CHAPTER 14.5. COVERAGE FOR SERVICES RELATED TO DIABETES
IC 27-8-14.5
Chapter 14.5. Coverage for Services Related to Diabetes
IC 27-8-14.5-1
"Health insurance plan" defined
Sec. 1. (a) As used in this chapter, "health insurance plan" meansany:
(1) hospital or medical expense incurred policy or certificate;
(2) hospital or medical service plan contract; or
(3) health maintenance organization subscriber contract;
provided to an insured.
(b) The term does not include the following:
(1) Accident only, credit, dental, vision, Medicare supplement,long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Worker's compensation or similar insurance.
(4) Automobile medical payment insurance.
(5) A specified disease policy.
(6) A short term insurance plan that:
(A) may not be renewed; and
(B) has a duration of not more than six (6) months.
(7) A policy that provides indemnity benefits not based on anyexpense incurred requirement, including a plan that providescoverage for:
(A) hospital confinement, critical illness, or intensive care;or
(B) gaps for deductibles or copayments.
(8) A supplemental plan that always pays in addition to othercoverage.
(9) A student health plan.
(10) An employer sponsored health benefit plan that is:
(A) provided to individuals who are eligible for Medicare;and
(B) not marketed as, or held out to be, a Medicaresupplement policy.
As added by P.L.190-1997, SEC.1. Amended by P.L.173-2007,SEC.33.
IC 27-8-14.5-2
"Insured" defined
Sec. 2. As used in this chapter, "insured" refers to an individualwith:
(1) insulin-using diabetes;
(2) non-insulin using diabetes; or
(3) elevated blood glucose levels induced by pregnancy oranother medical condition;
who is covered by a health insurance plan issued by an insurer.
As added by P.L.190-1997, SEC.1.
IC 27-8-14.5-3 "Insurer" defined
Sec. 3. As used in this chapter, "insurer" means any person whoprovides health insurance and issues health insurance plans inIndiana. The term includes the following:
(1) A licensed insurance company.
(2) A prepaid hospital or medical service plan.
(3) A health maintenance organization.
(4) A state employee health benefit plan.
(5) The state Medicaid plan.
(6) Any person providing a plan of health insurance subject tostate insurance law.
As added by P.L.190-1997, SEC.1.
IC 27-8-14.5-4
Coverage for treatments, supplies, and equipment
Sec. 4. A health insurance plan issued by an insurer must providecoverage to the insured for the medically necessary treatment fordiabetes, including medically necessary supplies and equipment asordered in writing by a physician licensed under IC 25-22.5 or apodiatrist licensed under IC 25-29, subject to the general provisionsof the health insurance plan.
As added by P.L.190-1997, SEC.1.
IC 27-8-14.5-5
Deductible, copayment, and coinsurance provisions
Sec. 5. (a) An insured may not be required to pay an annualdeductible or copayment that is greater than an annual deductible orcopayment established for similar benefits under the health insuranceplan. If the plan does not cover a similar benefit, the copayment ordeductible may not be set at a level that materially diminishes thevalue of the diabetes benefit required by this chapter.
(b) An insured may be subject to coinsurance that is not greaterthan coinsurance established for similar benefits under the healthinsurance plan. If the plan does not cover a similar benefit, thecoinsurance may not be set at a level that materially diminishes thevalue of the diabetes benefit required by this chapter.
As added by P.L.190-1997, SEC.1.
IC 27-8-14.5-6
Coverage for diabetes self-management training
Sec. 6. (a) A health insurance plan issued by an insurer mustprovide coverage for diabetes self-management training that is:
(1) medically necessary;
(2) ordered in writing by a physician licensed under IC 25-22.5or a podiatrist licensed under IC 25-29; and
(3) provided by a health care professional who:
(A) is licensed, registered, or certified under IC 25; and
(B) has specialized training in the management of diabetes.
(b) Coverage for diabetes self-management training may belimited to the following: (1) One (1) or more visits after receiving a diagnosis ofdiabetes.
(2) One (1) or more visits after receiving a diagnosis by aphysician licensed under IC 25-22.5 or a podiatrist licensedunder IC 25-29 that:
(A) represents a significant change in the insured'ssymptoms or condition; and
(B) makes changes in the insured's self-managementmedically necessary.
(3) One (1) or more visits for reeducation or refresher training.
(c) Coverage for diabetes self-management training is subject tothe requirements of the health insurance plan regarding the use ofparticipating providers.
As added by P.L.190-1997, SEC.1.
IC 27-8-14.5-7
Adoption of rules
Sec. 7. The department may adopt rules under IC 4-22-2 to carryout this chapter.
As added by P.L.190-1997, SEC.1.