Indiana § 27-13-7-14.5 Coverage for nonexperimental, surgical treatment of morbid obesity

Indiana Statutes

§ 27-13-7-14.5 — Coverage for nonexperimental, surgical treatment of morbid obesity

Indiana § 27-13-7-14.5

Title 27INSURANCE

Art. 13HEALTH MAINTENANCE ORGANIZATIONS

Ch. 7Requirements for Group Contracts, Individual Contracts,

This text of Indiana § 27-13-7-14.5 (Coverage for nonexperimental, surgical treatment of morbid obesity) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ind. Code § 27-13-7-14.5 (2026).

Text

5.

(a)As used in this section, "health care provider" means a:

(1)physician licensed under IC 25-22.5; or

(2)hospital licensed under IC 16-21; that provides health care services for surgical treatment of morbid obesity.

(b)As used in this section, "morbid obesity" means:

(1)a body mass index of at least thirty-five (35) kilograms per meter squared with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; or

(2)a body mass index of at least forty (40) kilograms per meter squared without comorbidity. For purposes of this subsection, body mass index equals weight in kilograms divided by height in meters squared.

(c)Except as provided in subsection (d), a health maintenance organization that provides coverage for basic

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5. (a) As used in this section, "health care
provider" means a:
(1) physician licensed under IC 25-22.5; or
(2) hospital licensed under IC 16-21;
that provides health care services for surgical treatment of morbid
obesity.
(b) As used in this section, "morbid obesity" means:
(1) a body mass index of at least thirty-five (35) kilograms per
meter squared with comorbidity or coexisting medical conditions
such as hypertension, cardiopulmonary conditions, sleep apnea,
or diabetes; or
(2) a body mass index of at least forty (40) kilograms per meter
squared without comorbidity.
For purposes of this subsection, body mass index equals weight in
kilograms divided by height in meters squared.
(c) Except as provided in subsection (d), a health maintenance
organization that provides coverage for basic health care services under
a group contract shall offer coverage for nonexperimental, surgical
treatment by a health care provider of morbid obesity:
(1) that has persisted for at least five (5) years; and
(2) for which nonsurgical treatment that is supervised by a
physician has been unsuccessful for at least six (6) consecutive
months.
(d) A health maintenance organization that provides coverage for
basic health care services may not provide coverage for surgical
treatment of morbid obesity for an enrollee who is less than twenty-one
(21) years of age unless two (2) physicians licensed under IC 25-22.5
determine that the surgery is necessary to:
(1) save the life of the enrollee; or
(2) restore the enrollee's ability to maintain a major life activity
(as defined in IC 4-23-29-6);
and each physician documents in the enrollee's medical record the
reason for the physician's determination.