1.
(a)A person is not eligible for an
association policy if the person is eligible for any of the coverage
described in subdivisions (1) and (2). A person other than a federally
eligible individual may not apply for an association policy unless the
person has applied for:
(2)coverage under the:
(A)preexisting condition insurance plan program established
by the Secretary of Health and Human Services under Section
1101 of Title I of the federal Patient Protection and Affordable
Care Act (P.L. 111-148); and
(B)healthy Indiana plan under IC 12-15-44.2;
not more than sixty (60) days before applying for the association
policy.
(b)Except as provided in subsection (c), a person is not eligible for
an association policy if, at the effective date of coverage, the person has
or
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1. (a) A person is not eligible for an
association policy if the person is eligible for any of the coverage
described in subdivisions (1) and (2). A person other than a federally
eligible individual may not apply for an association policy unless the
person has applied for:
(1) Medicaid; and
(2) coverage under the:
(A) preexisting condition insurance plan program established
by the Secretary of Health and Human Services under Section
1101 of Title I of the federal Patient Protection and Affordable
Care Act (P.L. 111-148); and
(B) healthy Indiana plan under IC 12-15-44.2;
not more than sixty (60) days before applying for the association
policy.
(b) Except as provided in subsection (c), a person is not eligible for
an association policy if, at the effective date of coverage, the person has
or is eligible for coverage under any insurance plan that equals or
exceeds the minimum requirements for accident and sickness insurance
policies issued in Indiana as set forth in IC 27. However, an offer of
coverage described in IC 27-8-5-2.5(e) (expired July 1, 2007, and
removed), IC 27-8-5-2.7, IC 27-8-5-19.2(e) (expired July 1, 2007, and
repealed), or IC 27-8-5-19.3 does not affect an individual's eligibility
for an association policy under this subsection. Coverage under any
association policy is in excess of, and may not duplicate, coverage
under any other form of health insurance.
(c) Except as provided in subsection (a), a person is eligible for an
association policy upon a showing that:
(1) the person has been rejected by one (1) carrier for coverage
under any insurance plan that equals or exceeds the minimum
requirements for accident and sickness insurance policies issued
in Indiana, as set forth in IC 27, without material underwriting
restrictions;
(2) an insurer has refused to issue insurance except at a rate
exceeding the association plan rate; or
(3) the person is a federally eligible individual.
For the purposes of this subsection, eligibility for Medicare coverage
does not disqualify a person who is less than sixty-five (65) years of
age from eligibility for an association policy.
(d) Coverage under an association policy terminates as follows:
(1) On the first date on which an insured is no longer a resident of
Indiana.
(2) On the date on which an insured requests cancellation of the
association policy.
(3) On the date of the death of an insured.
(4) At the end of the policy period for which the premium has
been paid.
(5) On the first date on which the insured no longer meets the
eligibility requirements under this section.
(e) An association policy must provide that coverage of a dependent
unmarried child terminates when the child becomes nineteen (19) years
of age (or twenty-five (25) years of age if the child is enrolled full time
in an accredited educational institution). The policy must also provide
in substance that attainment of the limiting age does not operate to
terminate a dependent unmarried child's coverage while the dependent
is and continues to be both:
(1) incapable of self-sustaining employment by reason of a
mental, intellectual, or physical disability; and
(2) chiefly dependent upon the person in whose name the contract
is issued for support and maintenance.
However, proof of such incapacity and dependency must be furnished
to the carrier within one hundred twenty (120) days of the child's
attainment of the limiting age, and subsequently as may be required by
the carrier, but not more frequently than annually after the two (2) year
period following the child's attainment of the limiting age.
(f) An association policy that provides coverage for a family
member of the person in whose name the contract is issued must, as to
the family member's coverage, also provide that the health insurance
benefits applicable for children are payable with respect to a newly
born child of the person in whose name the contract is issued from the
moment of birth. The coverage for newly born children must consist of
coverage of injury or illness, including the necessary care and treatment
of medically diagnosed congenital defects and birth abnormalities. If
payment of a specific premium is required to provide coverage for the
child, the contract may require that notification of the birth of a child
and payment of the required premium must be furnished to the carrier
within thirty-one (31) days after the date of birth in order to have the
coverage continued beyond the thirty-one (31) day period.
(g) Except as provided in subsection (h), an association policy may
contain provisions under which coverage is excluded during a period
of three (3) months following the effective date of coverage as to a
given covered individual for preexisting conditions, as long as medical
advice or treatment was recommended or received within a period of
three (3) months before the effective date of coverage. This subsection
may not be construed to prohibit preexisting condition provisions in an
insurance policy that are more favorable to the insured.
(h) If a person applies for an association policy within six (6)
months after termination of the person's coverage under a health
insurance arrangement and the person meets the eligibility
requirements of subsection (c), then an association policy may not
contain provisions under which:
(1) coverage as to a given individual is delayed to a date after the
effective date or excluded from the policy; or
(2) coverage as to a given condition is denied;
on the basis of a preexisting health condition. This subsection may not
be construed to prohibit preexisting condition provisions in an
insurance policy that are more favorable to the insured.
(i) For purposes of this section, coverage under a health insurance
arrangement includes, but is not limited to, coverage pursuant to the
Consolidated Omnibus Budget Reconciliation Act of 1985.