CHAPTER 18. ENROLLMENT PERIOD IN EVENT OF RECEIVERSHIP
IC 27-13-18
Chapter 18. Enrollment Period in Event of Receivership
IC 27-13-18-1
Offer of coverage required; allocation of contracts
Sec. 1. (a) In the event of receivership of a health maintenance
organization, the commissioner may order all other carriers that
participated in the enrollment process of the group covered by the
organization in receivership at the last regular enrollment period of
the group to offer the enrollees of the organization in receivership an
enrollment period of thirty (30) days beginning on the date of
receivership.
(b) Each carrier referred to in subsection (a) shall offer the
enrollees of the health maintenance organization in receivership:
(1) the same coverage;
(2) under the same terms; and
(3) at the same rates;
as the carrier had offered at the last regular enrollment period of the
group. The coverage required under this chapter shall begin on the
date of receivership and end on the date the contract period would
have ended had the health maintenance organization not gone into
receivership.
(c) If there is no carrier referred to in subsection (a), or the
commissioner determines that there is no carrier referred to in
subsection (a) that has adequate or accessible resources, the
commissioner shall equitably allocate the:
(1) group contracts of the health maintenance organization in
receivership; and
(2) individual contracts of the health maintenance organization
in receivership belonging to enrollees who are unable to obtain
other coverage;
among all health maintenance organizations operating within a
portion of the service area of the health maintenance organization in
receivership. The commissioner shall not allocate individual
contracts to a health maintenance organization that does not offer
direct individual enrollment.
(d) A health maintenance organization to which the commissioner
allocates a group contract under subsection (c)(1) shall offer to the
group existing coverage that is most similar to the group's coverage
with the health maintenance organization in receivership, at rates
consistent with the successor health maintenance organization's
existing rating methodology.
(e) A health maintenance organization to which the commissioner
allocates individual contracts under subsection (c)(2) shall offer to
the enrollee existing individual or conversion coverage that is most
similar to the enrollee's coverage with the health maintenance
organization in receivership, at rates consistent with the successor
health maintenance organization's existing rating methodology.
As added by P.L.26-1994, SEC.25. Amended by P.L.203-2001,
SEC.27.
IC 27-13-18-2
Failing to provide for continuation of benefits; assessments of
health maintenance organizations; tax credits or premium
adjustments
Sec. 2. (a) If for any reason the plan of the health maintenance
organization under IC 27-13-16 does not provide for continuation of
benefits as required by IC 27-13-16-1, the liquidator shall assess, or
cause to be assessed, each licensed health maintenance organization
doing business in Indiana. The amount that each licensed health
maintenance organization is assessed must be based on the ratio of
the amount of all subscriber premiums received by the health
maintenance organization for contracts issued in Indiana for the
previous calendar year to the amount of the total subscriber
premiums received by all licensed health maintenance organizations
for contracts issued in Indiana for the previous calendar year.
(b) The total assessments of health maintenance organizations
under subsection (a) must equal an amount sufficient to provide for
continuation of benefits as required by IC 27-13-16-1 to enrollees
covered under contracts issued by the health maintenance
organization to subscribers located in Indiana, and to pay
administrative expenses.
(c) The total amount of all assessments to be paid by a health
maintenance organization in any one (1) calendar year may not
exceed one percent (1%) of the premiums received by the health
maintenance organization from business in Indiana during the
calendar year preceding the assessment.
(d) If the total amount of all assessments in any one (1) calendar
year does not provide an amount sufficient to meet the requirements
of subsection (a), additional funds must be assessed in succeeding
calendar years.
(e) Health maintenance organizations that, during any preceding
calendar year, have paid one (1) or more assessments levied under
this section may either:
(1) take as a credit against adjusted gross income taxes or
similar taxes upon revenue or income of health maintenance
organizations that may be imposed by Indiana up to twenty
percent (20%) of any assessment described in this section for
each calendar year following the year in which those
assessments were paid until the aggregate of those assessments
have been offset; or
(2) include in the premiums charged for coverage to which this
article applies amounts sufficient to recoup a sum equal to the
amounts paid in assessments as long as the premiums are not
excessive by virtue of including an amount reasonably
calculated to recoup assessments paid by the health
maintenance organization.
As added by P.L.26-1994, SEC.25. Amended by P.L.192-2002(ss),
SEC.170.