IC 27-8-5.5
    Chapter 5.5. Accident and Sickness Insurance.Claim Forms

IC 27-8-5.5-1
Definitions
    Sec. 1. As used in this chapter:
    (a) "Commissioner" means the insurance commissioner ofIndiana.
    (b) "Accident and sickness insurance" means any policy orcontract of insurance described in classes 1(b), 2(a), 2(b), or 2(l), asdefined in IC 27-1-5-1.
As added by Acts 1977, P.L.288, SEC.1.

IC 27-8-5.5-2
Promulgation of forms; requisites; contents; acceptance of claims;explanation of benefits paid statements or claims summarystatements
    Sec. 2. (a) The commissioner shall prescribe by rule, afterconsultation with providers of health care or treatment, accident andsickness insurers, hospital, medical, and dental service corporationsand other prepayment organizations, such accident and sicknessinsurance claim forms as the commissioner determines will providefor uniformity and simplicity in insurance reporting. The forms shallinclude, but need not be limited to, information regarding themedical diagnosis, treatment and prognosis of the patient, togetherwith the details of charges incident to the providing of care,treatment or services, sufficient for the purpose of meeting the proofrequirements of an accident or sickness insurance policy or ahospital, medical, or dental service contract.
    (b) An accident and sickness insurer may not refuse to accept aclaim submitted on duly promulgated uniform claim forms. However,an insurer may accept claims submitted on any other form.
    (c) Accident and sickness insurer explanation of benefits paidstatements or claims summary statements sent to an insured by theaccident and sickness insurer may be sent in electronic or paper formand shall be in a format and written in a manner that promotesunderstanding by the insured by setting forth:
        (1) the total dollar amount submitted to the insurer for payment;
        (2) any reduction in the amount paid due to the application ofany co-payment or deductible, along with an explanation of theamount of the co-payment or deductible applied under theinsured's policy;
        (3) any reduction in the amount paid due to the application ofany other policy limitation or exclusion as set forth in theinsured's policy along with an explanation thereof;
        (4) the total dollar amount paid; and
        (5) the total dollar amount remaining unpaid.
In addition, the explanation shall clearly set forth a toll free numberthat the insured may call to obtain additional information about anyof the items contained in the explanation of benefits paid or claims

summary statement.
    (d) The commissioner may issue an order under IC 27-1-3-19(a)directing an accident and sickness insurer to comply with subsection(c).
    (e) An accident and sickness insurer does not violate subsection(c) by using a document that the accident and sickness insurer hasbeen required to use by the federal government or the state.
    (f) An accident and sickness insurer shall:
        (1) inform an insured that the insured may request that thestatements described in subsection (c) be sent in paper form;and
        (2) send the statements in paper form upon the request of theinsured.
As added by Acts 1977, P.L.288, SEC.1. Amended by P.L.252-1989,SEC.1; P.L.125-2005, SEC.4.

IC 27-8-5.5-3
Obtaining additional information regarding claims
    Sec. 3. The adoption of uniform claim forms by the commissionerpursuant to this chapter does not preclude an insurer, hospital,medical, or dental service corporation or other pre-paymentorganization, from obtaining any necessary additional informationregarding a claim from the claimant, provider of health care ortreatment, or certifier of coverage, as may be required.
As added by Acts 1977, P.L.288, SEC.1.