§ 27-8-5-15.6 — Treatment limitations or financial requirements on coverage of services for mental illness

Indiana § 27-8-5-15.6

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 5: Accident and Sickness Insurance─Policy Provisions

Text

6. (a) As used in this section, "coverage of
services for a mental illness" includes the services defined under the
policy of accident and sickness insurance. However, the term does not
include services for the treatment of substance abuse or chemical
dependency.
(b) This section applies to a policy of accident and sickness
insurance that:
(1) is issued on an individual basis or a group basis;
(2) is issued, entered into, or renewed after December 31, 1999;
and
(3) is issued to an employer that employs more than fifty (50)
full-time employees.
(c) This section does not apply to the following:
(1) A legal business entity that has obtained an exemption under
section 15.7 of this chapter.
(2) Accident only, credit, dental, vision, Medicare supplement,
long term care, or disability income insurance.
(3) Coverage issued as a supplement to liability insurance.
(4) Worker's compensation or similar insurance.
(5) Automobile medical payment insurance.
(6) A specified disease policy.
(7) A short term insurance plan that:
(A) may be renewed for the greater of:
(i) thirty-six (36) months; or
(ii) the maximum period permitted under federal law;
(B) has a term of not more than three hundred sixty-four (364)
days; and
(C) has an annual limit of at least two million dollars
($2,000,000).
(8) A policy that provides indemnity benefits not based on any
expense incurred requirement, including a plan that provides
coverage for:
(A) hospital confinement, critical illness, or intensive care; or
(B) gaps for deductibles or copayments.
(9) A supplemental plan that always pays in addition to other
coverage.
(10) A student health plan.
(11) An employer sponsored health benefit plan that is:
(A) provided to individuals who are eligible for Medicare; and
(B) not marketed as, or held out to be, a Medicare supplement
policy.
(d) A group or individual insurance policy or agreement may not
permit treatment limitations or financial requirements on the coverage
of services for a mental illness if similar limitations or requirements are
not imposed on the coverage of services for other medical or surgical
conditions.
(e) An insurer that issues a policy of accident and sickness
insurance that provides coverage of services for the treatment of
substance abuse and chemical dependency when the services are
required in the treatment of a mental illness shall offer to provide the
coverage without treatment limitations or financial requirements if
similar limitations or requirements are not imposed on the coverage of
services for other medical or surgical conditions.
(f) This section does not require a group or individual insurance
policy or agreement to offer mental health benefits.
(g) The benefits delivered under this section may be delivered under
a managed care system.

Legislative History

As added by P.L.42-1997, SEC.2. Amended by P.L.81-1999, SEC.3; P.L.226-2003, SEC.1; P.L.173-2007, SEC.24; P.L.288-2019, SEC.3.