CHAPTER 16. PROTECTION AGAINST RECEIVERSHIP; CONTINUATION OF BENEFITS
IC 27-13-16
Chapter 16. Protection Against Receivership; Continuation of
Benefits
IC 27-13-16-1
Plan for receivership
Sec. 1. The commissioner shall require a health maintenance
organization to have a plan for handling receivership that allows for
the continuation of benefits after the date of receivership:
(1) for the duration of the contract period for which premiums
have been paid; or
(2) if an enrollee is hospitalized on the date of receivership for
the longer of:
(A) the period ending when the enrollee is discharged from
hospitalization; or
(B) the duration of the contract period for which premiums
have been paid.
As added by P.L.26-1994, SEC.25. Amended by P.L.83-2003, SEC.1.
IC 27-13-16-2
Requirements of commissioner to ensure continuation of benefits
Sec. 2. (a) In considering the plan prepared by a health
maintenance organization under section 1 of this chapter, the
commissioner may require one (1) or more of the following:
(1) Insurance to cover the expenses to be paid for continued
benefits after receivership.
(2) Receivership reserves.
(3) Any other arrangements to ensure that benefits are
continued as required by section 1 of this chapter.
(b) However, the commissioner may not require provisions in
contracts between the health maintenance organization and
participating providers that obligate a provider to provide services
after the organization enters receivership.
As added by P.L.26-1994, SEC.25.
IC 27-13-16-3
Termination of continuation of benefits
Sec. 3. The continuation of benefits required under section 1 of
this chapter shall terminate on the date that an enrollee obtains
coverage under IC 27-13-18.
As added by P.L.26-1994, SEC.25.
IC 27-13-16-4
Eligibility for Indiana comprehensive health insurance policy
Sec. 4. If an enrollee is hospitalized continuously from the date of
receivership through the last date of the enrollee's continuation of
benefits under section 1 of this chapter, the enrollee shall be eligible
for an Indiana comprehensive health insurance policy under
IC 27-8-10. Notwithstanding any provision of IC 27-8-10, the policy
may not contain preexisting condition exclusions with respect to the
condition for which the enrollee was hospitalized. The enrollee shall
become eligible for coverage effective on the first day after the
enrollee's continuation of benefits ends.
As added by P.L.26-1994, SEC.25.
IC 27-13-16-5
Rules for governing plan
Sec. 5. The commissioner may adopt rules governing a health
maintenance organization's plan for covering all outstanding claims
during the first sixty (60) days that the health maintenance
organization enters receivership. These rules may govern at least the
following:
(1) Letters of guarantee from a parent company.
(2) Conversion policies.
(3) Insolvency insurance policies.
(4) Additional deposits.
As added by P.L.26-1994, SEC.25.