IC 27-13-4
    Chapter 4. Powers of Health Maintenance Organizations

IC 27-13-4-1
General powers
    Sec. 1. (a) Subject to section 3 of this chapter, the powers of ahealth maintenance organization include the following:
        (1) The purchase, lease, construction, renovation, operation, ormaintenance of:
            (A) hospitals and medical facilities;
            (B) equipment for hospitals and medical facilities; and
            (C) other property reasonably required for the principaloffice of the health maintenance organization or for purposesnecessary in the transaction of the business of theorganization.
        (2) Engaging in transactions between affiliated entities,including loans and the transfer of responsibility under any orall contracts:
            (A) between affiliates; or
            (B) between the health maintenance organization and theparent organization of the health maintenance organization.
        (3) The furnishing of health care services through:
            (A) providers;
            (B) provider associations; and
            (C) agents for providers;
        who are under contract with or are employed by the healthmaintenance organization. The contracts with providers,provider associations, or agents of providers may include fee forservice, cost plus, capitation, or other payment or risk-sharingarrangements.
        (4) Contracting with any person for the performance on behalfof the health maintenance organization of certain functions,including:
            (A) marketing;
            (B) enrollment; and
            (C) administration.
        (5) Contracting with:
            (A) an insurance company licensed in Indiana;
            (B) an authorized reinsurer; or
            (C) a hospital authorized to conduct business in Indiana;
        for the provision of insurance, indemnity, or reimbursementagainst the cost of health care services provided by the healthmaintenance organization.
        (6) The offering of point-of-service products.
        (7) The joint marketing of products with:
            (A) an insurance company that is licensed in Indiana; or
            (B) a hospital that is authorized to conduct business inIndiana;
        if the company that is offering each product is clearly identified.
        (8) Administration of the provision of health care services at the

expense of a self-funded plan.
    (b) A health maintenance organization may offer any of thefollowing:
        (1) Plans that include only basic health care services.
        (2) Plans that include basic health care services and other healthcare services.
        (3) Plans that include health care services other than basichealth care services so long as at least one (1) of the plansoffered by the health maintenance organization includes basichealth care services.
    (c) Notwithstanding subsection (a)(5), a health maintenanceorganization may not take credit for reinsurance unless the risk isceded to a reinsurer qualified under IC 27-6-10.
As added by P.L.26-1994, SEC.25. Amended by P.L.2-1995,SEC.111; P.L.203-2001, SEC.18.

IC 27-13-4-2
Asset of health maintenance organization as an admitted asset
    Sec. 2. Nothing in this chapter qualifies an asset of a healthmaintenance organization as an admitted asset.
As added by P.L.26-1994, SEC.25.

IC 27-13-4-3
Filing notice with commissioner before exercising power;disapproval of exercise of power; exemptions from filingrequirement
    Sec. 3. (a) A domestic health maintenance organization must filenotice with the commissioner, with supporting information that thecommissioner deems adequate, before exercising any power grantedin:
        (1) section 1(a)(1); or
        (2) section 1(a)(4);
of this chapter if the proposed transaction is equal to or greater thanten percent (10%) of the health maintenance organization's admittedassets.
    (b) A domestic health maintenance organization must file noticewith the commissioner, with the supporting information that thecommissioner deems adequate, before exercising any power grantedin section 1(a)(2), if the proposed transaction is equal to or greaterthan three percent (3%) of the health maintenance organization'sadmitted assets.
    (c) The commissioner may disapprove an exercise of powerreferred to in a notice received under subsection (a) or (b) only if, inthe opinion of the commissioner, the exercise of the power would:
        (1) substantially and adversely affect the financial soundness ofthe health maintenance organization; and
        (2) endanger the ability of the health maintenance organizationto meet its obligations.
    (d) If the commissioner does not disapprove an exercise of powerreferred to in a notice received under subsection (a) or (b) within

thirty (30) days after the notice is filed with the commissioner, theexercise of power is considered approved.
    (e) The commissioner may adopt rules under IC 4-22-2 exemptingfrom the filing requirement of this section certain activities that havea minimal effect on:
        (1) the financial soundness of the health maintenanceorganization; and
        (2) the ability of the health maintenance organization to meet itsobligations.
As added by P.L.26-1994, SEC.25. Amended by P.L.203-2001,SEC.19.