§ 5-10-8-23 — Reimbursement for emergency medical services

Indiana § 5-10-8-23

• Jurisdiction: Indiana
• Title 5: STATE AND LOCAL ADMINISTRATION
• Art. 10: PUBLIC EMPLOYEE BENEFITS
• Ch. 8: Group Insurance for Public Employees

Text

(a) As used in this section, "covered
individual" means an individual who is entitled to coverage under a
state employee health plan.
(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, "state employee health plan" means
either of the following that provides coverage for emergency medical
services:
(1) A self-insurance program established under section 7(b) of
this chapter to provide group health coverage.
(2) A contract with a prepaid health care delivery plan that is
entered into or renewed under section 7(c) of this chapter.
(d) A state employee health plan that provides coverage for
emergency medical services must at least provide reimbursement,
subject to applicable deductible and coinsurance, for a covered
individual 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 during a response initiated through the
911 system, regardless of whether the patient was transported.
(e) The director of the state personnel department may make a
determination to provide coverage for emergency medical services as
part of a mobile integrated healthcare program described in IC 16-31-12.
(f) If multiple emergency medical services provider organizations
qualify and submit a claim for reimbursement under this section for an
encounter, the state employee health plan:
(1) may only reimburse, subject to applicable deductible and
coinsurance, under this section for one (1) claim per patient
encounter; and
(2) shall reimburse, subject to applicable deductible and
coinsurance, 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 state personnel department may adopt rules under IC 4-22-2
to implement this section.
(h) This section does not restrict the state employee health plan from
providing coverage beyond the requirements in this section.

Legislative History

As added by P.L.115-2020, SEC.1. Amended by P.L.93-2024, SEC.42; P.L.236-2025, SEC.1.