CHAPTER 14.1. COVERAGE FOR SERVICES RELATED TO MORBID OBESITY
IC 27-8-14.1
Chapter 14.1. Coverage for Services Related to Morbid Obesity
IC 27-8-14.1-1
"Accident and sickness insurance policy" defined
Sec. 1. (a) As used in this chapter, "accident and sickness
insurance policy" means an insurance policy that:
(1) provides one (1) or more of the types of insurance described
in IC 27-1-5-1, classes 1(b) and 2(a); and
(2) is issued on a group basis.
(b) As used in this chapter, "accident and sickness insurance
policy" does not include the following:
(1) Accident only, credit, dental, vision, Medicare supplement,
long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Worker's compensation or similar insurance.
(4) Automobile medical payment insurance.
(5) A specified disease policy.
(6) A short term insurance plan that:
(A) may not be renewed; and
(B) has a duration of not more than six (6) months.
(7) A policy that provides indemnity benefits not based on any
expense incurred requirement, including a plan that provides
coverage for:
(A) hospital confinement, critical illness, or intensive care;
or
(B) gaps for deductibles or copayments.
(8) A supplemental plan that always pays in addition to other
coverage.
(9) A student health plan.
(10) An employer sponsored health benefit plan that is:
(A) provided to individuals who are eligible for Medicare;
and
(B) not marketed as, or held out to be, a Medicare
supplement policy.
As added by P.L.78-2000, SEC.2. Amended by P.L.173-2007,
SEC.31.
IC 27-8-14.1-2
"Health care provider" defined
Sec. 2. As used in this chapter, "health care provider" means a:
(1) physician licensed under IC 25-22.5; or
(2) hospital licensed under IC 16-21;
that provides health care services for surgical treatment of morbid
obesity.
As added by P.L.78-2000, SEC.2.
IC 27-8-14.1-3
"Morbid obesity" defined
Sec. 3. As used in this chapter, "morbid obesity" means:
(1) a body mass index of at least thirty-five (35) kilograms per
meter squared, with comorbidity or coexisting medical
conditions such as hypertension, cardiopulmonary conditions,
sleep apnea, or diabetes; or
(2) a body mass index of at least forty (40) kilograms per meter
squared without comorbidity.
For purposes of this section, body mass index is equal to weight in
kilograms divided by height in meters squared.
As added by P.L.78-2000, SEC.2. Amended by P.L.196-2005, SEC.4.
IC 27-8-14.1-4
Coverage for nonexperimental, surgical treatment of morbid
obesity
Sec. 4. (a) Except as provided in subsection (b), an insurer that
issues an accident and sickness insurance policy shall offer coverage
for nonexperimental, surgical treatment by a health care provider of
morbid obesity:
(1) that has persisted for at least five (5) years; and
(2) for which nonsurgical treatment that is supervised by a
physician has been unsuccessful for at least six (6) consecutive
months.
(b) An insurer that issues an accident and sickness insurance
policy may not provide coverage for a surgical treatment of morbid
obesity for an insured who is less than twenty-one (21) years of age
unless two (2) physicians licensed under IC 25-22.5 determine that
the surgery is necessary to:
(1) save the life of the insured; or
(2) restore the insured's ability to maintain a major life activity
(as defined in IC 4-23-29-6);
and each physician documents in the insured's medical record the
reason for the physician's determination.
As added by P.L.78-2000, SEC.2. Amended by P.L.196-2005, SEC.5;
P.L.102-2006, SEC.4.