CHAPTER 19. REPLACEMENT COVERAGE IN EVENT OF RECEIVERSHIP
IC 27-13-19
Chapter 19. Replacement Coverage in Event of Receivership
IC 27-13-19-1
"Discontinuance" defined
Sec. 1. As used in this chapter, "discontinuance" means the
termination of the contract between a group contract holder and a
health maintenance organization due to the receivership of the health
maintenance organization. The term does not refer to the termination
of an individual contract.
As added by P.L.26-1994, SEC.25.
IC 27-13-19-2
Replacement coverage; challenge of enrollee
Sec. 2. (a) A carrier that provides replacement coverage with
respect to group health care services after the discontinuance of the
prior health maintenance organization contract or policy providing
health care services must, immediately upon beginning to provide the
replacement coverage, cover all enrollees who were covered under
the previous health maintenance organization contract or policy on
the date of discontinuance.
(b) A carrier that provides replacement coverage under this
section may challenge whether an individual designated as an
enrollee under the previous health maintenance organization contract
qualified as an enrollee under the previous health maintenance
organization contract.
As added by P.L.26-1994, SEC.25.
IC 27-13-19-3
Provisions reducing or excluding benefits
Sec. 3. (a) Except as provided in subsection (b), a provision in a
succeeding carrier's contract of replacement coverage that would
operate to reduce or exclude benefits on the basis that the condition
giving rise to the benefits preexisted the effective date of the
succeeding carrier's contract may not be applied with respect to those
enrollees who were covered under the prior carrier's contract or
policy on the date of discontinuance.
(b) A provision in a succeeding carrier's contract of replacement
coverage may operate to reduce or exclude benefits on the basis of
a preexisting condition to the extent that the prior carrier's contract
or policy would have required that benefits for the condition be
reduced or excluded.
As added by P.L.26-1994, SEC.25.