§ 27-13-4-1 — General powers

Indiana § 27-13-4-1

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 13: HEALTH MAINTENANCE ORGANIZATIONS
• Ch. 4: Powers of Health Maintenance Organizations

Text

(a) Subject to section 3 of this chapter, the
powers of a health maintenance organization include the following:
(1) The purchase, lease, construction, renovation, operation, or
maintenance of:
(A) hospitals and medical facilities;
(B) equipment for hospitals and medical facilities; and
(C) other property reasonably required for the principal office
of the 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 health maintenance organization and the parent
organization of the health maintenance organization.
(3) The furnishing of health care services through:
(A) providers;
(B) provider associations; and
(C) agents for providers;
who are under contract with or are employed by the health
maintenance organization. The contracts with providers, provider
associations, or agents of providers may include fee for service,
cost plus, capitation, or other payment or risk-sharing
arrangements.
(4) Contracting with any person for the performance on behalf of
the health maintenance organization of certain functions,
including:
(A) marketing;
(B) enrollment; and
(C) administration.
(5) Contracting with:
(A) an insurance company licensed in Indiana;
(B) an authorized reinsurer; or
(C) a hospital authorized to conduct business in Indiana;
for the provision of insurance, indemnity, or reimbursement
against the cost of health care services provided by the health
maintenance organization.
(6) The offering of point-of-service products.
(7) The joint marketing of products with:
(A) an insurance company that is licensed in Indiana; or
(B) a hospital that is authorized to conduct business in Indiana;
if the company that is offering each product is clearly identified.
(8) Administration of the provision of health care services at the
expense of a self-funded plan.
(b) A health maintenance organization may offer any of the
following:
(1) Plans that include only basic health care services.
(2) Plans that include basic health care services and other health
care services.
(3) Plans that include health care services other than basic health
care services so long as at least one (1) of the plans offered by the
health maintenance organization includes basic health care
services.
(c) Notwithstanding subsection (a)(5), a health maintenance
organization may not take credit for reinsurance unless the risk is ceded
to a reinsurer qualified under IC 27-6-10.1.

Legislative History

As added by P.L.26-1994, SEC.25. Amended by P.L.2-1995, SEC.111; P.L.203-2001, SEC.18; P.L.130-2020, SEC.15.