the form of
a notice, circular, pamphlet, letter, or poster, or over any radio or
television station, or in any other way, an advertisement,
announcement, or statement containing any assertion,
representation, or statement with respect to any person in the
conduct of the person's insurance business, which is untrue,
deceptive, or misleading.
(3) Making, publishing, disseminating, or circulating, directly or
indirectly, or aiding, abetting, or encouraging the making,
publishing, disseminating, or circulating of any oral or written
statement or any pamphlet, circular, article, or literature which is
false, or maliciously critical of or derogatory to the financial
condition of an insurer, and which is calculated to injure any
person engaged in the business of insurance.
(4) Entering into any agreement to commit, or individually or by
a concerted action committing any act of boycott, coercion, or
intimidation resulting or tending to result in unreasonable
restraint of, or a monopoly in, the business of insurance.
(5) Filing with any supervisory or other public official, or making,
publishing, disseminating, circulating, or delivering to any person,
or placing before the public, or causing directly or indirectly, to
be made, published, disseminated, circulated, delivered to any
person, or placed before the public, any false statement of
financial condition of an insurer with intent to deceive. Making
any false entry in any book, report, or statement of any insurer
with intent to deceive any agent or examiner lawfully appointed
to examine into its condition or into any of its affairs, or any
public official to which such insurer is required by law to report,
or which has authority by law to examine into its condition or into
any of its affairs, or, with like intent, willfully omitting to make a
true entry of any material fact pertaining to the business of such
insurer in any book, report, or statement of such insurer.
(6) Issuing or delivering or permitting agents, officers, or
employees to issue or deliver, agency company stock or other
capital stock, or benefit certificates or shares in any common law
corporation, or securities or any special or advisory board
contracts or other contracts of any kind promising returns and
profits as an inducement to insurance.
(7) Making or permitting any of the following:
(A) Unfair discrimination between individuals of the same
class and equal expectation of life in the rates or assessments
charged for any contract of life insurance or of life annuity or
in the dividends or other benefits payable thereon, or in any
other of the terms and conditions of such contract. However,
in determining the class, consideration may be given to the
nature of the risk, plan of insurance, the actual or expected
expense of conducting the business, or any other relevant
factor.
(B) Unfair discrimination between individuals of the same
class involving essentially the same hazards in the amount of
premium, policy fees, assessments, or rates charged or made
for any policy or contract of accident or health insurance or in
the benefits payable thereunder, or in any of the terms or
conditions of such contract, or in any other manner whatever.
However, in determining the class, consideration may be given
to the nature of the risk, the plan of insurance, the actual or
expected expense of conducting the business, or any other
relevant factor.
(C) Excessive or inadequate charges for premiums, policy
fees, assessments, or rates, or making or permitting any unfair
discrimination between persons of the same class involving
essentially the same hazards, in the amount of premiums,
policy fees, assessments, or rates charged or made for:
(i) policies or contracts of reinsurance or joint reinsurance,
or abstract and title insurance;
(ii) policies or contracts of insurance against loss or damage
to aircraft, or against liability arising out of the ownership,
maintenance, or use of any aircraft, or of vessels or craft,
their cargoes, marine builders' risks, marine protection and
indemnity, or other risks commonly insured under marine,
as distinguished from inland marine, insurance; or
(iii) policies or contracts of any other kind or kinds of
insurance whatsoever.
However, nothing contained in clause (C) shall be construed to
apply to any of the kinds of insurance referred to in clauses (A)
and (B) nor to reinsurance in relation to such kinds of insurance.
Nothing in clause (A), (B), or (C) shall be construed as making or
permitting any excessive, inadequate, or unfairly discriminatory
charge or rate or any charge or rate determined by the department
or commissioner to meet the requirements of any other insurance
rate regulatory law of this state.
(8) Except as otherwise expressly provided by law, knowingly
permitting or offering to make or making any contract or policy
of insurance of any kind or kinds whatsoever, including but not in
limitation, life annuities, or agreement as to such contract or
policy other than as plainly expressed in such contract or policy
issued thereon, or paying or allowing, or giving or offering to pay,
allow, or give, directly or indirectly, as inducement to such
insurance, or annuity, any rebate of premiums payable on the
contract, or any special favor or advantage in the dividends,
savings, or other benefits thereon, or any valuable consideration
or inducement whatever not specified in the contract or policy; or
giving, or selling, or purchasing or offering to give, sell, or
purchase as inducement to such insurance or annuity or in
connection therewith, any stocks, bonds, or other securities of any
insurance company or other corporation, association, limited
liability company, or partnership, or any dividends, savings, or
profits accrued thereon, or anything of value whatsoever not
specified in the contract. Nothing in this subdivision and
subdivision (7) shall be construed as including within the
definition of discrimination or rebates any of the following
practices:
(A) Paying bonuses to policyholders or otherwise abating their
premiums in whole or in part out of surplus accumulated from
nonparticipating insurance, so long as any such bonuses or
abatement of premiums are fair and equitable to policyholders
and for the best interests of the company and its policyholders.
(B) In the case of life insurance policies issued on the
industrial debit plan, making allowance to policyholders who
have continuously for a specified period made premium
payments directly to an office of the insurer in an amount
which fairly represents the saving in collection expense.
(C) Readjustment of the rate of premium for a group insurance
policy based on the loss or expense experience thereunder, at
the end of the first year or of any subsequent year of insurance
thereunder, which may be made retroactive only for such
policy year.
(D) Paying by an insurer or insurance producer thereof duly
licensed as such under the laws of this state of money,
commission, or brokerage, or giving or allowing by an insurer
or such licensed insurance producer thereof anything of value,
for or on account of the solicitation or negotiation of policies
or other contracts of any kind or kinds, to a broker, an
insurance producer, or a solicitor duly licensed under the laws
of this state, but such broker, insurance producer, or solicitor
receiving such consideration shall not pay, give, or allow
credit for such consideration as received in whole or in part,
directly or indirectly, to the insured by way of rebate.
(9) Requiring, as a condition precedent to loaning money upon the
security of a mortgage upon real property, that the owner of the
property to whom the money is to be loaned negotiate any policy
of insurance covering such real property through a particular
insurance producer or broker or brokers. However, this
subdivision shall not prevent the exercise by any lender of the
lender's right to approve or disapprove of the insurance company
selected by the borrower to underwrite the insurance.
(10) Entering into any contract, combination in the form of a trust
or otherwise, or conspiracy in restraint of commerce in the
business of insurance.
(11) Monopolizing or attempting to monopolize or combining or
conspiring with any other person or persons to monopolize any
part of commerce in the business of insurance. However,
participation as a member, director, or officer in the activities of
any nonprofit organization of insurance producers or other
workers in the insurance business shall not be interpreted, in
itself, to constitute a combination in restraint of trade or as
combining to create a monopoly as provided in this subdivision
and subdivision (10). The enumeration in this chapter of specific
unfair methods of competition and unfair or deceptive acts and
practices in the business of insurance is not exclusive or
restrictive or intended to limit the powers of the commissioner or
department or of any court of review under section 8 of this
chapter.
(12) Requiring as a condition precedent to the sale of real or
personal property under any contract of sale, conditional sales
contract, or other similar instrument or upon the security of a
chattel mortgage, that the buyer of such property negotiate any
policy of insurance covering such property through a particular
insurance company, insurance producer, or broker or brokers.
However, this subdivision shall not prevent the exercise by any
seller of such property or the one making a loan thereon of the
right to approve or disapprove of the insurance company selected
by the buyer to underwrite the insurance.
(13) Issuing, offering, or participating in a plan to issue or offer,
any policy or certificate of insurance of any kind or character as
an inducement to the purchase of any property, real, personal, or
mixed, or services of any kind, where a charge to the insured is
not made for and on account of such policy or certificate of
insurance. However, this subdivision shall not apply to any of the
following:
(A) Insurance issued to credit unions or members of credit
unions in connection with the purchase of shares in such credit
unions.
(B) Insurance employed as a means of guaranteeing the
performance of goods and designed to benefit the purchasers
or users of such goods.
(C) Title insurance.
(D) Insurance written in connection with an indebtedness and
intended as a means of repaying such indebtedness in the
event of the death or disability of the insured.
(E) Insurance provided by or through motorists service clubs
or associations.
(F) Insurance that is provided to the purchaser or holder of an
air transportation ticket and that:
(i) insures against death or nonfatal injury that occurs during
the flight to which the ticket relates;
(ii) insures against personal injury or property damage that
occurs during travel to or from the airport in a common
carrier immediately before or after the flight;
(iii) insures against baggage loss during the flight to which
the ticket relates; or
(iv) insures against a flight cancellation to which the ticket
relates.
(14) Refusing, because of the for-profit status of a hospital or
medical facility, to make payments otherwise required to be made
under a contract or policy of insurance for charges incurred by an
insured in such a for-profit hospital or other for-profit medical
facility licensed by the state department of health.
(15) Refusing to insure an individual, refusing to continue to issue
insurance to an individual, limiting the amount, extent, or kind of
coverage available to an individual, or charging an individual a
different rate for the same coverage, solely because of that
individual's blindness or partial blindness, except where the
refusal, limitation, or rate differential is based on sound actuarial
principles or is related to actual or reasonably anticipated
experience.
(16) Committing or performing, with such frequency as to
indicate a general practice, unfair claim settlement practices (as
defined in section 4.5 of this chapter).
(17) Between policy renewal dates, unilaterally canceling an
individual's coverage under an individual or group health
insurance policy solely because of the individual's medical or
physical condition.
(18) Using a policy form or rider that would permit a cancellation
of coverage as described in subdivision (17).
(19) Violating IC 27-1-22-25, IC 27-1-22-26, or IC 27-1-22-26.1
concerning motor vehicle insurance rates.
(20) Violating IC 27-8-21-2 concerning advertisements referring
to interest rate guarantees.
(21) Violating IC 27-8-24.3 concerning insurance and health plan
coverage for victims of abuse.
(22) Violating IC 27-8-26 concerning genetic screening or testing.
(23) Violating IC 27-1-15.6-3(b) concerning licensure of
insurance producers.
(24) Violating IC 27-1-38 concerning depository institutions.
(25) Violating IC 27-8-28-17(c) or IC 27-13-10-8(c) concerning
the resolution of an appealed grievance decision.
(26) Violating IC 27-8-5-2.5(e) through IC 27-8-5-2.5(j) (expired
July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1,
2007, and repealed).
(27) Violating IC 27-2-21 concerning use of credit information.
(28) Violating IC 27-4-9-3 concerning recommendations to
consumers.
(29) Engaging in dishonest or predatory insurance practices in
marketing or sales of insurance to members of the United States
Armed Forces as:
(A) described in the federal Military Personnel Financial
Services Protection Act, P.L.109-290; or
(B) defined in rules adopted under subsection (b).
(30) Violating IC 27-8-19.8-20.1 concerning stranger originated
life insurance.
(31) Violating IC 27-2-22 concerning retained asset accounts.
(32) Violating IC 27-8-5-29 concerning health plans offered
through a health benefit exchange (as defined in
IC 27-19-2-8).
(33) Violating a requirement of the federal Patient Protection
and Affordable Care Act (P.L. 111-148), as amended by the
federal Health Care and Education Reconciliation Act of 2010
(P.L. 111-152), that is enforceable by the state.
(b) Except with respect to federal insurance programs under
Subchapter III of Chapter 19 of Title 38 of the United States Code, the
commissioner may, consistent with the federal Military Personnel
Financial Services Protection Act (P.L.109-290), adopt rules under
IC 4-22-2 to:
(1) define; and
(2) while the members are on a United States military installation
or elsewhere in Indiana, protect members of the United States
Armed Forces from;
dishonest or predatory insurance practices.
SOURCE: IC 27-8-5-1; (13)SB0551.1.17. -->
SECTION 17. IC 27-8-5-1, AS AMENDED BY P.L.160-2011,
SECTION 17, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 1. (a) The term "policy of accident and sickness
insurance", as used in this chapter, includes any policy or contract
covering one (1) or more of the kinds of insurance described in Class
1(b) or 2(a) of IC 27-1-5-1. Such policies may be on the individual
basis under this section and sections 2 through 9 of this chapter, on the
group basis under this section and sections 16 through 19 of this
chapter, on the franchise basis under this section and section 11 of this
chapter, or on a blanket basis under section 15 of this chapter and
(except as otherwise expressly provided in this chapter) shall be
exclusively governed by this chapter.
(b) No policy of accident and sickness insurance may be issued or
delivered to any person in this state, nor may any application, rider, or
endorsement be used in connection with an accident and sickness
insurance policy, until a copy of the form of the policy and of the
classification of risks and the premium rates, or, in the case of
assessment companies, the estimated cost pertaining thereto, have been
filed with and reviewed by the commissioner under section 1.5 of this
chapter. This section is applicable also to assessment companies and
fraternal benefit associations or societies.
(c) This chapter shall be applied in conformity with the
requirements of the federal Patient Protection and Affordable Care Act
(P.L. 111-148), as amended by the federal Health Care and Education
Reconciliation Act of 2010 (P.L. 111-152), as in effect on September
23, 2010.
(d) A policy of accident and sickness insurance that is issued or
delivered through a health benefit exchange established under the
federal Patient Protection and Affordable Care Act (P.L. 111-148),
as amended by the federal Health Care and Education
Reconciliation Act of 2010 (P.L. 111-152), is subject to the
requirements of this chapter. The commissioner may adopt rules
under IC 4-22-2 to implement this subsection, including rules
concerning:
(1) certification or decertification of a qualified health plan
(as defined in IC 27-19-2-15); and
(2) open enrollment.
SOURCE: IC 27-8-5-1.5; (13)SB0551.1.18. -->
SECTION 18. IC 27-8-5-1.5, AS AMENDED BY P.L.111-2008,
SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 1.5. (a) This section applies to a policy of accident
and sickness insurance issued on an individual, a group, a franchise, or
a blanket basis, including a policy issued by an assessment company or
a fraternal benefit society.
(b) As used in this section, "commissioner" refers to the insurance
commissioner appointed under IC 27-1-1-2.
(c) As used in this section, "grossly inadequate filing" means a
policy form filing:
(1) that fails to provide key information, including state specific
information, regarding a product, policy, or rate; or
(2) that demonstrates an insufficient understanding of applicable
legal requirements.
(d) As used in this section, "policy form" means a policy, a contract,
a certificate, a rider, an endorsement, an evidence of coverage, or any
amendment that is required by law to be filed with the commissioner
for approval before use in Indiana.
(e) As used in this section, "type of insurance" refers to a type of
coverage listed on the National Association of Insurance
Commissioners Uniform Life, Accident and Health, Annuity and Credit
Product Coding Matrix, or a successor document, under the heading
"Continuing Care Retirement Communities", "Health", "Long Term
Care", or "Medicare Supplement".
(f) Each person having a role in the filing process described in
subsection (i) shall act in good faith and with due diligence in the
performance of the person's duties.
(g) A policy form, including a policy form of a policy, contract,
certificate, rider, endorsement, evidence of coverage, or
amendment that is issued through a health benefit exchange (as
defined in IC 27-19-2-8), may not be issued or delivered in Indiana
unless the policy form has been filed with and approved by the
commissioner.
(h) The commissioner shall do the following:
(1) Create a document containing a list of all product filing
requirements for each type of insurance, with appropriate
citations to the law, administrative rule, or bulletin that specifies
the requirement, including the citation for the type of insurance
to which the requirement applies.
(2) Make the document described in subdivision (1) available on
the department of insurance Internet site.
(3) Update the document described in subdivision (1) at least
annually and not more than thirty (30) days following any change
in a filing requirement.
(i) The filing process is as follows:
(1) A filer shall submit a policy form filing that:
(A) includes a copy of the document described in subsection
(h);
(B) indicates the location within the policy form or supplement
that relates to each requirement contained in the document
described in subsection (h); and
(C) certifies that the policy form meets all requirements of
state law.
(2) The commissioner shall review a policy form filing and, not
more than thirty (30) days after the commissioner receives the
filing under subdivision (1):
(A) approve the filing; or
(B) provide written notice of a determination:
(i) that deficiencies exist in the filing; or
(ii) that the commissioner disapproves the filing.
A written notice provided by the commissioner under clause (B)
must be based only on the requirements set forth in the document
described in subsection (h) and must cite the specific
requirements not met by the filing. A written notice provided by
the commissioner under clause (B)(i) must state the reasons for
the commissioner's determination in sufficient detail to enable the
filer to bring the policy form into compliance with the
requirements not met by the filing.
(3) A filer may resubmit a policy form that:
(A) was determined deficient under subdivision (2) and has
been amended to correct the deficiencies; or
(B) was disapproved under subdivision (2) and has been
revised.
A policy form resubmitted under this subdivision must meet the
requirements set forth as described in subdivision (1) and must be
resubmitted not more than thirty (30) days after the filer receives
the commissioner's written notice of deficiency or disapproval. If
a policy form is not resubmitted within thirty (30) days after
receipt of the written notice, the commissioner's determination
regarding the policy form is final.
(4) The commissioner shall review a policy form filing
resubmitted under subdivision (3) and, not more than thirty (30)
days after the commissioner receives the resubmission:
(A) approve the resubmitted policy form; or
(B) provide written notice that the commissioner disapproves
the resubmitted policy form.
A written notice of disapproval provided by the commissioner
under clause (B) must be based only on the requirements set forth
in the document described in subsection (h), must cite the specific
requirements not met by the filing, and must state the reasons for
the commissioner's determination in detail. The commissioner's
approval or disapproval of a resubmitted policy form under this
subdivision is final, except that the commissioner may allow the
filer to resubmit a further revised policy form if the filer, in the
filer's resubmission under subdivision (3), introduced new
provisions or materially modified a substantive provision of the
policy form. If the commissioner allows a filer to resubmit a
further revised policy form under this subdivision, the filer must
resubmit the further revised policy form not more than thirty (30)
days after the filer receives notice under clause (B), and the
commissioner shall issue a final determination on the further
revised policy form not more than thirty (30) days after the
commissioner receives the further revised policy form.
(5) If the commissioner disapproves a policy form filing under
this subsection, the commissioner shall notify the filer, in writing,
of the filer's right to a hearing as described in subsection (m). A
disapproved policy form filing may not be used for a policy of
accident and sickness insurance unless the disapproval is
overturned in a hearing conducted under this subsection.
(6) If the commissioner does not take any action on a policy form
that is filed or resubmitted under this subsection in accordance
with any applicable period specified in subdivision (2), (3), or (4),
the policy form filing is considered to be approved.
(j) Except as provided in this subsection, the commissioner may not
disapprove a policy form resubmitted under subsection (i)(3) or (i)(4)
for a reason other than a reason specified in the original notice of
determination under subsection (i)(2)(B). The commissioner may
disapprove a resubmitted policy form for a reason other than a reason
specified in the original notice of determination under subsection (i)(2)
if:
(1) the filer has introduced a new provision in the resubmission;
(2) the filer has materially modified a substantive provision of the
policy form in the resubmission;
(3) there has been a change in requirements applying to the policy
form; or
(4) there has been reviewer error and the written disapproval fails
to state a specific requirement with which the policy form does
not comply.
(k) The commissioner may return a grossly inadequate filing to the
filer without triggering a deadline set forth in this section.
(l) The commissioner may disapprove a policy form if:
(1) the benefits provided under the policy form are not reasonable
in relation to the premium charged; or
(2) the policy form contains provisions that are unjust, unfair,
inequitable, misleading, or deceptive, or that encourage
misrepresentation of the policy.
(m) Upon disapproval of a filing under this section, the
commissioner shall provide written notice to the filer or insurer of the
right to a hearing within twenty (20) days of a request for a hearing.
(n) Unless a policy form approved under this chapter contains a
material error or omission, the commissioner may not:
(1) retroactively disapprove the policy form; or
(2) examine the filer of the policy form during a routine or
targeted market conduct examination for compliance with a policy
form filing requirement that was not in existence at the time the
policy form was filed.
SOURCE: IC 27-8-5-29; (13)SB0551.1.19. -->
SECTION 19. IC 27-8-5-29 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2013]: Sec. 29. (a) The definitions in IC 27-19-2 apply throughout
this section.
(b) A health plan may not be offered to any person in Indiana
through a health benefit exchange unless:
(1) the form of the policy, classification of risks, and premium
rates that apply to the health plan have been filed with and
reviewed and approved by the commissioner under this
chapter; and
(2) the insurer is authorized under this title to engage in the
business of insurance in Indiana.
(c) An insurer that offers a multistate health plan under Section
1334 of PPACA through a health benefit exchange shall file, for
review and approval, the form of the policy, classification of risks,
and premium rates that apply to the multistate health plan with the
commissioner and the federal government on the same business
day.
SOURCE: IC 27-8-10-0.5; (13)SB0551.1.20. -->
SECTION 20. IC 27-8-10-0.5 IS ADDED TO THE INDIANA
CODE AS A
NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]:
Sec. 0.5. (a) Except as provided in
this section, the insurance operations of the association cease on the
later of:
(1) the date on which a health benefit exchange (as defined in
IC 27-19-2-8) begins operating in Indiana; or
(2) December 31, 2013.
(b) A claim for payment under an association policy must be
made to the association not later than the later of:
(1) sixty (60) days after the date on which the insurance
operations cease under subsection (a); or
(2) March 1, 2014.
(c) An appeal or grievance under this chapter must be resolved
not later than ninety (90) days after the date on which the
insurance operations cease under subsection (a).
(d) Balance billing under this chapter by a health care provider
that is not a member of a health care provider network
arrangement used by the association is prohibited after the later
of:
(1) ninety (90) days after the date on which the insurance
operations cease under subsection (a); or
(2) March 30, 2014.
(e) The association shall, not later than June 30, 2013, submit to
the commissioner a plan of dissolution for the association. The
following apply to a plan of dissolution submitted under this
subsection:
(1) The plan of dissolution must provide for the following:
(A) Continuity of care for an individual who is covered
under an association policy and is an inpatient on the date
on which the insurance operations cease under subsection
(a).
(B) A final accounting described in section 2.1(g) of this
chapter of the:
(i) assessments; and
(ii) cessation of the liability;
of members of the association.
(C) Resolution of any net asset deficiency.
(D) Cessation of all liability of the association.
(E) Final dissolution of the association.
(2) The plan of dissolution may provide that, with the
approval of the board and the commissioner, a power or duty
of the association may be delegated to a person that is to
perform functions similar to the functions of the association.
(f) The commissioner shall, after notice and hearing, approve a
plan of dissolution submitted under subsection (e) if the
commissioner determines that the plan:
(1) is suitable to assure the fair, reasonable, and equitable
dissolution of the association; and
(2) complies with subsection (e).
(g) A plan of dissolution submitted under subsection (e) is
effective upon the written approval of the commissioner.
(h) An action by or against the association must be filed not
more than one (1) year after the date on which the insurance
operations cease under subsection (a).
(i) This chapter expires on the date on which final dissolution of
the association occurs under the plan of dissolution approved by
the commissioner under subsection (f).
(j) Funds remaining in the association on the date on which final
dissolution of the association occurs must be transferred into the
state general fund.
(k) The association, or the person to which the association
delegates powers under subsection (e), may implement this section
in accordance with the plan of dissolution approved by the
commissioner under subsection (f).
SOURCE: IC 27-19; (13)SB0551.1.21. -->
SECTION 21. IC 27-19 IS ADDED TO THE INDIANA CODE AS
A
NEW ARTICLE TO READ AS FOLLOWS [EFFECTIVE JULY 1,
2013]:
ARTICLE 19. HEALTH BENEFIT EXCHANGE
Chapter 1. General Provisions
Sec. 1. Except as otherwise provided in this title, a reference to
a federal law in this article is a reference to the federal law as in
effect on January 1, 2012.
Sec. 2. This article applies to a state agency with respect to the
state agency's interactions with a health benefit exchange operated
in Indiana.
Sec. 3. This article expires immediately upon the occurrence of
any of the following events:
(1) The complete repeal of PPACA.
(2) The repeal of the PPACA requirement that one (1) or
more health benefit exchanges be established in each state.
(3) Any other congressional action, or federal court decision,
rendering the establishment of a health benefit exchange
unnecessary.
(4) The issuance of an executive order by the governor
specifying that the establishment of a health benefit exchange
in Indiana is unnecessary or inappropriate.
Sec. 4. The commissioner may do the following to implement
this article:
(1) Adopt rules under IC 4-22-2.
(2) Enter into a contract, agreement, or memorandum of
understanding with the following:
(A) A health benefit exchange.
(B) An entity that contracts with, or is a subcontractor of,
a health benefit exchange.
(C) A federal or state agency.
(D) A health benefit exchange operating in another state.
(E) An agency of another state.
(F) A health plan.
(G) Another person, for purposes of the performance of
necessary functions, as determined by the commissioner.
(3) Enter with a person described in subdivision (2) into an
information sharing agreement:
(A) that concerns the disclosure and receiving of data
necessary to implement this article or PPACA; and
(B) that:
(i) includes adequate protections with respect to
confidentiality of the shared information; and
(ii) complies with applicable state and federal law.
Chapter 2. Definitions
Sec. 1. The definitions in this chapter apply throughout this
article.
Sec. 2. "Administrator" refers to the administrator of the office
of Medicaid policy and planning appointed under IC 12-8-6.5-2.
Sec. 3. (a) "Assister" means a person that:
(1) does not meet the standards established for a navigator
under Section 1311(i) of PPACA (42 U.S.C. 18031(i)); and
(2) performs the functions of a navigator with respect to a
health benefit exchange as established by the commissioner.
(b) The term does not include the following:
(1) A Medicaid authorized representative.
(2) A person that only provides assistance to consumers
regarding public assistance that is unrelated to an application
for participation in:
(A) Medicaid; or
(B) a health benefit exchange.
Sec. 4. "CHIP office" refers to the office of the children's health
insurance program established by IC 12-17.6-2-1.
Sec. 5. "Commissioner" refers to the insurance commissioner
appointed under IC 27-1-1-2.
Sec. 6. "Department" refers to the department of insurance
created by IC 27-1-1-1.
Sec. 7. "Group health plan" means a group health plan (as
defined in Section 2791 of the federal Public Health Service Act (42
U.S.C. 300gg-91)) that provides health insurance coverage.
Sec. 8. "Health benefit exchange" means an American health
benefit exchange operating in Indiana under PPACA.
Sec. 9. "Health insurance coverage" has the meaning set forth
in Section 2791 of the federal Public Health Service Act (42 U.S.C.
300gg-91).
Sec. 10. (a) "Health plan" means a policy or contract that
provides health insurance coverage.
(b) The term includes a group health plan.
Sec. 11. (a) "Navigator" means a person that:
(1) meets the grant funding requirements of Section 1311(i) of
PPACA (42 U.S.C. 18031(i)); and
(2) performs the functions of a navigator with respect to a
health benefit exchange as established by the commissioner.
(b) The term does not include the following:
(1) A Medicaid authorized representative.
(2) A person that only provides assistance to consumers
regarding public assistance that is unrelated to an application
for participation in:
(A) Medicaid; or
(B) a health benefit exchange.
Sec. 12. "Person" means an individual or an entity.
Sec. 13. "PPACA" refers to the federal Patient Protection and
Affordable Care Act (P.L. 111-148), as amended by the federal
Health Care and Education Reconciliation Act of 2010 (P.L.
111-152).
Sec. 14. (a) "Public health insurance program" refers to health
coverage provided under a state or federal government program.
(b) The term includes the following:
(1) Medicaid (42 U.S. C. 1396 et seq.).
(2) The Indiana check-up plan established by IC 12-15-44.2-3.
(3) The children's health insurance program established
under IC 12-17.6.
Sec. 15."Qualified health plan" means a health plan that has
been certified under Section 1301 of PPACA (42 U.S.C. 18021(a))
to meet the criteria for availability through a health benefit
exchange operated in Indiana.
Sec. 16. "Secretary" refers to the secretary of family and social
services appointed under IC 12-8-1.5-2.
Chapter 3. Health Benefit Exchange Authority
Sec. 1. This chapter applies to a health benefit exchange
operating in Indiana.
Sec. 2. (a) The commissioner and department may implement
and enforce the insurance law of this state in connection with a
health benefit exchange.
(b) A law of this state concerning a health benefit exchange does
not preempt or supersede the authority of the commissioner or
department to regulate the business of insurance in Indiana.
(c) This section does not require the department to perform any
function related to a health benefit exchange without being
appropriately compensated for the performance of the function.
Sec. 3. (a) The secretary, the administrator, and the CHIP office
may implement and enforce the social services law of this state in
connection with a health benefit exchange.
(b) A law of this state concerning a health benefit exchange does
not preempt or supersede the authority of the secretary, the
administrator, or the CHIP office to administer and regulate social
services in Indiana.
(c) This section does not require the secretary, the
administrator, or the CHIP office to perform any function related
to a health benefit exchange without being appropriately
compensated for the performance of the function.
(d) The secretary may adopt rules under IC 4-22-2 to implement
this section.
(e) The administrator and the CHIP office may do the following
to implement this section:
(1) Enter into a contract, agreement, or memorandum of
understanding with the following:
(A) A health benefit exchange.
(B) An entity that contracts with, or is a subcontractor of,
a health benefit exchange.
(C) A federal or state agency.
(D) A health benefit exchange operating in another state.
(E) An agency of another state.
(F) A health plan.
(2) Enter with a person described in subdivision (1) into an
information sharing agreement:
(A) that concerns the disclosure and receiving of data
necessary to implement this section or PPACA; and
(B) that:
(i) includes adequate protections with respect to
confidentiality of the shared information; and
(ii) complies with applicable state and federal law.
Chapter 4. Health Benefit Exchange Navigators and Assisters
Sec. 1. (a) This chapter applies to a person that acts as a
navigator or an assister for a health benefit exchange in Indiana.
This chapter must be applied in conformity with PPACA.
(b) An individual who intends to act as a navigator or an assister
shall obtain certification under this chapter before acting as a
navigator or an assister.
(c) An entity that intends to act as a navigator or an assister
shall obtain registration under this chapter before acting as a
navigator or an assister.
(d) An individual or entity that is a navigator or an assister is
subject to regulation by the commissioner and the secretary.
Sec. 2. A navigator or an assister is not subject to the licensing
requirements of IC 27-1-15.6.
Sec. 3. (a) A navigator or an assister must meet all of the
following:
(1) Shall not provide incorrect, misleading, incomplete, or
materially untrue information in an application for
certification or registration.
(2) Shall not violate any of the following:
(A) An insurance law.
(B) A regulation.
(C) A subpoena of the commissioner.
(D) An order of the commissioner.
(E) A rule of a health benefit exchange operating in
Indiana.
(F) A rule adopted under IC 27-19-3-3(d).
(3) Shall not intentionally misrepresent the terms of an actual
or proposed insurance contract or application for insurance.
(4) Must not have had:
(A) an insurance producer or consultant license;
(B) a navigator or an assister certification or registration;
or
(C) an equivalent to a license, certification, or registration
described in clause (A) or (B);
denied, suspended, or revoked in any state, province, district,
or territory.
(5) Shall not fail to satisfy the continuing education
requirements established under section 12 of this chapter.
(6) Shall not obtain or attempt to obtain a license,
certification, or registration through misrepresentation or
fraud.
(7) Shall not fail to disclose a conflict of interest to the
commissioner:
(A) in an application under this chapter; or
(B) arising after application is made under this chapter.
(8) Must not have been convicted of a felony or other crimes
determined by the commissioner or secretary.
(9) Must not have admitted to committing or have been found
to have committed an unfair trade practice or fraud in the
business of insurance.
(10) Shall not use fraudulent, coercive, or dishonest practices,
or demonstrate incompetence or untrustworthiness, in acting
as a navigator or an assister.
(11) Shall not improperly use notes or other reference
material to complete an examination for certification as a
navigator or an assister.
(12) Must not have failed, and shall not fail, to comply with an
administrative or court order imposing a child support
obligation.
(13) Must not have failed, and shall not fail, to pay state
income tax or comply with any administrative or court order
directing payment of state income tax.
(14) Shall not fail to timely inform the commissioner of a
change in legal name or address.
(15) If the navigator or assister is an entity, shall not fail to
verify that each navigator and assister who is an individual
working for the entity meets the following requirements:
(A) The navigator or assister is certified under this
chapter.
(B) The navigator or assister has not committed an act that
would be grounds for denial, suspension, or revocation of
certification under this chapter.
(b) The commissioner may:
(1) reprimand a navigator or an assister;
(2) levy a civil penalty against a navigator or an assister;
(3) place a navigator or an assister on probation;
(4) suspend a navigator's or an assister's certificate or
registration;
(5) revoke a navigator's or an assister's certificate or
registration for a period of years;
(6) permanently revoke a navigator's or an assister's
certificate or registration;
(7) issue a cease and desist order to a navigator or an assister;
or
(8) take any combination of the actions described in
subdivisions (1) through (7);
for a violation described in subsection (a).
Sec. 4. The commissioner shall, in consultation with the
secretary, do the following to implement this chapter:
(1) Develop a policy concerning conflicts of interest affecting
navigators and assisters, including conflicts of interest
involving financial and nonfinancial considerations.
(2) Develop a consumer complaint procedure and applicable
forms for filing a complaint.
(3) Define a reasonable period for the duration of navigator
or assister certification, after which the navigator or assister
must pay a renewal fee, complete continuing education, and
reapply for certification.
Sec. 5. (a) Before acting as a navigator or an assister in Indiana,
an individual must:
(1) apply for certification as a navigator or an assister on a
form prescribed by the commissioner; and
(2) declare, under penalty of denial, suspension, or revocation
of the certification, that the statements made in the
application are true, correct, and complete to the best of the
individual's knowledge and belief.
(b) Before approving an application submitted under subsection
(a), the commissioner shall determine whether the individual meets
the following requirements:
(1) The individual is at least eighteen (18) years of age.
(2) The individual has not committed any act described in
section 3 of this chapter that would be grounds for denial,
suspension, or revocation of certification.
(3) The individual has completed a precertification course of
study prescribed by the commissioner.
(4) The individual has paid the nonrefundable fees established
under section 7 of this chapter.
(5) The individual has successfully passed the examination
required by section 11 of this chapter.
Sec. 6. (a) Before acting as a navigator or assister in Indiana, an
entity must be registered as a navigator or an assister as follows:
(1) The entity must apply for registration as a navigator or an
assister on a form prescribed by the commissioner.
(2) The entity's application for registration:
(A) must be signed by an individual who is an owner,
partner, officer, director, member, or manager of the
entity, under penalty of denial, suspension, or revocation
of registration; and
(B) must declare that the statements made in the
application are true, correct, and complete to the best of
the signing individual's knowledge and belief.
(b) Before approving an application submitted under subsection
(a), the commissioner shall:
(1) verify that the entity is in good standing with the Indiana
secretary of state; and
(2) determine whether the entity meets the following
requirements:
(A) The entity has paid the nonrefundable fees established
under section 7 of this chapter.
(B) The entity has designated a certified individual
navigator or assister to be responsible for the entity's
compliance with this chapter.
(C) The entity has not committed any act described in
section 3 of this chapter that would be grounds for denial,
suspension, or revocation of registration.
(D) No owner, partner, officer, director, member, or
manager of the entity has committed an act described in
clause (C).
Sec. 7. (a) The commissioner may require the production of any
document that is reasonably necessary to verify the information
contained in an application submitted under section 5 or 6 of this
chapter.
(b) The commissioner shall collect from each applicant for
certification or registration under this chapter a nonrefundable
application fee established by the commissioner in an amount
expected to generate revenue sufficient to cover the costs incurred
by the commissioner in implementing this chapter.
Sec. 8. (a) An individual navigator or assister who works for an
entity that is a navigator or an assister must be appointed by the
entity in writing.
(b) If an entity, because of a violation described in section 3 of
this chapter, revokes the appointment of an individual navigator
or assister described in subsection (a) who works for the entity, the
entity shall, not more than thirty (30) days after the revocation
occurs:
(1) submit a written report to the commissioner concerning
the revocation; and
(2) provide a copy of the report to the individual at the
individual's last known address by:
(A) certified mail, return receipt requested, postage
prepaid; or
(B) overnight delivery using a nationally recognized
carrier.
Sec. 9. A certified individual navigator or assister who is unable
to comply with the certification renewal procedures under this
chapter due to military service or another extenuating
circumstance may request from the commissioner:
(1) a temporary waiver of:
(A) the renewal procedure; or
(B) an examination requirement; or
(2) a waiver of a penalty or sanction that might otherwise be
imposed for failure to comply with the renewal procedures.
Sec. 10. (a) A navigator or an assister certification or
registration must contain the navigator's or assister's name and
address, the date of issuance, the expiration date, and any other
information the commissioner considers necessary.
(b) A navigator or an assister shall inform the commissioner of
a change of address or legal name:
(1) not more than thirty (30) days after the change occurs;
and
(2) by any means acceptable to the commissioner.
Sec. 11. (a) An individual who applies for certification as a
navigator or an assister in Indiana must complete a course of study
and pass a written examination as prescribed by the commissioner
in consultation with the secretary.
(b) The course of study required under subsection (a) must
provide instruction in:
(1) the functions of a health benefit exchange;
(2) the duties and responsibilities of a navigator or an assister;
and
(3) the insurance laws of Indiana that apply to the functions
of a navigator or an assister with respect to a health benefit
exchange, including rules related to public health insurance
programs.
(c) The examination required by subsection (a) must test the
knowledge of the individual concerning the applicable:
(1) functions of a health benefit exchange;
(2) duties and responsibilities of a navigator or assister; and
(3) insurance laws of Indiana that apply to the functions of a
navigator or an assister with respect to a health benefit
exchange, including rules related to public health insurance
programs.
(d) The commissioner:
(1) in consultation with the secretary, shall develop a
curriculum for a course of study for navigators and assisters;
and
(2) may contract with a third party organization to:
(A) develop examinations and course materials;
(B) administer examinations and courses of study; and
(C) collect nonrefundable course and examination fees;
for the course of study for navigators and assisters.
(e) All examinations, course materials, and examination fees
referred to in subsection (d)(2) must be approved in advance by the
commissioner in consultation with the secretary.
Sec. 12. (a) The commissioner:
(1) in consultation with the secretary, shall develop continuing
education requirements for navigators and assisters; and
(2) may contract with a third party organization to:
(A) develop continuing education materials to meet the
requirements developed under subdivision (1);
(B) administer continuing education programs; and
(C) collect nonrefundable continuing education program
fees.
(b) All continuing education materials, programs, and fees
referred to in subsection (a)(2) must be approved in advance by the
commissioner in consultation with the secretary.
(c) The commissioner may require a navigator or an assister to
complete specific continuing education requirements, as prescribed
by the commissioner in consultation with the secretary, as a
prerequisite to the authority to perform specific functions with
respect to a health benefit exchange.
Sec. 13. An individual who fails to:
(1) appear for a scheduled examination required under
section 11(a) of this chapter; or
(2) pass the examination;
may not be rescheduled for the examination unless the individual
reapplies for the examination and remits all required fees and
forms.
Sec. 14. (a) An insurance producer or insurance consultant:
(1) may not act as a navigator or an assister unless the
insurance producer or insurance consultant has completed the
continuing education requirements that apply to a navigator
or an assister; and
(2) shall receive a designation from the commissioner as a
navigator or an assister upon completion of the continuing
education requirements;
under this chapter.
(b) The commissioner may require an insurance producer or
insurance consultant to complete specific continuing education
requirements, as prescribed by the commissioner in consultation
with the secretary, as a prerequisite to the authority to perform
specific functions with respect to a health benefit exchange.
SOURCE: ; (13)SB0551.1.22. -->
SECTION 22. [EFFECTIVE JULY 1, 2013] (a) As used in this
SECTION, "commission" refers to the health finance commission
established by IC 2-5-23-3.
(b) Before August 1, 2013, the office of Medicaid policy and
planning shall present a plan to the Indiana general assembly and
the commission concerning the following:
(1) Whether to require a Medicaid recipient who is eligible for
Medicaid based on the individual's aged, blind, or disabled
status to enroll in the risk-based managed care program.
(2) How to address the provision of health care for the
following populations:
(A) Individuals who currently participate in the Indiana
check-up plan (IC 12-15-44.2).
(B) Individuals who are dually eligible for the federal
Medicare program (42 U.S.C. 1395 et seq.) and the
Medicaid program (IC 12-15).
(3) Information concerning the number of individuals
participating in a program described in subdivision (2)(A) and
(2)(B) who would be eligible for a tax credit under the federal
Patient Protection and Affordable Care Act (P.L. 111-148).
(c) This SECTION expires December 31, 2013.
SOURCE: ; (13)SB0551.1.23. -->
SECTION 23. [EFFECTIVE UPON PASSAGE] (a) As used in this
SECTION, "Affordable Care Act" refers to the federal Patient
Protection and Affordable Care Act (P.L. 111-148), as amended by
the federal Health Care and Education Reconciliation Act of 2010
(P.L. 111-152).
(b) As used in this SECTION, "commission" refers to the health
finance commission established by IC 2-5-23-3.
(c) As used in this SECTION, "exchange" refers to an American
health benefit exchange established under the Affordable Care Act.
(d) Before August 1, 2013, the department of insurance, the
office of the secretary of family and social services, and the state
department of health shall work together to prepare a report for
the commission concerning the following:
(1) The establishment and implementation of an exchange in
Indiana.
(2) The definition of "essential health benefits" for use in
Indiana under the Affordable Care Act, including ensuring
that the definition results in adequate benefits.
(e) This chapter expires December 31, 2013.
SOURCE: ; (13)SB0551.1.24. -->
SECTION 24.
An emergency is declared for this act.