CHAPTER 8. GROUP INSURANCE FOR PUBLIC EMPLOYEES
IC 5-10-8
Chapter 8. Group Insurance for Public Employees
IC 5-10-8-1
Definitions
Sec. 1. The following definitions apply in this chapter:
(1) "Employee" means:
(A) an elected or appointed officer or official, or a full-timeemployee;
(B) if the individual is employed by a school corporation, afull-time or part-time employee;
(C) for a local unit public employer, a full-time or part-timeemployee or a person who provides personal services to theunit under contract during the contract period; or
(D) a senior judge appointed under IC 33-24-3-7;
whose services have continued without interruption at leastthirty (30) days.
(2) "Group insurance" means any of the kinds of insurancefulfilling the definitions and requirements of group insurancecontained in IC 27-1.
(3) "Insurance" means insurance upon or in relation to humanlife in all its forms, including life insurance, health insurance,disability insurance, accident insurance, hospitalizationinsurance, surgery insurance, medical insurance, andsupplemental medical insurance.
(4) "Local unit" includes a city, town, county, township, publiclibrary, municipal corporation (as defined in IC 5-10-9-1), orschool corporation.
(5) "New traditional plan" means a self-insurance programestablished under section 7(b) of this chapter to provide healthcare coverage.
(6) "Public employer" means the state or a local unit, includingany board, commission, department, division, authority,institution, establishment, facility, or governmental unit underthe supervision of either, having a payroll in relation to personsit immediately employs, even if it is not a separate taxing unit.With respect to the legislative branch of government, "publicemployer" or "employer" refers to the following:
(A) The president pro tempore of the senate, with respect toformer members or employees of the senate.
(B) The speaker of the house, with respect to formermembers or employees of the house of representatives.
(C) The legislative council, with respect to formeremployees of the legislative services agency.
(7) "Public employer" does not include a state educationalinstitution.
(8) "Retired employee" means:
(A) in the case of a public employer that participates in thepublic employees' retirement fund, a former employee whoqualifies for a benefit under IC 5-10.3-8 or IC 5-10.2-4; (B) in the case of a public employer that participates in theteachers' retirement fund under IC 5-10.4, a former employeewho qualifies for a benefit under IC 5-10.4-5; and
(C) in the case of any other public employer, a formeremployee who meets the requirements established by thepublic employer for participation in a group insurance planfor retired employees.
(9) "Retirement date" means the date that the employee haschosen to receive retirement benefits from the employees'retirement fund.
As added by Acts 1980, P.L.8, SEC.41. Amended by P.L.39-1986,SEC.1; P.L.56-1989, SEC.1; P.L.39-1990, SEC.1; P.L.40-1990,SEC.1; P.L.233-1999, SEC.1; P.L.50-2000, SEC.1; P.L.13-2001,SEC.7; P.L.98-2004, SEC.65; P.L.2-2006, SEC.14; P.L.2-2007,SEC.81; P.L.194-2007, SEC.1.
IC 5-10-8-2
Repealed
(Repealed by P.L.24-1985, SEC.25(c).)
IC 5-10-8-2.1
Repealed
(Repealed by P.L.1-1991, SEC.32.)
IC 5-10-8-2.2
Public safety employees; surviving spouses; dependents
Sec. 2.2. (a) As used in this section, "dependent" means a naturalchild, stepchild, or adopted child of a public safety employee who:
(1) is less than eighteen (18) years of age;
(2) is at least eighteen (18) years of age and has a physical ormental disability (using disability guidelines established by theSocial Security Administration); or
(3) is at least eighteen (18) and less than twenty-three (23) yearsof age and is enrolled in and regularly attending a secondaryschool or is a full-time student at an accredited college oruniversity.
(b) As used in this section, "public safety employee" means afull-time firefighter, police officer, county police officer, or sheriff.
(c) This section applies only to local unit public employers andtheir public safety employees.
(d) A local unit public employer may provide programs of grouphealth insurance for its active and retired public safety employeesthrough one (1) of the following methods:
(1) By purchasing policies of group insurance.
(2) By establishing self-insurance programs.
(3) By electing to participate in the local unit group of localunits that offer the state employee health plan under section 6.6of this chapter.
(4) If the local unit public employer is a school corporation, byelecting to provide the coverage through a state employee health
plan under section 6.7 of this chapter.
A local unit public employer may provide programs of groupinsurance other than group health insurance for the local unit publicemployer's active and retired public safety employees by purchasingpolicies of group insurance and by establishing self-insuranceprograms. However, the establishment of a self-insurance programis subject to the approval of the unit's fiscal body.
(e) A local unit public employer may pay a part of the cost ofgroup insurance for its active and retired public safety employees.However, a local unit public employer that provides group lifeinsurance for its active and retired public safety employees shall paya part of the cost of that insurance.
(f) A local unit public employer may not cancel an insurancecontract under this section during the policy term of the contract.
(g) After June 30, 1989, a local unit public employer that providesa group health insurance program for its active public safetyemployees shall also provide a group health insurance program to thefollowing persons:
(1) Retired public safety employees.
(2) Public safety employees who are receiving disabilitybenefits under IC 36-8-6, IC 36-8-7, IC 36-8-7.5, IC 36-8-8, orIC 36-8-10.
(3) Surviving spouses and dependents of public safetyemployees who die while in active service or after retirement.
(h) A public safety employee who is retired or has a disability andis eligible for group health insurance coverage under subsection(g)(1) or (g)(2):
(1) may elect to have the person's spouse, dependents, or spouseand dependents covered under the group health insuranceprogram at the time the person retires or becomes disabled;
(2) must file a written request for insurance coverage with theemployer within ninety (90) days after the person retires orbegins receiving disability benefits; and
(3) must pay an amount equal to the total of the employer's andthe employee's premiums for the group health insurance for anactive public safety employee (however, the employer may electto pay any part of the person's premiums).
(i) Except as provided in IC 36-8-6-9.7(f), IC 36-8-6-10.1(h),IC 36-8-7-12.3(g), IC 36-8-7-12.4(j), IC 36-8-7.5-13.7(h),IC 36-8-7.5-14.1(i), IC 36-8-8-13.9(d), IC 36-8-8-14.1(h), andIC 36-8-10-16.5 for a surviving spouse or dependent of a publicsafety employee who dies in the line of duty, a surviving spouse ordependent who is eligible for group health insurance undersubsection (g)(3):
(1) may elect to continue coverage under the group healthinsurance program after the death of the public safetyemployee;
(2) must file a written request for insurance coverage with theemployer within ninety (90) days after the death of the publicsafety employee; and (3) must pay the amount that the public safety employee wouldhave been required to pay under this section for coverageselected by the surviving spouse or dependent (however, theemployer may elect to pay any part of the surviving spouse's ordependents' premiums).
(j) The eligibility for group health insurance under this section fora public safety employee who is retired or has a disability ends on theearlier of the following:
(1) When the public safety employee becomes eligible forMedicare coverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the employer terminates the health insurance programfor active public safety employees.
(k) A surviving spouse's eligibility for group health insuranceunder this section ends on the earliest of the following:
(1) When the surviving spouse becomes eligible for Medicarecoverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the unit providing the insurance terminates the healthinsurance program for active public safety employees.
(3) The date of the surviving spouse's remarriage.
(4) When health insurance becomes available to the survivingspouse through employment.
(l) A dependent's eligibility for group health insurance under thissection ends on the earliest of the following:
(1) When the dependent becomes eligible for Medicarecoverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the unit providing the insurance terminates the healthinsurance program for active public safety employees.
(3) When the dependent no longer meets the criteria set forth insubsection (a).
(4) When health insurance becomes available to the dependentthrough employment.
(m) A public safety employee who is on leave without pay isentitled to participate for ninety (90) days in any group healthinsurance program maintained by the local unit public employer foractive public safety employees if the public safety employee pays anamount equal to the total of the employer's and the employee'spremiums for the insurance. However, the employer may pay all orpart of the employer's premium for the insurance.
(n) A local unit public employer may provide group healthinsurance for retired public safety employees or their spouses notcovered by subsections (g) through (l) and may provide group healthinsurance that contains provisions more favorable to retired publicsafety employees and their spouses than required by subsections (g)through (l). A local unit public employer may provide group healthinsurance to a public safety employee who is on leave without payfor a longer period than required by subsection (m), and maycontinue to pay all or a part of the employer's premium for theinsurance while the employee is on leave without pay.
As added by P.L.58-1989, SEC.2. Amended by P.L.41-1990, SEC.2;P.L.286-2001, SEC.1; P.L.86-2003, SEC.1; P.L.2-2005, SEC.15;
P.L.99-2007, SEC.13; P.L.3-2008, SEC.24; P.L.182-2009(ss),SEC.65.
IC 5-10-8-2.5
Repealed
(Repealed by P.L.14-1986, SEC.19.)
IC 5-10-8-2.6
Local unit public employers and employees; programs;self-insurance; payment of part of cost; noncancelability; retiredemployees
Sec. 2.6. (a) This section applies only to local unit publicemployers and their employees. This section does not apply to publicsafety employees, surviving spouses, and dependents covered bysection 2.2 of this chapter.
(b) A public employer may provide programs of group insurancefor its employees and retired employees. The public employer may,however, exclude part-time employees and persons who provideservices to the unit under contract from any group insurancecoverage that the public employer provides to the employer'sfull-time employees. A public employer may provide programs ofgroup health insurance under this section through one (1) of thefollowing methods:
(1) By purchasing policies of group insurance.
(2) By establishing self-insurance programs.
(3) By electing to participate in the local unit group of localunits that offer the state employee health plan under section 6.6of this chapter.
(4) If the local unit public employer is a school corporation, byelecting to provide the coverage through a state employee healthplan under section 6.7 of this chapter.
A public employer may provide programs of group insurance otherthan group health insurance under this section by purchasing policiesof group insurance and by establishing self-insurance programs.However, the establishment of a self-insurance program is subject tothe approval of the unit's fiscal body.
(c) A public employer may pay a part of the cost of groupinsurance, but shall pay a part of the cost of group life insurance forlocal employees. A public employer may pay, as supplementalwages, an amount equal to the deductible portion of group healthinsurance as long as payment of the supplemental wages will notresult in the payment of the total cost of the insurance by the publicemployer.
(d) An insurance contract for local employees under this sectionmay not be canceled by the public employer during the policy termof the contract.
(e) After June 30, 1986, a public employer shall provide a grouphealth insurance program under subsection (g) to each retiredemployee:
(1) whose retirement date is: (A) after May 31, 1986, for a retired employee who was ateacher (as defined in IC 20-18-2-22) for a schoolcorporation; or
(B) after June 30, 1986, for a retired employee not coveredby clause (A);
(2) who will have reached fifty-five (55) years of age on orbefore the employee's retirement date but who will not beeligible on that date for Medicare coverage as prescribed by 42U.S.C. 1395 et seq.;
(3) who will have completed twenty (20) years of creditableemployment with a public employer on or before the employee'sretirement date, ten (10) years of which must have beencompleted immediately preceding the retirement date; and
(4) who will have completed at least fifteen (15) years ofparticipation in the retirement plan of which the employee is amember on or before the employee's retirement date.
(f) A group health insurance program required by subsection (e)must be equal in coverage to that offered active employees and mustpermit the retired employee to participate if the retired employeepays an amount equal to the total of the employer's and theemployee's premiums for the group health insurance for an activeemployee and if the employee, within ninety (90) days after theemployee's retirement date, files a written request with the employerfor insurance coverage. However, the employer may elect to pay anypart of the retired employee's premiums.
(g) A retired employee's eligibility to continue insurance undersubsection (e) ends when the employee becomes eligible forMedicare coverage as prescribed by 42 U.S.C. 1395 et seq., or whenthe employer terminates the health insurance program. A retiredemployee who is eligible for insurance coverage under subsection (e)may elect to have the employee's spouse covered under the healthinsurance program at the time the employee retires. If a retiredemployee's spouse pays the amount the retired employee would havebeen required to pay for coverage selected by the spouse, thespouse's subsequent eligibility to continue insurance under thissection is not affected by the death of the retired employee. Thesurviving spouse's eligibility ends on the earliest of the following:
(1) When the spouse becomes eligible for Medicare coverage asprescribed by 42 U.S.C. 1395 et seq.
(2) When the employer terminates the health insuranceprogram.
(3) Two (2) years after the date of the employee's death.
(4) The date of the spouse's remarriage.
(h) This subsection does not apply to an employee who is entitledto group insurance coverage under IC 20-28-10-2(b). An employeewho is on leave without pay is entitled to participate for ninety (90)days in any group health insurance program maintained by the publicemployer for active employees if the employee pays an amount equalto the total of the employer's and the employee's premiums for theinsurance. However, the employer may pay all or part of the
employer's premium for the insurance.
(i) A public employer may provide group health insurance forretired employees or their spouses not covered by subsections (e)through (g) and may provide group health insurance that containsprovisions more favorable to retired employees and their spousesthan required by subsections (e) through (g). A public employer mayprovide group health insurance to an employee who is on leavewithout pay for a longer period than required by subsection (h), andmay continue to pay all or a part of the employer's premium for theinsurance while the employee is on leave without pay.
As added by P.L.1-1991, SEC.33. Amended by P.L.286-2001, SEC.2;P.L.1-2005, SEC.76; P.L.182-2009(ss), SEC.66.
IC 5-10-8-2.7
Insurance of rostered volunteers
Sec. 2.7. (a) As used in this section, "rostered volunteer" meansa volunteer:
(1) whose name has been entered on a roster of volunteers fora volunteer program operated by a local unit; and
(2) who has been approved by the proper authorities of the localunit.
The term does not include a volunteer firefighter (as defined inIC 36-8-12-2) or an inmate assigned to a correctional facilityoperated by the state or a local unit.
(b) As used in this section, "local unit" does not include a schoolcorporation.
(c) The fiscal body of a local unit may elect to provide insurancefor rostered volunteers for life, accident, or sickness coverage.
As added by P.L.51-1993, SEC.1.
IC 5-10-8-3
Repealed
(Repealed by P.L.24-1985, SEC.25(c).)
IC 5-10-8-3.1
Employees withholding from salaries or wages; retired employees;assignment of part of retirement benefit
Sec. 3.1. (a) A public employer that contracts for a groupinsurance plan or establishes a self-insurance plan for its employeesmay withhold or cause to be withheld from participating employees'salaries or wages whatever part of the cost of the plan the employeesare required to pay. The chief fiscal officer responsible for issuingpaychecks or warrants to the employees shall make deductions fromthe individual employees' paychecks or warrants to pay the premiumsfor the insurance. Except as provided by section 7(d) of this chapter,the fiscal officer shall require written authorization from stateemployees, and may require written authorization from localemployees, to make the deductions. One (1) authorization signed byan employee is sufficient authorization for the fiscal officer tocontinue to make deductions for this purpose until revoked in writing
by the employee.
(b) A public employer that contracts for a group insurance plan orestablishes a self-insurance plan for its retired employees mayrequire that the retired employees pay any part of the cost of the planthat is not paid by the public employer. A retired employee mayassign part or all of the retired employee's benefit payable underIC 5-10.3-8, IC 5-10.4-5, or any other retirement program for thisrequired payment.
As added by P.L.24-1985, SEC.10. Amended by P.L.27-1988, SEC.3;P.L.2-2006, SEC.15.
IC 5-10-8-4
Discrimination as to form of insurance between certain employees;exception
Sec. 4. Self-insurance plans for state employees involving incomedisability insurance, principal amount accident insurance, or both,must not, as to the form or forms of the insurance, discriminatebetween the employees of any department, commission, board,division, facility, institution, authority, or other establishment, exceptthat the contributions for the insurance and benefits from theinsurance may be equitably graduated in relation to:
(1) the employment compensation schedule; and
(2) if actuarially justified, the employee's age.
As added by Acts 1980, P.L.8, SEC.41. Amended by P.L.24-1985,SEC.11; P.L.27-1988, SEC.4.
IC 5-10-8-5
Establishment of common and unified plan of group insurance
Sec. 5. Two (2) or more local public employers may establish acommon and unified plan of group insurance for their employees,including retired local employees. The plan shall be effected througha trust, agency, or any other legal arrangement with carefulaccounting and fiscal responsibility.
As added by Acts 1980, P.L.8, SEC.41. Amended by P.L.24-1985,SEC.12.
IC 5-10-8-6
Establishment of common and unified plans by state lawenforcement agencies
Sec. 6. (a) The state police department, conservation officers ofthe department of natural resources, gaming agents of the Indianagaming commission, gaming control officers of the Indiana gamingcommission, and the state excise police may establish common andunified plans of self-insurance for their employees, including retiredemployees, as separate entities of state government. These plans maybe administered by a private agency, business firm, limited liabilitycompany, or corporation.
(b) Except as provided in IC 5-10-14, the state agencies listed insubsection (a) may not pay as the employer part of benefits for anyemployee or retiree an amount greater than that paid for other state
employees for group insurance.
As added by Acts 1980, P.L.8, SEC.41. Amended by Acts 1982,P.L.36, SEC.1; P.L.24-1985, SEC.13; P.L.14-1986, SEC.11;P.L.8-1993, SEC.53; P.L.24-2005, SEC.1; P.L.170-2005, SEC.15;P.L.1-2006, SEC.95; P.L.227-2007, SEC.55.
IC 5-10-8-6.5
General assembly members and former members
Sec. 6.5. (a) A member of the general assembly may elect toparticipate in either:
(1) the plan of self-insurance established by the state policedepartment under section 6 of this chapter;
(2) the plan of self-insurance established by the state personneldepartment under section 7 of this chapter; or
(3) a prepaid health care delivery plan established under section7 of this chapter.
(b) A former member of the general assembly who meets thecriteria for participation in a group health insurance programprovided under section 8(e) or 8.1 of this chapter may elect toparticipate in either:
(1) the plan of self-insurance established by the state policedepartment under section 6 of this chapter; or
(2) a group health insurance program provided under section8(e) or 8.1 of this chapter.
(c) A member of the general assembly or former member of thegeneral assembly who chooses a plan described in subsection (a)(1)or (b)(1) shall pay any amount of both the employer and theemployee share of the cost of the coverage that exceeds the cost ofthe coverage under the new traditional plan.
As added by P.L.233-1999, SEC.2.
IC 5-10-8-6.6
Local unit groups
Sec. 6.6. (a) As used in this section, "local unit group" means allof the local units that elect to provide coverage for health careservices for active and retired:
(1) elected or appointed officers and officials;
(2) full-time employees; and
(3) part-time employees;
of the local unit under this section.
(b) As used in this section, "state employee health plan" means:
(1) an accident and sickness insurance policy (as defined inIC 27-8-5.6-1) purchased through the state personneldepartment under section 7(a) of this chapter; or
(2) a contract with a prepaid health care delivery plan enteredinto by the state personnel department under section 7(c) of thischapter.
(c) The state personnel department shall allow a local unit toparticipate in the local unit group by electing to provide coverage ofhealth care services for active and retired: (1) elected or appointed officers and officials;
(2) full-time employees; and
(3) part-time employees;
of the local unit under a state employee health plan.
(d) If a local unit elects to provide coverage under subsection (c):
(1) the local unit group must be treated as a single group that isseparate from the group of state employees that is coveredunder a state employee health plan;
(2) the state personnel department shall:
(A) establish:
(i) the premium costs, as determined by an accident andsickness insurer or a prepaid health care delivery planunder which coverage is provided under this section;
(ii) the administrative costs; and
(iii) any other costs;
of the coverage provided under this section, including thecost of obtaining insurance or reinsurance, for the local unitgroup as a whole; and
(B) establish a uniform premium schedule for each accidentand sickness insurance policy or prepaid health care deliveryplan under which coverage is provided under this section forthe local unit group; and
(3) the local unit shall provide for payment of the cost of thecoverage as provided in sections 2.2 and 2.6 of this chapter.
The premium determined under subdivision (2) and paid by anindividual local unit shall not be determined based on claims madeby the local unit.
(e) The state personnel department shall provide an annualopportunity for local units to elect to provide or terminate coverageunder subsection (c).
(f) The state personnel department may adopt rules underIC 4-22-2 to establish minimum participation and contributionrequirements for participation in a state employee health plan underthis section.
As added by P.L.286-2001, SEC.3.
IC 5-10-8-6.7
Election of state employee health care program by schoolcorporation
Sec. 6.7. (a) As used in this section, "state employee health plan"means a:
(1) self-insurance program established under section 7(b) of thischapter; or
(2) contract with a prepaid health care delivery plan entered intounder section 7(c) of this chapter;
to provide group health coverage for state employees.
(b) The state personnel department shall allow a schoolcorporation to elect to provide coverage of health care services foractive and retired employees of the school corporation under anystate employee health plan. If a school corporation elects to provide
coverage of health care services for active and retired employees ofthe school corporation under a state employee health plan, it mustprovide coverage for all active and retired employees of the schoolcorporation under the state employee health plan (other than anyemployees covered by an Indiana comprehensive health insuranceassociation policy or individuals who retire from the schoolcorporation before July 1, 2010) if coverage was provided for theseemployees under the prior policies.
(c) The following apply if a school corporation elects to providecoverage for active and retired employees of the school corporationunder subsection (b):
(1) The state shall not pay any part of the cost of the coverage.
(2) The coverage provided to an active or retired schoolcorporation employee under this section must be the same as thecoverage provided to an active or retired state employee underthe state employee health plan.
(3) Notwithstanding sections 2.2 and 2.6 of this chapter:
(A) the school corporation shall pay for the coverageprovided to an active or retired school corporation employeeunder this section an amount not more than the amount paidby the state for coverage provided to an active or retiredstate employee under the state employee health plan; and
(B) an active or retired school corporation employee shallpay for the coverage provided to the active or retired schoolcorporation employee under this section an amount that is atleast equal to the amount paid by an active or retired stateemployee for coverage provided to the active or retired stateemployee under the state employee health plan.
However, this subdivision does not apply to contractualcommitments made by a school corporation to individuals whoretire before July 1, 2010.
(4) The school corporation shall pay any administrative costs ofthe school corporation's participation in the state employeehealth plan.
(5) The school corporation shall provide the coverage electedunder subsection (b) for a period of at least three (3) yearsbeginning on the date the coverage of the school corporationemployees under the state employee health plan begins.
(d) The state personnel department shall provide an enrollmentperiod at least every thirty (30) days for a school corporation thatelects to provide coverage under subsection (b).
(e) The state personnel department may adopt rules underIC 4-22-2 to implement this section.
(f) Neither this section nor a school corporation's election toparticipate in a state employee health plan as provided in this sectionimpairs the rights of an exclusive representative of the certificated ornoncertificated employees of the school corporation to collectivelybargain all matters related to school employee health insuranceprograms and benefits.
As added by P.L.182-2009(ss), SEC.67. Amended by
P.L.182-2009(ss), SEC.515; P.L.109-2010, SEC.1.
IC 5-10-8-7
Group insurance; self-insurance; health services; disability plans
Sec. 7. (a) The state, excluding state educational institutions, maynot purchase or maintain a policy of group insurance, except:
(1) life insurance for the state's employees;
(2) long term care insurance under a long term care insurancepolicy (as defined in IC 27-8-12-5), for the state's employees;
(3) an accident and sickness insurance policy (as defined inIC 27-8-5.6-1) that covers individuals to whom coverage isprovided by a local unit under section 6.6 of this chapter; or
(4) an insurance policy that provides coverage that supplementscoverage provided under a United States military health careplan.
(b) With the consent of the governor, the state personneldepartment may establish self-insurance programs to provide groupinsurance other than life or long term care insurance for stateemployees and retired state employees. The state personneldepartment may contract with a private agency, business firm,limited liability company, or corporation for administrative services.A commission may not be paid for the placement of the contract. Thedepartment may require, as part of a contract for administrativeservices, that the provider of the administrative services offer to anemployee terminating state employment the option to purchase,without evidence of insurability, an individual policy of insurance.
(c) Notwithstanding subsection (a), with the consent of thegovernor, the state personnel department may contract for healthservices for state employees and individuals to whom coverage isprovided by a local unit under section 6.6 of this chapter through one(1) or more prepaid health care delivery plans.
(d) The state personnel department shall adopt rules underIC 4-22-2 to establish long term and short term disability plans forstate employees (except employees who hold elected offices (asdefined by IC 3-5-2-17)). The plans adopted under this subsectionmay include any provisions the department considers necessary andproper and must:
(1) require participation in the plan by employees with six (6)months of continuous, full-time service;
(2) require an employee to make a contribution to the plan inthe form of a payroll deduction;
(3) require that an employee's benefits under the short termdisability plan be subject to a thirty (30) day elimination periodand that benefits under the long term plan be subject to a six (6)month elimination period;
(4) prohibit the termination of an employee who is eligible forbenefits under the plan;
(5) provide, after a seven (7) day elimination period, eightypercent (80%) of base biweekly wages for an employee disabledby injuries resulting from tortious acts, as distinguished from
passive negligence, that occur within the employee's scope ofstate employment;
(6) provide that an employee's benefits under the plan may bereduced, dollar for dollar, if the employee derives income from:
(A) Social Security;
(B) the public employees' retirement fund;
(C) the Indiana state teachers' retirement fund;
(D) pension disability;
(E) worker's compensation;
(F) benefits provided from another employer's group plan; or
(G) remuneration for employment entered into after thedisability was incurred.
(The department of state revenue and the department ofworkforce development shall cooperate with the state personneldepartment to confirm that an employee has disclosed completeand accurate information necessary to administer subdivision(6).)
(7) provide that an employee will not receive benefits under theplan for a disability resulting from causes specified in the rules;and
(8) provide that, if an employee refuses to:
(A) accept work assignments appropriate to the employee'smedical condition;
(B) submit information necessary for claim administration;or
(C) submit to examinations by designated physicians;
the employee forfeits benefits under the plan.
(e) This section does not affect insurance for retirees underIC 5-10.3 or IC 5-10.4.
(f) The state may pay part of the cost of self-insurance or prepaidhealth care delivery plans for its employees.
(g) A state agency may not provide any insurance benefits to itsemployees that are not generally available to other state employees,unless specifically authorized by law.
(h) The state may pay a part of the cost of group medical and lifecoverage for its employees.
As added by P.L.28-1983, SEC.50. Amended by P.L.24-1985,SEC.14; P.L.39-1986, SEC.4; P.L.14-1986, SEC.12; P.L.27-1988,SEC.5; P.L.8-1993, SEC.54; P.L.21-1995, SEC.10; P.L.14-1996,SEC.5; P.L.41-1997, SEC.1; P.L.286-2001, SEC.4; P.L.2-2006,SEC.16; P.L.158-2006, SEC.2; P.L.2-2007, SEC.82.
IC 5-10-8-7.1
Coverage for pervasive developmental disorder
Sec. 7.1. (a) As used in this section, "covered individual" meansan individual who is:
(1) covered under a self-insurance program established undersection 7(b) of this chapter to provide group health coverage; or
(2) entitled to health services under a contract with a prepaidhealth care delivery plan that is entered into or renewed under
section 7(c) of this chapter.
(b) As used in this section, "pervasive developmental disorder"means a neurological condition, including Asperger's syndrome andautism, as defined in the most recent edition of the Diagnostic andStatistical Manual of Mental Disorders of the American PsychiatricAssociation.
(c) A self-insurance program established under section 7(b) of thischapter to provide health care coverage must provide a coveredindividual with coverage for the treatment of a pervasivedevelopmental disorder. Coverage provided under this section islimited to treatment that is prescribed by the covered individual'streating physician in accordance with a treatment plan. Aself-insurance program may not deny or refuse to issue coverage on,refuse to contract with, or refuse to renew, refuse to reissue, orotherwise terminate or restrict coverage on, an individual under aninsurance policy or health plan solely because the individual isdiagnosed with a pervasive developmental disorder.
(d) A contract with a prepaid health care delivery plan that isentered into or renewed under section 7(c) of this chapter mustprovide a covered individual with services for the treatment of apervasive developmental disorder. Services provided under thissection are limited to treatment that is prescribed by the coveredindividual's treating physician in accordance with a treatment plan.A prepaid health care delivery plan may not deny or refuse to provideservices to, or refuse to renew, refuse to reissue, or otherwiseterminate or restrict services to, an individual solely because theindividual is diagnosed with a pervasive developmental disorder.
(e) The coverage required by subsection (c) and services requiredby subsection (d) may not be subject to dollar limits, deductibles,copayments, or coinsurance provisions that are less favorable to acovered individual than the dollar limits, deductibles, copayments,or coinsurance provisions that apply to physical illness generallyunder the self-insurance program or contract with a prepaid healthcare delivery plan.
As added by P.L.148-2001, SEC.1.
IC 5-10-8-7.2
Breast cancer; definitions; self-insurance programs; healthmaintenance organizations; diagnostic services
Sec. 7.2. (a) As used in this section, "breast cancer diagnosticservice" means a procedure intended to aid in the diagnosis of breastcancer. The term includes procedures performed on an inpatient basisand procedures performed on an outpatient basis, including thefollowing:
(1) Breast cancer screening mammography.
(2) Surgical breast biopsy.
(3) Pathologic examination and interpretation.
(b) As used in this section, "breast cancer outpatient treatmentservices" means procedures that are intended to treat cancer of thehuman breast and that are delivered on an outpatient basis. The term
includes the following:
(1) Chemotherapy.
(2) Hormonal therapy.
(3) Radiation therapy.
(4) Surgery.
(5) Other outpatient cancer treatment services prescribed by aphysician.
(6) Medical follow-up services related to the procedures setforth in subdivisions (1) through (5).
(c) As used in this section, "breast cancer rehabilitative services"means procedures that are intended to improve the results of or toameliorate the debilitating consequences of the treatment of breastcancer and that are delivered on an inpatient or outpatient basis. Theterm includes the following:
(1) Physical therapy.
(2) Psychological and social support services.
(3) Reconstructive plastic surgery.
(d) As used in this section, "breast cancer screeningmammography" means a standard, two (2) view per breast, low-doseradiographic examination of the breasts that is:
(1) furnished to an asymptomatic woman; and
(2) performed by a mammography services provider usingequipment designed by the manufacturer for and dedicatedspecifically to mammography in order to detect unsuspectedbreast cancer.
The term includes the interpretation of the results of a breast cancerscreening mammography by a physician.
(e) As used in this section, "covered individual" means a femaleindividual who is:
(1) covered under a self-insurance program established undersection 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a healthmaintenance organization (as defined in IC 27-13-1-19) that isentered into or renewed under section 7(c) of this chapter.
(f) As used in this section, "mammography services provider"means an individual or facility that:
(1) has been accredited by the American College of Radiology;
(2) meets equivalent guidelines established by the statedepartment of health; or
(3) is certified by the federal Department of Health and HumanServices for participation in the Medicare program (42 U.S.C.1395 et seq.).
(g) As used in this section, "woman at risk" means a woman whomeets at least one (1) of the following descriptions:
(1) A woman who has a personal history of breast cancer.
(2) A woman who has a personal history of breast disease thatwas proven benign by biopsy.
(3) A woman whose mother, sister, or daughter has had breastcancer.
(4) A woman who is at least thirty (30) years of age and has not
given birth.
(h) A self-insurance program established under section 7(b) of thischapter to provide health care coverage must provide coveredindividuals with coverage for breast cancer diagnostic services,breast cancer outpatient treatment services, and breast cancerrehabilitative services. The coverage must provide reimbursement forbreast cancer screening mammography at a level at least as high as:
(1) the limitation on payment for screening mammographyservices established in 42 CFR 405.534(b)(3) according to theMedicare Economic Index at the time the breast cancerscreening mammography is performed; or
(2) the rate negotiated by a contract provider according to theprovisions of the insurance policy;
whichever is lower. The costs of the coverage required by thissubsection may be paid by the state or by the employee or by acombination of the state and the employee.
(i) A contract with a health maintenance organization that isentered into or renewed under section 7(c) of this chapter mustprovide covered individuals with breast cancer diagnostic services,breast cancer outpatient treatment services, and breast cancerrehabilitative services.
(j) The coverage required by subsection (h) and services requiredby subsection (i) may not be subject to dollar limits, deductibles, orcoinsurance provisions that are less favorable to covered individualsthan the dollar limits, deductibles, or coinsurance provisionsapplying to physical illness generally under the self-insuranceprogram or contract with a health maintenance organization.
(k) The coverage for breast cancer diagnostic services required bysubsection (h) and the breast cancer diagnostic services required bysubsection (i) must include the following:
(1) In the case of a covered individual who is at least thirty-five(35) years of age but less than forty (40) years of age, at leastone (1) baseline breast cancer screening mammographyperformed upon the individual before she becomes forty (40)years of age.
(2) In the case of a covered individual who is:
(A) less than forty (40) years of age; and
(B) a woman at risk;
at least one (1) breast cancer screening mammographyperformed upon the covered individual every year.
(3) In the case of a covered individual who is at least forty (40)years of age, at least one (1) breast cancer screeningmammography performed upon the individual every year.
(4) Any additional mammography views that are required forproper evaluation.
(5) Ultrasound services, if determined medically necessary bythe physician treating the covered individual.
(l) The coverage for breast cancer diagnostic services required bysubsection (h) and the breast cancer diagnostic services required bysubsection (i) shall be provided in addition to any benefits
specifically provided for x-rays, laboratory testing, or wellnessexaminations.
As added by P.L.35-1992, SEC.1. Amended by P.L.26-1994, SEC.1;P.L.170-1999, SEC.1.
IC 5-10-8-7.3
Early intervention services for first steps children
Sec. 7.3. (a) As used in this section, "covered individual" meansan individual who is:
(1) covered under a self-insurance program established undersection 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a prepaid healthcare delivery plan that is entered into or renewed under section7(c) of this chapter.
(b) As used in this section, "early intervention services" meansservices provided to a first steps child under IC 12-12.7-2 and 20U.S.C. 1432(4).
(c) As used in this section, "first steps child" means an infant ortoddler from birth through two (2) years of age who is enrolled in theIndiana first steps program and is a covered individual.
(d) As used in this section, "first steps program" refers to theprogram established under IC 12-12.7-2 and 20 U.S.C. 1431 et seq.to meet the needs of:
(1) children who are eligible for early intervention services; and
(2) their families.
The term includes the coordination of all available federal, state,local, and private resources available to provide early interventionservices within Indiana.
(e) As used in this section, "health benefits plan" means a:
(1) self-insurance program established under section 7(b) of thischapter to provide group health coverage; or
(2) contract with a prepaid health care delivery plan that isentered into or renewed under section 7(c) of this chapter.
(f) A health benefits plan that provides coverage for earlyintervention services shall reimburse the first steps program forpayments made by the program for early intervention services thatare covered under the health benefits plan.
(g) The reimbursement required under subsection (f) may not beapplied to any annual or aggregate lifetime limit on the first stepschild's coverage under the health benefits plan.
(h) The first steps program may pay required deductibles,copayments, or other out-of-pocket expenses for a first steps childdirectly to a provider. A health benefits plan shall apply anypayments made by the first steps program to the health benefits plan'sdeductibles, copayments, or other out-of-pocket expenses accordingto the terms and conditions of the health benefits plan.
As added by P.L.121-1999, SEC.1. Amended by P.L.246-2005,SEC.47; P.L.93-2006, SEC.2.
IC 5-10-8-7.5
Prostate specific antigen test
Sec. 7.5. (a) As used in this section, "covered individual" meansa male individual who is:
(1) covered under a self-insurance program established undersection 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a healthmaintenance organization (as defined in IC 27-13-1-19) that isentered into or renewed under section 7(c) of this chapter.
(b) As used in this section, "prostate specific antigen test" meansa standard blood test performed to determine the level of prostatespecific antigen in the blood.
(c) A self-insurance program established under section 7(b) of thischapter to provide health care coverage must provide coveredindividuals with coverage for prostate specific antigen testing.
(d) A contract with a health maintenance organization that isentered into or renewed under section 7(c) of this chapter mustprovide covered individuals with prostate specific antigen screening.
(e) The coverage required under subsections (c) and (d) mustinclude the following:
(1) At least one (1) prostate specific antigen test annually for acovered individual who is at least fifty (50) years of age.
(2) At least one (1) prostate specific antigen test annually for acovered individual who is less than fifty (50) years of age andwho is at high risk for prostate cancer according to the mostrecent published guidelines of the American Cancer Society.
(f) The coverage required under this section may not be subject todollar limits, deductibles, copayments, or coinsurance provisions thatare less favorable to covered individuals than the dollar limits,deductibles, copayments, or coinsurance provisions applying tophysical illness generally under the self-insurance program orcontract with a health maintenance organization.
(g) The coverage for prostate specific antigen screening shall beprovided in addition to benefits specifically provided for x-rays,laboratory testing, or wellness examinations.
As added by P.L.170-1999, SEC.2.
IC 5-10-8-7.7
Surgical treatment for morbid obesity
Sec. 7.7. (a) As used in this section, "covered individual" meansan individual who is covered under a health care plan.
(b) As used in this section, "health care plan" means:
(1) a self-insurance program established under section 7(b) ofthis chapter to provide group health coverage; or
(2) a contract entered into under section 7(c) of this chapter toprovide health services through a prepaid health care deliveryplan.
(c) As used in this section, "health care provider" means a:
(1) physician licensed under IC 25-22.5; or
(2) hospital licensed under IC 16-21;that provides health care services for surgical treatment of morbidobesity.
(d) As used in this section, "morbid obesity" means:
(1) a body mass index of at least thirty-five (35) kilograms permeter squared, with comorbidity or coexisting medicalconditions such as hypertension, cardiopulmonary conditions,sleep apnea, or diabetes; or
(2) a body mass index of at least forty (40) kilograms per metersquared without comorbidity.
For purposes of this subsection, body mass index is equal to weightin kilograms divided by height in meters squared.
(e) Except as provided in subsection (f), the state shall providecoverage for nonexperimental, surgical treatment by a health careprovider of morbid obesity:
(1) that has persisted for at least five (5) years; and
(2) for which nonsurgical treatment that is supervised by aphysician has been unsuccessful for at least six (6) consecutivemonths.
(f) The state may not provide coverage for surgical treatment ofmorbid obesity for a covered individual who is less than twenty-one(21) years of age unless two (2) physicians licensed under IC 25-22.5determine that the surgery is necessary to:
(1) save the life of the covered individual; or
(2) restore the covered individual's ability to maintain a majorlife activity (as defined in IC 4-23-29-6);
and each physician documents in the covered individual's medicalrecord the reason for the physician's determination.
As added by P.L.78-2000, SEC.1. Amended by P.L.196-2005, SEC.1;P.L.102-2006, SEC.1.
IC 5-10-8-7.8
Colorectal cancer testing coverage
Sec. 7.8. (a) As used in this section, "covered individual" meansan individual who is:
(1) covered under a self-insurance program established undersection 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a healthmaintenance organization (as defined in IC 27-13-1-19) that isentered into or renewed under section 7(c) of this chapter.
(b) A:
(1) self-insurance program established under section 7(b) of thischapter to provide health care coverage; or
(2) contract with a health maintenance organization that isentered into or renewed under section 7(c) of this chapter;
must provide coverage for colorectal cancer examinations andlaboratory tests for cancer for any nonsymptomatic coveredindividual, in accordance with the current American Cancer Societyguidelines.
(c) For a covered individual who is:
(1) at least fifty (50) years of age; or (2) less than fifty (50) years of age and at high risk forcolorectal cancer according to the most recent publishedguidelines of the American Cancer Society;
the coverage required under this section must meet the requirementsset forth in subsection (d).
(d) A covered individual may not be required to pay an additionaldeductible or coinsurance for the colorectal cancer examination andlaboratory testing benefit that is greater than an annual deductible orcoinsurance established for similar benefits under a self-insuranceprogram or contract with a health maintenance organization. If theprogram or contract does not cover a similar benefit, a deductible orcoinsurance may not be set at a level that materially diminishes thevalue of the colorectal cancer examination and laboratory testingbenefit required under this section.
As added by P.L.54-2000, SEC.1.
IC 5-10-8-8
Retired employees; ability of employer to pay premiums
Sec. 8. (a) This section applies only to the state and employeeswho are not covered by a plan established under section 6 of thischapter.
(b) After June 30, 1986, the state shall provide a group healthinsurance plan to each retired employee:
(1) whose retirement date is:
(A) after June 29, 1986, for a retired employee who was amember of the field examiners' retirement fund;
(B) after May 31, 1986, for a retired employee who was amember of the Indiana state teachers' retirement fun