Introduced Version
HOUSE BILL No. 1327
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 12-15-1-18.5; IC 16-18-2; IC 16-19-18;
IC 27-1; IC 27-2-25.5; IC 27-4-1-4.
Synopsis: Health and insurance matters. Requires a hospital, physician
group practice, insurer, third party administrator, and pharmacy benefit
manager to file with the Indiana department of health (department) a
report that includes information regarding each person or entity that has
an ownership interest, in whole or in part, or a controlling interest in
the hospital, physician group practice, insurer, third party
administrator, or pharmacy benefit manager. Requires the department
to publicly post a searchable consolidated document on the
department's website that contains the information. Sets forth penalties
for a violation of the reporting requirements. Requires the department
to submit an annual report of violations of the reporting requirements
to certain members of the general assembly. Allows a contract holder
to request an audit of a pharmacy benefit manager up to one time each
quarter. Prohibits a third party administrator, health plan, or pharmacy
benefit manager from charging a fee if the plan sponsor opts out of an
additional offered service. Requires a contract with a third party
administrator, pharmacy benefit manager, or prepaid health care
delivery plan to provide that the plan sponsor has ownership of the
claims data. Allows a plan sponsor that contracts with a third party
administrator, the office of the secretary of family and social services
that contracts with a managed care organization to provide services to
a Medicaid recipient, or the state personnel department that contracts
with a prepaid health care delivery plan to provide group health
coverage for state employees to request an audit up to one time each
quarter. Provides that a violation of the requirements concerning audits
of a third party administrator, managed care organization, or prepaid
(Continued next page)
Effective: Upon passage; July 1, 2024.
Schaibley, Barrett, McGuire
January 10, 2024, read first time and referred to Committee on Public Health.
2024 IN 1327—LS 6888/DI 141 Digest Continued
health care delivery plan is an unfair or deceptive act or practice in the
business of insurance and allows the department of insurance to adopt
rules to set forth fines for a violation.
2024 IN 1327—LS 6888/DI 1412024 IN 1327—LS 6888/DI 141 Introduced
Second Regular Session of the 123rd General Assembly (2024)
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 2023 Regular Session of the General Assembly.
HOUSE BILL No. 1327
A BILL FOR AN ACT to amend the Indiana Code concerning
insurance.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 12-15-1-18.5, AS ADDED BY P.L.203-2023,
2 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
3 UPON PASSAGE]: Sec. 18.5. (a) The payer affordability penalty fund
4 is established for the purpose of receiving fines collected under
5 IC 16-19-18-7, IC 16-21-6-3, and fines collected under IC 27-2-25.5
6 to be used for:
7 (1) the state's share of the Medicaid program; and
8 (2) a study of hospitals that are impacted by changes made in the
9 disproportionate share hospital methodology payments set forth
10 in Section 203 of the federal Consolidated Appropriations Act of
11 2021.
12 The office of the secretary shall perform the study and provide the
13 results of the study described in subdivision (2) to the budget
14 committee.
15 (b) The fund shall be administered by the office of the secretary.
2024 IN 1327—LS 6888/DI 141 2
1 (c) The expenses of administering the fund shall be paid from
2 money in the fund.
3 (d) The treasurer of state shall invest the money in the fund not
4 currently needed to meet the obligations of the fund in the same
5 manner as other public money may be invested. Interest that accrues
6 from these investments shall be deposited in the fund.
7 (e) Money in the fund at the end of a state fiscal year does not revert
8 to the state general fund.
9 (f) Money in the fund is continually appropriated.
10 SECTION 2. IC 16-18-2-79.1 IS ADDED TO THE INDIANA
11 CODE AS A NEW SECTION TO READ AS FOLLOWS
12 [EFFECTIVE UPON PASSAGE]: Sec. 79.1. "Controlling", for
13 purposes of IC 16-19-18, has the meaning set forth in
14 IC 16-19-18-1.
15 SECTION 3. IC 16-18-2-190.9, AS ADDED BY P.L.203-2023,
16 SECTION 13, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
17 UPON PASSAGE]: Sec. 190.9. (a) "Insurer", for purposes of
18 IC 16-51-1, has the meaning set forth in IC 16-51-1-8.
19 (b) "Insurer", for purposes of IC 16-19-18, has the meaning set
20 forth in IC 16-19-18-2.
21 SECTION 4. IC 16-18-2-281.2 IS ADDED TO THE INDIANA
22 CODE AS A NEW SECTION TO READ AS FOLLOWS
23 [EFFECTIVE UPON PASSAGE]: Sec. 281.2. "Pharmacy benefit
24 manager", for purposes of IC 16-19-18, has the meaning set forth
25 in IC 16-19-18-3.
26 SECTION 5. IC 16-18-2-351.7 IS ADDED TO THE INDIANA
27 CODE AS A NEW SECTION TO READ AS FOLLOWS
28 [EFFECTIVE UPON PASSAGE]: Sec. 351.7. "Third party
29 administrator", for purposes of IC 16-19-18, has the meaning set
30 forth in IC 16-19-18-4.
31 SECTION 6. IC 16-19-18 IS ADDED TO THE INDIANA CODE
32 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
33 UPON PASSAGE]:
34 Chapter 18. Disclosure of Ownership or Controlling Interest
35 Sec. 1. As used in this chapter, "controlling" has the meaning set
36 forth in IC 23-1-43-8.
37 Sec. 2. As used in this chapter, "insurer" includes the following:
38 (1) An insurer (as defined in IC 27-1-2-3(x)) that issues a
39 policy of accident and sickness insurance (as defined in
40 IC 27-8-5-1(a)).
41 (2) A health maintenance organization (as defined in
42 IC 27-13-1-19) that provides coverage for basic health care
2024 IN 1327—LS 6888/DI 141 3
1 services (as defined in IC 27-13-1-4).
2 (3) A managed care organization (as defined in
3 IC 12-7-2-126.9) that provides services to a Medicaid
4 recipient.
5 (4) A prepaid health care delivery plan under IC 5-10-8-7(c)
6 that provides group health coverage for state employees.
7 Sec. 3. As used in this chapter, "pharmacy benefit manager" has
8 the meaning set forth in IC 27-1-24.5-12.
9 Sec. 4. As used in this chapter, "third party administrator"
10 means an individual or entity that performs administrative services
11 for an insurer or a self-funded health benefit plan, including:
12 (1) a self-funded health benefit plan that complies with the
13 federal Employee Retirement Income Security Act (ERISA)
14 of 1974 (29 U.S.C. 1001 et seq.); and
15 (2) a self-insurance program established under IC 5-10-8-7(b).
16 Sec. 5. Before July 1, 2024, and each July 1 thereafter, each
17 hospital, physician group practice, insurer, third party
18 administrator, and pharmacy benefit manager shall file with the
19 state department a report that includes the following information:
20 (1) The name of each person or entity that has:
21 (A) an ownership interest, in whole or in part; or
22 (B) a controlling interest;
23 in the hospital, physician group practice, insurer, third party
24 administrator, or pharmacy benefit manager.
25 (2) The mailing address of each person or entity identified
26 under subdivision (1). The mailing address must include a:
27 (A) building number;
28 (B) street name;
29 (C) city name;
30 (D) zip code; and
31 (E) country name.
32 The mailing address may not include a post office box
33 number.
34 (3) The website, if applicable, of each person or entity
35 identified under subdivision (1).
36 Sec. 6. (a) Before September 1, 2024, the state department shall
37 publicly post a searchable consolidated document on the state
38 department's website that contains the information collected under
39 section 5 of this chapter.
40 (b) The state department shall update the document under
41 subsection (a) before September 1 of each year.
42 Sec. 7. (a) The state department may assess a hospital, physician
2024 IN 1327—LS 6888/DI 141 4
1 group practice, insurer, third party administrator, or pharmacy
2 benefit manager that violates section 5 of this chapter a fine of one
3 thousand dollars ($1,000) per day for which the report is past due.
4 (b) A fine under this section shall be deposited into the payer
5 affordability penalty fund established by IC 12-15-1-18.5.
6 (c) The state health commissioner may take action against a
7 hospital under IC 16-21-3 for repeated violations of section 5 of
8 this chapter.
9 (d) The state department shall refer repeated violations of
10 section 5 of this chapter for review and possible disciplinary action
11 to the:
12 (1) medical licensing board for repeated violations committed
13 by a physician group practice; or
14 (2) department of insurance for repeated violations
15 committed by an insurer, a third party administrator, or a
16 pharmacy benefit manager.
17 Sec. 8. (a) Before September 1 of each year, the state
18 department shall submit an annual report of the violations assessed
19 by the state department under section 7 of this chapter in the
20 previous calendar year to the following:
21 (1) The speaker of the house of representatives.
22 (2) The president pro tempore of the senate.
23 (3) The chairperson of the house of representatives insurance
24 committee.
25 (4) The ranking minority member of the house of
26 representatives insurance committee.
27 (5) The chairperson of the senate insurance and financial
28 institutions committee.
29 (6) The ranking minority member of the senate insurance and
30 financial institutions committee.
31 (7) The chairperson of the house of representatives public
32 health committee.
33 (8) The ranking minority member of the house of
34 representatives public health committee.
35 (9) The chairperson of the senate health and provider services
36 committee.
37 (10) The ranking minority member of the senate health and
38 provider services committee.
39 (b) A report described in this section must be submitted in an
40 electronic format under IC 5-14-6.
41 SECTION 7. IC 27-1-24.5-0.7 IS ADDED TO THE INDIANA
42 CODE AS A NEW SECTION TO READ AS FOLLOWS
2024 IN 1327—LS 6888/DI 141 5
1 [EFFECTIVE JULY 1, 2024]: Sec. 0.7. As used in this chapter,
2 "contract holder" means:
3 (1) an individual or entity that offers health insurance
4 coverage to its employees or members through a health plan
5 or a self-funded health benefit plan, including a self-funded
6 health benefit plan that complies with the federal Employee
7 Retirement Income Security Act (ERISA) of 1974 (29 U.S.C.
8 1001 et seq.);
9 (2) a health plan; or
10 (3) Medicaid or a managed care organization (as defined in
11 IC 12-7-2-126.9) that provides services to a Medicaid
12 recipient;
13 that contracts with a pharmacy benefit manager to provide
14 services.
15 SECTION 8. IC 27-1-24.5-4.3 IS ADDED TO THE INDIANA
16 CODE AS A NEW SECTION TO READ AS FOLLOWS
17 [EFFECTIVE JULY 1, 2024]: Sec. 4.3. As used in this chapter,
18 "group purchasing organization" means an organization that
19 negotiates drug prices, rebates, fees, discounts, or other services on
20 behalf of a pharmacy benefit manager.
21 SECTION 9. IC 27-1-24.5-25, AS AMENDED BY P.L.32-2021,
22 SECTION 81, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
23 JULY 1, 2024]: Sec. 25. (a) A party that has contracted with a
24 pharmacy benefit manager to provide services contract holder may,
25 at least up to one (1) time in a calendar year, each quarter, request an
26 audit of compliance with the contract. If requested by the contract
27 holder, the audit may shall include full disclosure of the following:
28 (1) Rebate amounts secured on prescription drugs, whether
29 product specific or general rebates, that were provided by a
30 pharmaceutical manufacturer. The information provided under
31 this subdivision must identify the prescription drugs by:
32 (A) the national drug code number with the prescription
33 drug name; or
34 (B) the individual prescription drug name. and
35 (2) Pharmaceutical and device claims received by the
36 pharmacy benefit manager as ASC X12N 837 files. The files
37 must be unmodified copies of the files. In the event that paper
38 claims are received, the pharmacy benefit manager shall
39 convert the paper claims to the ASC X12N 837 electronic
40 format.
41 (3) Pharmaceutical and device claims payments or electronic
42 funds transfer or remittance advice notices provided by the
2024 IN 1327—LS 6888/DI 141 6
1 pharmacy benefit manager as ASC X12N 835 files. The files
2 must be unmodified copies of the files. In the event that paper
3 claims are provided, the pharmacy benefit manager shall
4 convert the paper claims to the ASC X12N 835 electronic
5 format.
6 (4) Any other revenue and fees derived by the pharmacy benefit
7 manager from the contract, including all direct and indirect
8 remuneration from pharmaceutical manufacturers regardless
9 of whether the remuneration is classified as a rebate, fee, or
10 another term.
11 (b) A contract pharmacy benefit manager may not contain
12 provisions that impose:
13 (1) unreasonable fees for an audit conducted under this
14 section; or
15 (2) conditions that would severely restrict a party's contract
16 holder's right to conduct an audit under this subsection, section,
17 including restrictions on the:
18 (A) time period of the audit;
19 (B) number of claims analyzed;
20 (C) type of analysis conducted;
21 (D) data elements used in the analysis; or
22 (E) selection of an auditor.
23 (b) (c) A pharmacy benefit manager shall disclose, upon request
24 from a party that has contracted with a pharmacy benefit manager,
25 contract holder, to the party contract holder the actual amounts
26 directly or indirectly paid by the pharmacy benefit manager to the
27 pharmacist or any pharmacy for the drug or for pharmacist services
28 related to the drug.
29 (c) (d) A pharmacy benefit manager shall provide notice to a party
30 contract holder contracting with the pharmacy benefit manager of any
31 consideration, including direct or indirect remuneration, that the
32 pharmacy benefit manager receives from a pharmacy pharmaceutical
33 manufacturer or group purchasing organization for any name brand
34 dispensing of a prescription when a generic or biologically similar
35 product is available for the prescription. formulary placement or any
36 other reason.
37 (d) (e) The commissioner may establish a procedure to release
38 information from an audit performed by the department to a party
39 contract holder that has requested an audit under this section in a
40 manner that does not violate confidential or proprietary information
41 laws.
42 (e) (f) Any provision of A contract that is entered into, issued,
2024 IN 1327—LS 6888/DI 141 7
1 amended, or renewed after June 30, 2020, 2024, may not contain a
2 provision that violates this section. is unenforceable.
3 (g) A pharmacy benefit manager shall:
4 (1) obtain any information requested in an audit under this
5 section from a group purchasing organization or other
6 partner entity of the pharmacy benefit manager; and
7 (2) provide any information requested in an audit under this
8 section to the contract holder not later than fifteen (15)
9 business days after the information is requested.
10 (h) Information provided in an audit under this section must be
11 provided in accordance with the federal Health Insurance
12 Portability and Accountability Act (HIPAA) (P.L. 104-191).
13 SECTION 10. IC 27-1-42.5 IS ADDED TO THE INDIANA CODE
14 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
15 JULY 1, 2024]:
16 Chapter 42.5. Prohibition on Fees for Additional Services
17 Sec. 1. This chapter applies to a contract entered into, issued,
18 amended, or renewed after June 30, 2024.
19 Sec. 2. As used in this chapter, "health plan" means the
20 following:
21 (1) A policy of accident and sickness insurance (as defined in
22 IC 27-8-5-1). However, the term does not include the
23 coverages described in IC 27-8-5-2.5(a).
24 (2) A contract with a health maintenance organization (as
25 defined in IC 27-13-1-19) that provides coverage for basic
26 health care services (as defined in IC 27-13-1-4).
27 (3) A prepaid health care delivery plan under IC 5-10-8-7(c)
28 to provide group health coverage for state employees.
29 Sec. 3. As used in this chapter, "pharmacy benefit manager" has
30 the meaning set forth in IC 27-1-24.5-12.
31 Sec. 4. As used in this chapter, "plan sponsor" means an
32 individual or entity that offers health insurance coverage to its
33 employees or members through a health plan or a self-funded
34 health benefit plan, including:
35 (1) a self-funded health benefit plan that complies with the
36 federal Employee Retirement Income Security Act (ERISA)
37 of 1974 (29 U.S.C. 1001 et seq.); and
38 (2) a self-insurance program established under IC 5-10-8-7(b).
39 Sec. 5. As used in this chapter, "third party administrator"
40 means an individual or entity that performs administrative services
41 for a health plan or a self-funded health benefit plan, including:
42 (1) a self-funded health benefit plan that complies with the
2024 IN 1327—LS 6888/DI 141 8
1 federal Employee Retirement Income Security Act (ERISA)
2 of 1974 (29 U.S.C. 1001 et seq.); and
3 (2) a self-insurance program established under IC 5-10-8-7(b).
4 Sec. 6. A:
5 (1) third party administrator;
6 (2) health plan; or
7 (3) pharmacy benefit manager;
8 may not charge a fee if the plan sponsor opts out of an additional
9 service offered by the third party administrator, health plan, or
10 pharmacy benefit manager.
11 SECTION 11. IC 27-2-25.5-0.5 IS ADDED TO THE INDIANA
12 CODE AS A NEW SECTION TO READ AS FOLLOWS
13 [EFFECTIVE JULY 1, 2024]: Sec. 0.5. As used in this chapter, "plan
14 sponsor" means an individual or entity that offers health insurance
15 coverage to its employees or members through a self-funded health
16 benefit plan, including:
17 (1) a self-funded health benefit plan that complies with the
18 federal Employee Retirement Income Security Act (ERISA)
19 of 1974 (29 U.S.C. 1001 et seq.); and
20 (2) a self-insurance program established under IC 5-10-8-7(b).
21 SECTION 12. IC 27-2-25.5-0.7 IS ADDED TO THE INDIANA
22 CODE AS A NEW SECTION TO READ AS FOLLOWS
23 [EFFECTIVE JULY 1, 2024]: Sec. 0.7. As used in sections 3 and 4 of
24 this chapter, "third party administrator" means an individual or
25 entity that performs administrative services for a self-funded
26 health benefit plan, including:
27 (1) a self-funded health benefit plan that complies with the
28 federal Employee Retirement Income Security Act (ERISA)
29 of 1974 (29 U.S.C. 1001 et seq.); and
30 (2) a self-insurance program established under IC 5-10-8-7(b).
31 SECTION 13. IC 27-2-25.5-3 IS ADDED TO THE INDIANA
32 CODE AS A NEW SECTION TO READ AS FOLLOWS
33 [EFFECTIVE JULY 1, 2024]: Sec. 3. (a) This section applies to a
34 contract entered into, issued, amended, or renewed after June 30,
35 2024.
36 (b) A contract between:
37 (1) a:
38 (A) third party administrator;
39 (B) pharmacy benefit manager (as defined in
40 IC 27-1-24.5-12); or
41 (C) prepaid health care delivery plan under IC 5-10-8-7(c)
42 to provide group health coverage for state employees; and
2024 IN 1327—LS 6888/DI 141 9
1 (2) a plan sponsor;
2 must provide that the plan sponsor owns the claims data relating
3 to the contract.
4 SECTION 14. IC 27-2-25.5-4 IS ADDED TO THE INDIANA
5 CODE AS A NEW SECTION TO READ AS FOLLOWS
6 [EFFECTIVE JULY 1, 2024]: Sec. 4. (a) A plan sponsor that
7 contracts with a third party administrator, the office of the
8 secretary of family and social services that contracts with a
9 managed care organization (as defined in IC 12-7-2-126.9) to
10 provide services to a Medicaid recipient, or the state personnel
11 department that contracts with a prepaid health care delivery plan
12 under IC 5-10-8-7(c) to provide group health coverage for state
13 employees may, up to one (1) time each quarter, request an audit
14 of compliance with the contract. If requested by the plan sponsor,
15 office of the secretary of family and social services, or state
16 personnel department, the audit shall include full disclosure of the
17 following:
18 (1) Claims data described in section 1 of this chapter.
19 (2) Claims received by the third party administrator,
20 managed care organization, or prepaid health care delivery
21 plan as ASC X12N 837 files. The files must be unmodified
22 copies of the files. In the event that paper claims are received,
23 the third party administrator, managed care organization, or
24 prepaid health care delivery plan shall convert the paper
25 claims to the ASC X12N 837 electronic format.
26 (3) Claims payments, electronic funds transfer, or remittance
27 advice notices provided by the third party administrator,
28 managed care organization, or prepaid health care delivery
29 plan as ASC X12N 835 files. The files must be unmodified
30 copies of the files. In the event that paper claims are provided,
31 the third party administrator, managed care organization, or
32 prepaid health care delivery plan shall convert the paper
33 claims to the ASC X12N 835 electronic format.
34 (4) Any fees charged to the plan sponsor, office of the
35 secretary of family and social services, or state personnel
36 department related to plan administration and claims
37 processing, including renegotiation fees, access fees, repricing
38 fees, or enhanced review fees.
39 (b) A third party administrator, managed care organization, or
40 prepaid health care delivery plan may not impose:
41 (1) fees for an audit conducted under this section; or
42 (2) conditions that would restrict a party's right to conduct an
2024 IN 1327—LS 6888/DI 141 10
1 audit under this section, including restrictions on the:
2 (A) time period of the audit;
3 (B) number of claims analyzed;
4 (C) type of analysis conducted;
5 (D) data elements used in the analysis; or
6 (E) selection of an auditor.
7 (c) A third party administrator, managed care organization, or
8 prepaid health care delivery plan shall provide any information
9 requested in an audit under this section to the plan sponsor, office
10 of the secretary of family and social services, or state personnel
11 department not later than fifteen (15) business days after the
12 information is requested.
13 (d) Information provided in an audit under this section must be
14 provided in accordance with the federal Health Insurance
15 Portability and Accountability Act (HIPAA) (P.L. 104-191).
16 (e) A contract that is entered into, issued, amended, or renewed
17 after June 30, 2024, may not contain a provision that violates this
18 section.
19 (f) A violation of this section is an unfair or deceptive act or
20 practice in the business of insurance under IC 27-4-1-4.
21 (g) The department may also adopt rules under IC 4-22-2 to set
22 forth fines for a violation under this section.
23 SECTION 15. IC 27-4-1-4, AS AMENDED BY P.L.56-2023,
24 SECTION 244, IS AMENDED TO READ AS FOLLOWS
25 [EFFECTIVE JULY 1, 2024]: Sec. 4. (a) The following are hereby
26 defined as unfair methods of competition and unfair and deceptive acts
27 and practices in the business of insurance:
28 (1) Making, issuing, circulating, or causing to be made, issued, or
29 circulated, any estimate, illustration, circular, or statement:
30 (A) misrepresenting the terms of any policy issued or to be
31 issued or the benefits or advantages promised thereby or the
32 dividends or share of the surplus to be received thereon;
33 (B) making any false or misleading statement as to the
34 dividends or share of surplus previously paid on similar
35 policies;
36 (C) making any misleading representation or any
37 misrepresentation as to the financial condition of any insurer,
38 or as to the legal reserve system upon which any life insurer
39 operates;
40 (D) using any name or title of any policy or class of policies
41 misrepresenting the true nature thereof; or
42 (E) making any misrepresentation to any policyholder insured
2024 IN 1327—LS 6888/DI 141 11
1 in any company for the purpose of inducing or tending to
2 induce such policyholder to lapse, forfeit, or surrender the
3 policyholder's insurance.
4 (2) Making, publishing, disseminating, circulating, or placing
5 before the public, or causing, directly or indirectly, to be made,
6 published, disseminated, circulated, or placed before the public,
7 in a newspaper, magazine, or other publication, or in the form of
8 a notice, circular, pamphlet, letter, or poster, or over any radio or
9 television station, or in any other way, an advertisement,
10 announcement, or statement containing any assertion,
11 representation, or statement with respect to any person in the
12 conduct of the person's insurance business, which is untrue,
13 deceptive, or misleading.
14 (3) Making, publishing, disseminating, or circulating, directly or
15 indirectly, or aiding, abetting, or encouraging the making,
16 publishing, disseminating, or circulating of any oral or written
17 statement or any pamphlet, circular, article, or literature which is
18 false, or maliciously critical of or derogatory to the financial
19 condition of an insurer, and which is calculated to injure any
20 person engaged in the business of insurance.
21 (4) Entering into any agreement to commit, or individually or by
22 a concerted action committing any act of boycott, coercion, or
23 intimidation resulting or tending to result in unreasonable
24 restraint of, or a monopoly in, the business of insurance.
25 (5) Filing with any supervisory or other public official, or making,
26 publishing, disseminating, circulating, or delivering to any person,
27 or placing before the public, or causing directly or indirectly, to
28 be made, published, disseminated, circulated, delivered to any
29 person, or placed before the public, any false statement of
30 financial condition of an insurer with intent to deceive. Making
31 any false entry in any book, report, or statement of any insurer
32 with intent to deceive any agent or examiner lawfully appointed
33 to examine into its condition or into any of its affairs, or any
34 public official to which such insurer is required by law to report,
35 or which has authority by law to examine into its condition or into
36 any of its affairs, or, with like intent, willfully omitting to make a
37 true entry of any material fact pertaining to the business of such
38 insurer in any book, report, or statement of such insurer.
39 (6) Issuing or delivering or permitting agents, officers, or
40 employees to issue or deliver, agency company stock or other
41 capital stock, or benefit certificates or shares in any common law
42 corporation, or securities or any special or advisory board
2024 IN 1327—LS 6888/DI 141 12
1 contracts or other contracts of any kind promising returns and
2 profits as an inducement to insurance.
3 (7) Making or permitting any of the following:
4 (A) Unfair discrimination between individuals of the same
5 class and equal expectation of life in the rates or assessments
6 charged for any contract of life insurance or of life annuity or
7 in the dividends or other benefits payable thereon, or in any
8 other of the terms and conditions of such contract. However,
9 in determining the class, consideration may be given to the
10 nature of the risk, plan of insurance, the actual or expected
11 expense of conducting the business, or any other relevant
12 factor.
13 (B) Unfair discrimination between individuals of the same
14 class involving essentially the same hazards in the amount of
15 premium, policy fees, assessments, or rates charged or made
16 for any policy or contract of accident or health insurance or in
17 the benefits payable thereunder, or in any of the terms or
18 conditions of such contract, or in any other manner whatever.
19 However, in determining the class, consideration may be given
20 to the nature of the risk, the plan of insurance, the actual or
21 expected expense of conducting the business, or any other
22 relevant factor.
23 (C) Excessive or inadequate charges for premiums, policy
24 fees, assessments, or rates, or making or permitting any unfair
25 discrimination between persons of the same class involving
26 essentially the same hazards, in the amount of premiums,
27 policy fees, assessments, or rates charged or made for:
28 (i) policies or contracts of reinsurance or joint reinsurance,
29 or abstract and title insurance;
30 (ii) policies or contracts of insurance against loss or damage
31 to aircraft, or against liability arising out of the ownership,
32 maintenance, or use of any aircraft, or of vessels or craft,
33 their cargoes, marine builders' risks, marine protection and
34 indemnity, or other risks commonly insured under marine,
35 as distinguished from inland marine, insurance; or
36 (iii) policies or contracts of any other kind or kinds of
37 insurance whatsoever.
38 However, nothing contained in clause (C) shall be construed to
39 apply to any of the kinds of insurance referred to in clauses (A)
40 and (B) nor to reinsurance in relation to such kinds of insurance.
41 Nothing in clause (A), (B), or (C) shall be construed as making or
42 permitting any excessive, inadequate, or unfairly discriminatory
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1 charge or rate or any charge or rate determined by the department
2 or commissioner to meet the requirements of any other insurance
3 rate regulatory law of this state.
4 (8) Except as otherwise expressly provided by IC 27-1-47 or
5 another law, knowingly permitting or offering to make or making
6 any contract or policy of insurance of any kind or kinds
7 whatsoever, including but not in limitation, life annuities, or
8 agreement as to such contract or policy other than as plainly
9 expressed in such contract or policy issued thereon, or paying or
10 allowing, or giving or offering to pay, allow, or give, directly or
11 indirectly, as inducement to such insurance, or annuity, any rebate
12 of premiums payable on the contract, or any special favor or
13 advantage in the dividends, savings, or other benefits thereon, or
14 any valuable consideration or inducement whatever not specified
15 in the contract or policy; or giving, or selling, or purchasing or
16 offering to give, sell, or purchase as inducement to such insurance
17 or annuity or in connection therewith, any stocks, bonds, or other
18 securities of any insurance company or other corporation,
19 association, limited liability company, or partnership, or any
20 dividends, savings, or profits accrued thereon, or anything of
21 value whatsoever not specified in the contract. Nothing in this
22 subdivision and subdivision (7) shall be construed as including
23 within the definition of discrimination or rebates any of the
24 following practices:
25 (A) Paying bonuses to policyholders or otherwise abating their
26 premiums in whole or in part out of surplus accumulated from
27 nonparticipating insurance, so long as any such bonuses or
28 abatement of premiums are fair and equitable to policyholders
29 and for the best interests of the company and its policyholders.
30 (B) In the case of life insurance policies issued on the
31 industrial debit plan, making allowance to policyholders who
32 have continuously for a specified period made premium
33 payments directly to an office of the insurer in an amount
34 which fairly represents the saving in collection expense.
35 (C) Readjustment of the rate of premium for a group insurance
36 policy based on the loss or expense experience thereunder, at
37 the end of the first year or of any subsequent year of insurance
38 thereunder, which may be made retroactive only for such
39 policy year.
40 (D) Paying by an insurer or insurance producer thereof duly
41 licensed as such under the laws of this state of money,
42 commission, or brokerage, or giving or allowing by an insurer
2024 IN 1327—LS 6888/DI 141 14
1 or such licensed insurance producer thereof anything of value,
2 for or on account of the solicitation or negotiation of policies
3 or other contracts of any kind or kinds, to a broker, an
4 insurance producer, or a solicitor duly licensed under the laws
5 of this state, but such broker, insurance producer, or solicitor
6 receiving such consideration shall not pay, give, or allow
7 credit for such consideration as received in whole or in part,
8 directly or indirectly, to the insured by way of rebate.
9 (9) Requiring, as a condition precedent to loaning money upon the
10 security of a mortgage upon real property, that the owner of the
11 property to whom the money is to be loaned negotiate any policy
12 of insurance covering such real property through a particular
13 insurance producer or broker or brokers. However, this
14 subdivision shall not prevent the exercise by any lender of the
15 lender's right to approve or disapprove of the insurance company
16 selected by the borrower to underwrite the insurance.
17 (10) Entering into any contract, combination in the form of a trust
18 or otherwise, or conspiracy in restraint of commerce in the
19 business of insurance.
20 (11) Monopolizing or attempting to monopolize or combining or
21 conspiring with any other person or persons to monopolize any
22 part of commerce in the business of insurance. However,
23 participation as a member, director, or officer in the activities of
24 any nonprofit organization of insurance producers or other
25 workers in the insurance business shall not be interpreted, in
26 itself, to constitute a combination in restraint of trade or as
27 combining to create a monopoly as provided in this subdivision
28 and subdivision (10). The enumeration in this chapter of specific
29 unfair methods of competition and unfair or deceptive acts and
30 practices in the business of insurance is not exclusive or
31 restrictive or intended to limit the powers of the commissioner or
32 department or of any court of review under section 8 of this
33 chapter.
34 (12) Requiring as a condition precedent to the sale of real or
35 personal property under any contract of sale, conditional sales
36 contract, or other similar instrument or upon the security of a
37 chattel mortgage, that the buyer of such property negotiate any
38 policy of insurance covering such property through a particular
39 insurance company, insurance producer, or broker or brokers.
40 However, this subdivision shall not prevent the exercise by any
41 seller of such property or the one making a loan thereon of the
42 right to approve or disapprove of the insurance company selected
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1 by the buyer to underwrite the insurance.
2 (13) Issuing, offering, or participating in a plan to issue or offer,
3 any policy or certificate of insurance of any kind or character as
4 an inducement to the purchase of any property, real, personal, or
5 mixed, or services of any kind, where a charge to the insured is
6 not made for and on account of such policy or certificate of
7 insurance. However, this subdivision shall not apply to any of the
8 following:
9 (A) Insurance issued to credit unions or members of credit
10 unions in connection with the purchase of shares in such credit
11 unions.
12 (B) Insurance employed as a means of guaranteeing the
13 performance of goods and designed to benefit the purchasers
14 or users of such goods.
15 (C) Title insurance.
16 (D) Insurance written in connection with an indebtedness and
17 intended as a means of repaying such indebtedness in the
18 event of the death or disability of the insured.
19 (E) Insurance provided by or through motorists service clubs
20 or associations.
21 (F) Insurance that is provided to the purchaser or holder of an
22 air transportation ticket and that:
23 (i) insures against death or nonfatal injury that occurs during
24 the flight to which the ticket relates;
25 (ii) insures against personal injury or property damage that
26 occurs during travel to or from the airport in a common
27 carrier immediately before or after the flight;
28 (iii) insures against baggage loss during the flight to which
29 the ticket relates; or
30 (iv) insures against a flight cancellation to which the ticket
31 relates.
32 (14) Refusing, because of the for-profit status of a hospital or
33 medical facility, to make payments otherwise required to be made
34 under a contract or policy of insurance for charges incurred by an
35 insured in such a for-profit hospital or other for-profit medical
36 facility licensed by the Indiana department of health.
37 (15) Refusing to insure an individual, refusing to continue to issue
38 insurance to an individual, limiting the amount, extent, or kind of
39 coverage available to an individual, or charging an individual a
40 different rate for the same coverage, solely because of that
41 individual's blindness or partial blindness, except where the
42 refusal, limitation, or rate differential is based on sound actuarial
2024 IN 1327—LS 6888/DI 141 16
1 principles or is related to actual or reasonably anticipated
2 experience.
3 (16) Committing or performing, with such frequency as to
4 indicate a general practice, unfair claim settlement practices (as
5 defined in section 4.5 of this chapter).
6 (17) Between policy renewal dates, unilaterally canceling an
7 individual's coverage under an individual or group health
8 insurance policy solely because of the individual's medical or
9 physical condition.
10 (18) Using a policy form or rider that would permit a cancellation
11 of coverage as described in subdivision (17).
12 (19) Violating IC 27-1-22-25, IC 27-1-22-26, or IC 27-1-22-26.1
13 concerning motor vehicle insurance rates.
14 (20) Violating IC 27-8-21-2 concerning advertisements referring
15 to interest rate guarantees.
16 (21) Violating IC 27-8-24.3 concerning insurance and health plan
17 coverage for victims of abuse.
18 (22) Violating IC 27-8-26 concerning genetic screening or testing.
19 (23) Violating IC 27-1-15.6-3(b) concerning licensure of
20 insurance producers.
21 (24) Violating IC 27-1-38 concerning depository institutions.
22 (25) Violating IC 27-8-28-17(c) or IC 27-13-10-8(c) concerning
23 the resolution of an appealed grievance decision.
24 (26) Violating IC 27-8-5-2.5(e) through IC 27-8-5-2.5(j) (expired
25 July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1,
26 2007, and repealed).
27 (27) Violating IC 27-2-21 concerning use of credit information.
28 (28) Violating IC 27-4-9-3 concerning recommendations to
29 consumers.
30 (29) Engaging in dishonest or predatory insurance practices in
31 marketing or sales of insurance to members of the United States
32 Armed Forces as:
33 (A) described in the federal Military Personnel Financial
34 Services Protection Act, P.L.109-290; or
35 (B) defined in rules adopted under subsection (b).
36 (30) Violating IC 27-8-19.8-20.1 concerning stranger originated
37 life insurance.
38 (31) Violating IC 27-2-22 concerning retained asset accounts.
39 (32) Violating IC 27-8-5-29 concerning health plans offered
40 through a health benefit exchange (as defined in IC 27-19-2-8).
41 (33) Violating a requirement of the federal Patient Protection and
42 Affordable Care Act (P.L. 111-148), as amended by the federal
2024 IN 1327—LS 6888/DI 141 17
1 Health Care and Education Reconciliation Act of 2010 (P.L.
2 111-152), that is enforceable by the state.
3 (34) After June 30, 2015, violating IC 27-2-23 concerning
4 unclaimed life insurance, annuity, or retained asset account
5 benefits.
6 (35) Willfully violating IC 27-1-12-46 concerning a life insurance
7 policy or certificate described in IC 27-1-12-46(a).
8 (36) Violating IC 27-1-37-7 concerning prohibiting the disclosure
9 of health care service claims data.
10 (37) Violating IC 27-4-10-10 concerning virtual claims payments.
11 (38) Violating IC 27-1-24.5 concerning pharmacy benefit
12 managers.
13 (39) Violating IC 27-7-17-16 or IC 27-7-17-17 concerning the
14 marketing of travel insurance policies.
15 (40) Violating IC 27-2-25.5-4 concerning audits of a third
16 party administrator, managed care organization, or prepaid
17 health care delivery plan.
18 (b) Except with respect to federal insurance programs under
19 Subchapter III of Chapter 19 of Title 38 of the United States Code, the
20 commissioner may, consistent with the federal Military Personnel
21 Financial Services Protection Act (10 U.S.C. 992 note), adopt rules
22 under IC 4-22-2 to:
23 (1) define; and
24 (2) while the members are on a United States military installation
25 or elsewhere in Indiana, protect members of the United States
26 Armed Forces from;
27 dishonest or predatory insurance practices.
28 SECTION 16. An emergency is declared for this act.
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