IC 27-1-37.3
    Chapter 37.3. Third Party Rights and Responsibilities UnderHealth Care Contracts

IC 27-1-37.3-1
Application of definitions
    Sec. 1. Unless otherwise specified in this chapter, the definitionsin IC 27-8-11-1 apply throughout this chapter.
As added by P.L.55-2008, SEC.1.

IC 27-1-37.3-2
"Affiliate"
    Sec. 2. As used in this chapter, "affiliate" has the meaning setforth in IC 27-1-25-1.
As added by P.L.55-2008, SEC.1.

IC 27-1-37.3-3
"Contractor"
    Sec. 3. As used in this chapter, "contractor" refers to a personwith a primary business purpose of entering into health care contractswith providers.
As added by P.L.55-2008, SEC.1.

IC 27-1-37.3-4
"Covered individual"
    Sec. 4. As used in this chapter, "covered individual" means anindividual who is entitled to coverage under a health plan.
As added by P.L.55-2008, SEC.1.

IC 27-1-37.3-5
"Health plan"
    Sec. 5. (a) As used in this chapter, "health plan" means a planthrough which coverage is provided for health care services throughinsurance, prepayment, reimbursement, or otherwise. The termincludes the following:
        (1) An employee welfare benefit plan (as defined in 29 U.S.C.1002 et seq.).
        (2) A policy of accident and sickness insurance (as defined inIC 27-8-5-1).
        (3) An individual contract (as defined in IC 27-13-1-21) or agroup contract (as defined in IC 27-13-1-16).
    (b) The term does not include the following:
        (1) Accident-only, credit, 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 issued as an individual 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 a stipulated daily, weekly, or monthlypayment to an insured during hospital confinement, withoutregard to the actual expense of the confinement.
As added by P.L.55-2008, SEC.1.

IC 27-1-37.3-6
"Health care contract"
    Sec. 6. As used in this chapter, "health care contract" means acontract between a person and a provider specifying the rights andresponsibilities of the:
        (1) person; and
        (2) provider;
in relation to payment for and delivery of health care services to acovered individual.
As added by P.L.55-2008, SEC.1.

IC 27-1-37.3-7
Granting access to contracted health care services; requirements
    Sec. 7. A contractor may not lease, rent, or otherwise grant accessto a provider's health care services under a health care contract unlessthe contractor complies with one (1) of the following:
        (1) The third party to which the access is granted is:
            (A) an employer or another entity providing coverage forhealth care services to the employer's or entity's employeesor members and the entity has a contract with the contractoror the contractor's affiliate for the administration orprocessing of claims for payment or service provided underthe health care contract; or
            (B) an affiliate or a subsidiary of the contractor or providingadministrative services to or receiving administrativeservices from the contractor or the contractor's affiliate orsubsidiary.
        (2) The:
            (A) health care contract specifically states that the contractormay lease, rent, or otherwise grant access to the provider'shealth care services under the health care contract;
            (B) third party accessing the health care contract is:
                (i) a payer or third party administrator or another entitythat administers claims on behalf of the payer;
                (ii) a preferred provider organization or preferred providernetwork, including a physician-hospital organization; or
                (iii) an entity engaged in the electronic claims transportbetween the contractor and the payer; and
            (C) third party that is granted access to the provider's healthcare services under the health care contract is obligated tocomply with all the applicable terms of the health carecontract.
As added by P.L.55-2008, SEC.1.
IC 27-1-37.3-8
List of third parties with access to contracted health care services
    Sec. 8. (a) A contractor that leases, rents, or otherwise grantsaccess to a provider's health care services as described in section 7(2)of this chapter shall maintain an Internet web page or a toll freetelephone number through which the provider may obtain a listing,updated at least semiannually, of the third parties to which access tothe provider's health care services has been granted.
    (b) A contractor shall, at the time a health care contract is enteredinto with a provider, identify and provide any preferred providerorganization, preferred provider network, physician hospitalorganization, or other entity identified in section 7(2)(B)(ii) of thischapter that is known at the time of contracting, to which thecontractor will grant access to the provider's health care servicesunder section 7 of this chapter.
As added by P.L.55-2008, SEC.1.

IC 27-1-37.3-9
Identification of contractual source of discounts
    Sec. 9. A contractor that leases, rents, or otherwise grants accessto a provider's health care services under section 7 of this chaptershall ensure that an explanation of benefits or remittance advicefurnished to the provider that delivers health care services under thehealth care contract identifies the contractual source of any discountthat applies.
As added by P.L.55-2008, SEC.1.

IC 27-1-37.3-10
Termination of third party rights
    Sec. 10. Subject to applicable continuity of care requirements, athird party's right to exercise a contractor's rights and responsibilitiesunder a health care contract terminates on the date that the healthcare contract is terminated.
As added by P.L.55-2008, SEC.1.

IC 27-1-37.3-11
Arbitration of disputes
    Sec. 11. A health care contract may provide for arbitration ofdisputes arising under this chapter.
As added by P.L.55-2008, SEC.1.