Indiana § 27-1-46.5-11 Provision of claims data by third party administrator; compliance with
federal law; complaint process

Indiana Statutes

§ 27-1-46.5-11 — Provision of claims data by third party administrator; compliance with federal law; complaint process

Indiana § 27-1-46.5-11

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 46.5Direct to Employer Health Care Arrangements

This text of Indiana § 27-1-46.5-11 (Provision of claims data by third party administrator; compliance with federal law; complaint process) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ind. Code § 27-1-46.5-11 (2026).

Text

(a)Not later than thirty (30) days after a request by a contract holder of a direct to employer health care arrangement, a third party administrator that has contracted to administer a direct to employer health care arrangement shall provide claims data to the contract holder. The claims data must include the following:

(1)The effective date of coverage.

(2)The total number of covered individuals.

(3)The total monthly earned premium.

(4)The total monthly dollar value of paid claims, regardless of the period in which the claims were incurred.

(5)The:

(A)beginning and end date of the period for which claims were paid; and

(B)percentage of claims that were paid in:

(i)less than thirty (30) days;

(ii)thirty (30) days to sixty (60) days;

(iii)sixty-one (61) to ninety (90) days; and (

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(a) Not later than thirty (30) days after a
request by a contract holder of a direct to employer health care
arrangement, a third party administrator that has contracted to
administer a direct to employer health care arrangement shall provide
claims data to the contract holder. The claims data must include the
following:
(1) The effective date of coverage.
(2) The total number of covered individuals.
(3) The total monthly earned premium.
(4) The total monthly dollar value of paid claims, regardless of the
period in which the claims were incurred.
(5) The:
(A) beginning and end date of the period for which claims were
paid; and
(B) percentage of claims that were paid in:
(i) less than thirty (30) days;
(ii) thirty (30) days to sixty (60) days;
(iii) sixty-one (61) to ninety (90) days; and
(iv) over ninety (90) days.
(6) The reserve value as of the beginning of the period and the
reserve value as of the date through which the paid claims data
was obtained.
(7) A description of each large or catastrophic claim exceeding
fifty thousand dollars ($50,000), including:
(A) the diagnosis;
(B) the dollar amount of the claim;
(C) whether the claim is opened or closed; and
(D) the length of time the claim was open.
(8) Any other claims data requested by the contract holder.
(b) Information provided under this section must be provided in
accordance with the federal Health Insurance Portability and
Accountability Act, including 45 CFR Part 160 and Part 164, Subparts
A and E.
(c) Before January 1, 2026, the department shall establish a process
for a contract holder of a direct to employer health care arrangement to
file a complaint with the department that a third party administrator
violated this section. The department shall conduct an examination
under IC 27-1-3.1 upon receiving a complaint under this subsection.