IC 27-1-37.1
Chapter 37.1. Termination of Health Provider Contracts
IC 27-1-37.1-1 "Health maintenance organization" defined
Sec. 1. As used in this chapter, "health maintenance organization"
means a person that undertakes to provide or arrange for the delivery
of health care services to individuals on a prepaid basis, except for
the individual's responsibility for copayments or deductibles. The
term includes a limited service health maintenance organization. The
term does not include a staff-model health maintenance organization
that employs a group of providers and that requires the providers to
provide health care services solely to individuals who are entitled to
coverage under a contract with the staff-model health maintenance
organization or an affiliate of the staff-model health maintenance
organization. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-2 "Health provider contract" defined
Sec. 2. As used in this chapter, "health provider contract" means
an agreement with a provider relating to terms and conditions of
reimbursement for health care services provided to an individual
under:
(1) an employee welfare benefit plan (as defined in 29 U.S.C.
1002 et seq.);
(2) a policy of accident and sickness insurance (as defined in
IC 27-8-5-1);
(3) a contract with a health maintenance organization;
(4) a self-insurance program established under IC 5-10-8-7(b);
or
(5) a prepaid health care delivery plan entered into under
IC 5-10-8-7(c). As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-3 "Person" defined
Sec. 3. (a) As used in this chapter, "person" means an individual,
an agency, a political subdivision, a partnership, a corporation, an
association, or any other entity that enters into a health provider
contract with a provider.
(b) The term does not include a health care provider described in
IC 16-18-2-163(a)(1), IC 16-18-2-163(a)(2), IC 16-18-2-163(a)(3),
or IC 16-18-2-163(a)(4). As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-4 "Provider" defined
Sec. 4. As used in this chapter, "provider" means:
(1) a physician licensed under IC 25-22.5;
(2) a dentist licensed under IC 25-14;
(3) an advanced practice nurse licensed under IC 25-23;
(4) a chiropractor licensed under IC 25-10;
(5) a podiatrist licensed under IC 25-29;
(6) an optometrist licensed under IC 25-24; or
(7) a clinical psychologist licensed under IC 25-33. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-5 Notice of amendment of contract
Sec. 5. A person who enters into a health provider contract with
a provider shall provide written notice to the provider of any
amendment to the health provider contract not less than forty-five
(45) days before the proposed effective date of the amendment. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-6 Termination of contract without penalty
Sec. 6. (a) Subject to subsection (b), a provider who receives
notice under section 5 of this chapter may terminate the health
provider contract without penalty by informing the person with
whom the health care provider contracts that the provider chooses
not to approve the amendment.
(b) Notice under subsection (a) must be:
(1) given not later than fifteen (15) days after the provider
receives notice under section 5 of this chapter; and
(2) in writing. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-7 Effective date of termination
Sec. 7. The termination of a contract under section 6 of this
chapter is effective:
(1) ninety (90) days after the person with whom the provider
contracts receives written notice from the provider that the
provider does not approve the amendment; or
(2) on a date earlier than the date described in subdivision (1),
if agreed to by the person with whom the provider contracts and
the provider. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-8 Compliance with proposed amendment not required
Sec. 8. If a person with whom a provider contracts receives notice
from a provider under section 6 of this chapter, the person with
whom a provider contracts may not require the provider to comply
with the proposed amendment. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-9 Notification to patient that provider's contract terminated
Sec. 9. Except in an emergency, a provider who elects to
terminate a health provider contract under this section shall, before
providing services to a patient who is covered by the contract, notify
the patient that the provider's contract has been or will be terminated. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-10 Contrary contract provisions void
Sec. 10. Except as provided in section 7(2) of this chapter, a
health provider contract provision that is contrary to this chapter is
void. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-11 Chapter inapplicable to compliance with state or federal laws
Sec. 11. This chapter does not apply to an amendment to a health
provider contract that is required to comply with a state or federal
law. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1
Chapter 37.1. Termination of Health Provider Contracts
IC 27-1-37.1-1 "Health maintenance organization" defined
Sec. 1. As used in this chapter, "health maintenance organization"
means a person that undertakes to provide or arrange for the delivery
of health care services to individuals on a prepaid basis, except for
the individual's responsibility for copayments or deductibles. The
term includes a limited service health maintenance organization. The
term does not include a staff-model health maintenance organization
that employs a group of providers and that requires the providers to
provide health care services solely to individuals who are entitled to
coverage under a contract with the staff-model health maintenance
organization or an affiliate of the staff-model health maintenance
organization. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-2 "Health provider contract" defined
Sec. 2. As used in this chapter, "health provider contract" means
an agreement with a provider relating to terms and conditions of
reimbursement for health care services provided to an individual
under:
(1) an employee welfare benefit plan (as defined in 29 U.S.C.
1002 et seq.);
(2) a policy of accident and sickness insurance (as defined in
IC 27-8-5-1);
(3) a contract with a health maintenance organization;
(4) a self-insurance program established under IC 5-10-8-7(b);
or
(5) a prepaid health care delivery plan entered into under
IC 5-10-8-7(c). As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-3 "Person" defined
Sec. 3. (a) As used in this chapter, "person" means an individual,
an agency, a political subdivision, a partnership, a corporation, an
association, or any other entity that enters into a health provider
contract with a provider.
(b) The term does not include a health care provider described in
IC 16-18-2-163(a)(1), IC 16-18-2-163(a)(2), IC 16-18-2-163(a)(3),
or IC 16-18-2-163(a)(4). As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-4 "Provider" defined
Sec. 4. As used in this chapter, "provider" means:
(1) a physician licensed under IC 25-22.5;
(2) a dentist licensed under IC 25-14;
(3) an advanced practice nurse licensed under IC 25-23;
(4) a chiropractor licensed under IC 25-10;
(5) a podiatrist licensed under IC 25-29;
(6) an optometrist licensed under IC 25-24; or
(7) a clinical psychologist licensed under IC 25-33. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-5 Notice of amendment of contract
Sec. 5. A person who enters into a health provider contract with
a provider shall provide written notice to the provider of any
amendment to the health provider contract not less than forty-five
(45) days before the proposed effective date of the amendment. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-6 Termination of contract without penalty
Sec. 6. (a) Subject to subsection (b), a provider who receives
notice under section 5 of this chapter may terminate the health
provider contract without penalty by informing the person with
whom the health care provider contracts that the provider chooses
not to approve the amendment.
(b) Notice under subsection (a) must be:
(1) given not later than fifteen (15) days after the provider
receives notice under section 5 of this chapter; and
(2) in writing. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-7 Effective date of termination
Sec. 7. The termination of a contract under section 6 of this
chapter is effective:
(1) ninety (90) days after the person with whom the provider
contracts receives written notice from the provider that the
provider does not approve the amendment; or
(2) on a date earlier than the date described in subdivision (1),
if agreed to by the person with whom the provider contracts and
the provider. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-8 Compliance with proposed amendment not required
Sec. 8. If a person with whom a provider contracts receives notice
from a provider under section 6 of this chapter, the person with
whom a provider contracts may not require the provider to comply
with the proposed amendment. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-9 Notification to patient that provider's contract terminated
Sec. 9. Except in an emergency, a provider who elects to
terminate a health provider contract under this section shall, before
providing services to a patient who is covered by the contract, notify
the patient that the provider's contract has been or will be terminated. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-10 Contrary contract provisions void
Sec. 10. Except as provided in section 7(2) of this chapter, a
health provider contract provision that is contrary to this chapter is
void. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-11 Chapter inapplicable to compliance with state or federal laws
Sec. 11. This chapter does not apply to an amendment to a health
provider contract that is required to comply with a state or federal
law. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1
Chapter 37.1. Termination of Health Provider Contracts
IC 27-1-37.1-1 "Health maintenance organization" defined
Sec. 1. As used in this chapter, "health maintenance organization"
means a person that undertakes to provide or arrange for the delivery
of health care services to individuals on a prepaid basis, except for
the individual's responsibility for copayments or deductibles. The
term includes a limited service health maintenance organization. The
term does not include a staff-model health maintenance organization
that employs a group of providers and that requires the providers to
provide health care services solely to individuals who are entitled to
coverage under a contract with the staff-model health maintenance
organization or an affiliate of the staff-model health maintenance
organization. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-2 "Health provider contract" defined
Sec. 2. As used in this chapter, "health provider contract" means
an agreement with a provider relating to terms and conditions of
reimbursement for health care services provided to an individual
under:
(1) an employee welfare benefit plan (as defined in 29 U.S.C.
1002 et seq.);
(2) a policy of accident and sickness insurance (as defined in
IC 27-8-5-1);
(3) a contract with a health maintenance organization;
(4) a self-insurance program established under IC 5-10-8-7(b);
or
(5) a prepaid health care delivery plan entered into under
IC 5-10-8-7(c). As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-3 "Person" defined
Sec. 3. (a) As used in this chapter, "person" means an individual,
an agency, a political subdivision, a partnership, a corporation, an
association, or any other entity that enters into a health provider
contract with a provider.
(b) The term does not include a health care provider described in
IC 16-18-2-163(a)(1), IC 16-18-2-163(a)(2), IC 16-18-2-163(a)(3),
or IC 16-18-2-163(a)(4). As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-4 "Provider" defined
Sec. 4. As used in this chapter, "provider" means:
(1) a physician licensed under IC 25-22.5;
(2) a dentist licensed under IC 25-14;
(3) an advanced practice nurse licensed under IC 25-23;
(4) a chiropractor licensed under IC 25-10;
(5) a podiatrist licensed under IC 25-29;
(6) an optometrist licensed under IC 25-24; or
(7) a clinical psychologist licensed under IC 25-33. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-5 Notice of amendment of contract
Sec. 5. A person who enters into a health provider contract with
a provider shall provide written notice to the provider of any
amendment to the health provider contract not less than forty-five
(45) days before the proposed effective date of the amendment. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-6 Termination of contract without penalty
Sec. 6. (a) Subject to subsection (b), a provider who receives
notice under section 5 of this chapter may terminate the health
provider contract without penalty by informing the person with
whom the health care provider contracts that the provider chooses
not to approve the amendment.
(b) Notice under subsection (a) must be:
(1) given not later than fifteen (15) days after the provider
receives notice under section 5 of this chapter; and
(2) in writing. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-7 Effective date of termination
Sec. 7. The termination of a contract under section 6 of this
chapter is effective:
(1) ninety (90) days after the person with whom the provider
contracts receives written notice from the provider that the
provider does not approve the amendment; or
(2) on a date earlier than the date described in subdivision (1),
if agreed to by the person with whom the provider contracts and
the provider. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-8 Compliance with proposed amendment not required
Sec. 8. If a person with whom a provider contracts receives notice
from a provider under section 6 of this chapter, the person with
whom a provider contracts may not require the provider to comply
with the proposed amendment. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-9 Notification to patient that provider's contract terminated
Sec. 9. Except in an emergency, a provider who elects to
terminate a health provider contract under this section shall, before
providing services to a patient who is covered by the contract, notify
the patient that the provider's contract has been or will be terminated. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-10 Contrary contract provisions void
Sec. 10. Except as provided in section 7(2) of this chapter, a
health provider contract provision that is contrary to this chapter is
void. As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-11 Chapter inapplicable to compliance with state or federal laws
Sec. 11. This chapter does not apply to an amendment to a health
provider contract that is required to comply with a state or federal
law. As added by P.L.196-2001, SEC.1.
