CHAPTER 5.8. INSURANCE BENEFIT CARDS
IC 27-8-5.8
Chapter 5.8. Insurance Benefit Cards
IC 27-8-5.8-1
"Accident and sickness insurance policy" defined
Sec. 1. As used in this chapter, "accident and sickness insurancepolicy" means an insurance policy that provides at least one (1) ofthe types of insurance described in IC 27-1-5-1, Classes 1(b) and2(a), and is issued on a group basis. The term does not include thefollowing:
(1) Accident only, credit, dental, vision, Medicare, Medicaresupplement, long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Automobile medical payment insurance.
(4) A specified disease policy.
(5) A limited benefit health insurance 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 a stipulated daily, weekly, or monthlypayment to an insured during hospital confinement, withoutregard to the actual expense of the confinement.
(8) Worker's compensation or similar insurance.
(9) A student health insurance policy.
As added by P.L.230-2001, SEC.2.
IC 27-8-5.8-2
"Commissioner" defined
Sec. 2. As used in this chapter, "commissioner" means theinsurance commissioner appointed under IC 27-1-1-2.
As added by P.L.230-2001, SEC.2.
IC 27-8-5.8-3
"Insured" defined
Sec. 3. As used in this chapter, "insured" means an individual whois entitled to coverage under an accident and sickness insurancepolicy.
As added by P.L.230-2001, SEC.2.
IC 27-8-5.8-4
Prescription drug information card
Sec. 4. (a) This section applies to an insurer that:
(1) issues an accident and sickness insurance policy thatprovides coverage for prescription drugs or devices; and
(2) issues a card or other technology for claims processing.
This section also applies to a third party administrator forself-insured plans, a pharmacy benefit manager, or a health benefitplan administered by the state if the administrator, manager, or planissues a card or other technology described in subdivision (2).
(b) The card or other technology issued by an insurer or another
entity referred to in subsection (a) must contain uniform prescriptiondrug information that complies with the requirements establishedunder 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 insured'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 ifdifferent than the 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) An insurer or an insurer's agents, contractors, oradministrators, including pharmacy benefits managers, may not berequired to issue a prescription drug information card or othertechnology to a person 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 insurance coverageother than the coverage to which this chapter applies.
As added by P.L.230-2001, SEC.2. Amended by P.L.1-2002,SEC.111.