CHAPTER 6. REIMBURSEMENT FOR CERTAIN MEDICAL SERVICES
IC 27-8-6
Chapter 6. Reimbursement for Certain Medical Services
IC 27-8-6-1
Professional services for which reimbursement authorized
Sec. 1. Notwithstanding any provision of any individual or group
policy of accident and health insurance, or any provision of a policy,
contract, plan, or agreement for hospital or medical service or
indemnity, wherever such policy, contract, plan, or agreement
provides for reimbursement for any service which is in the lawful
scope of practice of a duly licensed dentist, health service provider
in psychology, podiatrist, osteopath, optometrist, or chiropractor, the
person entitled to benefits or the person performing services under
the policy, contract, plan, or agreement shall be entitled to
reimbursement on an equal basis for such service, whether the
service is performed by a physician, dentist, health service provider
in psychology, podiatrist, osteopath, optometrist, or chiropractor duly
licensed under the laws of this state.
(Formerly: Acts 1969, c.409, s.1; Acts 1974, P.L.126, SEC.1.) As
amended by P.L.260-1985, SEC.1.
IC 27-8-6-2
Prior policies
Sec. 2. The provisions of section 1 of this chapter shall not apply
to any policy, contract, plan, or agreement in effect prior to May 1,
1969.
(Formerly: Acts 1969, c.409, s.2.) As amended by P.L.252-1985,
SEC.311.
IC 27-8-6-3
Application of amendments by Acts 1974, P.L.126
Sec. 3. The amendments to this chapter made by Acts 1974,
P.L.126 do not apply to a policy, contract, plan, or agreement in
effect before June 11, 1974.
As added by P.L.1-1989, SEC.55.
IC 27-8-6-4
Reimbursement for services; application of section; prohibitions
excluded
Sec. 4. (a) This section does not apply to any of the following:
(1) A health maintenance organization (as defined in
IC 27-13-1-19) or limited service health maintenance
organization (as defined in IC 27-13-34-4).
(2) A preferred provider plan (as defined in IC 27-8-11-1).
(3) An employee benefit program that is subject to the federal
Employee Retirement Income Security Act (29 U.S.C. 1001 et
seq.).
(4) Worker's compensation for an injury to or occupational
disease of an employee under IC 22-3.
(b) A group or individual policy or agreement providing
comprehensive accident and health benefits must reimburse an
insured for services rendered by a provider licensed under IC 25-10
within the scope of that provider's license in the same manner as that
policy or agreement reimburses an insured for services rendered by
a provider licensed under IC 25-22.5 within the scope of that
provider's license. The policy or agreement may not exclude or
otherwise limit reimbursement for any service that a provider
licensed under IC 25-10 renders under the scope of that provider's
license in the diagnosis and treatment of any illness or injury. This
section does not require that a health care policy or agreement cover
a particular illness or injury.
(c) This section does not prohibit the following:
(1) The application of coinsurance and deductible provisions to
providers licensed under IC 25-10 on the same basis as those
provisions are applied to providers licensed under IC 25-22.5.
(2) The application of cost containment or quality assurance
measures to providers licensed under IC 25-10 on the same
basis as those measures are applied to providers licensed under
IC 25-22.5.
(3) A review of the necessity of services that applies to services
rendered by providers licensed under IC 25-10 on the same
basis as the review applies to services provided by providers
licensed under IC 25-22.5.
As added by P.L.153-1990, SEC.1. Amended by P.L.26-1994,
SEC.12.
IC 27-8-6-5
Indemnity for services provided by certified registered nurse
anesthetist
Sec. 5. (a) As used in this section, "certified registered nurse
anesthetist" has the meaning set forth in IC 25-23-1-1.4.
(b) As used in this section, "insured" means an individual who is
entitled to the benefits provided by a policy of accident and sickness
insurance. The term includes the following:
(1) The policyholder of an individual policy of accident and
sickness insurance.
(2) A member of the group covered by a group policy of
accident and sickness insurance.
(3) An individual who is entitled to coverage under a policy of
accident and sickness insurance as a spouse or dependent of an
individual referred to in subdivision (1) or (2).
(c) As used in this section, "insurer" has the meaning set forth in
IC 27-1-2-3.
(d) As used in this section, "policy of accident and sickness
insurance" has the meaning set forth in IC 27-8-5-1.
(e) An insurer that issued a policy of accident and sickness
insurance that indemnifies an insured for anesthesiology services
shall indemnify an insured under the policy for any covered
anesthesiology services provided by a certified registered nurse
anesthetist.
As added by P.L.258-1995, SEC.1.