First Regular Session 117th General Assembly (2011)
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SENATE ENROLLED ACT No. 178
AN ACT concerning insurance.
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: ; (11)SE0178.1.1. -->
SECTION 1. [EFFECTIVE JULY 1, 2011]
(a) As used in this
SECTION, "enrollee" has the meaning set forth in IC 27-13-1-12.
(b) As used in this SECTION, "health maintenance
organization" has the meaning set forth in IC 27-13-1-19. The term
includes a pharmacy benefit manager.
(c) As used in this SECTION, "insured" means an individual
entitled to coverage under a policy of accident and sickness
insurance.
(d) As used in this SECTION, "insurer" means an insurer that
issues a policy of accident and sickness insurance. The term
includes a pharmacy benefit manager.
(e) As used in this SECTION, "policy of accident and sickness
insurance" has the meaning set forth in IC 27-8-5-1.
(f) As used in this SECTION, "subscriber" has the meaning set
forth in IC 27-13-1-32.
(g) As used in this SECTION, "substitution" means a
substitution of a treatment, including a drug, a device, or a
therapy, for the treatment ordered by an insured's or enrollee's
treating physician.
(h) The health finance commission established by IC 2-5-23-3
shall, during the 2011 interim of the general assembly, study the
following possible prohibitions on insurers and health maintenance
organizations related to outpatient benefits:
(1) Requesting a substitution from an insured's or enrollee's
treating physician.
(2) Contacting an insured, enrollee, or subscriber concerning
a substitution.
(3) Requesting from an insured's or enrollee's treating
physician a change in the quantity of a covered drug to be
dispensed.
(i) In studying the prohibitions described in subsection (h), the
health finance commission shall consider the following:
(1) The physician/patient relationship.
(2) The time and administrative costs related to unsolicited
requests and contacts from insurers.
(3) Whether such requests and contacts:
(A) are beneficial to the insured or enrollee; or
(B) should be limited or prohibited.
(j) This SECTION expires December 31, 2011.