§ 27-1-15.6-13.5 — Applicability; disclosure to policyholder or subscriber; acknowledgment; submission to all payer claims data base; examination

Indiana § 27-1-15.6-13.5

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 1: DEPARTMENT OF INSURANCE
• Ch. 15.6: Insurance Producers

Text

5. (a) This section applies only to the
following:
(1) An individual, group, franchise, or blanket policy of accident
and sickness insurance, as defined in IC 27-8-5-1. However, this
section does not apply to the types of insurance and coverage
described in IC 27-8-5-2.5(a).
(2) An individual or group health maintenance organization
contract entered into under IC 27-13.
(b) As used in this section, "third party administrator" means a
person who:
(1) is licensed under IC 27-1-25; and
(2) administers a policy of accident and sickness insurance
described in subsection (a)(1) or a health maintenance
organization contract described in subsection (a)(2).
(c) Except as provided in subsection (f), an insurer that issues an
insurance policy, a health maintenance organization that enters into a
health maintenance organization contract, or a third party administrator
shall disclose to the policyholder or subscriber in a separate written
notification:
(1) any commission, service fee, or brokerage fee that has been or
will be paid to an insurance producer for selling, soliciting, or
negotiating the policy or contract; and
(2) whether the amount disclosed under subdivision (1) is based
on a percentage of total plan premiums or a flat per member fee.
(d) An insurer, a health maintenance organization, or a third party
administrator shall provide a copy of the written notification described
in subsection (c) to the policyholder or subscriber:
(1) when the insurance policy is issued or the contract is entered
into; and
(2) each time the insurance policy or contract is renewed.
(e) Each copy of a written notification described in subsection (c)
must include a signature line on which the policyholder may sign to
acknowledge receiving the written notification.
(f) This section does not require the disclosure to the policyholder
of a commission, service fee, or brokerage fee in connection with the
issuance of an insurance policy if a federal law or regulation requires
disclosure of the commission, service fee, or brokerage fee to the
policyholder.
(g) An insurer, a health maintenance organization, and a third party
administrator shall submit the information described in subsection (c)
to the executive director of the all payer claims data base established
under IC 27-1-44.5 for inclusion in the data base.
(h) The department shall perform an examination under IC 27-1-3.1
for any alleged violation of this section.

Legislative History

As added by P.L.50-2020, SEC.4. Amended by P.L.216-2025, SEC.38.