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

Indiana Statutes

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

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

(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)s

Free access — add to your briefcase to read the full text and ask questions with AI

(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).

Indiana § 27-2-25-14 (Requirements of good faith estimate; provision of information; exemption from penalties) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.