§ 27-8-5-19.3 — Association and discretionary group policies of accident and sickness insurance; waiver of coverage

Indiana § 27-8-5-19.3

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

Text

3. (a) This section applies to an association
or a discretionary group policy of accident and sickness insurance:
(1) under which a certificate of coverage is issued after June 30,
2005, to an individual member of the association or discretionary
group;
(2) under which a member of the association or discretionary
group is individually underwritten; and
(3) that is not employer based.
(b) Notwithstanding sections 19 and 19.2 of this chapter and any
other law, and except as provided in subsection (e), a policy described
in subsection (a) may contain a waiver of coverage for a specified
condition and any complications that arise from the specified condition
if:
(1) the waiver period does not exceed ten (10) years; and
(2) all of the following conditions are met:
(A) The insurer provides to the applicant before issuance of the
certificate written notice explaining the waiver of coverage for
the specified condition and complications arising from the
specified condition.
(B) The:
(i) offer of coverage; and
(ii) certificate of coverage;
include the waiver in a separate section stating in bold print that
the applicant is receiving coverage with an exception for the
waived condition.
(C) The:
(i) offer of coverage; and
(ii) certificate of coverage;
do not include more than two (2) waivers per individual.
(D) The waiver period is concurrent with and not in addition to
any applicable preexisting condition limitation or exclusionary
period.
(E) The insurer agrees to:
(i) review the underwriting basis for the waiver upon request
one (1) time per year; and
(ii) remove the waiver if the insurer determines that evidence
of insurability is satisfactory.
(F) The insurer discloses to the applicant that the applicant may
decline the offer of coverage, and that any individual to whom
the waiver would have applied may apply for a policy issued by
the Indiana comprehensive health insurance association under
IC 27-8-10.
(G) An insurance benefit card issued by the insurer to the
applicant includes a telephone number for verification of
coverage waived.
(c) The insurer shall require an applicant to initial the written notice
provided under subsection (b)(2)(A) and the waiver included in the
offer of coverage and in the certificate of coverage under subsection
(b)(2)(B) to acknowledge acceptance of the waiver of coverage.
(d) An offer of coverage under a policy that includes a waiver under
this section does not preclude eligibility for an Indiana comprehensive
health insurance association policy under IC 27-8-10-5.1.
(e) A policy described in subsection (a) may not include a waiver of
coverage for a:
(1) mental health condition; or
(2) developmental disability.
(f) An insurer may not, on the basis of a waiver contained in a policy
as provided in this section, deny coverage for any condition or
complication that is not specified as required in the:
(1) written notice under subsection (b)(2)(A); and
(2) offer of coverage and certificate of coverage under subsection
(b)(2)(B).
(g) An insurer that removes a waiver under subsection (b)(2)(E)
shall not consider the condition or any complication to which the
waiver previously applied in making policy renewal and underwriting
determinations.
(h) Upon the expiration of the waiver period allowed under this
section, the insurer shall:
(1) remove the waiver;
(2) not consider the condition or any complication to which the
waiver previously applied in making policy underwriting
determinations; and
(3) renew the policy in accordance with 45 CFR 148.122.

Legislative History

As added by P.L.211-2005, SEC.2.