CHAPTER 18. ENROLLMENT PERIOD IN EVENT OF RECEIVERSHIP

IC 27-13-18
    Chapter 18. Enrollment Period in Event of Receivership

IC 27-13-18-1
Offer of coverage required; allocation of contracts
    Sec. 1. (a) In the event of receivership of a health maintenanceorganization, the commissioner may order all other carriers thatparticipated in the enrollment process of the group covered by theorganization in receivership at the last regular enrollment period ofthe group to offer the enrollees of the organization in receivership anenrollment period of thirty (30) days beginning on the date ofreceivership.
    (b) Each carrier referred to in subsection (a) shall offer theenrollees of the health maintenance organization in receivership:
        (1) the same coverage;
        (2) under the same terms; and
        (3) at the same rates;
as the carrier had offered at the last regular enrollment period of thegroup. The coverage required under this chapter shall begin on thedate of receivership and end on the date the contract period wouldhave ended had the health maintenance organization not gone intoreceivership.
    (c) If there is no carrier referred to in subsection (a), or thecommissioner determines that there is no carrier referred to insubsection (a) that has adequate or accessible resources, thecommissioner shall equitably allocate the:
        (1) group contracts of the health maintenance organization inreceivership; and
        (2) individual contracts of the health maintenance organizationin receivership belonging to enrollees who are unable to obtainother coverage;
among all health maintenance organizations operating within aportion of the service area of the health maintenance organization inreceivership. The commissioner shall not allocate individualcontracts to a health maintenance organization that does not offerdirect individual enrollment.
    (d) A health maintenance organization to which the commissionerallocates a group contract under subsection (c)(1) shall offer to thegroup existing coverage that is most similar to the group's coveragewith the health maintenance organization in receivership, at ratesconsistent with the successor health maintenance organization'sexisting rating methodology.
    (e) A health maintenance organization to which the commissionerallocates individual contracts under subsection (c)(2) shall offer tothe enrollee existing individual or conversion coverage that is mostsimilar to the enrollee's coverage with the health maintenanceorganization in receivership, at rates consistent with the successorhealth maintenance organization's existing rating methodology.
As added by P.L.26-1994, SEC.25. Amended by P.L.203-2001,SEC.27.
IC 27-13-18-2
Failing to provide for continuation of benefits; assessments ofhealth maintenance organizations; tax credits or premiumadjustments
    Sec. 2. (a) If for any reason the plan of the health maintenanceorganization under IC 27-13-16 does not provide for continuation ofbenefits as required by IC 27-13-16-1, the liquidator shall assess, orcause to be assessed, each licensed health maintenance organizationdoing business in Indiana. The amount that each licensed healthmaintenance organization is assessed must be based on the ratio ofthe amount of all subscriber premiums received by the healthmaintenance organization for contracts issued in Indiana for theprevious calendar year to the amount of the total subscriberpremiums received by all licensed health maintenance organizationsfor contracts issued in Indiana for the previous calendar year.
    (b) The total assessments of health maintenance organizationsunder subsection (a) must equal an amount sufficient to provide forcontinuation of benefits as required by IC 27-13-16-1 to enrolleescovered under contracts issued by the health maintenanceorganization to subscribers located in Indiana, and to payadministrative expenses.
    (c) The total amount of all assessments to be paid by a healthmaintenance organization in any one (1) calendar year may notexceed one percent (1%) of the premiums received by the healthmaintenance organization from business in Indiana during thecalendar year preceding the assessment.
    (d) If the total amount of all assessments in any one (1) calendaryear does not provide an amount sufficient to meet the requirementsof subsection (a), additional funds must be assessed in succeedingcalendar years.
    (e) Health maintenance organizations that, during any precedingcalendar year, have paid one (1) or more assessments levied underthis section may either:
        (1) take as a credit against adjusted gross income taxes orsimilar taxes upon revenue or income of health maintenanceorganizations that may be imposed by Indiana up to twentypercent (20%) of any assessment described in this section foreach calendar year following the year in which thoseassessments were paid until the aggregate of those assessmentshave been offset; or
        (2) include in the premiums charged for coverage to which thisarticle applies amounts sufficient to recoup a sum equal to theamounts paid in assessments as long as the premiums are notexcessive by virtue of including an amount reasonablycalculated to recoup assessments paid by the healthmaintenance organization.
As added by P.L.26-1994, SEC.25. Amended by P.L.192-2002(ss),SEC.170.