§ 27-8-6-4 — Reimbursement for services; application of section; prohibitions excluded

Indiana § 27-8-6-4

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 6: Reimbursement for Certain Medical Services

Text

(a) This section does not apply to any of the
following:
(1) A health maintenance organization (as defined in IC 27-13-1-19) or limited service health maintenance organization
(as defined in IC 27-13-34-4).
(2) A preferred provider plan (as defined in IC 27-8-11-1).
(3) An employee benefit program that is subject to the federal
Employee Retirement Income Security Act (29 U.S.C. 1001 et
seq.).
(4) Worker's compensation for an injury to or occupational
disease of an employee under IC 22-3.
(b) A group or individual policy or agreement providing
comprehensive accident and health benefits must reimburse an insured
for services rendered by a provider licensed under IC 25-10 within the
scope of that provider's license in the same manner as that policy or
agreement reimburses an insured for services rendered by a provider
licensed under IC 25-22.5 within the scope of that provider's license.
The policy or agreement may not exclude or otherwise limit
reimbursement for any service that a provider licensed under IC 25-10
renders under the scope of that provider's license in the diagnosis and
treatment of any illness or injury. This section does not require that a
health care policy or agreement cover a particular illness or injury.
(c) This section does not prohibit the following:
(1) The application of coinsurance and deductible provisions to
providers licensed under IC 25-10 on the same basis as those
provisions are applied to providers licensed under IC 25-22.5.
(2) The application of cost containment or quality assurance
measures to providers licensed under IC 25-10 on the same basis
as those measures are applied to providers licensed under IC 25-22.5.
(3) A review of the necessity of services that applies to services
rendered by providers licensed under IC 25-10 on the same basis
as the review applies to services provided by providers licensed
under IC 25-22.5.

Legislative History

As added by P.L.153-1990, SEC.1. Amended by P.L.26-1994, SEC.12.