§ 27-8-6-8 — Reimbursement for emergency medical services

Indiana § 27-8-6-8

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

Text

(a) As used in this section, "emergency medical
services" has the meaning set forth in IC 16-18-2-110.
(b) As used in this section, "emergency medical services provider
organization" means a provider of emergency medical services that is
certified by the Indiana emergency medical services commission as an
advanced life support provider organization under rules adopted under
IC 16-31-3.
(c) As used in this section, "policy of accident and sickness
insurance" has the meaning set forth in IC 27-8-5-1. However, for
purposes of this section, the term 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 policy that provides a stipulated daily, weekly, or monthly
payment to an insured without regard to the actual expense of the
confinement.
(6) A short term insurance plan (as defined in IC 27-8-5.9-3).
(d) A policy of accident and sickness insurance that provides
coverage for emergency medical services must provide reimbursement
for emergency medical services that are:
(1) rendered by an emergency medical services provider
organization;
(2) within the emergency medical services provider organization's
scope of practice;
(3) performed or provided as advanced life support services; and
(4) performed or provided:
(A) during a response initiated through the 911 system; or
(B) as part of a mobile integrated healthcare program described
in IC 16-31-12;
regardless of whether the patient is transported.
(e) Reimbursement for basic and advanced life support services
through a policy to which this section applies must be provided on an
equal basis regardless of whether the services involve transportation of
the patient by ambulance.
(f) If multiple emergency medical services provider organizations
qualify and submit a claim for reimbursement under this section for an
encounter, the insurer:
(1) may reimburse under this section only for one (1) claim per
patient encounter; and
(2) shall reimburse the claim submitted by the emergency medical
services provider organization that performed or provided the
majority of advanced life support services for the patient.
(g) The department may adopt rules under IC 4-22-2 to implement
this section.
(h) This section does not require a policy of accident and sickness
insurance to provide coverage for emergency medical services.

Legislative History

As added by P.L.115-2020, SEC.4. Amended by P.L.170-2022, SEC.37; P.L.93-2024, SEC.198; P.L.236-2025, SEC.11.