IC 27-13-9
    Chapter 9. Information to Enrollees or Subscribers

IC 27-13-9-1
List of providers
    Sec. 1. (a) Upon:
        (1) the enrollment; and
        (2) each reenrollment;
of a subscriber, a health maintenance organization must provide tothe subscriber in electronic or paper form a list of providers whoprovide health care services through the health maintenanceorganization. The health maintenance organization must also providethe list of providers in electronic or paper form to a potential enrolleeupon request.
    (b) A health maintenance organization shall:
        (1) inform a subscriber or potential enrollee that the subscriberor potential enrollee may request a list described in subsection(a) in paper form; and
        (2) provide the list in paper form upon the request of thesubscriber or potential enrollee.
As added by P.L.26-1994, SEC.25. Amended by P.L.69-1998, SEC.7;P.L.125-2005, SEC.7.

IC 27-13-9-2
Notice of change in operation of health maintenance organization
    Sec. 2. Not more than thirty (30) days after any material changein the operation of a health maintenance organization that willdirectly affect the subscribers or enrollees of the organization, thehealth maintenance organization shall provide notice of the changeto the subscribers or enrollees affected by the change.
As added by P.L.26-1994, SEC.25.

IC 27-13-9-3
Termination of provider
    Sec. 3. (a) A health maintenance organization shall notify anenrollee in writing of the termination of:
        (1) the provider who currently provides primary health careservices to that enrollee;
        (2) any other participating provider seen by the enrollee duringthe previous year; and
        (3) a hospital.
    (b) After the termination of the provider who provided primaryhealth care services to an enrollee, the health maintenanceorganization shall assist the enrollee in transferring to anotherparticipating primary care provider.
    (c) If a health maintenance organization notifies an enrollee of thetermination of a hospital, the notice must include the names of allparticipating providers employed by the hospital.
As added by P.L.26-1994, SEC.25. Amended by P.L.133-1999,SEC.3; P.L.196-2001, SEC.2.
IC 27-13-9-4
Information on services and filing grievances; telephone number
    Sec. 4. A health maintenance organization shall provide to eachenrollee and subscriber:
        (1) information on:
            (A) how services can be obtained;
            (B) where additional information on access to services canbe obtained;
            (C) how to file a grievance under IC 27-13-10 andIC 27-13-10.1;
            (D) the health maintenance organization's:
                (i) structure;
                (ii) health care benefits and exclusions; and
                (iii) criteria for denying coverage; and
            (E) costs for which the enrollee or subscriber is responsible;and
        (2) a toll free telephone number through which the enrollee cancontact the health maintenance organization at no cost to theenrollee to obtain information and to file grievances.
The information under this section must be provided to a potentialenrollee of the health maintenance organization upon request.
As added by P.L.26-1994, SEC.25. Amended by P.L.191-1997,SEC.3; P.L.69-1998, SEC.8; P.L.133-1999, SEC.4.

IC 27-13-9-5
Prescription drug information card
    Sec. 5. (a) This section applies to a health maintenanceorganization that provides coverage for prescription drugs or devicesand issues a card or other technology for claims processing.
    (b) The card or other technology issued by a health maintenanceorganization must contain uniform prescription drug information thatcomplies with the requirements established under subsection (c).
    (c) Prescription drug information cards or other technology mustmeet either of the following criteria:
        (1) Be in a format and contain information fields approved bythe National Council for Prescription Drug Programs (NCPDP)as contained in the National Council for Prescription DrugPrograms Pharmacy ID Card Implementation Guide in effect onthe October 1 most immediately preceding the issuance of thecard.
        (2) Contain the following information:
            (A) The health benefit plan's name.
            (B) The enrollee's name, group number, and identificationnumber.
            (C) A telephone number to inquire about pharmacy relatedissues.
            (D) The issuer's international identification number or ANSIBIN number, labeled as RxBIN.
            (E) The processor control number, labeled as RxPCN.
            (F) The insured's pharmacy benefits group number if

different than medical group number, labeled as RxGRP.
        Only those fields listed in clauses (A) through (F) that arerequired for proper adjudication of the claim must appear on thecard. If the card is used to adjudicate non-pharmacy claims,then the designation "Rx" listed in clauses (D) through (F) isnot required to be used by the issuer.
    (d) A health maintenance organization may not be required toissue a prescription drug information card or other technology to aperson more than one (1) time during a twelve (12) month period.
    (e) The prescription drug information cards or other technologyissued under this section may be used for health care servicecoverage other than the coverage to which this chapter applies.
As added by P.L.230-2001, SEC.3. Amended by P.L.1-2002,SEC.123.