§ 27-2-25-14 — Requirements of good faith estimate; provision of information; exemption from penalties

Indiana § 27-2-25-14

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 2: POWERS AND DUTIES OF INSURERS
• Ch. 25: Health Carrier Good Faith Estimates

Text

(a) A good faith estimate provided by a
health carrier to an individual under this chapter must:
(1) in the case of an insurer or another health carrier that pays or
reimburses the cost of health care services:
(A) provide a summary of the services and material items that
the good faith estimate is based on;
(B) include a total figure that is a sum of the amounts referred
to in clause (A); and
(C) state the out-of-pocket costs the covered individual will
incur, if any, beyond the amount that the health carrier will pay
or reimburse; and
(2) in the case of a health maintenance organization or another
health carrier that provides health care services:
(A) provide a summary of the applicable benefit limitations of
the health care services to which the covered individual is
entitled; and
(B) state the out-of-pocket costs the covered individual will
incur, if any, beyond being provided the health care services
referred to in clause (A).
(b) A practitioner and provider facility shall provide a health carrier
with the information needed by the health carrier to comply with the
requirements under this chapter not more than two (2) business days
after receiving the request.
(c) A health carrier is not subject to the penalties under section 16
of this chapter if:
(1) a provider facility or practitioner fails to provide the health
carrier with the information as required under subsection (b);
(2) the health carrier provides the individual with a good faith
estimate based on any information that the health carrier has; and
(3) the health carrier provides the individual with an updated
good faith estimate after the provider facility or practitioner has
provided the information required under subsection (b).

Legislative History

As added by P.L.93-2020, SEC.13.