CHAPTER 29. INSURANCE
IC 12-15-29
Chapter 29. Insurance
IC 12-15-29-1
Insurers; authorization to release information
Sec. 1. An applicant for or a recipient of Medicaid is considered
to have authorized an insurer to release to the office information
needed by the office to secure or enforce the office's rights under
Medicaid.
As added by P.L.2-1992, SEC.9.
IC 12-15-29-2
Requests for information from insurers; limitation
Sec. 2. (a) Subject to subsection (b), an insurer shall furnish
records or information pertaining to the coverage of an individual for
the individual's medical costs under an individual or a group policy
or other obligation, or the medical benefits paid or claims made
under a policy or an obligation, if the office or its agent does the
following:
(1) Requests the information electronically or by United States
mail.
(2) Certifies that the individual is:
(A) a Medicaid applicant or recipient; or
(B) a person who is legally responsible for the applicant or
recipient.
(b) The office may request only the records or information
necessary to determine whether insurance benefits have been or
should have been claimed and paid with respect to items of medical
care and services that were received by a particular individual and
for which Medicaid coverage would otherwise be available.
As added by P.L.2-1992, SEC.9. Amended by P.L.187-2007, SEC.4;
P.L.234-2007, SEC.209; P.L.3-2008, SEC.94.
IC 12-15-29-3
Guidelines for information requests
Sec. 3. The administrator and the insurance commissioner shall
establish guidelines for information requests under this chapter.
As added by P.L.2-1992, SEC.9.
IC 12-15-29-4
Direct payments by insurers to office; amount of payments
Sec. 4. (a) If:
(1) an insurer has not discharged the insurer's obligation to
make payments to an individual for medical services;
(2) the individual has received Medicaid from the office; and
(3) the insurer has received notice that Medicaid has been
furnished to the individual;
the insurer shall make payments directly to the office.
(b) The payments under subsection (a) may not exceed the amount
of Medicaid paid by the office.
As added by P.L.2-1992, SEC.9.
IC 12-15-29-4.5
Insurer's acceptance of Medicaid claims
Sec. 4.5. (a) An insurer shall accept a Medicaid claim for a
Medicaid recipient for three (3) years from the date the service was
provided.
(b) An insurer may not deny a Medicaid claim submitted by the
office solely on the basis of:
(1) the date of submission of the claim;
(2) the type or format of the claim form;
(3) the method of submission of the claim; or
(4) a failure to provide proper documentation at the point of
sale that is the basis of the claim;
if the claim is submitted by the office within three (3) years from the
date the service was provided as required in subsection (a) and the
office commences action to enforce the office's rights regarding the
claim within six (6) years of the office's submission of the claim.
(c) An insurer may not deny a Medicaid claim submitted by the
office solely due to a lack of prior authorization. An insurer shall
conduct the prior authorization on a retrospective basis for claims
where prior authorization is necessary and adjudicate any claim
authorized in this manner as if the claim received prior authorization.
As added by P.L.187-2007, SEC.5.
IC 12-15-29-5
Medicaid furnished by office; insurer put on notice of claim by
office; insurer paying person or entity other than office; office's
claim not discharged
Sec. 5. An insurer:
(1) that is put on notice of a claim by the office under section 4
of this chapter; and
(2) proceeds to pay the claim to a person or an entity other than
the office;
is not discharged from payment of the office's claim.
As added by P.L.2-1992, SEC.9.
IC 12-15-29-6
Payment by insurer to office; discharge of obligation
Sec. 6. Payment to the office by an insurer under section 4 of this
chapter discharges the insurer's obligation with respect to further
payment on the claim for the amount paid.
As added by P.L.2-1992, SEC.9.
IC 12-15-29-7
Notice to insurer that Medicaid has been furnished; requirements;
notification given office by insurer; payment of claim
Sec. 7. (a) The notice requirements of section 4 of this chapter are
satisfied if:
(1) the insurer receives from the office, electronically or by
United States mail, a statement of the claims paid or medical
services rendered by the office, together with a claim for
reimbursement; or
(2) the insurer receives a claim from a beneficiary stating that
the beneficiary has applied for or has received Medicaid from
the office in connection with the same claim.
(b) An insurer that receives a claim under subsection (a)(2) shall
notify the office of the insurer's obligation on the claim and shall:
(1) pay the obligation to the provider of service; or
(2) if the office has provided Medicaid, pay the office.
As added by P.L.2-1992, SEC.9. Amended by P.L.187-2007, SEC.6.
IC 12-15-29-8
Unlawful insurance clause
Sec. 8. A clause of an insurance contract, plan, or agreement
administered by an insurer is void if the clause limits or excludes
enrollment or payments to an individual who is eligible for Medicaid.
As added by P.L.2-1992, SEC.9. Amended by P.L.46-1995, SEC.41.
IC 12-15-29-9
State's acquisition of person's right to payment
Sec. 9. (a) IC 27-8-23 applies to this section.
(b) To the extent that payment for covered medical expenses has
been made under the state Medicaid program for health care items or
services furnished to a person, in a case where a third party has a
legal liability to make payments, the state is considered to have
acquired the rights of the person to payment by any other party for
the health care items or services.
(c) As required under 42 U.S.C. 1396a(a)(25), an insurer shall
accept the state's right of recovery and the assignment to the state of
any right of the individual or entity to payment for a health care item
or service for which payment has been made under the state
Medicaid plan.
As added by P.L.46-1995, SEC.42. Amended by P.L.187-2007,
SEC.7.
IC 12-15-29-10
Employer sponsored health insurance to include coverage for child
Sec. 10. (a) IC 27-8-23 and IC 31-16-15 apply to this section.
(b) This section does not apply if an employer has eliminated
family health coverage for all of its employees.
(c) Whenever a parent is required by a court or an administrative
order to provide health coverage for a child and the parent is eligible
for family health coverage through an employer doing business in
Indiana, the employer shall provide family health coverage to the
child in the manner described under IC 27-8-23-6 and in the notice
under IC 31-16-15-4.5(b). In addition, the employer shall:
(1) withhold from the employee's compensation the employee's
share, if any, of premiums for health coverage; and
(2) pay that amount to the insurer.
(d) Upon the initiation of withholding under subsection (c), an
employee whose applicable child support order did not include a
deduction from weekly available income for the cost of the health
care premium is entitled to a modification of the child support order,
taking into account the payments made as of the date withholding
began.
As added by P.L.46-1995, SEC.43. Amended by P.L.80-2010,
SEC.20.