First Regular Session 112th General Assembly (2001)
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HOUSE ENROLLED ACT No. 1461
AN ACT to amend the Indiana Code concerning insurance.
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: IC 27-1-37; (01)HE1461.1.1. -->
SECTION 1. IC 27-1-37 IS ADDED TO THE INDIANA CODE AS
CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY
Chapter 37. Health Provider Contracts
Sec. 1. As used in this chapter, "emergency" means a medical
condition that arises suddenly and unexpectedly and manifests
itself by acute symptoms of such severity, including severe pain,
that the absence of immediate medical attention could reasonably
be expected by a prudent lay person who possesses an average
knowledge of health and medicine to:
(1) place an individual's health in serious jeopardy;
(2) result in serious impairment to the individual's bodily
(3) result in serious dysfunction of a bodily organ or part of
Sec. 2. As used in this chapter, "health maintenance
organization" means a person that undertakes to provide or
arrange for the delivery of health care services to individuals on a
prepaid basis, except for the individual's responsibility for
copayments or deductibles. The term includes a limited service
health maintenance organization. The term does not include a
staff-model health maintenance organization that employs a group
of providers and that requires the providers to provide health care
services solely to individuals who are entitled to coverage under a
contract with the staff-model health maintenance organization or
an affiliate of the staff-model health maintenance organization.
Sec. 3. As used in this chapter, "health provider contract"
means an agreement with a provider relating to terms and
conditions of reimbursement for health care services provided to
an individual under:
(1) an employee welfare benefit plan (as defined in 29 U.S.C.
1002 et seq.);
(2) a policy of accident and sickness insurance (as defined in
(3) a contract with a health maintenance organization;
(4) a self-insurance program established under
IC 5-10-8-7(b); or
(5) a prepaid health care delivery plan entered into under
Sec. 4. (a) As used in this chapter, "person" means an
individual, an agency, a political subdivision, a partnership, a
corporation, an association, or any other entity.
(b) The term does not include a health care provider described
in IC 16-18-2-163(a)(1), IC 16-18-2-163(a)(2), IC 16-18-2-163(a)(3),
or IC 16-18-2-163(a)(4).
Sec. 5. As used in this chapter, "provider" means an individual
or entity licensed or legally authorized to provide health care
Sec. 6. (a) Except as provided in subsection (b), a person may
not require a provider, as a condition of entering into a health
provider contract for the provision of health care services other
than health care services to enrollees of a health maintenance
organization, to provide health care services to enrollees of a health
(b) A person may require a provider, as a condition of entering
into a health provider contract for the provision of health care
services other than health care services to enrollees of a health
maintenance organization, to provide health care services to
enrollees of a health maintenance organization:
(1) in an emergency; or
(2) upon referral.
(c) If a person requires a provider to provide health care
services to enrollees of a health maintenance organization under
subsection (b), the person:
(1) shall reimburse the provider at rates established under the
health provider contract; and
(2) may not require the provider to comply with the terms and
conditions of the health maintenance organization.
SOURCE: ; (01)HE1461.1.2. -->
SECTION 2. [EFFECTIVE JULY 1, 2001] (a) IC 27-1-37, as
added by this act, applies to a health provider contract that is
entered into or renewed after June 30, 2001.
(b) This SECTION expires June 30, 2005.
HEA 1461 _ Concur
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