CHAPTER 29. INSURANCE
IC 12-15-29
Chapter 29. Insurance
IC 12-15-29-1
Insurers; authorization to release information
Sec. 1. An applicant for or a recipient of Medicaid is consideredto have authorized an insurer to release to the office informationneeded by the office to secure or enforce the office's rights underMedicaid.
As added by P.L.2-1992, SEC.9.
IC 12-15-29-2
Requests for information from insurers; limitation
Sec. 2. (a) Subject to subsection (b), an insurer shall furnishrecords or information pertaining to the coverage of an individual forthe individual's medical costs under an individual or a group policyor other obligation, or the medical benefits paid or claims madeunder a policy or an obligation, if the office or its agent does thefollowing:
(1) Requests the information electronically or by United Statesmail.
(2) Certifies that the individual is:
(A) a Medicaid applicant or recipient; or
(B) a person who is legally responsible for the applicant orrecipient.
(b) The office may request only the records or informationnecessary to determine whether insurance benefits have been orshould have been claimed and paid with respect to items of medicalcare and services that were received by a particular individual andfor which Medicaid coverage would otherwise be available.
As added by P.L.2-1992, SEC.9. Amended by P.L.187-2007, SEC.4;P.L.234-2007, SEC.209; P.L.3-2008, SEC.94.
IC 12-15-29-3
Guidelines for information requests
Sec. 3. The administrator and the insurance commissioner shallestablish guidelines for information requests under this chapter.
As added by P.L.2-1992, SEC.9.
IC 12-15-29-4
Direct payments by insurers to office; amount of payments
Sec. 4. (a) If:
(1) an insurer has not discharged the insurer's obligation tomake payments to an individual for medical services;
(2) the individual has received Medicaid from the office; and
(3) the insurer has received notice that Medicaid has beenfurnished to the individual;
the insurer shall make payments directly to the office.
(b) The payments under subsection (a) may not exceed the amountof Medicaid paid by the office.As added by P.L.2-1992, SEC.9.
IC 12-15-29-4.5
Insurer's acceptance of Medicaid claims
Sec. 4.5. (a) An insurer shall accept a Medicaid claim for aMedicaid recipient for three (3) years from the date the service wasprovided.
(b) An insurer may not deny a Medicaid claim submitted by theoffice solely on the basis of:
(1) the date of submission of the claim;
(2) the type or format of the claim form;
(3) the method of submission of the claim; or
(4) a failure to provide proper documentation at the point ofsale that is the basis of the claim;
if the claim is submitted by the office within three (3) years from thedate the service was provided as required in subsection (a) and theoffice commences action to enforce the office's rights regarding theclaim within six (6) years of the office's submission of the claim.
(c) An insurer may not deny a Medicaid claim submitted by theoffice solely due to a lack of prior authorization. An insurer shallconduct the prior authorization on a retrospective basis for claimswhere prior authorization is necessary and adjudicate any claimauthorized in this manner as if the claim received prior authorization.
As added by P.L.187-2007, SEC.5.
IC 12-15-29-5
Medicaid furnished by office; insurer put on notice of claim byoffice; insurer paying person or entity other than office; office'sclaim not discharged
Sec. 5. An insurer:
(1) that is put on notice of a claim by the office under section 4of this chapter; and
(2) proceeds to pay the claim to a person or an entity other thanthe office;
is not discharged from payment of the office's claim.
As added by P.L.2-1992, SEC.9.
IC 12-15-29-6
Payment by insurer to office; discharge of obligation
Sec. 6. Payment to the office by an insurer under section 4 of thischapter discharges the insurer's obligation with respect to furtherpayment on the claim for the amount paid.
As added by P.L.2-1992, SEC.9.
IC 12-15-29-7
Notice to insurer that Medicaid has been furnished; requirements;notification given office by insurer; payment of claim
Sec. 7. (a) The notice requirements of section 4 of this chapter aresatisfied if:
(1) the insurer receives from the office, electronically or by
United States mail, a statement of the claims paid or medicalservices rendered by the office, together with a claim forreimbursement; or
(2) the insurer receives a claim from a beneficiary stating thatthe beneficiary has applied for or has received Medicaid fromthe office in connection with the same claim.
(b) An insurer that receives a claim under subsection (a)(2) shallnotify the office of the insurer's obligation on the claim and shall:
(1) pay the obligation to the provider of service; or
(2) if the office has provided Medicaid, pay the office.
As added by P.L.2-1992, SEC.9. Amended by P.L.187-2007, SEC.6.
IC 12-15-29-8
Unlawful insurance clause
Sec. 8. A clause of an insurance contract, plan, or agreementadministered by an insurer is void if the clause limits or excludesenrollment or payments to an individual who is eligible for Medicaid.
As added by P.L.2-1992, SEC.9. Amended by P.L.46-1995, SEC.41.
IC 12-15-29-9
State's acquisition of person's right to payment
Sec. 9. (a) IC 27-8-23 applies to this section.
(b) To the extent that payment for covered medical expenses hasbeen made under the state Medicaid program for health care items orservices furnished to a person, in a case where a third party has alegal liability to make payments, the state is considered to haveacquired the rights of the person to payment by any other party forthe health care items or services.
(c) As required under 42 U.S.C. 1396a(a)(25), an insurer shallaccept the state's right of recovery and the assignment to the state ofany right of the individual or entity to payment for a health care itemor service for which payment has been made under the stateMedicaid plan.
As added by P.L.46-1995, SEC.42. Amended by P.L.187-2007,SEC.7.
IC 12-15-29-10
Employer sponsored health insurance to include coverage for child
Sec. 10. (a) IC 27-8-23 and IC 31-16-15 apply to this section.
(b) This section does not apply if an employer has eliminatedfamily health coverage for all of its employees.
(c) Whenever a parent is required by a court or an administrativeorder to provide health coverage for a child and the parent is eligiblefor family health coverage through an employer doing business inIndiana, the employer shall provide family health coverage to thechild in the manner described under IC 27-8-23-6 and in the noticeunder IC 31-16-15-4.5(b). In addition, the employer shall:
(1) withhold from the employee's compensation the employee'sshare, if any, of premiums for health coverage; and
(2) pay that amount to the insurer. (d) Upon the initiation of withholding under subsection (c), anemployee whose applicable child support order did not include adeduction from weekly available income for the cost of the healthcare premium is entitled to a modification of the child support order,taking into account the payments made as of the date withholdingbegan.
As added by P.L.46-1995, SEC.43. Amended by P.L.80-2010,SEC.20.