IC 27-13-37
    Chapter 37. Patient Protection; Choice of Health CareProfessional

IC 27-13-37-1
Enrollees allowed to choose primary care provider from list
    Sec. 1. (a) A health maintenance organization shall allow eachenrollee of the health maintenance organization to choose theenrollee's own primary care provider from a list of participatingprimary care providers within the health maintenance organization.
    (b) The list described in subsection (a) shall be updatedsemiannually and must include a sufficient number of primary careproviders that accept new enrollees. The list must be:
        (1) provided to each enrollee annually; and
        (2) sent to an enrollee at the enrollee's request.
As added by P.L.69-1998, SEC.15.

IC 27-13-37-2
Use of participating provider other than primary care provider
    Sec. 2. (a) Each health maintenance organization shall develop asystem to allow an enrollee to use an appropriate participatingprovider to manage the enrollee's medical condition when theenrollee's primary care provider determines that the use of anotherappropriate participating provider is warranted by the enrollee'smedical condition.
    (b) A primary care provider who makes the requireddetermination under subsection (a) shall refer the enrollee to aparticipating provider whom the primary care provider determines isappropriate.
    (c) A health maintenance organization shall provide coverageunder this section for treatment received by an enrollee from anappropriate participating provider when the enrollee is referred to theparticipating provider as provided in this section for as long as thetreatment is appropriate for the medical condition, subject to theterms and conditions of the enrollee's contract with the healthmaintenance organization.
    (d) A contract between a health maintenance organization and aprimary care provider may not provide for a financial or otherpenalty to the primary care provider for making a referral allowedunder this section.
As added by P.L.69-1998, SEC.15.

IC 27-13-37-3
Continuity of care and referrals when specialty care warranted
    Sec. 3. Beginning July 1, 1999, each health maintenanceorganization shall provide continuity of care and referral toappropriate participating providers when specialty care is warranted,including the following:
        (1) Enrollees have access to appropriate participating providerson a timely basis.        (2) Enrollees have a choice of appropriate participatingproviders when a referral is made.
As added by P.L.69-1998, SEC.15.

IC 27-13-37-4
Point-of-service products; dental care services
    Sec. 4. (a) Each health maintenance organization shall offer toeach purchaser of a group contract or individual contract apoint-of-service product to the extent permitted by IC 27-13-13-8.
    (b) Beginning July 1, 2001, a limited service health maintenanceorganization that provides dental care services shall offer to eachpurchaser of a group contract or individual contract:
        (1) a point-of-service product to the extent permitted byIC 27-13-34-10(a)(6);
        (2) a preferred provider plan (as defined in IC 27-8-11-1); or
        (3) a policy of accident and sickness insurance (as defined inIC 27-8-5-1);
that provides dental care services.
As added by P.L.69-1998, SEC.15. Amended by P.L.91-2000, SEC.3.

IC 27-13-37-5
Second medical opinions
    Sec. 5. Each health maintenance organization shall allow anenrollee who has received a medical opinion from a participatingprovider to obtain a second medical opinion from an appropriateparticipating provider concerning the enrollee's medical condition atthe enrollee's request.
As added by P.L.69-1998, SEC.15.