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.
January 5, 2006, read first time and referred to Committee on Public Health.
A BILL FOR AN ACT to amend the Indiana Code concerning
insurance.
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
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: