§ 27-13-36-6 — Continuation of care provisions

Indiana § 27-13-36-6

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 13: HEALTH MAINTENANCE ORGANIZATIONS
• Ch. 36: Patient Protection; Clinical Decision Making; Access

Text

(a) A health maintenance organization shall
include provisions in the health maintenance organization's contracts
with providers to provide for continuation of care in the event that a
provider's contract with the health maintenance organization is
terminated, provided that the termination is not due to a quality of care
issue.
(b) The contract provisions under subsection (a) shall require that
the provider, upon the request of the enrollee, continue to treat the
enrollee for up to sixty (60) days following the termination of the
provider's contract with the health maintenance organization or, in the
case of a pregnant enrollee in the third trimester of pregnancy,
throughout the term of the enrollee's pregnancy. If the provider is a
hospital, the contract shall provide for continuation of treatment until
the earlier of the following:
(1) Sixty (60) days following the termination of the provider's
contract with the health maintenance organization.
(2) The enrollee is released from inpatient status at the hospital.
(c) During a continuation period under this section, the provider:
(1) shall agree to continue accepting the contract terms and
conditions, together with applicable deductibles and copayments,
as payment in full; and
(2) is prohibited from billing the enrollee for any amounts in
excess of the enrollee's applicable deductible or copayment.

Legislative History

As added by P.L.69-1998, SEC.14.