Indiana § 27-13-7-13 Continuation of coverage statement

Indiana Statutes

§ 27-13-7-13 — Continuation of coverage statement

Indiana·Title 27 INSURANCE·Art. 13 HEALTH MAINTENANCE ORGANIZATIONS·Ch. 7 Requirements for Group Contracts, Individual Contracts,

(a)A health maintenance organization must include in each contract a written statement that if the contract is terminated by the health maintenance organization, an enrollee who is hospitalized for a medical or surgical condition on the date of termination will have continuation of coverage for inpatient covered services.

(b)The continuation of coverage referred to in subsection (a) is not required after one (1) of the following occurs:

(1)The discharge of the enrollee from the hospital.

(2)Sixty (60) days pass after the contract is terminated by the health maintenance organization.

(3)The hospitalized enrollee obtains from another carrier coverage that includes the coverage provided by the terminating health maintenance organization.

(4)A contract holder terminates the contract with

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(a) A health maintenance organization must
include in each contract a written statement that if the contract is
terminated by the health maintenance organization, an enrollee who is
hospitalized for a medical or surgical condition on the date of
termination will have continuation of coverage for inpatient covered
services.
(b) The continuation of coverage referred to in subsection (a) is not
required after one (1) of the following occurs:
(1) The discharge of the enrollee from the hospital.
(2) Sixty (60) days pass after the contract is terminated by the
health maintenance organization.
(3) The hospitalized enrollee obtains from another carrier
coverage that includes the coverage provided by the terminating
health maintenance organization.
(4) A contract holder terminates the contract with the health
maintenance organization, as determined by:
(A) the effective date specified in written communication sent
by the contract holder to the health maintenance organization,
which effective date shall be at least fifteen (15) days after the
date the written communication is placed in the United States
mail or sent by facsimile transmission; or
(B) the failure to pay a premium within the grace period
permitted under the contract.
(5) Termination of an enrollee by a health maintenance
organization due to:
(A) the enrollee knowingly providing false information to the
health maintenance organization;
(B) the enrollee's failure to comply with the rules of the health
maintenance organization stated in the contract; or
(C) the enrollee's failure to pay a premium within the grace
period permitted under contract.
(c) In order to satisfy the requirements of subsection (a), a health
maintenance organization may provide benefits that exceed the
continuation of coverage required by this section, either in the types or
time period of health care services covered, or both.
(d) If an enrollee terminates the enrollee's coverage, the health
maintenance organization is not required to provide continuation of
coverage to that enrollee under this section after the termination.
(e) This section does not apply to a termination of coverage as the
result of the receivership of a health maintenance organization.