CHAPTER 8. ANNUAL REPORT
IC 27-13-8
Chapter 8. Annual Report
IC 27-13-8-1
Filing
Sec. 1. On or before March 1 of each year, a health maintenanceorganization must file with the commissioner a report that covers thepreceding calendar year. The report must be:
(1) made on forms prescribed by the commissioner; and
(2) verified by at least two (2) principal officers of the healthmaintenance organization.
As added by P.L.26-1994, SEC.25.
IC 27-13-8-1.5
Preparation of annual statement
Sec. 1.5. (a) Each health maintenance organization authorized toconduct business in Indiana and required to file an annual statementwith the department under this chapter shall prepare the healthmaintenance organization's statement:
(1) on the National Association of Insurance Commissioners(NAIC) Annual Statement Blank;
(2) in accordance with NAIC Annual Statement Instructions;and
(3) following practices and procedures prescribed by the mostrecent NAIC Accounting Practices and Procedures Manual.
(b) To the extent that the NAIC Annual Statement Instructionsrequire disclosure under subsection (a) of compensation paid to or onbehalf of a health maintenance organization's officers, directors, oremployees, the information may be filed with the department as anexhibit separate from the annual statement blank. The compensationinformation described under this subsection shall be maintained bythe department as confidential and may not be disclosed to the publicunder IC 5-14-3.
As added by P.L.203-2001, SEC.20.
IC 27-13-8-2
Additional information filed with commissioner
Sec. 2. (a) In addition to the report required by section 1 of thischapter, a health maintenance organization shall each year file withthe commissioner the following:
(1) Audited financial statements of the health maintenanceorganization for the preceding calendar year prepared inconformity with statutory accounting practices prescribed orotherwise permitted by the department.
(2) A list of participating providers who provide health careservices to enrollees or subscribers of the health maintenanceorganization.
(3) A description of the grievance procedure of the healthmaintenance organization:
(A) established under IC 27-13-10, including: (i) the total number of grievances handled through theprocedure during the preceding calendar year;
(ii) a compilation of the causes underlying thosegrievances; and
(iii) a summary of the final disposition of thosegrievances; and
(B) established under IC 27-13-10.1, including:
(i) the total number of external grievances handled throughthe procedure during the preceding calendar year;
(ii) a compilation of the causes underlying thosegrievances; and
(iii) a summary of the final disposition of thosegrievances;
for each independent review organization used by the healthmaintenance organization during the reporting year.
(4) The percentage of providers credentialed by the healthmaintenance organization according to the most currentstandards or guidelines, if any, developed by the NationalCommittee on Quality Assurance or a successor organization.
(5) The RBC report required under IC 27-1-36-25.
(6) The health maintenance organization's Health PlanEmployer Data and Information Set (HEDIS) data.
(b) The information required by subsection (a)(2) through (a)(5)must be filed with the commissioner on or before March 1 of eachyear. The audited financial statements required by subsection (a)(1)must be filed with the commissioner on or before June 1 of eachyear. The health maintenance organization's HEDIS data required bysubsection (a)(6) must be filed with the commissioner on or beforeJuly 1 of each year. The commissioner shall:
(1) make the information required to be filed under this sectionavailable to the public; and
(2) prepare an annual compilation of the data required undersubsections (a)(3), (a)(4), and (a)(6) that allows for comparativeanalysis.
(c) Upon a determination by a health maintenance organization'sauditor that the health maintenance organization:
(1) does not meet the requirements of IC 27-13-12-3; or
(2) is in the condition described in IC 27-13-24-1(a)(5);
the health maintenance organization shall notify the commissionerwithin five (5) business days after the auditor's determination.
(d) The commissioner may require any additional reports as arenecessary and appropriate for the commissioner to carry out thecommissioner's duties under this article.
As added by P.L.26-1994, SEC.25. Amended by P.L.195-1996,SEC.5; P.L.191-1997, SEC.2; P.L.133-1999, SEC.1; P.L.133-1999,SEC.2; P.L.203-2001, SEC.21; P.L.51-2002, SEC.10.
IC 27-13-8-3
Annual statement convention blank; quarterly reports
Sec. 3. (a) This section applies to a domestic health maintenance
organization that is authorized to transact business in Indiana.
(b) As used in this section, "NAIC" refers to the NationalAssociation of Insurance Commissioners.
(c) On or before March 1 of each year, a health maintenanceorganization shall file with the National Association of InsuranceCommissioners and with the department a copy of the healthmaintenance organization's annual statement convention blank andadditional filings prescribed by the commissioner for the precedingyear. A health maintenance organization shall also file quarterlystatements with the NAIC and with the department, on or before May15, August 15, and November 15 of each year, in a form prescribedby the commissioner. The information filed with the NAIC under thissubsection:
(1) must be:
(A) in the same format; and
(B) of the same scope;
as is required by the commissioner under section 1 of thischapter;
(2) to the extent required by the NAIC, must include the signedjurat page and the actuarial certification; and
(3) must be filed electronically in accordance with NAICelectronic filing specifications.
The commissioner may, for good cause shown, grant an exemptionfrom the requirement of this section to domestic health maintenanceorganizations that operate only in Indiana. If a health maintenanceorganization files any amendment or addendum to the healthmaintenance organization's annual statement convention blank orquarterly statement with the commissioner, the health maintenanceorganization shall also file a copy of the amendment or addendumwith the NAIC. Annual and quarterly financial statements areconsidered filed with the NAIC when delivered to the addressdesignated by the NAIC for the filings, regardless of whether thefiling is accompanied by any applicable fee.
(d) The commissioner may, for good cause shown, grant a healthmaintenance organization an extension of time for the filing requiredby subsection (c).
(e) In the absence of actual malice:
(1) members of the NAIC;
(2) duly authorized committees, subcommittees, and task forcesof members of the NAIC;
(3) delegates of members of the NAIC;
(4) employees of the NAIC; and
(5) other persons responsible for collecting, reviewing,analyzing, and disseminating information developed from thefiling of annual statement convention blanks under this section;
shall be considered to be acting as agents of the commissioner underthe authority of this section and are not subject to civil liability forlibel, slander, or any other cause of action by virtue of the collection,review, analysis, or dissemination of the data and informationcollected from the filings required by this section. (f) The commissioner may suspend, revoke, or refuse to renew thecertificate of authority of a health maintenance organization that failsto file the health maintenance organization's annual statementconvention blank or quarterly statements with the NAIC or with thedepartment within the time allowed by subsection (c) or (d).
As added by P.L.203-2001, SEC.22.
IC 27-13-8-4
Civil penalties
Sec. 4. (a) The commissioner may impose a civil penalty of fivehundred dollars ($500), after notice and hearing under IC 4-21.5-3,on a health maintenance organization that fails to file an annualstatement under this chapter.
(b) A domestic health maintenance organization that fails to filean audited annual financial statement under section 2(a)(1) of thischapter before June 1 of each year without obtaining an extension issubject to a civil penalty of fifty dollars ($50) per day until the reportis received by the commissioner.
As added by P.L.203-2001, SEC.23.