Introduced Version






HOUSE BILL No. 1226

_____


DIGEST OF INTRODUCED BILL



Citations Affected: IC 27-8-13.5; IC 27-13.

Synopsis: Mandated health benefit option. Allows, under certain circumstances, an accident and sickness insurer or a health maintenance organization to offer a policy or contract that does not include all state mandated health benefits.

Effective: July 1, 2004.





Behning




    January 15, 2004, read first time and referred to Committee on Insurance, Corporations and Small Business.







Introduced

Second Regular Session 113th General Assembly (2004)


PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts between statutes enacted by the 2003 Regular Session of the General Assembly.

HOUSE BILL No. 1226



    A BILL FOR AN ACT to amend the Indiana Code concerning insurance.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 27-8-13.5; (04)IN1226.1.1. -->     SECTION 1. IC 27-8-13.5 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2004]:
    Chapter 13.5. State Mandated Health Benefit Option
    Sec. 1. As used in this chapter, "insurer" refers to an insurer (as defined in IC 27-1-2-3) that issues or delivers a policy of accident and sickness insurance.
    Sec. 2. (a) As used in this chapter, "state mandated health benefit" means:
        (1) coverage for a particular condition or treatment that must be provided in; or
        (2) an offering of coverage for a particular condition or treatment that must be made in connection with the purchase of;
a policy of accident and sickness insurance under this title, except as provided in this chapter.
    (b) The term does not include coverage that must be provided

in a policy of accident and sickness insurance under federal law.
    Sec. 3. As used in this chapter, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1.
    Sec. 4. As used in this chapter, "prospective purchaser" means an:
        (1) individual who requests coverage under a policy of accident and sickness insurance issued on an individual basis; or
        (2) employer that:
            (A) employs not more than fifty (50) employees; and
            (B) requests coverage for the employer's employees under a policy of accident and sickness insurance issued on a group basis.
    Sec. 5. An insurer may offer to a prospective purchaser a policy of accident and sickness insurance that does not include all state mandated health benefits if the policy includes the following:
        (1) Newborn coverage required under IC 27-8-5.6.
        (2) Breast cancer screening related coverage required under IC 27-8-14.
        (3) Prostate cancer screening related coverage required under IC 27-8-14.7.
        (4) Colorectal cancer screening related coverage required under IC 27-8-14.8.
    Sec. 6. An insurer that offers to a prospective purchaser a policy of accident and sickness insurance described in section 5 of this chapter shall also offer to the prospective purchaser a policy of accident and sickness insurance that includes all state mandated health benefits.
    Sec. 7. An insurer that issues or delivers a policy of accident and sickness insurance that does not include all state mandated health benefits as described in section 5 of this chapter shall provide to an individual insured under the policy of accident and sickness insurance a written disclosure that:
        (1) acknowledges that the policy of accident and sickness insurance does not include all state mandated health benefits; and
        (2) lists in summary form the state mandated health benefits that are provided in the policy of accident and sickness insurance.

SOURCE: IC 27-13-1-27.8; (04)IN1226.1.2. -->     SECTION 2. IC 27-13-1-27.8 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2004]: Sec. 27.8. "Prospective purchaser"

means an:
        (1) individual who requests coverage under an individual contract; or
        (2) employer that:
            (A) employs not more than fifty (50) employees; and
            (B) requests coverage for the employer's employees under a group contract.

SOURCE: IC 27-13-1-31.5; (04)IN1226.1.3. -->     SECTION 3. IC 27-13-1-31.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2004]: Sec. 31.5. (a) "State mandated health benefit" means:
        (1) coverage for a particular condition or treatment that must be provided in; or
        (2) an offering of coverage for a particular condition or treatment that must be made in connection with the purchase of;
an individual contract or a group contract under this title, except as provided in IC 27-13-7.5.
    (b) The term does not include coverage that must be provided in an individual contract or a group contract under federal law.

SOURCE: IC 27-13-7.5; (04)IN1226.1.4. -->     SECTION 4. IC 27-13-7.5 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2004]:
    Chapter 7.5. State Mandated Health Benefit Option
    Sec. 1. A health maintenance organization may offer to a prospective purchaser an individual contract or a group contract that does not include all state mandated health benefits if the contract includes the following:
        (1) Newborn coverage that is substantially similar to the coverage required under IC 27-8-5.6.
        (2) Breast cancer screening related coverage required under IC 27-13-7-15.3.
        (3) Prostate cancer screening related coverage required under IC 27-13-7-16.
        (4) Colorectal cancer screening related coverage required under IC 27-13-7-17.
    Sec. 2. A health maintenance organization that offers to a prospective purchaser an individual contract or a group contract described in section 1 of this chapter shall also offer to the prospective purchaser
an individual contract or a group contract that includes all state mandated health benefits.
    Sec. 3. A health maintenance organization that enters into an

individual contract or a group contract that does not include all state mandated health benefits as described in section 1 of this chapter shall provide to an enrollee a written disclosure that:
        (1) acknowledges that the individual contract or group contract does not include all state mandated health benefits; and
        (2) lists in summary form the state mandated health benefits that are provided in the individual contract or group contract.