Indiana § 27-13-34-10 Powers of limited service health maintenance organization

Indiana Statutes

§ 27-13-34-10 — Powers of limited service health maintenance organization

Indiana·Title 27 INSURANCE·Art. 13 HEALTH MAINTENANCE ORGANIZATIONS·Ch. 34 Limited Service Health Maintenance Organizations

(a)Subject to subsection (b), the powers of a limited service health maintenance organization include the following:

(1)The purchase, lease, construction, renovation, operation, or maintenance of:

(A)medical facilities that will provide limited health services;

(B)equipment for medical facilities providing limited health services; and

(C)other property reasonably required for the principal office of the limited service health maintenance organization or for purposes necessary in the transaction of the business of the organization.

(2)Engaging in transactions between affiliated entities, including loans and the transfer of responsibility under any or all contracts:

(A)between affiliates; or

(B)between the limited service health maintenance organization and the parent organization of

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(a) Subject to subsection (b), the powers of
a limited service health maintenance organization include the
following:
(1) The purchase, lease, construction, renovation, operation, or
maintenance of:
(A) medical facilities that will provide limited health services;
(B) equipment for medical facilities providing limited health
services; and
(C) other property reasonably required for the principal office
of the limited service health maintenance organization or for
purposes necessary in the transaction of the business of the
organization.
(2) Engaging in transactions between affiliated entities, including
loans and the transfer of responsibility under any or all contracts:
(A) between affiliates; or
(B) between the limited service health maintenance
organization and the parent organization of the limited service
health maintenance organization.
(3) The furnishing of limited health services through the
following:
(A) Providers.
(B) Provider associations.
(C) Agents for providers who are under contract with or are
employed by the limited service health maintenance
organization. The contracts with providers, provider
associations, or agents for providers may include fee for
service, cost plus, capitation, or other payment or risk-sharing
agreements.
(4) Contracting with any person for the performance on behalf of
the limited service health maintenance organization of certain
functions, including:
(A) marketing;
(B) enrollment; and
(C) administration.
(5) Contracting with:
(A) an insurance company licensed in Indiana; or
(B) an authorized reinsurer for the provision of insurance,
indemnity, or reimbursement against the cost of health care
services provided by the limited service health maintenance
organization.
(6) The offering of point-of-service products for the limited health
services for which the limited service health maintenance
organization is licensed so long as the limited service health
maintenance organization complies with the reinsurance or ratio
requirements of IC 27-13-13-8.
(7) The joint marketing of products with:
(A) an insurance company that is licensed in Indiana; or
(B) a health maintenance organization that is authorized to
conduct business in Indiana;
if the company that is offering each product is clearly identified.
(8) Providing limited health services at the expense of a
self-funded plan.
(b) Nothing in this section qualifies an asset of a prepaid limited
health service organization as an admitted asset.

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