Introduced Version






HOUSE BILL No. 1097

_____


DIGEST OF INTRODUCED BILL



Citations Affected: IC 27-17.

Synopsis: Discount medical card programs. Provides for registration of discount medical card program organizations. Specifies requirements for registration and conduct of a discount medical card program organization.

Effective: July 1, 2006.





Frizzell




    January 5, 2006, read first time and referred to Committee on Public Health.







Introduced

Second Regular Session 114th General Assembly (2006)


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.
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HOUSE BILL No. 1097



    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 27-17; (06)IN1097.1.1. -->     SECTION 1. IC 27-17 IS ADDED TO THE INDIANA CODE AS A NEW ARTICLE TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]:
     ARTICLE 17. DISCOUNT MEDICAL CARD PROGRAM ORGANIZATIONS
    Chapter 1. Definitions
    Sec. 1. The definitions in this chapter apply throughout this article.
    Sec. 2. "Cardholder" means a person that pays consideration for the right to participate in a discount medical card program.
    Sec. 3. "Commissioner" refers to the insurance commissioner appointed under IC 27-1-1-2.
    Sec. 4. "Department" refers to the department of insurance created by IC 27-1-1-1.
    Sec. 5. "Discount medical card program" means a program through which a discount medical card program organization provides, in exchange for consideration, a cardholder with access

to medical services provided by a program provider under a provider agreement. The term does not include:
        (1) a policy or contract regulated under this title; or
        (2) self-funded coverage regulated under the federal Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.).
    Sec. 6. "Discount medical card program organization" means a person that:
        (1) negotiates and enters into provider agreements; and
        (2) in exchange for consideration, provides cardholders with a right of access to the discounted prices available under the provider agreements entered into under subdivision (1).
    Sec. 7. "Marketer" means a person that markets, promotes, sells, or distributes a discount medical card program. The term includes a person that markets or distributes a discount medical card program under the person's own name, but does not operate a discount medical card program.
    Sec. 8. (a) "Medical service" means care, service, or treatment related to:
        (1) an illness or a dysfunction of; or
        (2) injury to;
the human body.
    (b) The term includes physician care, inpatient care, hospital services, surgical services, emergency services, ambulance services, dental care services, vision care services, mental health services, substance abuse services, chiropractic services, podiatric care services, laboratory services, radiology services, and medical equipment and supplies.
    (c) The term does not include pharmaceutical supplies or prescriptions.
    Sec. 9. "Person" means an individual or a business entity.
    Sec. 10. "Program provider" means a provider that has, individually or through a provider network, entered into a provider agreement with a discount medical card program organization.
    Sec. 11. "Provider" means a person that is licensed under Indiana law to provide medical services.
    Sec. 12. "Provider agreement" means a written agreement between a discount medical card program organization and a:
        (1) provider; or
        (2) provider network;
for the provider or providers that belong to the provider network

to render medical services to cardholders at discounted rates.
    Sec. 13. "Provider network" means a group of two (2) or more providers that is represented by a person for purposes of negotiations with third parties.
    Sec. 14. "Service area" means a geographic area within a radius of sixty (60) miles from the home or place of business of a cardholder.
    Chapter 2. Registration of Discount Medical Card Program Organizations
    Sec. 1. A discount medical card program organization may not transact business in Indiana unless the discount medical card program organization is:
        (1) authorized to transact business in Indiana; and
        (2) registered under this chapter.
    Sec. 2. (a) An application for registration to operate as a discount medical card program organization must be filed with the department on a form prescribed by the department.
    (b) An application filed under subsection (a) must be:
        (1) sworn to by an officer or authorized representative of the applicant; and
        (2) accompanied by the following:
            (A) A copy of the applicant's organizational documents, such as articles of incorporation, including all amendments.
            (B) A copy of the applicant's bylaws or other enabling documents that establish the organizational structure and governance of the applicant.
            (C) A list of the names, addresses, official positions, and biographical information of each individual responsible for conducting the applicant's affairs, including each:
                (i) member of the board of directors, board of trustees, executive committee, or other governing board or committee; and
                (ii) officer.
            (D) A statement generally describing the applicant, the applicant's facilities and personnel, and the medical services for which discounts will be available.
            (E) A complete list of all program providers available to Indiana cardholders.
            (F) A copy of the form of any contract or arrangement between the applicant and a person listed in clause (C).
            (G) A copy of the form of any contract between the

applicant and a person for the performance on the applicant's behalf of any function, including marketing, administration, enrollment, investment management, and contracting for the provision of medical services to cardholders.
            (H) A description of the proposed method of marketing.
            (I) A toll free telephone number for program providers and cardholders to contact the applicant at least forty (40) hours per week during normal business hours.
            (J) A copy of the applicant's cancellation and refund policy.
            (K) A description of program provider and cardholder complaint procedures.
            (L) The name and address of the applicant's agent for service of process, notice or demand, or an executed power of attorney appointing the commissioner as the attorney of the applicant in Indiana for service of process for a cause of action arising in Indiana.
            (M) Other information the commissioner reasonably requires to make the determinations required under this chapter.
    Sec. 3. (a) The fee for issuance of a registration under this chapter is five hundred dollars ($500).
    (b) A registration issued or renewed under this chapter expires one (1) year from the date of issuance or renewal.
    (c) The fee for renewal of a registration under this chapter is two hundred fifty dollars ($250).
    (d) The department shall renew a registration issued under this chapter if:
        (1) the fee specified under subsection (c) is paid; and
        (2) the commissioner is satisfied that the discount medical card program organization is in compliance with this article.
    (e) Fees collected under this section must be deposited in the department of insurance fund established by IC 27-1-3-28.
    Sec. 4. This article does not require a provider that provides discounted prices for medical services to the provider's patients to be registered under this chapter.
    Sec. 5. A marketing organization that is wholly owned by an insurer or a health maintenance organization granted a certificate of authority under this title is not required to register under this chapter.
    Chapter 3. Examinations and Investigations


    Sec. 1. (a) The department may examine or investigate the business and affairs of a discount medical card program organization.
    (b) The department may:
        (1) order a discount medical card program organization or applicant for registration under IC 27-17-2 to produce records, books, files, advertising and solicitation materials, and other information; and
        (2) take statements under oath to determine whether the discount medical card program organization or applicant is in violation of the law or is acting contrary to the public interest.
    (c) A discount medical card program organization or applicant that is examined or investigated under this chapter shall pay any expense incurred in conducting the examination or investigation.
    Sec. 2. A discount medical card program organization's failure to:
        (1) comply with an action of the department under section 1 of this chapter; or
        (2) pay expenses incurred under section 1 of this chapter;
is grounds for denial or revocation of a of registration issued under IC 27-17-2.
    Chapter 4. Prohibited Activities
    Sec. 1. A discount medical card program organization may not do the following:
        (1) Use the following in the discount medical card program organization's advertisements, marketing materials, brochures, or discount cards:
            (A) The term "insurance", except as otherwise provided in this article.
            (B) The terms "health plan", "coverage", "copay", "copayment", "preexisting condition", "guaranteed issue", "portability", "premium", "underwriting", or another term that could reasonably mislead a person to believe that a discount medical card program is health insurance.
        (2) Implement restrictions on cardholder access to program providers, including waiting periods and notification periods.
        (3) Pay a provider a fee for medical services.
        (4) Collect or accept money from a cardholder for payment to a provider for medical services furnished to the cardholder unless the discount medical card program organization is an

administrator licensed under IC 27-1-25.
        (5) Make misleading, deceptive, or fraudulent representations regarding the discount, range of discounts, or access to the range of discounts offered by the discount medical card program.
    Chapter 5. Disclosures
    Sec. 1. (a) A discount medical card program organization shall make to a prospective cardholder, and print on the first page of advertisements, marketing materials, and brochures relating to a discount medical card program, the following written disclosures:
        (1) That the discount medical card program is not health insurance.
        (2) That the discount medical card program provides discounts for medical services rendered by program providers.
        (3) That the discount medical card program does not make payments to providers.
        (4) That the discount medical card program makes available, before purchase and upon request, a list of program providers, including the:
            (A) name;
            (B) city;
            (C) state; and
            (D) specialty;
        of each program provider that is located in the prospective cardholder's service area.
        (5) That the cardholder:
            (A) is obligated to pay for all medical services; and
            (B) will receive a discount from a program provider.
        (6) The name and the locations of the discount medical card program organization and the corresponding customer service toll free telephone number.
    (b) The disclosures made under subsection (a) must be printed in at least 12 point type.
    (c) The front of an identification card or other materials designed to identify an individual as a cardholder must include, in boldface, 8 point type, the statement "This is not insurance".
    Sec. 2. (a) A person that wishes to be a cardholder of a discount medical card program shall enter into a written agreement with the discount medical card program organization.
    (b) A written agreement entered into under subsection (a) must:
        (1) specify the cardholder's benefits under the discount

medical card program;
        (2) specify excluded medical services;
        (3) specify that the discount medical card program organization will continuously make available to the cardholder, through a toll free telephone number, the Internet, or in writing upon request, the:
            (A) name;
            (B) address;
            (C) telephone number; and
            (D) specialty;
        of each program provider in the cardholder's service area; and
        (4) comply with the disclosure requirements specified under section 1 of this chapter.
    Sec. 3. A marketing organization that is wholly owned by an insurer or a health maintenance organization granted a certificate of authority under this title shall disclose the marketing organization's parent company affiliation in all marketing and membership materials.
    Chapter 6. Filings
    Sec. 1. Before using an advertisement, marketing materials, or a brochure, a discount medical card program organization shall file the advertisement, marketing materials, or brochure with the commissioner and:
        (1) obtain the commissioner's approval for use; or
        (2) wait at least sixty (60) days after filing and receive no notice of the commissioner's disapproval;
of the advertisement, marketing materials, or brochure.
    Sec. 2. (a) The commissioner shall:
        (1) notify a discount medical card program organization of the commissioner's approval or disapproval of a filing under section 1 of this chapter; and
        (2) specify in the notice the reason for a disapproval.
    (b) A discount medical card program organization that receives a notice of disapproval under subsection (a) may, not more than twenty-one (21) days after the date the discount medical card program organization receives the notice, request a hearing under IC 4-21.5.
    Chapter 7. Annual Reports
    Sec. 1. A discount medical card program organization shall file an annual report with the department not later than three (3) months after the end of the discount medical card program

organization's fiscal year.
    Sec. 2. A report filed under section 1 of this chapter must be on a form prescribed by the commissioner and must include the following:
        (1) A:
            (A) list of the name and residence address of each individual responsible for conducting the discount medical card program organization's affairs, including:
                (i) each member of the board of directors, board of trustees, executive committee, or other governing board or committee; and
                (ii) each officer; and
            (B) disclosure of the extent and nature of any contract or arrangement between each individual listed under clause (A) and the discount medical card program organization, including possible conflicts of interest.
        (2) The number of cardholders of the discount medical card program organization's discount medical card program.
    Sec. 3. (a) The department shall notify a discount medical card program organization that is not in compliance with this chapter.
    (b) A discount medical card program organization that fails to file an annual report as required under this chapter shall pay to the department for deposit in the department of insurance fund established by IC 27-1-3-28:
        (1) five hundred dollars ($500) per day for the first ten (10) days of noncompliance; and
        (2) one thousand dollars ($1,000) per day for the eleventh day and each subsequent day of noncompliance.
    (c) Upon receiving notice under subsection (a), a discount medical card program organization's registration is suspended until the commissioner determines that the discount medical card program organization is in compliance with this chapter.
    Chapter 8. Cancellation
    Sec. 1. (a) A written agreement entered into under IC 27-17-5-2 may be canceled for any reason by the cardholder within:
        (1) thirty (30) days after the date the cardholder's identification card is delivered; or
        (2) a period that exceeds the period specified in subdivision (1), as provided in the written agreement.
    (b) A cardholder that cancels a written agreement under subsection (a) shall receive a full refund of all fees paid by the cardholder, less nominal fees associated with the enrollment cost

of the identification card.
    Sec. 2. A discount medical card program organization:
        (1) shall ensure that a cardholder receives, with the cardholder's identification card, notice that the written agreement may be canceled as provided in section 1 of this chapter; and
        (2) may not charge or collect a fee, including a cancellation fee, after a cardholder provides notice to the discount medical card program organization of the cardholder's intention to cancel the written agreement under section 1 of this chapter.
    Sec. 3. A written agreement that is:
        (1) entered into under IC 27-17-5-2; and
        (2) canceled as provided in section 1 of this chapter;
is void from the date the written agreement is entered into.
    Chapter 9. Financial Requirements
    Sec. 1. This chapter does not apply to a person that is exempt from registration under IC 27-17-2.
    Sec. 2. Except as provided in section 3 of this chapter, a discount medical card program organization shall maintain in force a surety bond issued:
        (1) by an insurer granted a certificate of authority under this title;
        (2) in the discount medical card organization's name; and
        (3) in an amount equal to at least thirty-five thousand dollars ($35,000);
for the commissioner's use in protecting the financial interest of a cardholder who may be adversely affected by the insolvency of the discount medical card program organization.
    Sec. 3. (a) A discount medical card program organization may, instead of maintaining a surety bond under section 2 of this chapter, maintain a deposit with:
        (1) the commissioner; or
        (2) at the discretion of the commissioner, an organization or a trustee approved by the commissioner and using a custodial or controlled account;
cash, securities, a combination of cash and securities, or another measure approved by the commissioner and having at all times a market value equal to at least thirty-five thousand dollars ($35,000).
    (b) Income that results from a deposit made under subsection (a) is an asset of the discount medical card program organization.
    Sec. 4. Assets or securities held in Indiana as a deposit under

this chapter are not subject to levy by a judgment creditor or other claimant, except the commissioner, against the discount medical card program organization.
    Chapter 10. Suspension or Revocation of License
    Sec. 1. The department may suspend or revoke a discount medical card program organization's registration or order compliance if the department finds any of the following:
        (1) The discount medical card program organization is not in compliance with this article.
        (2) The discount medical card program organization is not in compliance with the financial requirements of IC 27-17-9.
        (3) The discount medical card program organization has:
            (A) advertised, marketed, or attempted to market the discount medical card program organization's services in such a manner as to misrepresent the discount medical card program organization's services or capacity for service; or
            (B) engaged in deceptive, misleading, or unfair practices with respect to advertising or marketing.
        (4) The discount medical card program organization is not fulfilling the discount medical card program organization's obligations as a discount medical card program organization.
        (5) The continued operation of the discount medical card program organization would be hazardous to the discount medical card program organization's cardholders.
    Sec. 2. If the department has cause to believe that grounds for the suspension or revocation of a registration under this article exist, the department shall:
        (1) notify the discount medical card program organization in writing specifically stating the grounds for suspension or revocation; and
        (2) pursue a hearing under IC 4-21.5.
    Sec. 3. Upon the effective date of the surrender or revocation of a discount medical card program organization's registration, the discount medical card program organization shall conclude the discount medical card program organization's affairs transacted under the registration. The discount medical card program organization may not engage in any further advertising, solicitation, collection of consideration, or renewal of agreements.
    Sec. 4. (a) If the department suspends the registration of a discount medical card program organization, the department must specify in the order of suspension the:


        (1) period during which the suspension is in effect; and
        (2) conditions that must be met by the discount medical card program organization before the registration is reinstated.
    (b) An order of suspension may be rescinded or modified by further order of the department before the expiration of the suspension period specified under subsection (a).
    (c) The department may not reinstate a suspended registration unless reinstatement is requested by the discount medical card program organization.
    (d) The department may not reinstate a suspended registration if the department determines that the circumstances for which the suspension occurred continue to exist or are likely to recur.
    Sec. 5. On the date that a discount medical card program organization receives notice from the department that the discount medical card program organization's registration is suspended, the discount medical card program organization shall:
        (1) cease to enroll new cardholders;
        (2) honor discounts for existing cardholders for expenses incurred before and on the date of suspension;
        (3) discontinue collection of fees from existing cardholders after the date of suspension; and
        (4) refund fees collected from existing cardholders after the date of suspension.
    Chapter 11. Notice of Change of Name or Address
    Sec. 1. A discount medical card program organization shall notify the department of a change of the discount medical card program organization's name, address, principal business address, or mailing address at least thirty (30) days before the change occurs.
    Chapter 12. Marketing of Discount Medical Card Programs
    Sec. 1. A discount medical card program organization shall approve in writing all advertisements, marketing materials, brochures, and discount cards before the advertisements, marketing materials, brochures, and discount cards are used by marketers.
    Sec. 2. A discount medical card program organization:
        (1) shall enter into a written agreement with a marketer before the marketer may begin marketing, promoting, selling, or distributing the discount medical card program; and
        (2) is responsible and financially liable for any acts of the discount medical card program organization's marketers that do not comply with this article.
    Chapter 13. Rulemaking
    Sec. 1. The department may adopt rules under IC 4-22-2 to implement this article.
    Chapter 14. Violations
    Sec. 1. The department may impose a civil penalty of:
        (1) at least five hundred dollars ($500); and
        (2) not more than fifty thousand dollars ($50,000);
for a violation of this article.
    Sec. 2. IC 27-4-5 applies to a discount medical card program organization that operates without registration under this article as if the discount medical card program organization were an unauthorized insurer.