Indiana § 27-1-37-8 Prohibited contract provisions; severable and void; investigative
demand by attorney general

Indiana Statutes

§ 27-1-37-8 — Prohibited contract provisions; severable and void; investigative demand by attorney general

Indiana·Title 27 INSURANCE·Art. 1 DEPARTMENT OF INSURANCE·Ch. 37 Health Provider Contracts

(a)This section applies to a health provider contract entered into, amended, or renewed after June 30, 2025.

(b)A health provider contract, including a contract with a pharmacy benefit manager, may not contain a provision that does any of the following:

(1)Limits the ability of the health carrier, the health provider facility, or the provider to disclose the allowed amount and fees of services to any insured (as defined in IC 27-8-5.8-3) or enrollee (as defined in IC 27-13-1-12), or to the treating health provider facility or provider of the insured or enrollee.

(2)Limits the ability of the health carrier, the health provider facility, or the provider to disclose out-of-pocket costs to an insured (as defined in IC 27-8-5.8-3) or an enrollee (as defined in IC 27-13-1-12).

(3)Limits the

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(a) This section applies to a health provider
contract entered into, amended, or renewed after June 30, 2025.
(b) A health provider contract, including a contract with a pharmacy
benefit manager, may not contain a provision that does any of the
following:
(1) Limits the ability of the health carrier, the health provider
facility, or the provider to disclose the allowed amount and fees
of services to any insured (as defined in IC 27-8-5.8-3) or enrollee
(as defined in IC 27-13-1-12), or to the treating health provider
facility or provider of the insured or enrollee.
(2) Limits the ability of the health carrier, the health provider
facility, or the provider to disclose out-of-pocket costs to an
insured (as defined in IC 27-8-5.8-3) or an enrollee (as defined in
IC 27-13-1-12).
(3) Limits the ability of the health carrier to introduce or modify
a select network plan or tiered network plan by granting the
provider a guaranteed right of participation.
(4) Requires the health carrier to place all facilities in the same
tier of a tiered network plan.
(5) Requires the health carrier to include all facilities in a select
network plan on an all-or-nothing basis.
(6) Requires a provider to participate in a new select network or
tiered network plan that the health carrier introduces without
granting the provider the right to opt out of the new plan at least
sixty (60) days before the new plan is submitted to the
commissioner for approval.
(c) Any provision of a health provider contract that includes a
provision described in subsection (b) in violation of this section is
severable and the provision in violation is null and void. The remaining
provisions of the health provider contract, excluding the provision in
violation of this section, remain in effect and are enforceable.
(d) The attorney general may issue a civil investigative demand to
obtain information from a party of, or pertaining to, a health provider
contract and compliance of this section.

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