§ 27-13-15-4 — Participating provider agreement prohibitions

Indiana § 27-13-15-4

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 13: HEALTH MAINTENANCE ORGANIZATIONS
• Ch. 15: Participating Providers; Contracts and Legal Actions

Text

(a) As used in this section, "health
maintenance organization" includes the following:
(1) A limited service health maintenance organization.
(2) A person that pays or administers claims on behalf of a health
maintenance organization or a limited service health maintenance
organization.
(b) An agreement between a health maintenance organization and
a participating provider under this chapter may not contain a provision
that:
(1) prohibits, or grants the health maintenance organization an
option to prohibit, the participating provider from contracting
with another health maintenance organization to accept lower
payment for health care services than the payment specified in the
agreement;
(2) requires, or grants the health maintenance organization an
option to require, the participating provider to accept a lower
payment from the health maintenance organization if the
participating provider agrees with another health maintenance
organization to accept lower payment for health care services;
(3) requires, or grants the health maintenance organization an
option of, termination or renegotiation of the agreement if the
participating provider agrees with another health maintenance
organization to accept lower payment for health care services; or
(4) requires the participating provider to disclose the participating
provider's reimbursement rates under contracts with other health
maintenance organizations.
(c) A contract provision that violates this section is void.

Legislative History

As added by P.L.74-2007, SEC.2.