Bill Text: IN HB1319 | 2013 | Regular Session | Amended
Bill Title: Health benefit exchange provisions.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Engrossed - Dead) 2013-02-27 - First reading: referred to Committee on Appropriations [HB1319 Detail]
Download: Indiana-2013-HB1319-Amended.html
Citations Affected: IC 12-15; IC 27-1; IC 27-4; IC 27-8; IC 27-19.
Synopsis: Health benefit exchange provisions. Provides for
implementation of the federal Patient Protection and Affordable Care
Act with respect to a health benefit exchange in Indiana. Specifies that
Indiana insurance law applies to a health plan offered through a health
benefit exchange to the same extent the law applies to a health plan
offered independent of the health benefit exchange. Specifies
requirements for health plans issued through a health benefit exchange.
Requires a navigator to be certified and an application organization to
be registered before providing services with respect to a health benefit
exchange. Provides for dissolution of the Indiana comprehensive health
insurance association.
Effective: Upon passage; July 1, 2013.
January 17, 2013, read first time and referred to Committee on Insurance.
January 24, 2013, amended, reported _ Do Pass. Referred to Committee on Ways and
Means pursuant to Rule 127.
February 18, 2013, amended, reported _ Do Pass.
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in
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A BILL FOR AN ACT to amend the Indiana Code concerning
insurance.
(1) The individual is at least eighteen (18) years of age and less than sixty-five (65) years of age.
(2) The individual is a United States citizen and has been a resident of Indiana for at least twelve (12) months.
(3) The individual has an annual household income of not more than the following:
(A) Effective through December 31, 2013, two hundred percent (200%) of the federal income poverty level.
(B) Beginning January 1, 2014, one hundred thirty-three percent (133%) of the federal income poverty level, based on the adjusted gross income provisions set forth in Section 2001(a)(1) of the federal Patient Protection and Affordable Care Act.
(4) Effective through December 31, 2013, the individual is not eligible for health insurance coverage through the individual's employer.
(5) Effective through December 31, 2013, the individual has:
(A) not had health insurance coverage for at least six (6) months; or
(B) had coverage under the Indiana comprehensive health insurance association (IC 27-8-10) within the immediately preceding six (6) months and the coverage no longer applies under IC 27-8-10-0.5.
(b) The following individuals are not eligible for the plan:
(1) An individual who participates in the federal Medicare program (42 U.S.C. 1395 et seq.).
(2) A pregnant woman for purposes of pregnancy related services.
(3) An individual who is otherwise eligible for medical assistance.
(c) The eligibility requirements specified in subsection (a) are subject to approval for federal financial participation by the United States Department of Health and Human Services.
(1) For the conduct of the work of the department.
(2) Prescribing the methods and standards to be used in making the examinations and prescribing the forms of reports of the several insurance companies to which IC 27-1 is applicable.
(3) Defining what is a safe or an unsafe manner and a safe or an unsafe condition for conducting business by any insurance company to which IC 27-1 is applicable.
(4) For the establishment of safe and sound methods for the transaction of business by such insurance companies and for the purpose of safeguarding the interests of policyholders, creditors, and shareholders respecting the withdrawal or payment of funds by any life insurance company in times of emergency. Any rule or regulation promulgated under this subdivision may apply to one (1) or more insurance companies as the department may determine.
(5) For the administration and termination of the affairs of any such insurance company which is in involuntary liquidation or whose business and property have been taken possession of by the department for the purpose of rehabilitation, liquidation, conservation, or dissolution under IC 27-1.
(6) For the regulation of the solicitation or use of proxies, in general and as they concern consents or authorizations, in respect of securities issued by any domestic stock company for the purpose of protecting investors by prescribing the form of proxies, including such consents or authorizations, and by requiring adequate disclosure of information relevant to such proxies, including such consents or authorizations, and relevant to the business to be transacted at any meeting of shareholders with respect to which such proxies, including such consents or authorizations, may be used, which regulations may, in general, conform to those prescribed by the National Association of Insurance Commissioners.
(7) For regulation related to a health benefit exchange established under the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), and operating in Indiana.
(b) The department may adopt a rule under IC 4-22-2 to provide reasonable simplification of the terms and coverage of individual and group Medicare supplement accident and sickness insurance policies and individual and group Medicare supplement subscriber contracts in order to facilitate public understanding and comparison and to eliminate provisions contained in those policies or contracts which may be misleading or confusing in connection either with the purchase of those coverages or with the settlement of claims and to provide for full disclosure in the sale of those coverages.
(b) The commissioner may not:
(1) disclose; or
(2) subject to subpoena;
financial information regarding material transactions disclosed by an insurer under IC 27-2-18.
(c) The commissioner may not disclose any information, including any document or report received from:
(1) the National Association of Insurance Commissioners; or
(2) an insurance department of another state;
if the information is designated as confidential information in the other jurisdiction.
(d) The commissioner may share confidential information with:
(1) the National Association of Insurance Commissioners; or
(2) an insurance department of another state;
on the condition that the National Association of Insurance Commissioners and the other state agree to maintain the same level of confidentiality that is provided to the information under Indiana law.
(e) The commissioner may share confidential information related to a health benefit exchange established under the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), with the health benefit exchange if the health benefit exchange:
(1) agrees to maintain the same level of confidentiality that is provided to the confidential information under Indiana law; and
(2) complies with all applicable confidentiality requirements under federal law.
(b) Except as provided in subsection (c), to renew a license issued under IC 27-1-15.6, a limited lines producer with a title qualification under IC 27-1-15.6-7(a)(8) must complete at least seven (7) hours of credit in continuing education courses related to the business of title insurance with at least one (1) hour of instruction in a structured setting or comparable self-study in each of the following:
(1) Ethical practices in the marketing and selling of title insurance.
(2) Title insurance underwriting.
(3) Escrow issues.
(4) Principles of the federal Real Estate Settlement Procedures Act (12 U.S.C. 2608).
An attorney in good standing who is admitted to the practice of law in Indiana and holds a license issued under IC 27-1-15.6 with a title
qualification under IC 27-1-15.6-7(a)(8) may complete all or any
number of hours of continuing education required by this subsection by
completing an equivalent number of hours in continuing legal
education courses related to the business of title insurance or any
aspect of real property law.
(c) The following insurance producers are not required to complete
continuing education courses to renew a license under this chapter:
(1) A limited lines producer who is licensed without examination
under IC 27-1-15.6-18(1) or IC 27-1-15.6-18(2).
(2) A limited line credit insurance producer.
(3) A nonresident limited lines producer with a title qualification:
(A) whose home state requires continuing education for a title
qualification; and
(B) who has met the continuing education requirements
described in clause (A).
(d) To satisfy the requirements of subsection (a) or (b), a licensee
may use only those credit hours earned in continuing education courses
completed by the licensee:
(1) after the effective date of the licensee's last renewal of a
license under this chapter; or
(2) if the licensee is renewing a license for the first time, after the
date on which the licensee was issued the license under this
chapter.
(e) If an insurance producer receives qualification for a license in
more than one (1) line of authority under IC 27-1-15.6, the insurance
producer may not be required to complete a total of more than
twenty-four (24) hours of credit in continuing education courses to
renew the license.
(f) Except as provided in subsection (g), a licensee may receive
credit only for completing the following continuing education courses:
(1) Continuing education courses that have been approved by
the commissioner under section 4 of this chapter.
(2) Continuing education courses that are required for the
licensee under IC 27-19-4-14.
(g) A licensee who teaches a course approved by the commissioner
under section 4 of this chapter shall receive continuing education credit
for teaching the course.
(h) When a licensee renews a license issued under this chapter, the
licensee must submit:
(1) a continuing education statement that:
(A) is in a format authorized by the commissioner;
(B) is signed by the licensee under oath; and
(C) lists the continuing education courses completed by the licensee to satisfy the continuing education requirements of this section; and
(2) any other information required by the commissioner.
(i) A continuing education statement submitted under subsection (h) may be reviewed and audited by the department.
(j) A licensee shall retain a copy of the original certificate of completion received by the licensee for completion of a continuing education course.
(k) A licensee who completes a continuing education course that:
(1) is approved by the commissioner under section 4 of this chapter;
(2) is held in a classroom setting; and
(3) concerns ethics;
shall receive continuing education credit not to exceed four (4) hours in a renewal period.
(1) Making, issuing, circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, or statement:
(A) misrepresenting the terms of any policy issued or to be issued or the benefits or advantages promised thereby or the dividends or share of the surplus to be received thereon;
(B) making any false or misleading statement as to the dividends or share of surplus previously paid on similar policies;
(C) making any misleading representation or any misrepresentation as to the financial condition of any insurer, or as to the legal reserve system upon which any life insurer operates;
(D) using any name or title of any policy or class of policies misrepresenting the true nature thereof; or
(E) making any misrepresentation to any policyholder insured in any company for the purpose of inducing or tending to induce such policyholder to lapse, forfeit, or surrender the policyholder's insurance.
(2) Making, publishing, disseminating, circulating, or placing before the public, or causing, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public,
in a newspaper, magazine, or other publication, or in the form of
a notice, circular, pamphlet, letter, or poster, or over any radio or
television station, or in any other way, an advertisement,
announcement, or statement containing any assertion,
representation, or statement with respect to any person in the
conduct of the person's insurance business, which is untrue,
deceptive, or misleading.
(3) Making, publishing, disseminating, or circulating, directly or
indirectly, or aiding, abetting, or encouraging the making,
publishing, disseminating, or circulating of any oral or written
statement or any pamphlet, circular, article, or literature which is
false, or maliciously critical of or derogatory to the financial
condition of an insurer, and which is calculated to injure any
person engaged in the business of insurance.
(4) Entering into any agreement to commit, or individually or by
a concerted action committing any act of boycott, coercion, or
intimidation resulting or tending to result in unreasonable
restraint of, or a monopoly in, the business of insurance.
(5) Filing with any supervisory or other public official, or making,
publishing, disseminating, circulating, or delivering to any person,
or placing before the public, or causing directly or indirectly, to
be made, published, disseminated, circulated, delivered to any
person, or placed before the public, any false statement of
financial condition of an insurer with intent to deceive. Making
any false entry in any book, report, or statement of any insurer
with intent to deceive any agent or examiner lawfully appointed
to examine into its condition or into any of its affairs, or any
public official to which such insurer is required by law to report,
or which has authority by law to examine into its condition or into
any of its affairs, or, with like intent, willfully omitting to make a
true entry of any material fact pertaining to the business of such
insurer in any book, report, or statement of such insurer.
(6) Issuing or delivering or permitting agents, officers, or
employees to issue or deliver, agency company stock or other
capital stock, or benefit certificates or shares in any common law
corporation, or securities or any special or advisory board
contracts or other contracts of any kind promising returns and
profits as an inducement to insurance.
(7) Making or permitting any of the following:
(A) Unfair discrimination between individuals of the same
class and equal expectation of life in the rates or assessments
charged for any contract of life insurance or of life annuity or
in the dividends or other benefits payable thereon, or in any
other of the terms and conditions of such contract. However,
in determining the class, consideration may be given to the
nature of the risk, plan of insurance, the actual or expected
expense of conducting the business, or any other relevant
factor.
(B) Unfair discrimination between individuals of the same
class involving essentially the same hazards in the amount of
premium, policy fees, assessments, or rates charged or made
for any policy or contract of accident or health insurance or in
the benefits payable thereunder, or in any of the terms or
conditions of such contract, or in any other manner whatever.
However, in determining the class, consideration may be given
to the nature of the risk, the plan of insurance, the actual or
expected expense of conducting the business, or any other
relevant factor.
(C) Excessive or inadequate charges for premiums, policy
fees, assessments, or rates, or making or permitting any unfair
discrimination between persons of the same class involving
essentially the same hazards, in the amount of premiums,
policy fees, assessments, or rates charged or made for:
(i) policies or contracts of reinsurance or joint reinsurance,
or abstract and title insurance;
(ii) policies or contracts of insurance against loss or damage
to aircraft, or against liability arising out of the ownership,
maintenance, or use of any aircraft, or of vessels or craft,
their cargoes, marine builders' risks, marine protection and
indemnity, or other risks commonly insured under marine,
as distinguished from inland marine, insurance; or
(iii) policies or contracts of any other kind or kinds of
insurance whatsoever.
However, nothing contained in clause (C) shall be construed to
apply to any of the kinds of insurance referred to in clauses (A)
and (B) nor to reinsurance in relation to such kinds of insurance.
Nothing in clause (A), (B), or (C) shall be construed as making or
permitting any excessive, inadequate, or unfairly discriminatory
charge or rate or any charge or rate determined by the department
or commissioner to meet the requirements of any other insurance
rate regulatory law of this state.
(8) Except as otherwise expressly provided by law, knowingly
permitting or offering to make or making any contract or policy
of insurance of any kind or kinds whatsoever, including but not in
limitation, life annuities, or agreement as to such contract or
policy other than as plainly expressed in such contract or policy
issued thereon, or paying or allowing, or giving or offering to pay,
allow, or give, directly or indirectly, as inducement to such
insurance, or annuity, any rebate of premiums payable on the
contract, or any special favor or advantage in the dividends,
savings, or other benefits thereon, or any valuable consideration
or inducement whatever not specified in the contract or policy; or
giving, or selling, or purchasing or offering to give, sell, or
purchase as inducement to such insurance or annuity or in
connection therewith, any stocks, bonds, or other securities of any
insurance company or other corporation, association, limited
liability company, or partnership, or any dividends, savings, or
profits accrued thereon, or anything of value whatsoever not
specified in the contract. Nothing in this subdivision and
subdivision (7) shall be construed as including within the
definition of discrimination or rebates any of the following
practices:
(A) Paying bonuses to policyholders or otherwise abating their
premiums in whole or in part out of surplus accumulated from
nonparticipating insurance, so long as any such bonuses or
abatement of premiums are fair and equitable to policyholders
and for the best interests of the company and its policyholders.
(B) In the case of life insurance policies issued on the
industrial debit plan, making allowance to policyholders who
have continuously for a specified period made premium
payments directly to an office of the insurer in an amount
which fairly represents the saving in collection expense.
(C) Readjustment of the rate of premium for a group insurance
policy based on the loss or expense experience thereunder, at
the end of the first year or of any subsequent year of insurance
thereunder, which may be made retroactive only for such
policy year.
(D) Paying by an insurer or insurance producer thereof duly
licensed as such under the laws of this state of money,
commission, or brokerage, or giving or allowing by an insurer
or such licensed insurance producer thereof anything of value,
for or on account of the solicitation or negotiation of policies
or other contracts of any kind or kinds, to a broker, an
insurance producer, or a solicitor duly licensed under the laws
of this state, but such broker, insurance producer, or solicitor
receiving such consideration shall not pay, give, or allow
credit for such consideration as received in whole or in part,
directly or indirectly, to the insured by way of rebate.
(9) Requiring, as a condition precedent to loaning money upon the
security of a mortgage upon real property, that the owner of the
property to whom the money is to be loaned negotiate any policy
of insurance covering such real property through a particular
insurance producer or broker or brokers. However, this
subdivision shall not prevent the exercise by any lender of the
lender's right to approve or disapprove of the insurance company
selected by the borrower to underwrite the insurance.
(10) Entering into any contract, combination in the form of a trust
or otherwise, or conspiracy in restraint of commerce in the
business of insurance.
(11) Monopolizing or attempting to monopolize or combining or
conspiring with any other person or persons to monopolize any
part of commerce in the business of insurance. However,
participation as a member, director, or officer in the activities of
any nonprofit organization of insurance producers or other
workers in the insurance business shall not be interpreted, in
itself, to constitute a combination in restraint of trade or as
combining to create a monopoly as provided in this subdivision
and subdivision (10). The enumeration in this chapter of specific
unfair methods of competition and unfair or deceptive acts and
practices in the business of insurance is not exclusive or
restrictive or intended to limit the powers of the commissioner or
department or of any court of review under section 8 of this
chapter.
(12) Requiring as a condition precedent to the sale of real or
personal property under any contract of sale, conditional sales
contract, or other similar instrument or upon the security of a
chattel mortgage, that the buyer of such property negotiate any
policy of insurance covering such property through a particular
insurance company, insurance producer, or broker or brokers.
However, this subdivision shall not prevent the exercise by any
seller of such property or the one making a loan thereon of the
right to approve or disapprove of the insurance company selected
by the buyer to underwrite the insurance.
(13) Issuing, offering, or participating in a plan to issue or offer,
any policy or certificate of insurance of any kind or character as
an inducement to the purchase of any property, real, personal, or
mixed, or services of any kind, where a charge to the insured is
not made for and on account of such policy or certificate of
insurance. However, this subdivision shall not apply to any of the
following:
(A) Insurance issued to credit unions or members of credit
unions in connection with the purchase of shares in such credit
unions.
(B) Insurance employed as a means of guaranteeing the
performance of goods and designed to benefit the purchasers
or users of such goods.
(C) Title insurance.
(D) Insurance written in connection with an indebtedness and
intended as a means of repaying such indebtedness in the
event of the death or disability of the insured.
(E) Insurance provided by or through motorists service clubs
or associations.
(F) Insurance that is provided to the purchaser or holder of an
air transportation ticket and that:
(i) insures against death or nonfatal injury that occurs during
the flight to which the ticket relates;
(ii) insures against personal injury or property damage that
occurs during travel to or from the airport in a common
carrier immediately before or after the flight;
(iii) insures against baggage loss during the flight to which
the ticket relates; or
(iv) insures against a flight cancellation to which the ticket
relates.
(14) Refusing, because of the for-profit status of a hospital or
medical facility, to make payments otherwise required to be made
under a contract or policy of insurance for charges incurred by an
insured in such a for-profit hospital or other for-profit medical
facility licensed by the state department of health.
(15) Refusing to insure an individual, refusing to continue to issue
insurance to an individual, limiting the amount, extent, or kind of
coverage available to an individual, or charging an individual a
different rate for the same coverage, solely because of that
individual's blindness or partial blindness, except where the
refusal, limitation, or rate differential is based on sound actuarial
principles or is related to actual or reasonably anticipated
experience.
(16) Committing or performing, with such frequency as to
indicate a general practice, unfair claim settlement practices (as
defined in section 4.5 of this chapter).
(17) Between policy renewal dates, unilaterally canceling an
individual's coverage under an individual or group health
insurance policy solely because of the individual's medical or
physical condition.
(18) Using a policy form or rider that would permit a cancellation
of coverage as described in subdivision (17).
(19) Violating IC 27-1-22-25, IC 27-1-22-26, or IC 27-1-22-26.1
concerning motor vehicle insurance rates.
(20) Violating IC 27-8-21-2 concerning advertisements referring
to interest rate guarantees.
(21) Violating IC 27-8-24.3 concerning insurance and health plan
coverage for victims of abuse.
(22) Violating IC 27-8-26 concerning genetic screening or testing.
(23) Violating IC 27-1-15.6-3(b) concerning licensure of
insurance producers.
(24) Violating IC 27-1-38 concerning depository institutions.
(25) Violating IC 27-8-28-17(c) or IC 27-13-10-8(c) concerning
the resolution of an appealed grievance decision.
(26) Violating IC 27-8-5-2.5(e) through IC 27-8-5-2.5(j) (expired
July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1,
2007, and repealed).
(27) Violating IC 27-2-21 concerning use of credit information.
(28) Violating IC 27-4-9-3 concerning recommendations to
consumers.
(29) Engaging in dishonest or predatory insurance practices in
marketing or sales of insurance to members of the United States
Armed Forces as:
(A) described in the federal Military Personnel Financial
Services Protection Act, P.L.109-290; or
(B) defined in rules adopted under subsection (b).
(30) Violating IC 27-8-19.8-20.1 concerning stranger originated
life insurance.
(31) Violating IC 27-2-22 concerning retained asset accounts.
(32) Violating IC 27-8-5-29 concerning health plans offered
through a health benefit exchange (as defined in
IC 27-19-2-8).
(33) Violating a requirement of the federal Patient Protection
and Affordable Care Act (P.L. 111-148), as amended by the
federal Health Care and Education Reconciliation Act of 2010
(P.L. 111-152), that is enforceable by the state.
(b) Except with respect to federal insurance programs under
Subchapter III of Chapter 19 of Title 38 of the United States Code, the
commissioner may, consistent with the federal Military Personnel
Financial Services Protection Act (P.L.109-290), adopt rules under
IC 4-22-2 to:
(1) define; and
(2) while the members are on a United States military installation
or elsewhere in Indiana, protect members of the United States
Armed Forces from;
dishonest or predatory insurance practices.
(b) No policy of accident and sickness insurance may be issued or delivered to any person in this state, nor may any application, rider, or endorsement be used in connection with an accident and sickness insurance policy, until a copy of the form of the policy and of the classification of risks and the premium rates, or, in the case of assessment companies, the estimated cost pertaining thereto, have been filed with and reviewed by the commissioner under section 1.5 of this chapter. This section is applicable also to assessment companies and fraternal benefit associations or societies.
(c) This chapter shall be applied in conformity with the requirements of the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), as in effect on September 23, 2010.
(d) A policy of accident and sickness insurance that is issued or delivered through a health benefit exchange established under the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), is subject to the requirements of this chapter. The commissioner may adopt rules under IC 4-22-2 to implement this subsection, including rules concerning:
(1) certification or decertification of a qualified health plan
(as defined in IC 27-19-2-15); and
(2) open enrollment.
(b) As used in this section, "commissioner" refers to the insurance commissioner appointed under IC 27-1-1-2.
(c) As used in this section, "grossly inadequate filing" means a policy form filing:
(1) that fails to provide key information, including state specific information, regarding a product, policy, or rate; or
(2) that demonstrates an insufficient understanding of applicable legal requirements.
(d) As used in this section, "policy form" means a policy, a contract, a certificate, a rider, an endorsement, an evidence of coverage, or any amendment that is required by law to be filed with the commissioner for approval before use in Indiana.
(e) As used in this section, "type of insurance" refers to a type of coverage listed on the National Association of Insurance Commissioners Uniform Life, Accident and Health, Annuity and Credit Product Coding Matrix, or a successor document, under the heading "Continuing Care Retirement Communities", "Health", "Long Term Care", or "Medicare Supplement".
(f) Each person having a role in the filing process described in subsection (i) shall act in good faith and with due diligence in the performance of the person's duties.
(g) A policy form, including a policy form of a policy, contract, certificate, rider, endorsement, evidence of coverage, or amendment that is issued through a health benefit exchange (as defined in IC 27-19-2-8), may not be issued or delivered in Indiana unless the policy form has been filed with and approved by the commissioner.
(h) The commissioner shall do the following:
(1) Create a document containing a list of all product filing requirements for each type of insurance, with appropriate citations to the law, administrative rule, or bulletin that specifies the requirement, including the citation for the type of insurance to which the requirement applies.
(2) Make the document described in subdivision (1) available on
the department of insurance Internet site.
(3) Update the document described in subdivision (1) at least
annually and not more than thirty (30) days following any change
in a filing requirement.
(i) The filing process is as follows:
(1) A filer shall submit a policy form filing that:
(A) includes a copy of the document described in subsection
(h);
(B) indicates the location within the policy form or supplement
that relates to each requirement contained in the document
described in subsection (h); and
(C) certifies that the policy form meets all requirements of
state law.
(2) The commissioner shall review a policy form filing and, not
more than thirty (30) days after the commissioner receives the
filing under subdivision (1):
(A) approve the filing; or
(B) provide written notice of a determination:
(i) that deficiencies exist in the filing; or
(ii) that the commissioner disapproves the filing.
A written notice provided by the commissioner under clause (B)
must be based only on the requirements set forth in the document
described in subsection (h) and must cite the specific
requirements not met by the filing. A written notice provided by
the commissioner under clause (B)(i) must state the reasons for
the commissioner's determination in sufficient detail to enable the
filer to bring the policy form into compliance with the
requirements not met by the filing.
(3) A filer may resubmit a policy form that:
(A) was determined deficient under subdivision (2) and has
been amended to correct the deficiencies; or
(B) was disapproved under subdivision (2) and has been
revised.
A policy form resubmitted under this subdivision must meet the
requirements set forth as described in subdivision (1) and must be
resubmitted not more than thirty (30) days after the filer receives
the commissioner's written notice of deficiency or disapproval. If
a policy form is not resubmitted within thirty (30) days after
receipt of the written notice, the commissioner's determination
regarding the policy form is final.
(4) The commissioner shall review a policy form filing
resubmitted under subdivision (3) and, not more than thirty (30)
days after the commissioner receives the resubmission:
(A) approve the resubmitted policy form; or
(B) provide written notice that the commissioner disapproves
the resubmitted policy form.
A written notice of disapproval provided by the commissioner
under clause (B) must be based only on the requirements set forth
in the document described in subsection (h), must cite the specific
requirements not met by the filing, and must state the reasons for
the commissioner's determination in detail. The commissioner's
approval or disapproval of a resubmitted policy form under this
subdivision is final, except that the commissioner may allow the
filer to resubmit a further revised policy form if the filer, in the
filer's resubmission under subdivision (3), introduced new
provisions or materially modified a substantive provision of the
policy form. If the commissioner allows a filer to resubmit a
further revised policy form under this subdivision, the filer must
resubmit the further revised policy form not more than thirty (30)
days after the filer receives notice under clause (B), and the
commissioner shall issue a final determination on the further
revised policy form not more than thirty (30) days after the
commissioner receives the further revised policy form.
(5) If the commissioner disapproves a policy form filing under
this subsection, the commissioner shall notify the filer, in writing,
of the filer's right to a hearing as described in subsection (m). A
disapproved policy form filing may not be used for a policy of
accident and sickness insurance unless the disapproval is
overturned in a hearing conducted under this subsection.
(6) If the commissioner does not take any action on a policy form
that is filed or resubmitted under this subsection in accordance
with any applicable period specified in subdivision (2), (3), or (4),
the policy form filing is considered to be approved.
(j) Except as provided in this subsection, the commissioner may not
disapprove a policy form resubmitted under subsection (i)(3) or (i)(4)
for a reason other than a reason specified in the original notice of
determination under subsection (i)(2)(B). The commissioner may
disapprove a resubmitted policy form for a reason other than a reason
specified in the original notice of determination under subsection (i)(2)
if:
(1) the filer has introduced a new provision in the resubmission;
(2) the filer has materially modified a substantive provision of the
policy form in the resubmission;
(3) there has been a change in requirements applying to the policy
form; or
(4) there has been reviewer error and the written disapproval fails
to state a specific requirement with which the policy form does
not comply.
(k) The commissioner may return a grossly inadequate filing to the
filer without triggering a deadline set forth in this section.
(l) The commissioner may disapprove a policy form if:
(1) the benefits provided under the policy form are not reasonable
in relation to the premium charged; or
(2) the policy form contains provisions that are unjust, unfair,
inequitable, misleading, or deceptive, or that encourage
misrepresentation of the policy.
(m) Upon disapproval of a filing under this section, the
commissioner shall provide written notice to the filer or insurer of the
right to a hearing within twenty (20) days of a request for a hearing.
(n) Unless a policy form approved under this chapter contains a
material error or omission, the commissioner may not:
(1) retroactively disapprove the policy form; or
(2) examine the filer of the policy form during a routine or
targeted market conduct examination for compliance with a policy
form filing requirement that was not in existence at the time the
policy form was filed.
(b) A health plan may not be offered to any person in Indiana through a health benefit exchange unless:
(1) the form of the policy, classification of risks, and premium rates that apply to the health plan have been filed with and reviewed and approved by the commissioner under this chapter; and
(2) the insurer is authorized under this title to engage in the business of insurance in Indiana.
(c) An insurer that offers a multistate health plan under Section 1334 of PPACA through a health benefit exchange shall file, for review and approval, the form of the policy, classification of risks, and premium rates that apply to the multistate health plan with the commissioner and the federal government on the same business day.
(d) This title, in conformity with PPACA, applies to a health plan offered through a health benefit exchange to the same extent
that this title would apply if the health plan were offered
independent of a health benefit exchange.
(1) the date on which a health benefit exchange (as defined in IC 27-19-2-8) begins operating in Indiana; or
(2) December 31, 2013.
(b) A claim for payment under an association policy must be made to the association not later than the later of:
(1) sixty (60) days after the date on which the insurance operations cease under subsection (a); or
(2) March 1, 2014.
(c) An appeal or grievance under this chapter must be resolved not later than ninety (90) days after the date on which the insurance operations cease under subsection (a).
(d) Balance billing under this chapter by a health care provider that is not a member of a health care provider network arrangement used by the association is prohibited after the later of:
(1) ninety (90) days after the date on which the insurance operations cease under subsection (a); or
(2) March 30, 2014.
(e) The association shall, not later than June 30, 2013, submit to the commissioner a plan of dissolution for the association. The following apply to a plan of dissolution submitted under this subsection:
(1) The plan of dissolution must provide for the following:
(A) Continuity of care for an individual who is covered under an association policy and is an inpatient on the date on which the insurance operations cease under subsection (a).
(B) A final accounting described in section 2.1(g) of this chapter of the:
(i) assessments; and
(ii) cessation of the liability;
of members of the association.
(C) Resolution of any net asset deficiency.
(D) Cessation of all liability of the association.
(E) Final dissolution of the association.
(2) The plan of dissolution may provide that, with the
approval of the board and the commissioner, a power or duty
of the association may be delegated to a person that is to
perform functions similar to the functions of the association.
(f) The commissioner shall, after notice and hearing, approve a
plan of dissolution submitted under subsection (e) if the
commissioner determines that the plan:
(1) is suitable to assure the fair, reasonable, and equitable
dissolution of the association; and
(2) complies with subsection (e).
(g) A plan of dissolution submitted under subsection (e) is
effective upon the written approval of the commissioner.
(h) An action by or against the association must be filed not
more than one (1) year after the date on which the insurance
operations cease under subsection (a).
(i) This chapter expires on the date on which final dissolution of
the association occurs under the plan of dissolution approved by
the commissioner under subsection (f).
(j) Funds remaining in the association on the date on which final
dissolution of the association occurs must be transferred into the
state general fund.
(k) The association, or the person to which the association
delegates powers under subsection (e), may implement this section
in accordance with the plan of dissolution approved by the
commissioner under subsection (f).
ARTICLE 19. HEALTH BENEFIT EXCHANGE
Chapter 1. General Provisions
Sec. 1. Except as otherwise provided in this title, a reference to a federal law in this article is a reference to the federal law as in effect on January 1, 2012.
Sec. 2. This article applies to a state agency with respect to the state agency's interactions with a health benefit exchange operated in Indiana.
Sec. 3. This article expires immediately upon the occurrence of any of the following events:
(1) The complete repeal of PPACA.
(2) The repeal of the PPACA requirement that one (1) or more health benefit exchanges be established in each state.
(3) Any other congressional action, or federal court decision, rendering the establishment of a health benefit exchange
unnecessary.
(4) The issuance of an executive order by the governor
specifying that the establishment of a health benefit exchange
in Indiana is unnecessary or inappropriate.
Sec. 4. The commissioner may do the following to implement
this article:
(1) Adopt rules under IC 4-22-2.
(2) Enter into a contract, agreement, or memorandum of
understanding with the following:
(A) A health benefit exchange.
(B) An entity that contracts with, or is a subcontractor of,
a health benefit exchange.
(C) A federal or state agency.
(D) A health benefit exchange operating in another state.
(E) An agency of another state.
(F) A health plan.
(G) Another person, for purposes of the performance of
necessary functions, as determined by the commissioner.
(3) Enter with a person described in subdivision (2) into an
information sharing agreement:
(A) that concerns the disclosure and receiving of data
necessary to implement this article or PPACA; and
(B) that:
(i) includes adequate protections with respect to
confidentiality of the shared information; and
(ii) complies with applicable state and federal law.
Chapter 2. Definitions
Sec. 1. The definitions in this chapter apply throughout this
article.
Sec. 2. "Administrator" refers to the administrator of the office
of Medicaid policy and planning appointed under IC 12-8-6.5-2.
Sec. 3. "Application organization" means an entity that:
(1) is a navigator described in Section 1311(i) of PPACA (42
U.S.C. 18031(i));
(2) assists individuals with application for and enrollment in
a health benefit exchange or public health insurance program,
including an entity that makes presumptive eligibility
determinations; and
(3) performs the functions of a navigator with respect to a
health benefit exchange as established by the commissioner.
Sec. 4. "CHIP office" refers to the office of the children's health
insurance program established by IC 12-17.6-2-1.
Sec. 5. "Commissioner" refers to the insurance commissioner appointed under IC 27-1-1-2.
Sec. 6. "Department" refers to the department of insurance created by IC 27-1-1-1.
Sec. 7. "Group health plan" means a group health plan (as defined in Section 2791 of the federal Public Health Service Act (42 U.S.C. 300gg-91)) that provides health insurance coverage.
Sec. 8. "Health benefit exchange" means an American health benefit exchange operating in Indiana under PPACA.
Sec. 9. "Health insurance coverage" has the meaning set forth in Section 2791 of the federal Public Health Service Act (42 U.S.C. 300gg-91).
Sec. 10. (a) "Health plan" means a policy or contract that provides health insurance coverage.
(b) The term includes a group health plan.
Sec. 11. (a) "Navigator" means an individual who:
(1) is described in Section 1311(i) of PPACA (42 U.S.C. 18031(i));
(2) assists other individuals with application for and enrollment in a health benefit exchange or public health insurance program, including an individual who makes presumptive eligibility determinations; and
(3) performs the functions of a navigator with respect to a health benefit exchange as established by the commissioner.
(b) The term does not include a representative authorized by an individual to perform functions on behalf of the individual in connection with Medicaid.
Sec. 12. "Person" means an individual or an entity.
Sec. 13. "PPACA" refers to the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152).
Sec. 14. (a) "Public health insurance program" refers to health coverage provided under a state or federal government program.
(b) The term includes the following:
(1) Medicaid (42 U.S.C. 1396 et seq.).
(2) The Indiana check-up plan established by IC 12-15-44.2-3.
(3) The children's health insurance program established under IC 12-17.6.
Sec. 15."Qualified health plan" means a health plan that has been certified under Section 1301 of PPACA (42 U.S.C. 18021(a)) to meet the criteria for availability through a health benefit
exchange operated in Indiana.
Sec. 16. "Secretary" refers to the secretary of family and social
services appointed under IC 12-8-1.5-2.
Chapter 3. Health Benefit Exchange Authority
Sec. 1. This chapter applies to a health benefit exchange
operating in Indiana.
Sec. 2. (a) The commissioner and department may implement
and enforce the insurance law of this state in connection with a
health benefit exchange.
(b) A law of this state concerning a health benefit exchange does
not preempt or supersede the authority of the commissioner or
department to regulate the business of insurance in Indiana.
(c) This section does not require the department to perform any
function related to a health benefit exchange without being
appropriately compensated for the performance of the function.
Sec. 3. (a) The secretary, the administrator, and the CHIP office
may implement and enforce the social services law of this state in
connection with a health benefit exchange.
(b) A law of this state concerning a health benefit exchange does
not preempt or supersede the authority of the secretary, the
administrator, or the CHIP office to administer and regulate social
services in Indiana.
(c) This section does not require the secretary, the
administrator, or the CHIP office to perform any function related
to a health benefit exchange without being appropriately
compensated for the performance of the function.
(d) The secretary may adopt rules under IC 4-22-2 to implement
this section.
(e) The administrator and the CHIP office may do the following
to implement this section:
(1) Enter into a contract, agreement, or memorandum of
understanding with the following:
(A) A health benefit exchange.
(B) An entity that contracts with, or is a subcontractor of,
a health benefit exchange.
(C) A federal or state agency.
(D) A health benefit exchange operating in another state.
(E) An agency of another state.
(F) A health plan.
(2) Enter with a person described in subdivision (1) into an
information sharing agreement:
(A) that concerns the disclosure and receiving of data
necessary to implement this section or PPACA; and
(B) that:
(i) includes adequate protections with respect to
confidentiality of the shared information; and
(ii) complies with applicable state and federal law.
Chapter 4. Health Benefit Exchange Navigators and Application
Organizations
Sec. 1. (a) This chapter applies to a person that acts as a
navigator or an application organization for a health benefit
exchange in Indiana. This chapter must be applied in conformity
with PPACA.
(b) An individual who intends to act as a navigator shall obtain
certification under this chapter before acting as a navigator.
(c) An entity that intends to act as an application organization
shall obtain registration under this chapter before acting as an
application organization.
(d) The following are subject to regulation by the commissioner
and the secretary:
(1) A navigator.
(2) An application organization.
Sec. 2. Neither a navigator nor an application organization is
subject to the licensing requirements of IC 27-1-15.6.
Sec. 3. (a) A person that is a navigator or an application
organization must meet all of the following:
(1) Shall not provide incorrect, misleading, incomplete, or
materially untrue information in an application for
certification or registration.
(2) Shall not violate any of the following:
(A) An insurance law.
(B) A regulation.
(C) A subpoena of the commissioner.
(D) An order of the commissioner.
(E) A rule of a health benefit exchange operating in
Indiana.
(F) A rule adopted under IC 27-19-3-3(d).
(3) Shall not intentionally misrepresent the terms of an actual
or proposed insurance contract or application for insurance.
(4) Must not have had:
(A) an insurance producer or consultant license;
(B) a navigator certification or an application organization
registration; or
(C) an equivalent to a license, certification, or registration
described in clause (A) or (B);
denied, suspended, or revoked in any state, province, district,
or territory.
(5) If the person is a navigator, shall not fail to satisfy the
continuing education requirements established under section
12 of this chapter.
(6) Shall not obtain or attempt to obtain a license,
certification, or registration through misrepresentation or
fraud.
(7) Shall not fail to disclose a conflict of interest to the
commissioner:
(A) in an application under this chapter; or
(B) arising after application is made under this chapter.
(8) If the person is a navigator, must not have been convicted
of a felony or other crimes determined by the commissioner
or secretary.
(9) Must not have admitted to committing or have been found
to have committed an unfair trade practice or fraud in the
business of insurance.
(10) Shall not use fraudulent, coercive, or dishonest practices,
or demonstrate incompetence or untrustworthiness, in acting
as a navigator or an application organization.
(11) Shall not improperly use notes or other reference
material to complete an examination for certification under
this chapter.
(12) If the person is a navigator, must not have failed, and
shall not fail, to comply with an administrative or court order
imposing a child support obligation.
(13) Must not have failed, and shall not fail, to pay state
income tax or comply with any administrative or court order
directing payment of state income tax.
(14) Shall not fail to timely inform the commissioner of a
change in legal name or address.
(15) If the person is an application organization, shall not fail
to verify that each navigator working for the application
organization meets the following requirements:
(A) The navigator is certified under this chapter.
(B) The navigator has not committed an act that would be
grounds for denial, suspension, or revocation of
certification under this chapter.
(b) The commissioner may:
(1) reprimand a navigator or an application organization;
(2) levy a civil penalty against a navigator or an application organization;
(3) place a navigator or an application organization on probation;
(4) suspend a navigator's certification or an application organization's registration;
(5) revoke a navigator's certification or an application organization's registration for a period of years;
(6) permanently revoke a navigator's certification or an application organization's registration;
(7) issue a cease and desist order to a navigator or an application organization; or
(8) take any combination of the actions described in subdivisions (1) through (7);
for a violation described in subsection (a).
Sec. 4. The commissioner shall, in consultation with the secretary, do the following to implement this chapter:
(1) Develop a policy concerning conflicts of interest affecting navigators and application organizations, including conflicts of interest involving financial and nonfinancial considerations.
(2) Develop a consumer complaint procedure and applicable forms for filing a complaint.
(3) Define a reasonable period for the duration of navigator certification, after which the navigator must pay a renewal fee, complete continuing education, and reapply for certification.
(4) Define a reasonable period for the duration of application organization registration, after which the application organization must pay a renewal fee and reapply for registration.
(5) Develop a policy, procedure, and form for use by an application organization to attest to the commissioner that a navigator who provides the navigator's services on behalf of the application organization meets the requirements of section 3 of this chapter.
Sec. 5. (a) Before acting as a navigator in Indiana, an individual must:
(1) apply for certification as a navigator on a form prescribed by the commissioner; and
(2) declare, under penalty of denial, suspension, or revocation of the certification, that the statements made in the application are true, correct, and complete to the best of the
individual's knowledge and belief.
(b) Before approving an application submitted under subsection
(a), the commissioner shall determine whether the individual meets
the following requirements:
(1) The individual is at least eighteen (18) years of age.
(2) The individual has not committed any act described in
section 3 of this chapter that would be grounds for denial,
suspension, or revocation of certification.
(3) The individual has completed a precertification course of
study prescribed by the commissioner.
(4) The individual has paid the nonrefundable fees established
under section 7 of this chapter.
(5) The individual has successfully passed the examination
required by section 11 of this chapter.
Sec. 6. (a) Before acting as an application organization in
Indiana, an entity must be registered as an application
organization as follows:
(1) The entity must apply for registration as an application
organization on a form prescribed by the commissioner.
(2) The entity's application for registration:
(A) must be signed by an individual who is an owner,
partner, officer, director, member, or manager of the
entity, under penalty of denial, suspension, or revocation
of registration; and
(B) must declare that the statements made in the
application are true, correct, and complete to the best of
the signing individual's knowledge and belief.
(b) Before approving an application submitted under subsection
(a), the commissioner shall:
(1) verify that the entity is in good standing with the Indiana
secretary of state; and
(2) determine whether the entity meets the following
requirements:
(A) The entity has paid the nonrefundable fees established
under section 7 of this chapter.
(B) The entity has designated a certified individual
navigator to be responsible for the entity's compliance with
this chapter.
(C) The entity has not committed any act described in
section 3 of this chapter that would be grounds for denial,
suspension, or revocation of registration.
(D) No owner, partner, officer, director, member, or
manager of the entity has committed an act described in
clause (C) or in section 3 of this chapter that would be
grounds for denial, suspension, or revocation of
certification as a navigator under this chapter.
Sec. 7. (a) The commissioner may require the production of any
document that is reasonably necessary to verify the information
contained in an application submitted under section 5 or 6 of this
chapter.
(b) The commissioner shall collect from each applicant for
certification or registration under this chapter a nonrefundable
application fee established by the commissioner in an amount
expected to generate revenue sufficient to cover the costs incurred
by the commissioner in implementing this chapter.
Sec. 8. (a) A navigator who works for an application
organization must be appointed by the application organization in
writing.
(b) If an application organization, because of a violation
described in section 3 of this chapter, revokes the appointment of
a navigator described in subsection (a) who works for the
application organization, the application organization shall, not
more than thirty (30) days after the revocation occurs:
(1) submit a written report to the commissioner concerning
the revocation; and
(2) provide a copy of the report to the navigator at the
navigator's last known address by:
(A) certified mail, return receipt requested, postage
prepaid; or
(B) overnight delivery using a nationally recognized
carrier.
Sec. 9. A certified navigator who is unable to comply with the
certification renewal procedures under this chapter due to military
service or another extenuating circumstance may request from the
commissioner:
(1) a temporary waiver of:
(A) the renewal procedure; or
(B) an examination requirement; or
(2) a waiver of a penalty or sanction that might otherwise be
imposed for failure to comply with the renewal procedures.
Sec. 10. (a) A certification or registration under this chapter
must contain the navigator's or application organization's name
and address, the date of issuance, the expiration date, and any
other information the commissioner considers necessary.
(b) A navigator or an application organization shall inform the
commissioner of a change of address or legal name:
(1) not more than thirty (30) days after the change occurs;
and
(2) by any means acceptable to the commissioner.
Sec. 11. (a) An individual who applies for certification as a
navigator in Indiana must complete a course of study and pass a
written examination as prescribed by the commissioner in
consultation with the secretary.
(b) The course of study required under subsection (a) must
provide instruction in:
(1) the functions of a health benefit exchange;
(2) the duties and responsibilities of a navigator;
(3) the insurance laws of Indiana that apply to the functions
of a navigator with respect to a health benefit exchange,
including rules related to public health insurance programs;
and
(4) the obligations of a navigator related to confidentiality of
information and conflicts of interest.
(c) The examination required by subsection (a) must test the
knowledge of the individual concerning the applicable:
(1) functions of a health benefit exchange;
(2) duties and responsibilities of a navigator;
(3) insurance laws of Indiana that apply to the functions of a
navigator with respect to a health benefit exchange, including
rules related to public health insurance programs; and
(4) the obligations of a navigator related to confidentiality of
information and conflicts of interest.
(d) The commissioner:
(1) in consultation with the secretary, shall develop:
(A) a curriculum for a course of study for navigators; and
(B) policies and procedures to allow a registered
application organization to develop a training program
and course curriculum that meets the requirements of
subsection (b) for use in training navigators who perform
the navigators' services on behalf of the registered
application organization; and
(2) may contract with one (1) or more third party
organizations to do any of the following with respect to the
course of study described in subdivision (1)(A):
(A) Develop examinations and course materials.
(B) Administer examinations and courses of study.
(C) Collect nonrefundable course and examination fees.
(e) All training programs, course curriculums, examinations,
course materials, and examination fees referred to in subsection (d)
must be approved in advance by the commissioner in consultation
with the secretary.
Sec. 12. (a) The commissioner:
(1) in consultation with the secretary, shall develop continuing
education requirements for navigators; and
(2) may contract with one (1) or more third party
organizations to:
(A) develop continuing education materials to meet the
requirements developed under subdivision (1);
(B) administer continuing education programs; and
(C) collect nonrefundable continuing education program
fees.
(b) All continuing education materials, programs, and fees
referred to in subsection (a)(2) must be approved in advance by the
commissioner in consultation with the secretary.
(c) The commissioner may require a navigator to complete
specific continuing education requirements, as prescribed by the
commissioner in consultation with the secretary, as a prerequisite
to the authority to perform specific functions with respect to a
health benefit exchange.
Sec. 13. An individual who fails to:
(1) appear for a scheduled examination required under
section 11(a) of this chapter; or
(2) pass the examination;
may not be rescheduled for the examination unless the individual
reapplies for the examination and remits all required fees and
forms.
Sec. 14. (a) An insurance producer or insurance consultant:
(1) may not act as a navigator unless the insurance producer
or insurance consultant has completed the continuing
education requirements that apply to a navigator; and
(2) shall receive a designation from the commissioner as a
navigator upon completion of the continuing education
requirements;
under this chapter.
(b) The commissioner may require an insurance producer or
insurance consultant to complete specific continuing education
requirements, as prescribed by the commissioner in consultation
with the secretary, as a prerequisite to the authority to perform
specific functions with respect to a health benefit exchange.
(c) An insurance producer or insurance consultant is not
required to complete continuing education hours of credit in excess
of the required number of hours of credit in continuing education
that apply to the insurance producer or insurance consultant under
IC 27-1-15.7.
