Indiana § 27-1-46.5-9 Offer of a direct to employer health care arrangement by Indiana
nonprofit hospital system; benchmark; requirements; audit; assessment

Indiana Statutes

§ 27-1-46.5-9 — Offer of a direct to employer health care arrangement by Indiana nonprofit hospital system; benchmark; requirements; audit; assessment

Indiana § 27-1-46.5-9

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 46.5Direct to Employer Health Care Arrangements

This text of Indiana § 27-1-46.5-9 (Offer of a direct to employer health care arrangement by Indiana nonprofit hospital system; benchmark; requirements; audit; assessment) 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 § 27-1-46.5-9 (2026).

Text

(a)Beginning September 1, 2025, an Indiana nonprofit hospital system shall offer a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare.

(b)The benchmark described in subsection (a) shall be calculated by taking the sum of:

(1)hospital inpatient facility prices; and

(2)hospital outpatient facility prices; expressed as a percentage of full Medicare.

(c)An Indiana nonprofit hospital system meets the requirements of subsection (a) by doing any of the following:

(1)Offering a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare at each individual hospital within the Indiana nonprofit hospital system.

(2)Offering a direct to employer health

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(a) Beginning September 1, 2025, an Indiana
nonprofit hospital system shall offer a direct to employer health care
arrangement that is at or below a benchmark of two hundred sixty
percent (260%) of full Medicare.
(b) The benchmark described in subsection (a) shall be calculated
by taking the sum of:
(1) hospital inpatient facility prices; and
(2) hospital outpatient facility prices;
expressed as a percentage of full Medicare.
(c) An Indiana nonprofit hospital system meets the requirements of
subsection (a) by doing any of the following:
(1) Offering a direct to employer health care arrangement that is
at or below a benchmark of two hundred sixty percent (260%) of
full Medicare at each individual hospital within the Indiana
nonprofit hospital system.
(2) Offering a direct to employer health care arrangement that is
at or below a benchmark of two hundred sixty percent (260%) of
full Medicare as an Indiana nonprofit hospital system.
(3) Participating in a narrow network of hospitals to offer a direct
to employer health care arrangement that is at or below a
benchmark of two hundred sixty percent (260%) of full Medicare.
(d) Beginning October 1, 2025, and before every October 1
thereafter, an Indiana nonprofit hospital system shall cooperate with an
audit by the Indiana department of health to determine compliance with
this section.
(e) The Indiana department of health shall assess an Indiana
nonprofit hospital system that the Indiana department of health
determines through an audit has violated this section with a civil
penalty of ten thousand dollars ($10,000) per day per hospital for
which the Indiana nonprofit hospital system is unable to demonstrate
compliance with this section. A fine collected under this subsection
shall be deposited into the payer affordability penalty fund established
by IC 12-15-1-18.5.