Second Regular Session of the 122nd General Assembly (2022)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2021 Regular Session of the General Assembly.
HOUSE ENROLLED ACT No. 1238
AN ACT to amend the Indiana Code concerning insurance.
Be it enacted by the General Assembly of the State of Indiana:
SECTION 1. IC 25-1-9-23, AS AMENDED BY P.L.202-2021,
SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 23. (a) This section does not apply to emergency
services.
(b) As used in this section, "covered individual" means an
individual who is entitled to be provided health care services at a cost
established according to a network plan.
(c) As used in this section, "emergency services" means services
that are:
(1) furnished by a provider qualified to furnish emergency
services; and
(2) needed to evaluate or stabilize an emergency medical
condition.
(d) As used in this section, "in network practitioner" means a
practitioner who is required under a network plan to provide health
care services to covered individuals at not more than a preestablished
rate or amount of compensation.
(e) As used in this section, "network plan" means a plan under
which facilities and practitioners are required by contract to provide
health care services to covered individuals at not more than a
preestablished rate or amount of compensation.
(f) As used in this section, "out of network" means that the health
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care services provided by the practitioner to a covered individual are
not subject to the covered individual's health carrier network plan.
(g) As used in this section, "practitioner" means the following:
(1) An individual who holds:
(A) an unlimited license, certificate, or registration;
(B) a limited or probationary license, certificate, or
registration;
(C) a temporary license, certificate, registration, or permit;
(D) an intern permit; or
(E) a provisional license;
issued by the board (as defined in IC 25-0.5-11-1) regulating the
profession in question.
(2) An entity that:
(A) is owned by, or employs; or
(B) performs billing for professional health care services
rendered by;
an individual described in subdivision (1).
The term does not include a dentist licensed under IC 25-14, an
optometrist licensed under IC 25-24, or a provider facility (as defined
in IC 25-1-9.8-10).
(h) An in network practitioner who provides covered health care
services to a covered individual may not charge more for the covered
health care services than allowed according to the rate or amount of
compensation established by the individual's network plan.
(i) This subsection is effective beginning January 1, 2022. Except
as provided in subsection (n), a practitioner shall comply with the
requirements set forth in Section 2799B-6 of the Public Health Service
Act, as added by Public Law 116-260.
(j) (i) An out of network practitioner who provides health care
services at an in network facility to a covered individual may not be
reimbursed more for the health care services than allowed according to
the rate or amount of compensation established by the covered
individual's network plan unless all of the following conditions are met:
(1) At least five (5) business days before the health care services
are scheduled to be provided to the covered individual, the
practitioner provides to the covered individual, on a form separate
from any other form provided to the covered individual by the
practitioner, a statement in conspicuous type that meets the
following requirements:
(A) Includes a notice reading substantially as follows: "[Name
of practitioner] is an out of network practitioner providing
[type of care] with [name of in network facility], which is an
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in network provider facility within your health carrier's plan.
[Name of practitioner] will not be allowed to bill you the
difference between the price charged by the practitioner and
the rate your health carrier will reimburse for the services
during your care at [name of in network facility] unless you
give your written consent to the charge.".
(B) Sets forth the practitioner's good faith estimate of the
amount that the practitioner intends to charge for the health
care services provided to the covered individual.
(C) Includes a notice reading substantially as follows
concerning the good faith estimate set forth under clause (B):
"The estimate of our intended charge for [name or description
of health care services] set forth in this statement is provided
in good faith and is our best estimate of the amount we will
charge. If our actual charge for [name or description of health
care services] exceeds our estimate by the greater of:
(i) one hundred dollars ($100); or
(ii) five percent (5%);
we will explain to you why the charge exceeds the estimate.".
(2) The covered individual signs the statement provided under
subdivision (1), signifying the covered individual's consent to the
charge for the health care services being greater than allowed
according to the rate or amount of compensation established by
the network plan.
(k) (j) If an out of network practitioner does not meet the
requirements of subsection (j), (i), the out of network practitioner shall
include on any bill remitted to a covered individual a written statement
in conspicuous type stating that the covered individual is not
responsible for more than the rate or amount of compensation
established by the covered individual's network plan plus any required
copayment, deductible, or coinsurance.
(l) (k) If a covered individual's network plan remits reimbursement
to the covered individual for health care services subject to the
reimbursement limitation of subsection (j), (i), the network plan shall
provide with the reimbursement a written statement in conspicuous
type that states that the covered individual is not responsible for more
than the rate or amount of compensation established by the covered
individual's network plan and that is included in the reimbursement
plus any required copayment, deductible, or coinsurance.
(m) (l) If the charge of a practitioner for health care services
provided to a covered individual exceeds the estimate provided to the
covered individual under subsection (j)(1)(B) (i)(1)(B) by the greater
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of:
(1) one hundred dollars ($100); or
(2) five percent (5%);
the facility or practitioner shall explain in a writing provided to the
covered individual why the charge exceeds the estimate.
(n) (m) An in network practitioner is not required to provide a
covered individual with the good faith estimate required under
subsection (i) if the nonemergency health care service is scheduled to
be performed by the practitioner within five (5) business days after the
health care service is ordered.
(o) (n) The department of insurance shall adopt emergency rules
under IC 4-22-2-37.1 to specify the requirements of the notifications
set forth in subsections (k) (j) and (l). (k).
(o) A practitioner may satisfy the requirements of this section
by complying with the requirements set forth in Section 2799B-6
of the federal Public Health Service Act, as added by Public Law
116-260.
SECTION 2. IC 25-1-9.8-20 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2022]: Sec. 20. A practitioner may satisfy the requirements of
this chapter by complying with the requirements set forth in
Section 2799B-6 of the federal Public Health Service Act, as added
by Public Law 116-260.
SECTION 3. IC 27-1-12.5-3 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2022]: Sec. 3. (a) The minimum
values as specified in sections 4, 5, 6, 7, and 9 of this chapter of any
paid-up annuity, cash surrender or death benefits available under an
annuity contract shall be based upon minimum nonforfeiture amounts
as defined in this section.
(b) With respect to any annuity contract, the minimum nonforfeiture
amounts at any time at or prior to the commencement of any annuity
payments shall be equal to an accumulation up to such time at an
annual rate of interest determined under subsections (d) and (e) of the
net considerations as set forth in subsection (c) paid prior to such time,
decreased by the sum of the following:
(1) Any prior withdrawals from or partial surrenders of the
annuity contract accumulated at an annual rate of interest
determined under subsections (d) and (e).
(2) The amount of any indebtedness to the company on the
annuity contract, including interest due and accrued.
(3) An annual contract charge of fifty dollars ($50), accumulated
at the annual rate of interest determined under subsections (d) and
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(e).
(c) The net considerations for a given contract year used to define
the minimum nonforfeiture amount shall be an amount equal to
eighty-seven and one-half percent (87.5%) of the gross considerations
credited to the annuity contract during that contract year.
(d) Except as provided in subsection (e), the interest rate used in
determining minimum nonforfeiture amounts is an annual rate of
interest determined under either of the following methods:
(1) The five-year constant maturity treasury rate, rounded to the
nearest five-hundredths of one percent (0.05%), as reported by the
Federal Reserve as of a date specified in the annuity contract.
Reduce this amount by one hundred twenty-five (125) basis
points.
(2) An average of the five-year constant maturity treasury rate as
reported by the Federal Reserve, rounded to the nearest
five-hundredths of one percent (0.05%), over a specified period
as set forth in the annuity contract. Reduce this amount by one
hundred twenty-five (125) basis points.
The date under subdivision (1) or the average period used under
subdivision (2) may not be longer than fifteen (15) months before the
annuity contract issue date or the redetermination date as determined
under subsection (f).
(e) If the rate of interest determined under subsection (d) is:
(1) less than one percent (1%), the interest rate used in
determining minimum nonforfeiture amounts is fifteen
one-hundredths of one percent (1%); (0.15%); or
(2) greater than three percent (3%), the interest rate used in
determining minimum nonforfeiture amounts is three percent
(3%).
(f) The interest rate determined under subsections (d) and (e)
applies for an initial period and may be redetermined for subsequent
periods. The redetermination date, basis, and period, if any, must be
specified in the annuity contract. The basis is:
(1) the date; or
(2) an average calculated over a specified period;
that produces the value of the five-year constant maturity treasury rate
reported by the Federal Reserve to be used at each redetermination
date.
(g) During the period or term that an annuity contract provides
substantive participation in an equity index benefit, the contract may
increase the basis point reduction described in subsection (d) by not
more than an additional one hundred (100) basis points to reflect the
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value of the equity index benefit. The present value at the annuity
contract issue date, and at each redetermination date after the annuity
contract issue date, of the additional reduction may not exceed the
market value of the benefit. The commissioner may require a
demonstration that the present value of the additional reduction does
not exceed the market value of the benefit. If the demonstration is not
acceptable to the commissioner, the commissioner may disallow or
limit the additional reduction.
(h) The commissioner may adopt rules under IC 4-22-2 to provide
for further adjustments to the calculation of minimum nonforfeiture
amounts for:
(1) annuity contracts that provide participation in an equity index
benefit; and
(2) other annuity contracts for which the commissioner
determines adjustments are justified.
SECTION 4. IC 27-1-15.7-2, AS AMENDED BY P.L.196-2021,
SECTION 18, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 2. (a) Except as provided in subsection (b), to
renew a license issued under IC 27-1-15.6, a resident insurance
producer must complete at least twenty-four (24) hours of credit in
continuing education courses, not more than four (4) hours of which
may be in courses concerning one (1) or a combination of the
following:
(1) Sales promotion.
(2) Sales technique.
(3) Motivation.
(4) Psychology.
(5) Time management.
If the insurance producer has a qualification described in
IC 27-1-15.6-7(a)(1), IC 27-1-15.6-7(a)(2), or IC 27-1-15.6-7(a)(5), for
a license renewal that occurs after June 30, 2014, at least three (3) of
the hours of credit required by this subsection must be related to ethical
practices in the marketing and sale of life, health, or annuity insurance
products. An attorney in good standing who is admitted to the practice
of law in Indiana and holds a license issued under IC 27-1-15.6 may
complete all or any number of hours of continuing education required
by this subsection by completing an equivalent number of hours in
continuing legal education courses that are related to the business of
insurance.
(b) Except as provided in subsection (c), to renew a license issued
under IC 27-1-15.6, a limited lines producer with a title qualification
under IC 27-1-15.6-7(a)(8) must complete at least seven (7) hours of
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credit in continuing education courses related to the business of title
insurance, with at least one (1) hour of instruction in a structured
setting or comparable self-study, in each any of the following or any
combination of the following:
(1) Ethical practices in the marketing and selling of title
insurance, including provisions of the Dodd-Frank Wall Street
Reform and Consumer Protection Act set forth in 12 U.S.C.
2608.
(2) Title insurance underwriting.
(3) Escrow issues. matters.
(4) Principles of the federal Real Estate Settlement Procedures
Act (12 U.S.C. 2608). Matters concerning regulation by the
department.
(5) Any other topic related to the marketing and selling of title
insurance.
An attorney in good standing who is admitted to the practice of law in
Indiana and holds a license issued under IC 27-1-15.6 with a title
qualification under IC 27-1-15.6-7(a)(8) may complete all or any
number of hours of continuing education required by this subsection by
completing an equivalent number of hours in continuing legal
education courses related to the business of title insurance or any
aspect of real property law.
(c) The following insurance producers are not required to complete
continuing education courses to renew a license under this chapter:
(1) A limited lines producer who is licensed without examination
under IC 27-1-15.6-18(1).
(2) A limited line credit insurance producer.
(3) A nonresident limited lines producer with a title qualification:
(A) whose home state requires continuing education for a title
qualification; and
(B) who has met the continuing education requirements
described in clause (A).
(d) Except as provided in section 2.2 of this chapter, to satisfy the
requirements of subsection (a) or (b), a licensee may use only those
credit hours earned in continuing education courses completed by the
licensee:
(1) after the effective date of the licensee's last renewal of a
license under this chapter; or
(2) if the licensee is renewing a license for the first time, after the
date on which the licensee was issued the license under this
chapter.
(e) If an insurance producer receives qualification for a license in
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more than one (1) line of authority under IC 27-1-15.6, the insurance
producer may not be required to complete a total of more than
twenty-four (24) hours of credit in continuing education courses to
renew the license.
(f) Except as provided in subsection (g), a licensee may receive
credit only for completing the following continuing education courses:
(1) Continuing education courses that have been approved by the
commissioner under section 4 of this chapter.
(2) Continuing education courses that are required for the licensee
under IC 27-19-4-14.
(g) A licensee who teaches a course approved by the commissioner
under section 4 of this chapter shall receive continuing education credit
for teaching the course.
(h) When a licensee renews a license issued under this chapter, the
licensee must submit:
(1) a continuing education statement that:
(A) is in a format authorized by the commissioner;
(B) is signed by the licensee under oath; and
(C) lists the continuing education courses completed by the
licensee to satisfy the continuing education requirements of
this section; and
(2) any other information required by the commissioner.
(i) A continuing education statement submitted under subsection (h)
may be reviewed and audited by the department.
(j) A licensee shall retain a copy of the original certificate of
completion received by the licensee for completion of a continuing
education course.
(k) A licensee who completes a continuing education course that:
(1) is approved by the commissioner under section 4 of this
chapter;
(2) is held in a classroom setting; and
(3) concerns ethics;
shall receive continuing education credit not to exceed four (4) hours
in a renewal period.
SECTION 5. IC 27-1-30.4 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]:
Chapter 30.4. Group Property and Casualty Insurance for
Permitted Groups
Sec. 1. As used in this chapter, "permitted group" means a
group of ten (10) or more commercial, business, or not-for-profit
entities that have a preexisting relationship to one another
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through:
(1) a common trade;
(2) an association;
(3) an affiliation; or
(4) another organizational relationship that is separate and
distinct from any group insurance arrangement of the group.
Sec. 2. As used in this chapter, "property and casualty
insurance" means one (1) or more of the types of insurance
described in IC 27-1-5-1, Class 2 and Class 3.
Sec. 3. As used in this chapter, "property and casualty insurance
company" means a company authorized to make one (1) or more
types of property or casualty insurance.
Sec. 4. (a) An insurer authorized under IC 27-1-3-20 to transact
business as a property and casualty insurance company may
provide property and casualty insurance to a permitted group on
a group basis.
(b) A policy may not be issued or renewed to provide group
coverage under this chapter to a group that includes fewer than ten
(10) commercial, business, or not-for-profit entities as part of the
group.
Sec. 5. The commissioner may adopt rules under IC 4-22-2 to
implement and administer this chapter.
SECTION 6. IC 27-1-44.5-2, AS AMENDED BY P.L.195-2021,
SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 2. As used in this chapter, "health payer"
includes the following:
(1) Medicare.
(2) Medicaid or a managed care organization (as defined in
IC 12-7-2-126.9) that has contracted with Medicaid to provide
services to a Medicaid recipient.
(3) An insurer that issues a policy of accident and sickness
insurance (as defined in IC 27-8-5-1), except for the following
types of coverage:
(A) Accident only, credit, dental, vision, Medicare
supplement, long term care, or disability income insurance.
(B) Coverage issued as a supplement to liability insurance.
(C) Automobile medical payment insurance.
(D) A specified disease policy.
(E) A policy that provides indemnity benefits not based on any
expense incurred requirements, including a plan that provides
coverage for:
(i) hospital confinement, critical illness, or intensive care; or
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(ii) gaps for deductibles or copayments.
(F) Worker's compensation or similar insurance.
(G) A student health plan.
(H) A supplemental plan that always pays in addition to other
coverage.
(I) An employer sponsored health benefit plan that is:
(i) provided to individuals who are eligible for Medicare;
and
(ii) not marketed as, or held out to be, a Medicare
supplement policy.
(4) A health maintenance organization (as defined in
IC 27-13-1-19).
(5) A pharmacy benefit manager (as defined in IC 27-1-24.5-12).
(6) An administrator (as defined in IC 27-1-25-1).
(7) A multiple employer welfare arrangement (as defined in
IC 27-1-34-1).
(7) (8) Any other person identified by the commissioner for
participation in the data base described in this chapter.
SECTION 7. IC 27-1-45-7, AS AMENDED BY P.L.202-2021,
SECTION 9, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 7. (a) This section is effective beginning January
1, 2022.
(b) Except as provided in subsection (c), a:
(1) facility; and
(2) practitioner;
shall comply with the requirements of Section 2799B-6 of the Public
Health Service Act, as added by Public Law 116-260.
(c) (b) A facility or a practitioner is not required to provide the good
faith estimate required in subsection (b) if the health care service to be
provided to the covered individual is scheduled to be performed within
five (5) business days after the health care service is ordered.
SECTION 8. IC 27-1-45-8, AS AMENDED BY P.L.202-2021,
SECTION 10, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 8. (a) An out of network practitioner who provides
health care services at an in network facility to a covered individual
may not be reimbursed more for the health care services than allowed
according to the rate or amount of compensation established by the
covered individual's network plan as described in subsection (b) unless
all of the following conditions are met:
(1) At least five (5) business days before the health care service
is scheduled to be provided to the covered individual, the facility
or practitioner provides to the covered individual, on a form
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separate from any other form provided to the covered individual
by the facility or practitioner, a statement in conspicuous type that
meets the following requirements:
(A) Includes a notice reading substantially as follows: "[Name
of facility or practitioner] is an out of network practitioner
providing [type of care], with [name of in network facility],
which is an in network provider facility within your health
carrier's plan. [Name of facility or practitioner] will not be
allowed to bill you the difference between the price charged
for the services and the rate your health carrier will reimburse
for the services during your care at [name of in network
facility] unless you give your written consent to the charge.".
(B) Sets forth the facility's or practitioner's good faith estimate
of the established fee for the health care services provided to
the covered individual.
(C) Includes a notice reading substantially as follows
concerning the good faith estimate set forth under clause (B):
"The estimate of our intended charge for [name or description
of health care services] set forth in this statement is provided
in good faith and is our best estimate of the amount we will
charge. If the actual charge for [name or description of health
care services] exceeds our estimate by the greater of:
(i) one hundred dollars ($100); or
(ii) five percent (5%);
we will explain to you why the charge exceeds the estimate.".
(2) The covered individual signs the statement provided under
subdivision (1), signifying the covered individual's consent to the
charge for the health care services being greater than allowed
according to the rate or amount of compensation established by
the network plan.
(b) If an out of network practitioner does not meet the requirements
of subsection (a), the out of network practitioner shall include on any
bill remitted to a covered individual a written statement in conspicuous
type stating that the covered individual is not responsible for more than
the rate or amount of compensation established by the covered
individual's network plan plus any required copayment, deductible, or
coinsurance.
(c) If a covered individual's network plan remits reimbursement to
the covered individual for health care services that did not meet the
requirements of subsection (a), the network plan shall provide with the
reimbursement a written statement in conspicuous type that states that
the covered individual is not responsible for more than the rate or
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amount of compensation established by the covered individual's
network plan and that is included in the reimbursement plus any
required copayment, deductible, or coinsurance.
(d) If the charge of a facility or practitioner for health care services
provided to a covered individual exceeds the estimate provided to the
covered individual under subsection (a)(1)(B) by an amount greater
than:
(1) one hundred dollars ($100); or
(2) five percent (5%);
the facility or practitioner shall explain in a writing provided to the
covered individual why the charge exceeds the estimate.
(e) The department shall adopt emergency rules under
IC 4-22-2-37.1 to specify the requirements of the notifications set forth
in:
(1) subsections (b) and (c); and
(2) IC 25-1-9-23(j) and IC 25-1-9-23(k). and IC 25-1-9-23(l).
SECTION 9. IC 27-1-45-10 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2022]: Sec. 10. A facility or a practitioner may satisfy the
requirements of this chapter by complying with the requirements
set forth in Section 2799B-6 of the federal Public Health Service
Act, as added by Public Law 116-260.
SECTION 10. IC 27-1-46-18 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2022]: Sec. 18. A provider facility may satisfy
the requirements of this chapter by complying with the
requirements set forth in Section 2799B-6 of the federal Public
Health Service Act, as added by Public Law 116-260.
SECTION 11. IC 27-5.1-2-6 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2022]: Sec. 6. A farm mutual
insurance company with an annual direct written premium of more than
ten million dollars ($10,000,000) fifteen million dollars ($15,000,000)
may not function as a farm mutual insurance company and shall be
regulated as a domestic mutual insurance company described in
IC 27-1-6-15.
SECTION 12. IC 27-8-14.8-3, AS AMENDED BY P.L.36-2020,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 3. (a) As used in this section, "follow-up
colonoscopy" means a colonoscopy that is performed as a
follow-up to a colorectal cancer screening test, other than a
colonoscopy, that is assigned a grade of "A" or "B" by the United
States Preventive Services Task Force and for which the result was
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positive.
(a) (b) Except as provided in subsection (d), (e), an insurer shall
provide coverage for colorectal cancer examinations and laboratory
tests for cancer for any nonsymptomatic insured in any accident and
sickness insurance policy that the insurer issues in Indiana or issues for
delivery in Indiana. Except as provided in subsection (f), covered
services must include:
(1) a colorectal cancer screening test assigned either an "A"
or "B" grade by the United States Preventive Services Task
Force; and
(2) a follow-up colonoscopy.
(b) (c) For an insured who is:
(1) at least forty-five (45) years of age; or
(2) less than forty-five (45) years of age and at high risk for
colorectal cancer;
the coverage required under this section must meet the requirements set
forth in subsection (c), (d), except as provided in subsection (e). (f).
(c) (d) An insured may not be required to pay an additional annual
deductible or coinsurance for the colorectal cancer examination and
laboratory testing benefit required by this section that is greater than an
annual deductible or coinsurance established for similar benefits under
the accident and sickness insurance policy under which the insured is
covered. If the accident and sickness insurance policy does not cover
a similar benefit, a deductible or coinsurance for the colorectal cancer
examination and laboratory testing benefit may not be set at a level that
materially diminishes the value of the colorectal cancer examination
and laboratory testing benefit.
(d) (e) In the case of an accident and sickness insurance policy that
is not employer based, the insurer shall offer to provide the coverage
described in this section.
(e) (f) The requirements imposed under this section do not apply to
a high deductible health plan, as defined by Section 223 of the Internal
Revenue Code. High deductible health plans described in this
subsection may not excuse a deductible requirement with respect to
colorectal cancer screening in a manner inconsistent with Section
223(c)(2)(C) of the Internal Revenue Code. The requirements
imposed under subsection (b)(2) do not apply to grandfathered
health plans as defined in 45 CFR 147.140.
SECTION 13. IC 27-13-7-17, AS AMENDED BY P.L.36-2020,
SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 17. (a) As used in this section, "colorectal cancer
testing" means examinations and laboratory tests for cancer for any
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nonsymptomatic enrollee.
(b) As used in this section, "follow-up colonoscopy" means a
colonoscopy that is performed as a follow-up to a colorectal cancer
screening test, other than a colonoscopy, that is assigned a grade of
"A" or "B" by the United States Preventive Services Task Force
and for which the result was positive.
(b) (c) Except as provided in subsection (e), (f), a health
maintenance organization issued a certificate of authority in Indiana
shall provide colorectal cancer testing, including:
(1) a colorectal cancer screening test assigned either an "A"
or "B" grade by the United States Preventive Services Task
Force; and
(2) a follow-up colonoscopy;
as a covered service under every group contract that provides coverage
for basic health care services.
(c) (d) For an enrollee who is:
(1) at least forty-five (45) years of age; or
(2) less than forty-five (45) years of age and at high risk for
colorectal cancer;
the colorectal cancer testing required under this section must meet the
requirements set forth in subsection (d), (e), except as provided in
subsection (f). (g).
(d) (e) An enrollee may not be required to pay a copayment for the
colorectal cancer testing benefit required by this section that is greater
than a copayment established for similar benefits under the group
contract under which the enrollee is entitled to services. If the group
contract does not cover a similar covered service, the copayment for the
colorectal cancer testing benefit may not be set at a level that materially
diminishes the value of the colorectal cancer testing benefit.
(e) (f) In the case of coverage that is not employer based, the health
maintenance organization is required only to offer to provide colorectal
cancer testing as a covered service under a proposed group contract
providing coverage for basic health care services.
(f) (g) The requirements imposed under this section do not apply to
a high deductible health plan, as defined by Section 223 of the Internal
Revenue Code. High deductible health plans described in this
subsection may not excuse a deductible requirement with respect to
colorectal cancer screening in a manner inconsistent with Section
223(c)(2)(C) of the Internal Revenue Code. The requirements
imposed under subsection (c)(2) do not apply to grandfathered
health plans as defined in 45 CFR 147.140.
SECTION 14. An emergency is declared for this act.
HEA 1238 — CC 1 Speaker of the House of Representatives
President of the Senate
President Pro Tempore
Governor of the State of Indiana
Date: Time:
HEA 1238 — CC 1