CHAPTER 8. ANNUAL REPORT
IC 27-13-8
Chapter 8. Annual Report
IC 27-13-8-1
Filing
Sec. 1. On or before March 1 of each year, a health maintenance
organization must file with the commissioner a report that covers the
preceding calendar year. The report must be:
(1) made on forms prescribed by the commissioner; and
(2) verified by at least two (2) principal officers of the health
maintenance organization.
As added by P.L.26-1994, SEC.25.
IC 27-13-8-1.5
Preparation of annual statement
Sec. 1.5. (a) Each health maintenance organization authorized to
conduct business in Indiana and required to file an annual statement
with the department under this chapter shall prepare the health
maintenance organization's statement:
(1) on the National Association of Insurance Commissioners
(NAIC) Annual Statement Blank;
(2) in accordance with NAIC Annual Statement Instructions;
and
(3) following practices and procedures prescribed by the most
recent NAIC Accounting Practices and Procedures Manual.
(b) To the extent that the NAIC Annual Statement Instructions
require disclosure under subsection (a) of compensation paid to or on
behalf of a health maintenance organization's officers, directors, or
employees, the information may be filed with the department as an
exhibit separate from the annual statement blank. The compensation
information described under this subsection shall be maintained by
the department as confidential and may not be disclosed to the public
under IC 5-14-3.
As added by P.L.203-2001, SEC.20.
IC 27-13-8-2
Additional information filed with commissioner
Sec. 2. (a) In addition to the report required by section 1 of this
chapter, a health maintenance organization shall each year file with
the commissioner the following:
(1) Audited financial statements of the health maintenance
organization for the preceding calendar year prepared in
conformity with statutory accounting practices prescribed or
otherwise permitted by the department.
(2) A list of participating providers who provide health care
services to enrollees or subscribers of the health maintenance
organization.
(3) A description of the grievance procedure of the health
maintenance organization:
(A) established under IC 27-13-10, including:
(i) the total number of grievances handled through the
procedure during the preceding calendar year;
(ii) a compilation of the causes underlying those
grievances; and
(iii) a summary of the final disposition of those
grievances; and
(B) established under IC 27-13-10.1, including:
(i) the total number of external grievances handled through
the procedure during the preceding calendar year;
(ii) a compilation of the causes underlying those
grievances; and
(iii) a summary of the final disposition of those
grievances;
for each independent review organization used by the health
maintenance organization during the reporting year.
(4) The percentage of providers credentialed by the health
maintenance organization according to the most current
standards or guidelines, if any, developed by the National
Committee on Quality Assurance or a successor organization.
(5) The RBC report required under IC 27-1-36-25.
(6) The health maintenance organization's Health Plan
Employer Data and Information Set (HEDIS) data.
(b) The information required by subsection (a)(2) through (a)(5)
must be filed with the commissioner on or before March 1 of each
year. The audited financial statements required by subsection (a)(1)
must be filed with the commissioner on or before June 1 of each
year. The health maintenance organization's HEDIS data required by
subsection (a)(6) must be filed with the commissioner on or before
July 1 of each year. The commissioner shall:
(1) make the information required to be filed under this section
available to the public; and
(2) prepare an annual compilation of the data required under
subsections (a)(3), (a)(4), and (a)(6) that allows for comparative
analysis.
(c) Upon a determination by a health maintenance organization's
auditor that the health maintenance organization:
(1) does not meet the requirements of IC 27-13-12-3; or
(2) is in the condition described in IC 27-13-24-1(a)(5);
the health maintenance organization shall notify the commissioner
within five (5) business days after the auditor's determination.
(d) The commissioner may require any additional reports as are
necessary and appropriate for the commissioner to carry out the
commissioner's duties under this article.
As added by P.L.26-1994, SEC.25. Amended by P.L.195-1996,
SEC.5; P.L.191-1997, SEC.2; P.L.133-1999, SEC.1; P.L.133-1999,
SEC.2; P.L.203-2001, SEC.21; P.L.51-2002, SEC.10.
IC 27-13-8-3
Annual statement convention blank; quarterly reports
Sec. 3. (a) This section applies to a domestic health maintenance
organization that is authorized to transact business in Indiana.
(b) As used in this section, "NAIC" refers to the National
Association of Insurance Commissioners.
(c) On or before March 1 of each year, a health maintenance
organization shall file with the National Association of Insurance
Commissioners and with the department a copy of the health
maintenance organization's annual statement convention blank and
additional filings prescribed by the commissioner for the preceding
year. A health maintenance organization shall also file quarterly
statements with the NAIC and with the department, on or before May
15, August 15, and November 15 of each year, in a form prescribed
by the commissioner. The information filed with the NAIC under this
subsection:
(1) must be:
(A) in the same format; and
(B) of the same scope;
as is required by the commissioner under section 1 of this
chapter;
(2) to the extent required by the NAIC, must include the signed
jurat page and the actuarial certification; and
(3) must be filed electronically in accordance with NAIC
electronic filing specifications.
The commissioner may, for good cause shown, grant an exemption
from the requirement of this section to domestic health maintenance
organizations that operate only in Indiana. If a health maintenance
organization files any amendment or addendum to the health
maintenance organization's annual statement convention blank or
quarterly statement with the commissioner, the health maintenance
organization shall also file a copy of the amendment or addendum
with the NAIC. Annual and quarterly financial statements are
considered filed with the NAIC when delivered to the address
designated by the NAIC for the filings, regardless of whether the
filing is accompanied by any applicable fee.
(d) The commissioner may, for good cause shown, grant a health
maintenance organization an extension of time for the filing required
by subsection (c).
(e) In the absence of actual malice:
(1) members of the NAIC;
(2) duly authorized committees, subcommittees, and task forces
of members of the NAIC;
(3) delegates of members of the NAIC;
(4) employees of the NAIC; and
(5) other persons responsible for collecting, reviewing,
analyzing, and disseminating information developed from the
filing of annual statement convention blanks under this section;
shall be considered to be acting as agents of the commissioner under
the authority of this section and are not subject to civil liability for
libel, slander, or any other cause of action by virtue of the collection,
review, analysis, or dissemination of the data and information
collected from the filings required by this section.
(f) The commissioner may suspend, revoke, or refuse to renew the
certificate of authority of a health maintenance organization that fails
to file the health maintenance organization's annual statement
convention blank or quarterly statements with the NAIC or with the
department within the time allowed by subsection (c) or (d).
As added by P.L.203-2001, SEC.22.
IC 27-13-8-4
Civil penalties
Sec. 4. (a) The commissioner may impose a civil penalty of five
hundred dollars ($500), after notice and hearing under IC 4-21.5-3,
on a health maintenance organization that fails to file an annual
statement under this chapter.
(b) A domestic health maintenance organization that fails to file
an audited annual financial statement under section 2(a)(1) of this
chapter before June 1 of each year without obtaining an extension is
subject to a civil penalty of fifty dollars ($50) per day until the report
is received by the commissioner.
As added by P.L.203-2001, SEC.23.