§ 27-8-5-2.7 — Individual policy of accident and sickness insurance; waiver of coverage

Indiana § 27-8-5-2.7

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

Text

7. (a) Notwithstanding section 2.5 of this
chapter and any other law, and except as provided in subsection (b), an
individual policy of accident and sickness insurance that is issued after
June 30, 2005, 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 the following conditions are met:
(A) The insurer provides to the applicant before issuance of the
policy 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) policy;
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) policy;
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 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.
The insurer shall require an applicant to initial the written notice
provided under subdivision (2)(A) and the waiver included in the offer
of coverage and in the policy under subdivision (2)(B) to acknowledge
acceptance of the waiver of coverage. An offer of coverage under a
policy that includes a waiver under this subsection does not preclude
eligibility for an Indiana comprehensive health insurance association
policy under IC 27-8-10-5.1.
(b) An individual policy of accident and sickness insurance may not
include a waiver of coverage for a:
(1) mental health condition; or
(2) developmental disability.
(c) An insurer may not, on the basis of a waiver contained in a
policy as provided in subsection (a), deny coverage for any condition
or complication that is not specified as required in the:
(1) written notice under subsection (a)(2)(A); and
(2) offer of coverage and policy under subsection (a)(2)(B).
(d) An insurer that removes a waiver under subsection (a)(2)(E)
shall not consider the condition or any complication to which the
waiver previously applied in making policy renewal and underwriting
determinations.
(e) 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.1.