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-time
employee;
(B) if the individual is employed by a school corporation, a
full-time or part-time employee;
(C) for a local unit public employer, a full-time or part-time
employee or a person who provides personal services to the
unit 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 least
thirty (30) days.
(2) "Group insurance" means any of the kinds of insurance
fulfilling the definitions and requirements of group insurance
contained in IC 27-1.
(3) "Insurance" means insurance upon or in relation to human
life in all its forms, including life insurance, health insurance,
disability insurance, accident insurance, hospitalization
insurance, surgery insurance, medical insurance, and
supplemental medical insurance.
(4) "Local unit" includes a city, town, county, township, public
library, municipal corporation (as defined in IC 5-10-9-1), or
school corporation.
(5) "New traditional plan" means a self-insurance program
established under section 7(b) of this chapter to provide health
care coverage.
(6) "Public employer" means the state or a local unit, including
any board, commission, department, division, authority,
institution, establishment, facility, or governmental unit under
the supervision of either, having a payroll in relation to persons
it immediately employs, even if it is not a separate taxing unit.
With respect to the legislative branch of government, "public
employer" or "employer" refers to the following:
(A) The president pro tempore of the senate, with respect to
former members or employees of the senate.
(B) The speaker of the house, with respect to former
members or employees of the house of representatives.
(C) The legislative council, with respect to former
employees of the legislative services agency.
(7) "Public employer" does not include a state educational
institution.
(8) "Retired employee" means:
(A) in the case of a public employer that participates in the
public employees' retirement fund, a former employee who
qualifies 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 the
teachers' retirement fund under IC 5-10.4, a former employee
who qualifies for a benefit under IC 5-10.4-5; and
(C) in the case of any other public employer, a former
employee who meets the requirements established by the
public employer for participation in a group insurance plan
for retired employees.
(9) "Retirement date" means the date that the employee has
chosen 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 natural
child, 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 or
mental disability (using disability guidelines established by the
Social Security Administration); or
(3) is at least eighteen (18) and less than twenty-three (23) years
of age and is enrolled in and regularly attending a secondary
school or is a full-time student at an accredited college or
university.
(b) As used in this section, "public safety employee" means a
full-time firefighter, police officer, county police officer, or sheriff.
(c) This section applies only to local unit public employers and
their public safety employees.
(d) A local unit public employer may provide programs of group
health insurance for its active and retired public safety employees
through 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 local
units that offer the state employee health plan under section 6.6
of this chapter.
(4) If the local unit public employer is a school corporation, by
electing 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 group
insurance other than group health insurance for the local unit public
employer's active and retired public safety employees by purchasing
policies of group insurance and by establishing self-insurance
programs. However, the establishment of a self-insurance program
is subject to the approval of the unit's fiscal body.
(e) A local unit public employer may pay a part of the cost of
group insurance for its active and retired public safety employees.
However, a local unit public employer that provides group life
insurance for its active and retired public safety employees shall pay
a part of the cost of that insurance.
(f) A local unit public employer may not cancel an insurance
contract under this section during the policy term of the contract.
(g) After June 30, 1989, a local unit public employer that provides
a group health insurance program for its active public safety
employees shall also provide a group health insurance program to the
following persons:
(1) Retired public safety employees.
(2) Public safety employees who are receiving disability
benefits under IC 36-8-6, IC 36-8-7, IC 36-8-7.5, IC 36-8-8, or
IC 36-8-10.
(3) Surviving spouses and dependents of public safety
employees who die while in active service or after retirement.
(h) A public safety employee who is retired or has a disability and
is eligible for group health insurance coverage under subsection
(g)(1) or (g)(2):
(1) may elect to have the person's spouse, dependents, or spouse
and dependents covered under the group health insurance
program at the time the person retires or becomes disabled;
(2) must file a written request for insurance coverage with the
employer within ninety (90) days after the person retires or
begins receiving disability benefits; and
(3) must pay an amount equal to the total of the employer's and
the employee's premiums for the group health insurance for an
active public safety employee (however, the employer may elect
to 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), and
IC 36-8-10-16.5 for a surviving spouse or dependent of a public
safety employee who dies in the line of duty, a surviving spouse or
dependent who is eligible for group health insurance under
subsection (g)(3):
(1) may elect to continue coverage under the group health
insurance program after the death of the public safety
employee;
(2) must file a written request for insurance coverage with the
employer within ninety (90) days after the death of the public
safety employee; and
(3) must pay the amount that the public safety employee would
have been required to pay under this section for coverage
selected by the surviving spouse or dependent (however, the
employer may elect to pay any part of the surviving spouse's or
dependents' premiums).
(j) The eligibility for group health insurance under this section for
a public safety employee who is retired or has a disability ends on the
earlier of the following:
(1) When the public safety employee becomes eligible for
Medicare coverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the employer terminates the health insurance program
for active public safety employees.
(k) A surviving spouse's eligibility for group health insurance
under this section ends on the earliest of the following:
(1) When the surviving spouse becomes eligible for Medicare
coverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the unit providing the insurance terminates the health
insurance program for active public safety employees.
(3) The date of the surviving spouse's remarriage.
(4) When health insurance becomes available to the surviving
spouse through employment.
(l) A dependent's eligibility for group health insurance under this
section ends on the earliest of the following:
(1) When the dependent becomes eligible for Medicare
coverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the unit providing the insurance terminates the health
insurance program for active public safety employees.
(3) When the dependent no longer meets the criteria set forth in
subsection (a).
(4) When health insurance becomes available to the dependent
through employment.
(m) A public safety employee who is on leave without pay is
entitled to participate for ninety (90) days in any group health
insurance program maintained by the local unit public employer for
active public safety employees if the public safety employee pays an
amount equal to the total of the employer's and the employee's
premiums for the insurance. However, the employer may pay all or
part of the employer's premium for the insurance.
(n) A local unit public employer may provide group health
insurance for retired public safety employees or their spouses not
covered by subsections (g) through (l) and may provide group health
insurance that contains provisions more favorable to retired public
safety employees and their spouses than required by subsections (g)
through (l). A local unit public employer may provide group health
insurance to a public safety employee who is on leave without pay
for a longer period than required by subsection (m), and may
continue to pay all or a part of the employer's premium for the
insurance 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;
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; retired
employees
Sec. 2.6. (a) This section applies only to local unit public
employers and their employees. This section does not apply to public
safety employees, surviving spouses, and dependents covered by
section 2.2 of this chapter.
(b) A public employer may provide programs of group insurance
for its employees and retired employees. The public employer may,
however, exclude part-time employees and persons who provide
services to the unit under contract from any group insurance
coverage that the public employer provides to the employer's
full-time employees. A public employer may provide programs of
group health insurance under this section through 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 local
units that offer the state employee health plan under section 6.6
of this chapter.
(4) If the local unit public employer is a school corporation, by
electing to provide the coverage through a state employee health
plan under section 6.7 of this chapter.
A public employer may provide programs of group insurance other
than group health insurance under this section by purchasing policies
of group insurance and by establishing self-insurance programs.
However, the establishment of a self-insurance program is subject to
the approval of the unit's fiscal body.
(c) A public employer may pay a part of the cost of group
insurance, but shall pay a part of the cost of group life insurance for
local employees. A public employer may pay, as supplemental
wages, an amount equal to the deductible portion of group health
insurance as long as payment of the supplemental wages will not
result in the payment of the total cost of the insurance by the public
employer.
(d) An insurance contract for local employees under this section
may not be canceled by the public employer during the policy term
of the contract.
(e) After June 30, 1986, a public employer shall provide a group
health insurance program under subsection (g) to each retired
employee:
(1) whose retirement date is:
(A) after May 31, 1986, for a retired employee who was a
teacher (as defined in IC 20-18-2-22) for a school
corporation; or
(B) after June 30, 1986, for a retired employee not covered
by clause (A);
(2) who will have reached fifty-five (55) years of age on or
before the employee's retirement date but who will not be
eligible on that date for Medicare coverage as prescribed by 42
U.S.C. 1395 et seq.;
(3) who will have completed twenty (20) years of creditable
employment with a public employer on or before the employee's
retirement date, ten (10) years of which must have been
completed immediately preceding the retirement date; and
(4) who will have completed at least fifteen (15) years of
participation in the retirement plan of which the employee is a
member 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 must
permit the retired employee to participate if the retired employee
pays an amount equal to the total of the employer's and the
employee's premiums for the group health insurance for an active
employee and if the employee, within ninety (90) days after the
employee's retirement date, files a written request with the employer
for insurance coverage. However, the employer may elect to pay any
part of the retired employee's premiums.
(g) A retired employee's eligibility to continue insurance under
subsection (e) ends when the employee becomes eligible for
Medicare coverage as prescribed by 42 U.S.C. 1395 et seq., or when
the employer terminates the health insurance program. A retired
employee who is eligible for insurance coverage under subsection (e)
may elect to have the employee's spouse covered under the health
insurance program at the time the employee retires. If a retired
employee's spouse pays the amount the retired employee would have
been required to pay for coverage selected by the spouse, the
spouse's subsequent eligibility to continue insurance under this
section is not affected by the death of the retired employee. The
surviving spouse's eligibility ends on the earliest of the following:
(1) When the spouse becomes eligible for Medicare coverage as
prescribed by 42 U.S.C. 1395 et seq.
(2) When the employer terminates the health insurance
program.
(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 entitled
to group insurance coverage under IC 20-28-10-2(b). An employee
who is on leave without pay is entitled to participate for ninety (90)
days in any group health insurance program maintained by the public
employer for active employees if the employee pays an amount equal
to the total of the employer's and the employee's premiums for the
insurance. 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 for
retired employees or their spouses not covered by subsections (e)
through (g) and may provide group health insurance that contains
provisions more favorable to retired employees and their spouses
than required by subsections (e) through (g). A public employer may
provide group health insurance to an employee who is on leave
without pay for a longer period than required by subsection (h), and
may continue to pay all or a part of the employer's premium for the
insurance 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" means
a volunteer:
(1) whose name has been entered on a roster of volunteers for
a volunteer program operated by a local unit; and
(2) who has been approved by the proper authorities of the local
unit.
The term does not include a volunteer firefighter (as defined in
IC 36-8-12-2) or an inmate assigned to a correctional facility
operated by the state or a local unit.
(b) As used in this section, "local unit" does not include a school
corporation.
(c) The fiscal body of a local unit may elect to provide insurance
for 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 group
insurance plan or establishes a self-insurance plan for its employees
may withhold or cause to be withheld from participating employees'
salaries or wages whatever part of the cost of the plan the employees
are required to pay. The chief fiscal officer responsible for issuing
paychecks or warrants to the employees shall make deductions from
the individual employees' paychecks or warrants to pay the premiums
for the insurance. Except as provided by section 7(d) of this chapter,
the fiscal officer shall require written authorization from state
employees, and may require written authorization from local
employees, to make the deductions. One (1) authorization signed by
an employee is sufficient authorization for the fiscal officer to
continue to make deductions for this purpose until revoked in writing
by the employee.
(b) A public employer that contracts for a group insurance plan or
establishes a self-insurance plan for its retired employees may
require that the retired employees pay any part of the cost of the plan
that is not paid by the public employer. A retired employee may
assign part or all of the retired employee's benefit payable under
IC 5-10.3-8, IC 5-10.4-5, or any other retirement program for this
required 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 income
disability insurance, principal amount accident insurance, or both,
must not, as to the form or forms of the insurance, discriminate
between the employees of any department, commission, board,
division, facility, institution, authority, or other establishment, except
that the contributions for the insurance and benefits from the
insurance 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 a
common and unified plan of group insurance for their employees,
including retired local employees. The plan shall be effected through
a trust, agency, or any other legal arrangement with careful
accounting 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 law
enforcement agencies
Sec. 6. (a) The state police department, conservation officers of
the department of natural resources, gaming agents of the Indiana
gaming commission, gaming control officers of the Indiana gaming
commission, and the state excise police may establish common and
unified plans of self-insurance for their employees, including retired
employees, as separate entities of state government. These plans may
be administered by a private agency, business firm, limited liability
company, or corporation.
(b) Except as provided in IC 5-10-14, the state agencies listed in
subsection (a) may not pay as the employer part of benefits for any
employee 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 to
participate in either:
(1) the plan of self-insurance established by the state police
department under section 6 of this chapter;
(2) the plan of self-insurance established by the state personnel
department under section 7 of this chapter; or
(3) a prepaid health care delivery plan established under section
7 of this chapter.
(b) A former member of the general assembly who meets the
criteria for participation in a group health insurance program
provided under section 8(e) or 8.1 of this chapter may elect to
participate in either:
(1) the plan of self-insurance established by the state police
department under section 6 of this chapter; or
(2) a group health insurance program provided under section
8(e) or 8.1 of this chapter.
(c) A member of the general assembly or former member of the
general assembly who chooses a plan described in subsection (a)(1)
or (b)(1) shall pay any amount of both the employer and the
employee share of the cost of the coverage that exceeds the cost of
the 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 all
of the local units that elect to provide coverage for health 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 this section.
(b) As used in this section, "state employee health plan" means:
(1) an accident and sickness insurance policy (as defined in
IC 27-8-5.6-1) purchased through the state personnel
department under section 7(a) of this chapter; or
(2) a contract with a prepaid health care delivery plan entered
into by the state personnel department under section 7(c) of this
chapter.
(c) The state personnel department shall allow a local unit to
participate in the local unit group by electing to provide coverage of
health 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 is
separate from the group of state employees that is covered
under a state employee health plan;
(2) the state personnel department shall:
(A) establish:
(i) the premium costs, as determined by an accident and
sickness insurer or a prepaid health care delivery plan
under which coverage is provided under this section;
(ii) the administrative costs; and
(iii) any other costs;
of the coverage provided under this section, including the
cost of obtaining insurance or reinsurance, for the local unit
group as a whole; and
(B) establish a uniform premium schedule for each accident
and sickness insurance policy or prepaid health care delivery
plan under which coverage is provided under this section for
the local unit group; and
(3) the local unit shall provide for payment of the cost of the
coverage as provided in sections 2.2 and 2.6 of this chapter.
The premium determined under subdivision (2) and paid by an
individual local unit shall not be determined based on claims made
by the local unit.
(e) The state personnel department shall provide an annual
opportunity for local units to elect to provide or terminate coverage
under subsection (c).
(f) The state personnel department may adopt rules under
IC 4-22-2 to establish minimum participation and contribution
requirements for participation in a state employee health plan under
this section. As added by P.L.286-2001, SEC.3.
IC 5-10-8-6.7 Election of state employee health care program by school
corporation
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 this
chapter; or
(2) contract with a prepaid health care delivery plan entered into
under section 7(c) of this chapter;
to provide group health coverage for state employees.
(b) The state personnel department shall allow a school
corporation to elect to provide coverage of health care services for
active and retired employees of the school corporation under any
state employee health plan. If a school corporation elects to provide
coverage of health care services for active and retired employees of
the school corporation under a state employee health plan, it must
provide coverage for all active and retired employees of the school
corporation under the state employee health plan (other than any
employees covered by an Indiana comprehensive health insurance
association policy or individuals who retire from the school
corporation before July 1, 2010) if coverage was provided for these
employees under the prior policies.
(c) The following apply if a school corporation elects to provide
coverage for active and retired employees of the school corporation
under 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 school
corporation employee under this section must be the same as the
coverage provided to an active or retired state employee under
the state employee health plan.
(3) Notwithstanding sections 2.2 and 2.6 of this chapter:
(A) the school corporation shall pay for the coverage
provided to an active or retired school corporation employee
under this section an amount not more than the amount paid
by the state for coverage provided to an active or retired
state employee under the state employee health plan; and
(B) an active or retired school corporation employee shall
pay for the coverage provided to the active or retired school
corporation employee under this section an amount that is at
least equal to the amount paid by an active or retired state
employee for coverage provided to the active or retired state
employee under the state employee health plan.
However, this subdivision does not apply to contractual
commitments made by a school corporation to individuals who
retire before July 1, 2010.
(4) The school corporation shall pay any administrative costs of
the school corporation's participation in the state employee
health plan.
(5) The school corporation shall provide the coverage elected
under subsection (b) for a period of at least three (3) years
beginning on the date the coverage of the school corporation
employees under the state employee health plan begins.
(d) The state personnel department shall provide an enrollment
period at least every thirty (30) days for a school corporation that
elects to provide coverage under subsection (b).
(e) The state personnel department may adopt rules under
IC 4-22-2 to implement this section.
(f) Neither this section nor a school corporation's election to
participate in a state employee health plan as provided in this section
impairs the rights of an exclusive representative of the certificated or
noncertificated employees of the school corporation to collectively
bargain all matters related to school employee health insurance
programs 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, may
not 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 insurance
policy (as defined in IC 27-8-12-5), for the state's employees;
(3) an accident and sickness insurance policy (as defined in
IC 27-8-5.6-1) that covers individuals to whom coverage is
provided by a local unit under section 6.6 of this chapter; or
(4) an insurance policy that provides coverage that supplements
coverage provided under a United States military health care
plan.
(b) With the consent of the governor, the state personnel
department may establish self-insurance programs to provide group
insurance other than life or long term care insurance for state
employees and retired state employees. The state personnel
department 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. The
department may require, as part of a contract for administrative
services, that the provider of the administrative services offer to an
employee terminating state employment the option to purchase,
without evidence of insurability, an individual policy of insurance.
(c) Notwithstanding subsection (a), with the consent of the
governor, the state personnel department may contract for health
services for state employees and individuals to whom coverage is
provided 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 under
IC 4-22-2 to establish long term and short term disability plans for
state employees (except employees who hold elected offices (as
defined by IC 3-5-2-17)). The plans adopted under this subsection
may include any provisions the department considers necessary and
proper 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 in
the form of a payroll deduction;
(3) require that an employee's benefits under the short term
disability plan be subject to a thirty (30) day elimination period
and 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 for
benefits under the plan;
(5) provide, after a seven (7) day elimination period, eighty
percent (80%) of base biweekly wages for an employee disabled
by injuries resulting from tortious acts, as distinguished from
passive negligence, that occur within the employee's scope of
state employment;
(6) provide that an employee's benefits under the plan may be
reduced, 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 the
disability was incurred.
(The department of state revenue and the department of
workforce development shall cooperate with the state personnel
department to confirm that an employee has disclosed complete
and accurate information necessary to administer subdivision
(6).)
(7) provide that an employee will not receive benefits under the
plan 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's
medical 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 under
IC 5-10.3 or IC 5-10.4.
(f) The state may pay part of the cost of self-insurance or prepaid
health care delivery plans for its employees.
(g) A state agency may not provide any insurance benefits to its
employees 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 life
coverage 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" means
an individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to health services under a contract with a prepaid
health 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 and
autism, as defined in the most recent edition of the Diagnostic and
Statistical Manual of Mental Disorders of the American Psychiatric
Association.
(c) A self-insurance program established under section 7(b) of this
chapter to provide health care coverage must provide a covered
individual with coverage for the treatment of a pervasive
developmental disorder. Coverage provided under this section is
limited to treatment that is prescribed by the covered individual's
treating physician in accordance with a treatment plan. A
self-insurance program may not deny or refuse to issue coverage on,
refuse to contract with, or refuse to renew, refuse to reissue, or
otherwise terminate or restrict coverage on, an individual under an
insurance policy or health plan solely because the individual is
diagnosed with a pervasive developmental disorder.
(d) A contract with a prepaid health care delivery plan that is
entered into or renewed under section 7(c) of this chapter must
provide a covered individual with services for the treatment of a
pervasive developmental disorder. Services provided under this
section are limited to treatment that is prescribed by the covered
individual's treating physician in accordance with a treatment plan.
A prepaid health care delivery plan may not deny or refuse to provide
services to, or refuse to renew, refuse to reissue, or otherwise
terminate or restrict services to, an individual solely because the
individual is diagnosed with a pervasive developmental disorder.
(e) The coverage required by subsection (c) and services required
by subsection (d) may not be subject to dollar limits, deductibles,
copayments, or coinsurance provisions that are less favorable to a
covered individual than the dollar limits, deductibles, copayments,
or coinsurance provisions that apply to physical illness generally
under the self-insurance program or contract with a prepaid health
care delivery plan. As added by P.L.148-2001, SEC.1.
IC 5-10-8-7.2 Breast cancer; definitions; self-insurance programs; health
maintenance organizations; diagnostic services
Sec. 7.2. (a) As used in this section, "breast cancer diagnostic
service" means a procedure intended to aid in the diagnosis of breast
cancer. The term includes procedures performed on an inpatient basis
and procedures performed on an outpatient basis, including the
following:
(1) Breast cancer screening mammography.
(2) Surgical breast biopsy.
(3) Pathologic examination and interpretation.
(b) As used in this section, "breast cancer outpatient treatment
services" means procedures that are intended to treat cancer of the
human 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 a
physician.
(6) Medical follow-up services related to the procedures set
forth 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 to
ameliorate the debilitating consequences of the treatment of breast
cancer and that are delivered on an inpatient or outpatient basis. The
term includes the following:
(1) Physical therapy.
(2) Psychological and social support services.
(3) Reconstructive plastic surgery.
(d) As used in this section, "breast cancer screening
mammography" means a standard, two (2) view per breast, low-dose
radiographic examination of the breasts that is:
(1) furnished to an asymptomatic woman; and
(2) performed by a mammography services provider using
equipment designed by the manufacturer for and dedicated
specifically to mammography in order to detect unsuspected
breast cancer.
The term includes the interpretation of the results of a breast cancer
screening mammography by a physician.
(e) As used in this section, "covered individual" means a female
individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a health
maintenance organization (as defined in IC 27-13-1-19) that is
entered 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 state
department of health; or
(3) is certified by the federal Department of Health and Human
Services 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 who
meets 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 that
was proven benign by biopsy.
(3) A woman whose mother, sister, or daughter has had breast
cancer.
(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 this
chapter to provide health care coverage must provide covered
individuals with coverage for breast cancer diagnostic services,
breast cancer outpatient treatment services, and breast cancer
rehabilitative services. The coverage must provide reimbursement for
breast cancer screening mammography at a level at least as high as:
(1) the limitation on payment for screening mammography
services established in 42 CFR 405.534(b)(3) according to the
Medicare Economic Index at the time the breast cancer
screening mammography is performed; or
(2) the rate negotiated by a contract provider according to the
provisions of the insurance policy;
whichever is lower. The costs of the coverage required by this
subsection may be paid by the state or by the employee or by a
combination of the state and the employee.
(i) A contract with a health maintenance organization that is
entered into or renewed under section 7(c) of this chapter must
provide covered individuals with breast cancer diagnostic services,
breast cancer outpatient treatment services, and breast cancer
rehabilitative services.
(j) The coverage required by subsection (h) and services required
by subsection (i) may not be subject to dollar limits, deductibles, or
coinsurance provisions that are less favorable to covered individuals
than the dollar limits, deductibles, or coinsurance provisions
applying to physical illness generally under the self-insurance
program or contract with a health maintenance organization.
(k) The coverage for breast cancer diagnostic services required by
subsection (h) and the breast cancer diagnostic services required by
subsection (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 least
one (1) baseline breast cancer screening mammography
performed 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 mammography
performed 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 screening
mammography performed upon the individual every year.
(4) Any additional mammography views that are required for
proper evaluation.
(5) Ultrasound services, if determined medically necessary by
the physician treating the covered individual.
(l) The coverage for breast cancer diagnostic services required by
subsection (h) and the breast cancer diagnostic services required by
subsection (i) shall be provided in addition to any benefits
specifically provided for x-rays, laboratory testing, or wellness
examinations. 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" means
an individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a prepaid health
care delivery plan that is entered into or renewed under section
7(c) of this chapter.
(b) As used in this section, "early intervention services" means
services provided to a first steps child under IC 12-12.7-2 and 20
U.S.C. 1432(4).
(c) As used in this section, "first steps child" means an infant or
toddler from birth through two (2) years of age who is enrolled in the
Indiana first steps program and is a covered individual.
(d) As used in this section, "first steps program" refers to the
program 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 intervention
services within Indiana.
(e) As used in this section, "health benefits plan" means a:
(1) self-insurance program established under section 7(b) of this
chapter to provide group health coverage; or
(2) contract with a prepaid health care delivery plan that is
entered into or renewed under section 7(c) of this chapter.
(f) A health benefits plan that provides coverage for early
intervention services shall reimburse the first steps program for
payments made by the program for early intervention services that
are covered under the health benefits plan.
(g) The reimbursement required under subsection (f) may not be
applied to any annual or aggregate lifetime limit on the first steps
child'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 child
directly to a provider. A health benefits plan shall apply any
payments made by the first steps program to the health benefits plan's
deductibles, copayments, or other out-of-pocket expenses according
to 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" means
a male individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a health
maintenance organization (as defined in IC 27-13-1-19) that is
entered into or renewed under section 7(c) of this chapter.
(b) As used in this section, "prostate specific antigen test" means
a standard blood test performed to determine the level of prostate
specific antigen in the blood.
(c) A self-insurance program established under section 7(b) of this
chapter to provide health care coverage must provide covered
individuals with coverage for prostate specific antigen testing.
(d) A contract with a health maintenance organization that is
entered into or renewed under section 7(c) of this chapter must
provide covered individuals with prostate specific antigen screening.
(e) The coverage required under subsections (c) and (d) must
include the following:
(1) At least one (1) prostate specific antigen test annually for a
covered individual who is at least fifty (50) years of age.
(2) At least one (1) prostate specific antigen test annually for a
covered individual who is less than fifty (50) years of age and
who is at high risk for prostate cancer according to the most
recent published guidelines of the American Cancer Society.
(f) The coverage required under this section may not be subject to
dollar limits, deductibles, copayments, or coinsurance provisions that
are less favorable to covered individuals than the dollar limits,
deductibles, copayments, or coinsurance provisions applying to
physical illness generally under the self-insurance program or
contract with a health maintenance organization.
(g) The coverage for prostate specific antigen screening shall be
provided 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" means
an 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) of
this chapter to provide group health coverage; or
(2) a contract entered into under section 7(c) of this chapter to
provide health services through a prepaid health care delivery
plan.
(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 morbid
obesity.
(d) As used in this section, "morbid obesity" means:
(1) a body mass index of at least thirty-five (35) kilograms per
meter squared, with comorbidity or coexisting medical
conditions such as hypertension, cardiopulmonary conditions,
sleep apnea, or diabetes; or
(2) a body mass index of at least forty (40) kilograms per meter
squared without comorbidity.
For purposes of this subsection, body mass index is equal to weight
in kilograms divided by height in meters squared.
(e) Except as provided in subsection (f), the state shall provide
coverage for nonexperimental, surgical treatment by a health care
provider of morbid obesity:
(1) that has persisted for at least five (5) years; and
(2) for which nonsurgical treatment that is supervised by a
physician has been unsuccessful for at least six (6) consecutive
months.
(f) The state may not provide coverage for surgical treatment of
morbid obesity for a covered individual who is less than twenty-one
(21) years of age unless two (2) physicians licensed under IC 25-22.5
determine 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 major
life activity (as defined in IC 4-23-29-6);
and each physician documents in the covered individual's medical
record 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" means
an individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a health
maintenance organization (as defined in IC 27-13-1-19) that is
entered into or renewed under section 7(c) of this chapter.
(b) A:
(1) self-insurance program established under section 7(b) of this
chapter to provide health care coverage; or
(2) contract with a health maintenance organization that is
entered into or renewed under section 7(c) of this chapter;
must provide coverage for colorectal cancer examinations and
laboratory tests for cancer for any nonsymptomatic covered
individual, in accordance with the current American Cancer Society
guidelines.
(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 for
colorectal cancer according to the most recent published
guidelines of the American Cancer Society;
the coverage required under this section must meet the requirements
set forth in subsection (d).
(d) A covered individual may not be required to pay an additional
deductible or coinsurance for the colorectal cancer examination and
laboratory testing benefit that is greater than an annual deductible or
coinsurance established for similar benefits under a self-insurance
program or contract with a health maintenance organization. If the
program or contract does not cover a similar benefit, a deductible or
coinsurance may not be set at a level that materially diminishes the
value of the colorectal cancer examination and laboratory testing
benefit 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 employees
who are not covered by a plan established under section 6 of this
chapter.
(b) After June 30, 1986, the state shall provide a group health
insurance plan to each retired employee:
(1) whose retirement date is:
(A) after June 29, 1986, for a retired employee who was a
member of the field examiners' retirement fund;
(B) after May 31, 1986, for a retired employee who was a
member of the Indiana state teachers' retirement fun
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-time
employee;
(B) if the individual is employed by a school corporation, a
full-time or part-time employee;
(C) for a local unit public employer, a full-time or part-time
employee or a person who provides personal services to the
unit 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 least
thirty (30) days.
(2) "Group insurance" means any of the kinds of insurance
fulfilling the definitions and requirements of group insurance
contained in IC 27-1.
(3) "Insurance" means insurance upon or in relation to human
life in all its forms, including life insurance, health insurance,
disability insurance, accident insurance, hospitalization
insurance, surgery insurance, medical insurance, and
supplemental medical insurance.
(4) "Local unit" includes a city, town, county, township, public
library, municipal corporation (as defined in IC 5-10-9-1), or
school corporation.
(5) "New traditional plan" means a self-insurance program
established under section 7(b) of this chapter to provide health
care coverage.
(6) "Public employer" means the state or a local unit, including
any board, commission, department, division, authority,
institution, establishment, facility, or governmental unit under
the supervision of either, having a payroll in relation to persons
it immediately employs, even if it is not a separate taxing unit.
With respect to the legislative branch of government, "public
employer" or "employer" refers to the following:
(A) The president pro tempore of the senate, with respect to
former members or employees of the senate.
(B) The speaker of the house, with respect to former
members or employees of the house of representatives.
(C) The legislative council, with respect to former
employees of the legislative services agency.
(7) "Public employer" does not include a state educational
institution.
(8) "Retired employee" means:
(A) in the case of a public employer that participates in the
public employees' retirement fund, a former employee who
qualifies 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 the
teachers' retirement fund under IC 5-10.4, a former employee
who qualifies for a benefit under IC 5-10.4-5; and
(C) in the case of any other public employer, a former
employee who meets the requirements established by the
public employer for participation in a group insurance plan
for retired employees.
(9) "Retirement date" means the date that the employee has
chosen 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 natural
child, 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 or
mental disability (using disability guidelines established by the
Social Security Administration); or
(3) is at least eighteen (18) and less than twenty-three (23) years
of age and is enrolled in and regularly attending a secondary
school or is a full-time student at an accredited college or
university.
(b) As used in this section, "public safety employee" means a
full-time firefighter, police officer, county police officer, or sheriff.
(c) This section applies only to local unit public employers and
their public safety employees.
(d) A local unit public employer may provide programs of group
health insurance for its active and retired public safety employees
through 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 local
units that offer the state employee health plan under section 6.6
of this chapter.
(4) If the local unit public employer is a school corporation, by
electing 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 group
insurance other than group health insurance for the local unit public
employer's active and retired public safety employees by purchasing
policies of group insurance and by establishing self-insurance
programs. However, the establishment of a self-insurance program
is subject to the approval of the unit's fiscal body.
(e) A local unit public employer may pay a part of the cost of
group insurance for its active and retired public safety employees.
However, a local unit public employer that provides group life
insurance for its active and retired public safety employees shall pay
a part of the cost of that insurance.
(f) A local unit public employer may not cancel an insurance
contract under this section during the policy term of the contract.
(g) After June 30, 1989, a local unit public employer that provides
a group health insurance program for its active public safety
employees shall also provide a group health insurance program to the
following persons:
(1) Retired public safety employees.
(2) Public safety employees who are receiving disability
benefits under IC 36-8-6, IC 36-8-7, IC 36-8-7.5, IC 36-8-8, or
IC 36-8-10.
(3) Surviving spouses and dependents of public safety
employees who die while in active service or after retirement.
(h) A public safety employee who is retired or has a disability and
is eligible for group health insurance coverage under subsection
(g)(1) or (g)(2):
(1) may elect to have the person's spouse, dependents, or spouse
and dependents covered under the group health insurance
program at the time the person retires or becomes disabled;
(2) must file a written request for insurance coverage with the
employer within ninety (90) days after the person retires or
begins receiving disability benefits; and
(3) must pay an amount equal to the total of the employer's and
the employee's premiums for the group health insurance for an
active public safety employee (however, the employer may elect
to 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), and
IC 36-8-10-16.5 for a surviving spouse or dependent of a public
safety employee who dies in the line of duty, a surviving spouse or
dependent who is eligible for group health insurance under
subsection (g)(3):
(1) may elect to continue coverage under the group health
insurance program after the death of the public safety
employee;
(2) must file a written request for insurance coverage with the
employer within ninety (90) days after the death of the public
safety employee; and
(3) must pay the amount that the public safety employee would
have been required to pay under this section for coverage
selected by the surviving spouse or dependent (however, the
employer may elect to pay any part of the surviving spouse's or
dependents' premiums).
(j) The eligibility for group health insurance under this section for
a public safety employee who is retired or has a disability ends on the
earlier of the following:
(1) When the public safety employee becomes eligible for
Medicare coverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the employer terminates the health insurance program
for active public safety employees.
(k) A surviving spouse's eligibility for group health insurance
under this section ends on the earliest of the following:
(1) When the surviving spouse becomes eligible for Medicare
coverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the unit providing the insurance terminates the health
insurance program for active public safety employees.
(3) The date of the surviving spouse's remarriage.
(4) When health insurance becomes available to the surviving
spouse through employment.
(l) A dependent's eligibility for group health insurance under this
section ends on the earliest of the following:
(1) When the dependent becomes eligible for Medicare
coverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the unit providing the insurance terminates the health
insurance program for active public safety employees.
(3) When the dependent no longer meets the criteria set forth in
subsection (a).
(4) When health insurance becomes available to the dependent
through employment.
(m) A public safety employee who is on leave without pay is
entitled to participate for ninety (90) days in any group health
insurance program maintained by the local unit public employer for
active public safety employees if the public safety employee pays an
amount equal to the total of the employer's and the employee's
premiums for the insurance. However, the employer may pay all or
part of the employer's premium for the insurance.
(n) A local unit public employer may provide group health
insurance for retired public safety employees or their spouses not
covered by subsections (g) through (l) and may provide group health
insurance that contains provisions more favorable to retired public
safety employees and their spouses than required by subsections (g)
through (l). A local unit public employer may provide group health
insurance to a public safety employee who is on leave without pay
for a longer period than required by subsection (m), and may
continue to pay all or a part of the employer's premium for the
insurance 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;
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; retired
employees
Sec. 2.6. (a) This section applies only to local unit public
employers and their employees. This section does not apply to public
safety employees, surviving spouses, and dependents covered by
section 2.2 of this chapter.
(b) A public employer may provide programs of group insurance
for its employees and retired employees. The public employer may,
however, exclude part-time employees and persons who provide
services to the unit under contract from any group insurance
coverage that the public employer provides to the employer's
full-time employees. A public employer may provide programs of
group health insurance under this section through 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 local
units that offer the state employee health plan under section 6.6
of this chapter.
(4) If the local unit public employer is a school corporation, by
electing to provide the coverage through a state employee health
plan under section 6.7 of this chapter.
A public employer may provide programs of group insurance other
than group health insurance under this section by purchasing policies
of group insurance and by establishing self-insurance programs.
However, the establishment of a self-insurance program is subject to
the approval of the unit's fiscal body.
(c) A public employer may pay a part of the cost of group
insurance, but shall pay a part of the cost of group life insurance for
local employees. A public employer may pay, as supplemental
wages, an amount equal to the deductible portion of group health
insurance as long as payment of the supplemental wages will not
result in the payment of the total cost of the insurance by the public
employer.
(d) An insurance contract for local employees under this section
may not be canceled by the public employer during the policy term
of the contract.
(e) After June 30, 1986, a public employer shall provide a group
health insurance program under subsection (g) to each retired
employee:
(1) whose retirement date is:
(A) after May 31, 1986, for a retired employee who was a
teacher (as defined in IC 20-18-2-22) for a school
corporation; or
(B) after June 30, 1986, for a retired employee not covered
by clause (A);
(2) who will have reached fifty-five (55) years of age on or
before the employee's retirement date but who will not be
eligible on that date for Medicare coverage as prescribed by 42
U.S.C. 1395 et seq.;
(3) who will have completed twenty (20) years of creditable
employment with a public employer on or before the employee's
retirement date, ten (10) years of which must have been
completed immediately preceding the retirement date; and
(4) who will have completed at least fifteen (15) years of
participation in the retirement plan of which the employee is a
member 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 must
permit the retired employee to participate if the retired employee
pays an amount equal to the total of the employer's and the
employee's premiums for the group health insurance for an active
employee and if the employee, within ninety (90) days after the
employee's retirement date, files a written request with the employer
for insurance coverage. However, the employer may elect to pay any
part of the retired employee's premiums.
(g) A retired employee's eligibility to continue insurance under
subsection (e) ends when the employee becomes eligible for
Medicare coverage as prescribed by 42 U.S.C. 1395 et seq., or when
the employer terminates the health insurance program. A retired
employee who is eligible for insurance coverage under subsection (e)
may elect to have the employee's spouse covered under the health
insurance program at the time the employee retires. If a retired
employee's spouse pays the amount the retired employee would have
been required to pay for coverage selected by the spouse, the
spouse's subsequent eligibility to continue insurance under this
section is not affected by the death of the retired employee. The
surviving spouse's eligibility ends on the earliest of the following:
(1) When the spouse becomes eligible for Medicare coverage as
prescribed by 42 U.S.C. 1395 et seq.
(2) When the employer terminates the health insurance
program.
(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 entitled
to group insurance coverage under IC 20-28-10-2(b). An employee
who is on leave without pay is entitled to participate for ninety (90)
days in any group health insurance program maintained by the public
employer for active employees if the employee pays an amount equal
to the total of the employer's and the employee's premiums for the
insurance. 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 for
retired employees or their spouses not covered by subsections (e)
through (g) and may provide group health insurance that contains
provisions more favorable to retired employees and their spouses
than required by subsections (e) through (g). A public employer may
provide group health insurance to an employee who is on leave
without pay for a longer period than required by subsection (h), and
may continue to pay all or a part of the employer's premium for the
insurance 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" means
a volunteer:
(1) whose name has been entered on a roster of volunteers for
a volunteer program operated by a local unit; and
(2) who has been approved by the proper authorities of the local
unit.
The term does not include a volunteer firefighter (as defined in
IC 36-8-12-2) or an inmate assigned to a correctional facility
operated by the state or a local unit.
(b) As used in this section, "local unit" does not include a school
corporation.
(c) The fiscal body of a local unit may elect to provide insurance
for 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 group
insurance plan or establishes a self-insurance plan for its employees
may withhold or cause to be withheld from participating employees'
salaries or wages whatever part of the cost of the plan the employees
are required to pay. The chief fiscal officer responsible for issuing
paychecks or warrants to the employees shall make deductions from
the individual employees' paychecks or warrants to pay the premiums
for the insurance. Except as provided by section 7(d) of this chapter,
the fiscal officer shall require written authorization from state
employees, and may require written authorization from local
employees, to make the deductions. One (1) authorization signed by
an employee is sufficient authorization for the fiscal officer to
continue to make deductions for this purpose until revoked in writing
by the employee.
(b) A public employer that contracts for a group insurance plan or
establishes a self-insurance plan for its retired employees may
require that the retired employees pay any part of the cost of the plan
that is not paid by the public employer. A retired employee may
assign part or all of the retired employee's benefit payable under
IC 5-10.3-8, IC 5-10.4-5, or any other retirement program for this
required 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 income
disability insurance, principal amount accident insurance, or both,
must not, as to the form or forms of the insurance, discriminate
between the employees of any department, commission, board,
division, facility, institution, authority, or other establishment, except
that the contributions for the insurance and benefits from the
insurance 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 a
common and unified plan of group insurance for their employees,
including retired local employees. The plan shall be effected through
a trust, agency, or any other legal arrangement with careful
accounting 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 law
enforcement agencies
Sec. 6. (a) The state police department, conservation officers of
the department of natural resources, gaming agents of the Indiana
gaming commission, gaming control officers of the Indiana gaming
commission, and the state excise police may establish common and
unified plans of self-insurance for their employees, including retired
employees, as separate entities of state government. These plans may
be administered by a private agency, business firm, limited liability
company, or corporation.
(b) Except as provided in IC 5-10-14, the state agencies listed in
subsection (a) may not pay as the employer part of benefits for any
employee 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 to
participate in either:
(1) the plan of self-insurance established by the state police
department under section 6 of this chapter;
(2) the plan of self-insurance established by the state personnel
department under section 7 of this chapter; or
(3) a prepaid health care delivery plan established under section
7 of this chapter.
(b) A former member of the general assembly who meets the
criteria for participation in a group health insurance program
provided under section 8(e) or 8.1 of this chapter may elect to
participate in either:
(1) the plan of self-insurance established by the state police
department under section 6 of this chapter; or
(2) a group health insurance program provided under section
8(e) or 8.1 of this chapter.
(c) A member of the general assembly or former member of the
general assembly who chooses a plan described in subsection (a)(1)
or (b)(1) shall pay any amount of both the employer and the
employee share of the cost of the coverage that exceeds the cost of
the 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 all
of the local units that elect to provide coverage for health 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 this section.
(b) As used in this section, "state employee health plan" means:
(1) an accident and sickness insurance policy (as defined in
IC 27-8-5.6-1) purchased through the state personnel
department under section 7(a) of this chapter; or
(2) a contract with a prepaid health care delivery plan entered
into by the state personnel department under section 7(c) of this
chapter.
(c) The state personnel department shall allow a local unit to
participate in the local unit group by electing to provide coverage of
health 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 is
separate from the group of state employees that is covered
under a state employee health plan;
(2) the state personnel department shall:
(A) establish:
(i) the premium costs, as determined by an accident and
sickness insurer or a prepaid health care delivery plan
under which coverage is provided under this section;
(ii) the administrative costs; and
(iii) any other costs;
of the coverage provided under this section, including the
cost of obtaining insurance or reinsurance, for the local unit
group as a whole; and
(B) establish a uniform premium schedule for each accident
and sickness insurance policy or prepaid health care delivery
plan under which coverage is provided under this section for
the local unit group; and
(3) the local unit shall provide for payment of the cost of the
coverage as provided in sections 2.2 and 2.6 of this chapter.
The premium determined under subdivision (2) and paid by an
individual local unit shall not be determined based on claims made
by the local unit.
(e) The state personnel department shall provide an annual
opportunity for local units to elect to provide or terminate coverage
under subsection (c).
(f) The state personnel department may adopt rules under
IC 4-22-2 to establish minimum participation and contribution
requirements for participation in a state employee health plan under
this section. As added by P.L.286-2001, SEC.3.
IC 5-10-8-6.7 Election of state employee health care program by school
corporation
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 this
chapter; or
(2) contract with a prepaid health care delivery plan entered into
under section 7(c) of this chapter;
to provide group health coverage for state employees.
(b) The state personnel department shall allow a school
corporation to elect to provide coverage of health care services for
active and retired employees of the school corporation under any
state employee health plan. If a school corporation elects to provide
coverage of health care services for active and retired employees of
the school corporation under a state employee health plan, it must
provide coverage for all active and retired employees of the school
corporation under the state employee health plan (other than any
employees covered by an Indiana comprehensive health insurance
association policy or individuals who retire from the school
corporation before July 1, 2010) if coverage was provided for these
employees under the prior policies.
(c) The following apply if a school corporation elects to provide
coverage for active and retired employees of the school corporation
under 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 school
corporation employee under this section must be the same as the
coverage provided to an active or retired state employee under
the state employee health plan.
(3) Notwithstanding sections 2.2 and 2.6 of this chapter:
(A) the school corporation shall pay for the coverage
provided to an active or retired school corporation employee
under this section an amount not more than the amount paid
by the state for coverage provided to an active or retired
state employee under the state employee health plan; and
(B) an active or retired school corporation employee shall
pay for the coverage provided to the active or retired school
corporation employee under this section an amount that is at
least equal to the amount paid by an active or retired state
employee for coverage provided to the active or retired state
employee under the state employee health plan.
However, this subdivision does not apply to contractual
commitments made by a school corporation to individuals who
retire before July 1, 2010.
(4) The school corporation shall pay any administrative costs of
the school corporation's participation in the state employee
health plan.
(5) The school corporation shall provide the coverage elected
under subsection (b) for a period of at least three (3) years
beginning on the date the coverage of the school corporation
employees under the state employee health plan begins.
(d) The state personnel department shall provide an enrollment
period at least every thirty (30) days for a school corporation that
elects to provide coverage under subsection (b).
(e) The state personnel department may adopt rules under
IC 4-22-2 to implement this section.
(f) Neither this section nor a school corporation's election to
participate in a state employee health plan as provided in this section
impairs the rights of an exclusive representative of the certificated or
noncertificated employees of the school corporation to collectively
bargain all matters related to school employee health insurance
programs 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, may
not 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 insurance
policy (as defined in IC 27-8-12-5), for the state's employees;
(3) an accident and sickness insurance policy (as defined in
IC 27-8-5.6-1) that covers individuals to whom coverage is
provided by a local unit under section 6.6 of this chapter; or
(4) an insurance policy that provides coverage that supplements
coverage provided under a United States military health care
plan.
(b) With the consent of the governor, the state personnel
department may establish self-insurance programs to provide group
insurance other than life or long term care insurance for state
employees and retired state employees. The state personnel
department 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. The
department may require, as part of a contract for administrative
services, that the provider of the administrative services offer to an
employee terminating state employment the option to purchase,
without evidence of insurability, an individual policy of insurance.
(c) Notwithstanding subsection (a), with the consent of the
governor, the state personnel department may contract for health
services for state employees and individuals to whom coverage is
provided 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 under
IC 4-22-2 to establish long term and short term disability plans for
state employees (except employees who hold elected offices (as
defined by IC 3-5-2-17)). The plans adopted under this subsection
may include any provisions the department considers necessary and
proper 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 in
the form of a payroll deduction;
(3) require that an employee's benefits under the short term
disability plan be subject to a thirty (30) day elimination period
and 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 for
benefits under the plan;
(5) provide, after a seven (7) day elimination period, eighty
percent (80%) of base biweekly wages for an employee disabled
by injuries resulting from tortious acts, as distinguished from
passive negligence, that occur within the employee's scope of
state employment;
(6) provide that an employee's benefits under the plan may be
reduced, 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 the
disability was incurred.
(The department of state revenue and the department of
workforce development shall cooperate with the state personnel
department to confirm that an employee has disclosed complete
and accurate information necessary to administer subdivision
(6).)
(7) provide that an employee will not receive benefits under the
plan 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's
medical 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 under
IC 5-10.3 or IC 5-10.4.
(f) The state may pay part of the cost of self-insurance or prepaid
health care delivery plans for its employees.
(g) A state agency may not provide any insurance benefits to its
employees 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 life
coverage 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" means
an individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to health services under a contract with a prepaid
health 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 and
autism, as defined in the most recent edition of the Diagnostic and
Statistical Manual of Mental Disorders of the American Psychiatric
Association.
(c) A self-insurance program established under section 7(b) of this
chapter to provide health care coverage must provide a covered
individual with coverage for the treatment of a pervasive
developmental disorder. Coverage provided under this section is
limited to treatment that is prescribed by the covered individual's
treating physician in accordance with a treatment plan. A
self-insurance program may not deny or refuse to issue coverage on,
refuse to contract with, or refuse to renew, refuse to reissue, or
otherwise terminate or restrict coverage on, an individual under an
insurance policy or health plan solely because the individual is
diagnosed with a pervasive developmental disorder.
(d) A contract with a prepaid health care delivery plan that is
entered into or renewed under section 7(c) of this chapter must
provide a covered individual with services for the treatment of a
pervasive developmental disorder. Services provided under this
section are limited to treatment that is prescribed by the covered
individual's treating physician in accordance with a treatment plan.
A prepaid health care delivery plan may not deny or refuse to provide
services to, or refuse to renew, refuse to reissue, or otherwise
terminate or restrict services to, an individual solely because the
individual is diagnosed with a pervasive developmental disorder.
(e) The coverage required by subsection (c) and services required
by subsection (d) may not be subject to dollar limits, deductibles,
copayments, or coinsurance provisions that are less favorable to a
covered individual than the dollar limits, deductibles, copayments,
or coinsurance provisions that apply to physical illness generally
under the self-insurance program or contract with a prepaid health
care delivery plan. As added by P.L.148-2001, SEC.1.
IC 5-10-8-7.2 Breast cancer; definitions; self-insurance programs; health
maintenance organizations; diagnostic services
Sec. 7.2. (a) As used in this section, "breast cancer diagnostic
service" means a procedure intended to aid in the diagnosis of breast
cancer. The term includes procedures performed on an inpatient basis
and procedures performed on an outpatient basis, including the
following:
(1) Breast cancer screening mammography.
(2) Surgical breast biopsy.
(3) Pathologic examination and interpretation.
(b) As used in this section, "breast cancer outpatient treatment
services" means procedures that are intended to treat cancer of the
human 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 a
physician.
(6) Medical follow-up services related to the procedures set
forth 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 to
ameliorate the debilitating consequences of the treatment of breast
cancer and that are delivered on an inpatient or outpatient basis. The
term includes the following:
(1) Physical therapy.
(2) Psychological and social support services.
(3) Reconstructive plastic surgery.
(d) As used in this section, "breast cancer screening
mammography" means a standard, two (2) view per breast, low-dose
radiographic examination of the breasts that is:
(1) furnished to an asymptomatic woman; and
(2) performed by a mammography services provider using
equipment designed by the manufacturer for and dedicated
specifically to mammography in order to detect unsuspected
breast cancer.
The term includes the interpretation of the results of a breast cancer
screening mammography by a physician.
(e) As used in this section, "covered individual" means a female
individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a health
maintenance organization (as defined in IC 27-13-1-19) that is
entered 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 state
department of health; or
(3) is certified by the federal Department of Health and Human
Services 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 who
meets 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 that
was proven benign by biopsy.
(3) A woman whose mother, sister, or daughter has had breast
cancer.
(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 this
chapter to provide health care coverage must provide covered
individuals with coverage for breast cancer diagnostic services,
breast cancer outpatient treatment services, and breast cancer
rehabilitative services. The coverage must provide reimbursement for
breast cancer screening mammography at a level at least as high as:
(1) the limitation on payment for screening mammography
services established in 42 CFR 405.534(b)(3) according to the
Medicare Economic Index at the time the breast cancer
screening mammography is performed; or
(2) the rate negotiated by a contract provider according to the
provisions of the insurance policy;
whichever is lower. The costs of the coverage required by this
subsection may be paid by the state or by the employee or by a
combination of the state and the employee.
(i) A contract with a health maintenance organization that is
entered into or renewed under section 7(c) of this chapter must
provide covered individuals with breast cancer diagnostic services,
breast cancer outpatient treatment services, and breast cancer
rehabilitative services.
(j) The coverage required by subsection (h) and services required
by subsection (i) may not be subject to dollar limits, deductibles, or
coinsurance provisions that are less favorable to covered individuals
than the dollar limits, deductibles, or coinsurance provisions
applying to physical illness generally under the self-insurance
program or contract with a health maintenance organization.
(k) The coverage for breast cancer diagnostic services required by
subsection (h) and the breast cancer diagnostic services required by
subsection (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 least
one (1) baseline breast cancer screening mammography
performed 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 mammography
performed 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 screening
mammography performed upon the individual every year.
(4) Any additional mammography views that are required for
proper evaluation.
(5) Ultrasound services, if determined medically necessary by
the physician treating the covered individual.
(l) The coverage for breast cancer diagnostic services required by
subsection (h) and the breast cancer diagnostic services required by
subsection (i) shall be provided in addition to any benefits
specifically provided for x-rays, laboratory testing, or wellness
examinations. 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" means
an individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a prepaid health
care delivery plan that is entered into or renewed under section
7(c) of this chapter.
(b) As used in this section, "early intervention services" means
services provided to a first steps child under IC 12-12.7-2 and 20
U.S.C. 1432(4).
(c) As used in this section, "first steps child" means an infant or
toddler from birth through two (2) years of age who is enrolled in the
Indiana first steps program and is a covered individual.
(d) As used in this section, "first steps program" refers to the
program 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 intervention
services within Indiana.
(e) As used in this section, "health benefits plan" means a:
(1) self-insurance program established under section 7(b) of this
chapter to provide group health coverage; or
(2) contract with a prepaid health care delivery plan that is
entered into or renewed under section 7(c) of this chapter.
(f) A health benefits plan that provides coverage for early
intervention services shall reimburse the first steps program for
payments made by the program for early intervention services that
are covered under the health benefits plan.
(g) The reimbursement required under subsection (f) may not be
applied to any annual or aggregate lifetime limit on the first steps
child'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 child
directly to a provider. A health benefits plan shall apply any
payments made by the first steps program to the health benefits plan's
deductibles, copayments, or other out-of-pocket expenses according
to 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" means
a male individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a health
maintenance organization (as defined in IC 27-13-1-19) that is
entered into or renewed under section 7(c) of this chapter.
(b) As used in this section, "prostate specific antigen test" means
a standard blood test performed to determine the level of prostate
specific antigen in the blood.
(c) A self-insurance program established under section 7(b) of this
chapter to provide health care coverage must provide covered
individuals with coverage for prostate specific antigen testing.
(d) A contract with a health maintenance organization that is
entered into or renewed under section 7(c) of this chapter must
provide covered individuals with prostate specific antigen screening.
(e) The coverage required under subsections (c) and (d) must
include the following:
(1) At least one (1) prostate specific antigen test annually for a
covered individual who is at least fifty (50) years of age.
(2) At least one (1) prostate specific antigen test annually for a
covered individual who is less than fifty (50) years of age and
who is at high risk for prostate cancer according to the most
recent published guidelines of the American Cancer Society.
(f) The coverage required under this section may not be subject to
dollar limits, deductibles, copayments, or coinsurance provisions that
are less favorable to covered individuals than the dollar limits,
deductibles, copayments, or coinsurance provisions applying to
physical illness generally under the self-insurance program or
contract with a health maintenance organization.
(g) The coverage for prostate specific antigen screening shall be
provided 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" means
an 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) of
this chapter to provide group health coverage; or
(2) a contract entered into under section 7(c) of this chapter to
provide health services through a prepaid health care delivery
plan.
(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 morbid
obesity.
(d) As used in this section, "morbid obesity" means:
(1) a body mass index of at least thirty-five (35) kilograms per
meter squared, with comorbidity or coexisting medical
conditions such as hypertension, cardiopulmonary conditions,
sleep apnea, or diabetes; or
(2) a body mass index of at least forty (40) kilograms per meter
squared without comorbidity.
For purposes of this subsection, body mass index is equal to weight
in kilograms divided by height in meters squared.
(e) Except as provided in subsection (f), the state shall provide
coverage for nonexperimental, surgical treatment by a health care
provider of morbid obesity:
(1) that has persisted for at least five (5) years; and
(2) for which nonsurgical treatment that is supervised by a
physician has been unsuccessful for at least six (6) consecutive
months.
(f) The state may not provide coverage for surgical treatment of
morbid obesity for a covered individual who is less than twenty-one
(21) years of age unless two (2) physicians licensed under IC 25-22.5
determine 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 major
life activity (as defined in IC 4-23-29-6);
and each physician documents in the covered individual's medical
record 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" means
an individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a health
maintenance organization (as defined in IC 27-13-1-19) that is
entered into or renewed under section 7(c) of this chapter.
(b) A:
(1) self-insurance program established under section 7(b) of this
chapter to provide health care coverage; or
(2) contract with a health maintenance organization that is
entered into or renewed under section 7(c) of this chapter;
must provide coverage for colorectal cancer examinations and
laboratory tests for cancer for any nonsymptomatic covered
individual, in accordance with the current American Cancer Society
guidelines.
(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 for
colorectal cancer according to the most recent published
guidelines of the American Cancer Society;
the coverage required under this section must meet the requirements
set forth in subsection (d).
(d) A covered individual may not be required to pay an additional
deductible or coinsurance for the colorectal cancer examination and
laboratory testing benefit that is greater than an annual deductible or
coinsurance established for similar benefits under a self-insurance
program or contract with a health maintenance organization. If the
program or contract does not cover a similar benefit, a deductible or
coinsurance may not be set at a level that materially diminishes the
value of the colorectal cancer examination and laboratory testing
benefit 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 employees
who are not covered by a plan established under section 6 of this
chapter.
(b) After June 30, 1986, the state shall provide a group health
insurance plan to each retired employee:
(1) whose retirement date is:
(A) after June 29, 1986, for a retired employee who was a
member of the field examiners' retirement fund;
(B) after May 31, 1986, for a retired employee who was a
member of the Indiana state teachers' retirement fun
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-time
employee;
(B) if the individual is employed by a school corporation, a
full-time or part-time employee;
(C) for a local unit public employer, a full-time or part-time
employee or a person who provides personal services to the
unit 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 least
thirty (30) days.
(2) "Group insurance" means any of the kinds of insurance
fulfilling the definitions and requirements of group insurance
contained in IC 27-1.
(3) "Insurance" means insurance upon or in relation to human
life in all its forms, including life insurance, health insurance,
disability insurance, accident insurance, hospitalization
insurance, surgery insurance, medical insurance, and
supplemental medical insurance.
(4) "Local unit" includes a city, town, county, township, public
library, municipal corporation (as defined in IC 5-10-9-1), or
school corporation.
(5) "New traditional plan" means a self-insurance program
established under section 7(b) of this chapter to provide health
care coverage.
(6) "Public employer" means the state or a local unit, including
any board, commission, department, division, authority,
institution, establishment, facility, or governmental unit under
the supervision of either, having a payroll in relation to persons
it immediately employs, even if it is not a separate taxing unit.
With respect to the legislative branch of government, "public
employer" or "employer" refers to the following:
(A) The president pro tempore of the senate, with respect to
former members or employees of the senate.
(B) The speaker of the house, with respect to former
members or employees of the house of representatives.
(C) The legislative council, with respect to former
employees of the legislative services agency.
(7) "Public employer" does not include a state educational
institution.
(8) "Retired employee" means:
(A) in the case of a public employer that participates in the
public employees' retirement fund, a former employee who
qualifies 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 the
teachers' retirement fund under IC 5-10.4, a former employee
who qualifies for a benefit under IC 5-10.4-5; and
(C) in the case of any other public employer, a former
employee who meets the requirements established by the
public employer for participation in a group insurance plan
for retired employees.
(9) "Retirement date" means the date that the employee has
chosen 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 natural
child, 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 or
mental disability (using disability guidelines established by the
Social Security Administration); or
(3) is at least eighteen (18) and less than twenty-three (23) years
of age and is enrolled in and regularly attending a secondary
school or is a full-time student at an accredited college or
university.
(b) As used in this section, "public safety employee" means a
full-time firefighter, police officer, county police officer, or sheriff.
(c) This section applies only to local unit public employers and
their public safety employees.
(d) A local unit public employer may provide programs of group
health insurance for its active and retired public safety employees
through 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 local
units that offer the state employee health plan under section 6.6
of this chapter.
(4) If the local unit public employer is a school corporation, by
electing 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 group
insurance other than group health insurance for the local unit public
employer's active and retired public safety employees by purchasing
policies of group insurance and by establishing self-insurance
programs. However, the establishment of a self-insurance program
is subject to the approval of the unit's fiscal body.
(e) A local unit public employer may pay a part of the cost of
group insurance for its active and retired public safety employees.
However, a local unit public employer that provides group life
insurance for its active and retired public safety employees shall pay
a part of the cost of that insurance.
(f) A local unit public employer may not cancel an insurance
contract under this section during the policy term of the contract.
(g) After June 30, 1989, a local unit public employer that provides
a group health insurance program for its active public safety
employees shall also provide a group health insurance program to the
following persons:
(1) Retired public safety employees.
(2) Public safety employees who are receiving disability
benefits under IC 36-8-6, IC 36-8-7, IC 36-8-7.5, IC 36-8-8, or
IC 36-8-10.
(3) Surviving spouses and dependents of public safety
employees who die while in active service or after retirement.
(h) A public safety employee who is retired or has a disability and
is eligible for group health insurance coverage under subsection
(g)(1) or (g)(2):
(1) may elect to have the person's spouse, dependents, or spouse
and dependents covered under the group health insurance
program at the time the person retires or becomes disabled;
(2) must file a written request for insurance coverage with the
employer within ninety (90) days after the person retires or
begins receiving disability benefits; and
(3) must pay an amount equal to the total of the employer's and
the employee's premiums for the group health insurance for an
active public safety employee (however, the employer may elect
to 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), and
IC 36-8-10-16.5 for a surviving spouse or dependent of a public
safety employee who dies in the line of duty, a surviving spouse or
dependent who is eligible for group health insurance under
subsection (g)(3):
(1) may elect to continue coverage under the group health
insurance program after the death of the public safety
employee;
(2) must file a written request for insurance coverage with the
employer within ninety (90) days after the death of the public
safety employee; and
(3) must pay the amount that the public safety employee would
have been required to pay under this section for coverage
selected by the surviving spouse or dependent (however, the
employer may elect to pay any part of the surviving spouse's or
dependents' premiums).
(j) The eligibility for group health insurance under this section for
a public safety employee who is retired or has a disability ends on the
earlier of the following:
(1) When the public safety employee becomes eligible for
Medicare coverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the employer terminates the health insurance program
for active public safety employees.
(k) A surviving spouse's eligibility for group health insurance
under this section ends on the earliest of the following:
(1) When the surviving spouse becomes eligible for Medicare
coverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the unit providing the insurance terminates the health
insurance program for active public safety employees.
(3) The date of the surviving spouse's remarriage.
(4) When health insurance becomes available to the surviving
spouse through employment.
(l) A dependent's eligibility for group health insurance under this
section ends on the earliest of the following:
(1) When the dependent becomes eligible for Medicare
coverage as prescribed by 42 U.S.C. 1395 et seq.
(2) When the unit providing the insurance terminates the health
insurance program for active public safety employees.
(3) When the dependent no longer meets the criteria set forth in
subsection (a).
(4) When health insurance becomes available to the dependent
through employment.
(m) A public safety employee who is on leave without pay is
entitled to participate for ninety (90) days in any group health
insurance program maintained by the local unit public employer for
active public safety employees if the public safety employee pays an
amount equal to the total of the employer's and the employee's
premiums for the insurance. However, the employer may pay all or
part of the employer's premium for the insurance.
(n) A local unit public employer may provide group health
insurance for retired public safety employees or their spouses not
covered by subsections (g) through (l) and may provide group health
insurance that contains provisions more favorable to retired public
safety employees and their spouses than required by subsections (g)
through (l). A local unit public employer may provide group health
insurance to a public safety employee who is on leave without pay
for a longer period than required by subsection (m), and may
continue to pay all or a part of the employer's premium for the
insurance 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;
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; retired
employees
Sec. 2.6. (a) This section applies only to local unit public
employers and their employees. This section does not apply to public
safety employees, surviving spouses, and dependents covered by
section 2.2 of this chapter.
(b) A public employer may provide programs of group insurance
for its employees and retired employees. The public employer may,
however, exclude part-time employees and persons who provide
services to the unit under contract from any group insurance
coverage that the public employer provides to the employer's
full-time employees. A public employer may provide programs of
group health insurance under this section through 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 local
units that offer the state employee health plan under section 6.6
of this chapter.
(4) If the local unit public employer is a school corporation, by
electing to provide the coverage through a state employee health
plan under section 6.7 of this chapter.
A public employer may provide programs of group insurance other
than group health insurance under this section by purchasing policies
of group insurance and by establishing self-insurance programs.
However, the establishment of a self-insurance program is subject to
the approval of the unit's fiscal body.
(c) A public employer may pay a part of the cost of group
insurance, but shall pay a part of the cost of group life insurance for
local employees. A public employer may pay, as supplemental
wages, an amount equal to the deductible portion of group health
insurance as long as payment of the supplemental wages will not
result in the payment of the total cost of the insurance by the public
employer.
(d) An insurance contract for local employees under this section
may not be canceled by the public employer during the policy term
of the contract.
(e) After June 30, 1986, a public employer shall provide a group
health insurance program under subsection (g) to each retired
employee:
(1) whose retirement date is:
(A) after May 31, 1986, for a retired employee who was a
teacher (as defined in IC 20-18-2-22) for a school
corporation; or
(B) after June 30, 1986, for a retired employee not covered
by clause (A);
(2) who will have reached fifty-five (55) years of age on or
before the employee's retirement date but who will not be
eligible on that date for Medicare coverage as prescribed by 42
U.S.C. 1395 et seq.;
(3) who will have completed twenty (20) years of creditable
employment with a public employer on or before the employee's
retirement date, ten (10) years of which must have been
completed immediately preceding the retirement date; and
(4) who will have completed at least fifteen (15) years of
participation in the retirement plan of which the employee is a
member 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 must
permit the retired employee to participate if the retired employee
pays an amount equal to the total of the employer's and the
employee's premiums for the group health insurance for an active
employee and if the employee, within ninety (90) days after the
employee's retirement date, files a written request with the employer
for insurance coverage. However, the employer may elect to pay any
part of the retired employee's premiums.
(g) A retired employee's eligibility to continue insurance under
subsection (e) ends when the employee becomes eligible for
Medicare coverage as prescribed by 42 U.S.C. 1395 et seq., or when
the employer terminates the health insurance program. A retired
employee who is eligible for insurance coverage under subsection (e)
may elect to have the employee's spouse covered under the health
insurance program at the time the employee retires. If a retired
employee's spouse pays the amount the retired employee would have
been required to pay for coverage selected by the spouse, the
spouse's subsequent eligibility to continue insurance under this
section is not affected by the death of the retired employee. The
surviving spouse's eligibility ends on the earliest of the following:
(1) When the spouse becomes eligible for Medicare coverage as
prescribed by 42 U.S.C. 1395 et seq.
(2) When the employer terminates the health insurance
program.
(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 entitled
to group insurance coverage under IC 20-28-10-2(b). An employee
who is on leave without pay is entitled to participate for ninety (90)
days in any group health insurance program maintained by the public
employer for active employees if the employee pays an amount equal
to the total of the employer's and the employee's premiums for the
insurance. 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 for
retired employees or their spouses not covered by subsections (e)
through (g) and may provide group health insurance that contains
provisions more favorable to retired employees and their spouses
than required by subsections (e) through (g). A public employer may
provide group health insurance to an employee who is on leave
without pay for a longer period than required by subsection (h), and
may continue to pay all or a part of the employer's premium for the
insurance 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" means
a volunteer:
(1) whose name has been entered on a roster of volunteers for
a volunteer program operated by a local unit; and
(2) who has been approved by the proper authorities of the local
unit.
The term does not include a volunteer firefighter (as defined in
IC 36-8-12-2) or an inmate assigned to a correctional facility
operated by the state or a local unit.
(b) As used in this section, "local unit" does not include a school
corporation.
(c) The fiscal body of a local unit may elect to provide insurance
for 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 group
insurance plan or establishes a self-insurance plan for its employees
may withhold or cause to be withheld from participating employees'
salaries or wages whatever part of the cost of the plan the employees
are required to pay. The chief fiscal officer responsible for issuing
paychecks or warrants to the employees shall make deductions from
the individual employees' paychecks or warrants to pay the premiums
for the insurance. Except as provided by section 7(d) of this chapter,
the fiscal officer shall require written authorization from state
employees, and may require written authorization from local
employees, to make the deductions. One (1) authorization signed by
an employee is sufficient authorization for the fiscal officer to
continue to make deductions for this purpose until revoked in writing
by the employee.
(b) A public employer that contracts for a group insurance plan or
establishes a self-insurance plan for its retired employees may
require that the retired employees pay any part of the cost of the plan
that is not paid by the public employer. A retired employee may
assign part or all of the retired employee's benefit payable under
IC 5-10.3-8, IC 5-10.4-5, or any other retirement program for this
required 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 income
disability insurance, principal amount accident insurance, or both,
must not, as to the form or forms of the insurance, discriminate
between the employees of any department, commission, board,
division, facility, institution, authority, or other establishment, except
that the contributions for the insurance and benefits from the
insurance 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 a
common and unified plan of group insurance for their employees,
including retired local employees. The plan shall be effected through
a trust, agency, or any other legal arrangement with careful
accounting 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 law
enforcement agencies
Sec. 6. (a) The state police department, conservation officers of
the department of natural resources, gaming agents of the Indiana
gaming commission, gaming control officers of the Indiana gaming
commission, and the state excise police may establish common and
unified plans of self-insurance for their employees, including retired
employees, as separate entities of state government. These plans may
be administered by a private agency, business firm, limited liability
company, or corporation.
(b) Except as provided in IC 5-10-14, the state agencies listed in
subsection (a) may not pay as the employer part of benefits for any
employee 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 to
participate in either:
(1) the plan of self-insurance established by the state police
department under section 6 of this chapter;
(2) the plan of self-insurance established by the state personnel
department under section 7 of this chapter; or
(3) a prepaid health care delivery plan established under section
7 of this chapter.
(b) A former member of the general assembly who meets the
criteria for participation in a group health insurance program
provided under section 8(e) or 8.1 of this chapter may elect to
participate in either:
(1) the plan of self-insurance established by the state police
department under section 6 of this chapter; or
(2) a group health insurance program provided under section
8(e) or 8.1 of this chapter.
(c) A member of the general assembly or former member of the
general assembly who chooses a plan described in subsection (a)(1)
or (b)(1) shall pay any amount of both the employer and the
employee share of the cost of the coverage that exceeds the cost of
the 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 all
of the local units that elect to provide coverage for health 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 this section.
(b) As used in this section, "state employee health plan" means:
(1) an accident and sickness insurance policy (as defined in
IC 27-8-5.6-1) purchased through the state personnel
department under section 7(a) of this chapter; or
(2) a contract with a prepaid health care delivery plan entered
into by the state personnel department under section 7(c) of this
chapter.
(c) The state personnel department shall allow a local unit to
participate in the local unit group by electing to provide coverage of
health 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 is
separate from the group of state employees that is covered
under a state employee health plan;
(2) the state personnel department shall:
(A) establish:
(i) the premium costs, as determined by an accident and
sickness insurer or a prepaid health care delivery plan
under which coverage is provided under this section;
(ii) the administrative costs; and
(iii) any other costs;
of the coverage provided under this section, including the
cost of obtaining insurance or reinsurance, for the local unit
group as a whole; and
(B) establish a uniform premium schedule for each accident
and sickness insurance policy or prepaid health care delivery
plan under which coverage is provided under this section for
the local unit group; and
(3) the local unit shall provide for payment of the cost of the
coverage as provided in sections 2.2 and 2.6 of this chapter.
The premium determined under subdivision (2) and paid by an
individual local unit shall not be determined based on claims made
by the local unit.
(e) The state personnel department shall provide an annual
opportunity for local units to elect to provide or terminate coverage
under subsection (c).
(f) The state personnel department may adopt rules under
IC 4-22-2 to establish minimum participation and contribution
requirements for participation in a state employee health plan under
this section. As added by P.L.286-2001, SEC.3.
IC 5-10-8-6.7 Election of state employee health care program by school
corporation
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 this
chapter; or
(2) contract with a prepaid health care delivery plan entered into
under section 7(c) of this chapter;
to provide group health coverage for state employees.
(b) The state personnel department shall allow a school
corporation to elect to provide coverage of health care services for
active and retired employees of the school corporation under any
state employee health plan. If a school corporation elects to provide
coverage of health care services for active and retired employees of
the school corporation under a state employee health plan, it must
provide coverage for all active and retired employees of the school
corporation under the state employee health plan (other than any
employees covered by an Indiana comprehensive health insurance
association policy or individuals who retire from the school
corporation before July 1, 2010) if coverage was provided for these
employees under the prior policies.
(c) The following apply if a school corporation elects to provide
coverage for active and retired employees of the school corporation
under 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 school
corporation employee under this section must be the same as the
coverage provided to an active or retired state employee under
the state employee health plan.
(3) Notwithstanding sections 2.2 and 2.6 of this chapter:
(A) the school corporation shall pay for the coverage
provided to an active or retired school corporation employee
under this section an amount not more than the amount paid
by the state for coverage provided to an active or retired
state employee under the state employee health plan; and
(B) an active or retired school corporation employee shall
pay for the coverage provided to the active or retired school
corporation employee under this section an amount that is at
least equal to the amount paid by an active or retired state
employee for coverage provided to the active or retired state
employee under the state employee health plan.
However, this subdivision does not apply to contractual
commitments made by a school corporation to individuals who
retire before July 1, 2010.
(4) The school corporation shall pay any administrative costs of
the school corporation's participation in the state employee
health plan.
(5) The school corporation shall provide the coverage elected
under subsection (b) for a period of at least three (3) years
beginning on the date the coverage of the school corporation
employees under the state employee health plan begins.
(d) The state personnel department shall provide an enrollment
period at least every thirty (30) days for a school corporation that
elects to provide coverage under subsection (b).
(e) The state personnel department may adopt rules under
IC 4-22-2 to implement this section.
(f) Neither this section nor a school corporation's election to
participate in a state employee health plan as provided in this section
impairs the rights of an exclusive representative of the certificated or
noncertificated employees of the school corporation to collectively
bargain all matters related to school employee health insurance
programs 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, may
not 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 insurance
policy (as defined in IC 27-8-12-5), for the state's employees;
(3) an accident and sickness insurance policy (as defined in
IC 27-8-5.6-1) that covers individuals to whom coverage is
provided by a local unit under section 6.6 of this chapter; or
(4) an insurance policy that provides coverage that supplements
coverage provided under a United States military health care
plan.
(b) With the consent of the governor, the state personnel
department may establish self-insurance programs to provide group
insurance other than life or long term care insurance for state
employees and retired state employees. The state personnel
department 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. The
department may require, as part of a contract for administrative
services, that the provider of the administrative services offer to an
employee terminating state employment the option to purchase,
without evidence of insurability, an individual policy of insurance.
(c) Notwithstanding subsection (a), with the consent of the
governor, the state personnel department may contract for health
services for state employees and individuals to whom coverage is
provided 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 under
IC 4-22-2 to establish long term and short term disability plans for
state employees (except employees who hold elected offices (as
defined by IC 3-5-2-17)). The plans adopted under this subsection
may include any provisions the department considers necessary and
proper 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 in
the form of a payroll deduction;
(3) require that an employee's benefits under the short term
disability plan be subject to a thirty (30) day elimination period
and 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 for
benefits under the plan;
(5) provide, after a seven (7) day elimination period, eighty
percent (80%) of base biweekly wages for an employee disabled
by injuries resulting from tortious acts, as distinguished from
passive negligence, that occur within the employee's scope of
state employment;
(6) provide that an employee's benefits under the plan may be
reduced, 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 the
disability was incurred.
(The department of state revenue and the department of
workforce development shall cooperate with the state personnel
department to confirm that an employee has disclosed complete
and accurate information necessary to administer subdivision
(6).)
(7) provide that an employee will not receive benefits under the
plan 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's
medical 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 under
IC 5-10.3 or IC 5-10.4.
(f) The state may pay part of the cost of self-insurance or prepaid
health care delivery plans for its employees.
(g) A state agency may not provide any insurance benefits to its
employees 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 life
coverage 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" means
an individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to health services under a contract with a prepaid
health 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 and
autism, as defined in the most recent edition of the Diagnostic and
Statistical Manual of Mental Disorders of the American Psychiatric
Association.
(c) A self-insurance program established under section 7(b) of this
chapter to provide health care coverage must provide a covered
individual with coverage for the treatment of a pervasive
developmental disorder. Coverage provided under this section is
limited to treatment that is prescribed by the covered individual's
treating physician in accordance with a treatment plan. A
self-insurance program may not deny or refuse to issue coverage on,
refuse to contract with, or refuse to renew, refuse to reissue, or
otherwise terminate or restrict coverage on, an individual under an
insurance policy or health plan solely because the individual is
diagnosed with a pervasive developmental disorder.
(d) A contract with a prepaid health care delivery plan that is
entered into or renewed under section 7(c) of this chapter must
provide a covered individual with services for the treatment of a
pervasive developmental disorder. Services provided under this
section are limited to treatment that is prescribed by the covered
individual's treating physician in accordance with a treatment plan.
A prepaid health care delivery plan may not deny or refuse to provide
services to, or refuse to renew, refuse to reissue, or otherwise
terminate or restrict services to, an individual solely because the
individual is diagnosed with a pervasive developmental disorder.
(e) The coverage required by subsection (c) and services required
by subsection (d) may not be subject to dollar limits, deductibles,
copayments, or coinsurance provisions that are less favorable to a
covered individual than the dollar limits, deductibles, copayments,
or coinsurance provisions that apply to physical illness generally
under the self-insurance program or contract with a prepaid health
care delivery plan. As added by P.L.148-2001, SEC.1.
IC 5-10-8-7.2 Breast cancer; definitions; self-insurance programs; health
maintenance organizations; diagnostic services
Sec. 7.2. (a) As used in this section, "breast cancer diagnostic
service" means a procedure intended to aid in the diagnosis of breast
cancer. The term includes procedures performed on an inpatient basis
and procedures performed on an outpatient basis, including the
following:
(1) Breast cancer screening mammography.
(2) Surgical breast biopsy.
(3) Pathologic examination and interpretation.
(b) As used in this section, "breast cancer outpatient treatment
services" means procedures that are intended to treat cancer of the
human 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 a
physician.
(6) Medical follow-up services related to the procedures set
forth 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 to
ameliorate the debilitating consequences of the treatment of breast
cancer and that are delivered on an inpatient or outpatient basis. The
term includes the following:
(1) Physical therapy.
(2) Psychological and social support services.
(3) Reconstructive plastic surgery.
(d) As used in this section, "breast cancer screening
mammography" means a standard, two (2) view per breast, low-dose
radiographic examination of the breasts that is:
(1) furnished to an asymptomatic woman; and
(2) performed by a mammography services provider using
equipment designed by the manufacturer for and dedicated
specifically to mammography in order to detect unsuspected
breast cancer.
The term includes the interpretation of the results of a breast cancer
screening mammography by a physician.
(e) As used in this section, "covered individual" means a female
individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a health
maintenance organization (as defined in IC 27-13-1-19) that is
entered 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 state
department of health; or
(3) is certified by the federal Department of Health and Human
Services 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 who
meets 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 that
was proven benign by biopsy.
(3) A woman whose mother, sister, or daughter has had breast
cancer.
(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 this
chapter to provide health care coverage must provide covered
individuals with coverage for breast cancer diagnostic services,
breast cancer outpatient treatment services, and breast cancer
rehabilitative services. The coverage must provide reimbursement for
breast cancer screening mammography at a level at least as high as:
(1) the limitation on payment for screening mammography
services established in 42 CFR 405.534(b)(3) according to the
Medicare Economic Index at the time the breast cancer
screening mammography is performed; or
(2) the rate negotiated by a contract provider according to the
provisions of the insurance policy;
whichever is lower. The costs of the coverage required by this
subsection may be paid by the state or by the employee or by a
combination of the state and the employee.
(i) A contract with a health maintenance organization that is
entered into or renewed under section 7(c) of this chapter must
provide covered individuals with breast cancer diagnostic services,
breast cancer outpatient treatment services, and breast cancer
rehabilitative services.
(j) The coverage required by subsection (h) and services required
by subsection (i) may not be subject to dollar limits, deductibles, or
coinsurance provisions that are less favorable to covered individuals
than the dollar limits, deductibles, or coinsurance provisions
applying to physical illness generally under the self-insurance
program or contract with a health maintenance organization.
(k) The coverage for breast cancer diagnostic services required by
subsection (h) and the breast cancer diagnostic services required by
subsection (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 least
one (1) baseline breast cancer screening mammography
performed 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 mammography
performed 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 screening
mammography performed upon the individual every year.
(4) Any additional mammography views that are required for
proper evaluation.
(5) Ultrasound services, if determined medically necessary by
the physician treating the covered individual.
(l) The coverage for breast cancer diagnostic services required by
subsection (h) and the breast cancer diagnostic services required by
subsection (i) shall be provided in addition to any benefits
specifically provided for x-rays, laboratory testing, or wellness
examinations. 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" means
an individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a prepaid health
care delivery plan that is entered into or renewed under section
7(c) of this chapter.
(b) As used in this section, "early intervention services" means
services provided to a first steps child under IC 12-12.7-2 and 20
U.S.C. 1432(4).
(c) As used in this section, "first steps child" means an infant or
toddler from birth through two (2) years of age who is enrolled in the
Indiana first steps program and is a covered individual.
(d) As used in this section, "first steps program" refers to the
program 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 intervention
services within Indiana.
(e) As used in this section, "health benefits plan" means a:
(1) self-insurance program established under section 7(b) of this
chapter to provide group health coverage; or
(2) contract with a prepaid health care delivery plan that is
entered into or renewed under section 7(c) of this chapter.
(f) A health benefits plan that provides coverage for early
intervention services shall reimburse the first steps program for
payments made by the program for early intervention services that
are covered under the health benefits plan.
(g) The reimbursement required under subsection (f) may not be
applied to any annual or aggregate lifetime limit on the first steps
child'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 child
directly to a provider. A health benefits plan shall apply any
payments made by the first steps program to the health benefits plan's
deductibles, copayments, or other out-of-pocket expenses according
to 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" means
a male individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a health
maintenance organization (as defined in IC 27-13-1-19) that is
entered into or renewed under section 7(c) of this chapter.
(b) As used in this section, "prostate specific antigen test" means
a standard blood test performed to determine the level of prostate
specific antigen in the blood.
(c) A self-insurance program established under section 7(b) of this
chapter to provide health care coverage must provide covered
individuals with coverage for prostate specific antigen testing.
(d) A contract with a health maintenance organization that is
entered into or renewed under section 7(c) of this chapter must
provide covered individuals with prostate specific antigen screening.
(e) The coverage required under subsections (c) and (d) must
include the following:
(1) At least one (1) prostate specific antigen test annually for a
covered individual who is at least fifty (50) years of age.
(2) At least one (1) prostate specific antigen test annually for a
covered individual who is less than fifty (50) years of age and
who is at high risk for prostate cancer according to the most
recent published guidelines of the American Cancer Society.
(f) The coverage required under this section may not be subject to
dollar limits, deductibles, copayments, or coinsurance provisions that
are less favorable to covered individuals than the dollar limits,
deductibles, copayments, or coinsurance provisions applying to
physical illness generally under the self-insurance program or
contract with a health maintenance organization.
(g) The coverage for prostate specific antigen screening shall be
provided 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" means
an 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) of
this chapter to provide group health coverage; or
(2) a contract entered into under section 7(c) of this chapter to
provide health services through a prepaid health care delivery
plan.
(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 morbid
obesity.
(d) As used in this section, "morbid obesity" means:
(1) a body mass index of at least thirty-five (35) kilograms per
meter squared, with comorbidity or coexisting medical
conditions such as hypertension, cardiopulmonary conditions,
sleep apnea, or diabetes; or
(2) a body mass index of at least forty (40) kilograms per meter
squared without comorbidity.
For purposes of this subsection, body mass index is equal to weight
in kilograms divided by height in meters squared.
(e) Except as provided in subsection (f), the state shall provide
coverage for nonexperimental, surgical treatment by a health care
provider of morbid obesity:
(1) that has persisted for at least five (5) years; and
(2) for which nonsurgical treatment that is supervised by a
physician has been unsuccessful for at least six (6) consecutive
months.
(f) The state may not provide coverage for surgical treatment of
morbid obesity for a covered individual who is less than twenty-one
(21) years of age unless two (2) physicians licensed under IC 25-22.5
determine 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 major
life activity (as defined in IC 4-23-29-6);
and each physician documents in the covered individual's medical
record 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" means
an individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a health
maintenance organization (as defined in IC 27-13-1-19) that is
entered into or renewed under section 7(c) of this chapter.
(b) A:
(1) self-insurance program established under section 7(b) of this
chapter to provide health care coverage; or
(2) contract with a health maintenance organization that is
entered into or renewed under section 7(c) of this chapter;
must provide coverage for colorectal cancer examinations and
laboratory tests for cancer for any nonsymptomatic covered
individual, in accordance with the current American Cancer Society
guidelines.
(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 for
colorectal cancer according to the most recent published
guidelines of the American Cancer Society;
the coverage required under this section must meet the requirements
set forth in subsection (d).
(d) A covered individual may not be required to pay an additional
deductible or coinsurance for the colorectal cancer examination and
laboratory testing benefit that is greater than an annual deductible or
coinsurance established for similar benefits under a self-insurance
program or contract with a health maintenance organization. If the
program or contract does not cover a similar benefit, a deductible or
coinsurance may not be set at a level that materially diminishes the
value of the colorectal cancer examination and laboratory testing
benefit 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 employees
who are not covered by a plan established under section 6 of this
chapter.
(b) After June 30, 1986, the state shall provide a group health
insurance plan to each retired employee:
(1) whose retirement date is:
(A) after June 29, 1986, for a retired employee who was a
member of the field examiners' retirement fund;
(B) after May 31, 1986, for a retired employee who was a
member of the Indiana state teachers' retirement fun
