§ 27-8-5-2.5 — Coverage under individual, and certain association group, policies of accident and sickness insurance; waivers

Indiana § 27-8-5-2.5

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

Text

5. (a) As used in this section, the term "policy
of accident and sickness insurance" does not include the following:
(1) Accident only, credit, dental, vision, Medicare supplement,
long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Automobile medical payment insurance.
(4) A specified disease policy.
(5) 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).
(6) 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.
(7) Worker's compensation or similar insurance.
(8) A student health plan.
(9) A supplemental plan that always pays in addition to other
coverage.
(10) 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.
(b) The benefits provided by:
(1) an individual policy of accident and sickness insurance; or
(2) a certificate of coverage that is issued under a nonemployer
based association group policy of accident and sickness insurance
to an individual who is a resident of Indiana;
may not be excluded, limited, or denied for more than twelve (12)
months after the effective date of the coverage because of a preexisting
condition of the individual.
(c) An individual policy of accident and sickness insurance or a
certificate of coverage described in subsection (b) may not define a
preexisting condition, a rider, or an endorsement more restrictively
than as:
(1) a condition that would have caused an ordinarily prudent
person to seek medical advice, diagnosis, care, or treatment
during the twelve (12) months immediately preceding the
effective date of the plan;
(2) a condition for which medical advice, diagnosis, care, or
treatment was recommended or received during the twelve (12)
months immediately preceding the effective date of the plan; or
(3) a pregnancy existing on the effective date of the plan.
(d) An insurer shall reduce the period allowed for a preexisting
condition exclusion described in subsection (b) by the amount of time
the individual has continuously served under a preexisting condition
clause for a policy of accident and sickness insurance issued under IC 27-8-15 if the individual applies for a policy under this chapter not
more than thirty (30) days after coverage under a policy of accident and
sickness insurance issued under IC 27-8-15 expires.

Legislative History

As added by P.L.93-1995, SEC.6. Amended by P.L.190-1996, SEC.1; P.L.211-2003, SEC.2; P.L.127-2006, SEC.1; P.L.173-2007, SEC.23; P.L.3-2008, SEC.212; P.L.288-2019, SEC.2.