insurance coverage through the individual's
(5) The individual has not had health insurance coverage for at least six (6) months.
(b) The following individuals are not eligible for this program:
(1) An individual who participates in the federal Medicare program (42 U.S.C. 1395 et seq.).
(2) A pregnant woman for purposes of pregnancy related services.
(3) An individual who is eligible for the Medicaid program as a disabled person.
Sec. 6. (a) In order to participate in the program, an individual shall do the following:
(1) Apply for the program on a form prescribed by the office. The office may develop and allow a joint application for a household.
(2) If the individual is approved by the office to participate in the program, contribute to the individual's health care account:
(A) at least one thousand one hundred dollars ($1,100) per year, but not more than five percent (5%) of the individual's annual household income; or
(B) one thousand one hundred dollars ($1,100) per year less the individual's contributions to the Medicaid program under IC 12-15, the children's health insurance program under IC 12-17.6, or the Medicare program (42 U.S.C. 1395 et seq.), as determined by the office.
(b) The state shall contribute the difference into the individual's account if the individual's contribution of five percent (5%) of the individual's annual income is less than the required one thousand one hundred dollars ($1,100).
(c) If the individual does not make the individual's contributions to the program within thirty (30) days of the required payment, the individual may be terminated from participating in the program. The individual shall receive written notice before the individual is terminated from the program.
(d) After termination from the program under subsection (c), the individual may not reapply to participate in the program for eighteen (18) months.
(e) An individual may be held responsible under the program for receiving nonemergency services in an emergency room setting. This may include requiring the individual to pay for services received in the emergency room with money outside the
individual's health care account.
Sec. 7. (a) A participant must have a health care account in which contributions are made by the participant, an employer, or the office.
(b) The minimum amount in the account is the amount contributed by the individual and the state as described in section 6 of this chapter.
(c) The account is to be used for paying the individual's deductible for health care services in the program.
(d) The individual may contribute to the individual's health care account through the following means:
(1) By the employer withholding or causing to be withheld from the participating employee's wages or salary, after taxes are taken out of the wages or salary, the participating employee's required share described in this chapter and distributed equally throughout the calendar year.
(2) By submitting the individual's required share to the office to deposit into the individual's account in a manner prescribed by the office.
(3) Any other means determined by the office.
(e) An employer may not contribute more than fifty percent (50%) of the individual's required share to the health care account.
Sec. 8. (a) The program must cover preventative care services, as determined by the office, for a participant of not more than five hundred dollars ($500) per year. This amount shall be paid by the state at no cost to the participant.
(b) The office shall provide a participant with a list of health care services that will qualify as preventative care services for the age, gender, and preexisting conditions of the participant. The office shall consult the federal Centers for Disease Control and Prevention for a list of recommended preventative care services.
Sec. 9. (a) The office shall determine the health care services covered under the program.
(b) The program is not an entitlement program, and the number of individuals who may participate in the program is dependent upon the funds appropriated for use for the plan.
Sec. 10. The program has the following per recipient coverage limitations:
(1) An annual individual maximum coverage limitation of three hundred thousand dollars ($300,000).
(2) A lifetime individual maximum coverage of one million dollars ($1,000,000).
Sec. 11. (a) An individual who is approved to participate in the program is eligible for a twelve (12) month period. Once the
individual has been approved for participation, the individual may
not be turned down for renewal into the program for the sole
reason that the program has reached the maximum number of
(b) If the individual chooses to renew participation in the program, the individual shall complete a renewal application, any necessary documentation, and submit the documentation and application on a form prescribed by the office to the office in order to continue participating in the program.
(c) If the individual chooses not to renew participation in the program, the individual may not reapply to participate in the program for at least eighteen (18) months.
Sec. 12. (a) An insurer or health maintenance organization that has contracted with the office to provide health insurance for individuals under this program:
(1) bears the risk of the health insurance program;
(2) is responsible for the claim processing under the program;
(3) shall reimburse providers at a reimbursement rate of:
(A) at least the federal Medicare reimbursement rate for the service provided; or
(B) at a rate of one hundred thirty percent (130%) of the Medicaid reimbursement rate for a service that does not have a Medicare reimbursement rate; and
(4) may not deny coverage to an eligible individual who has been approved by the office to participate in the program, except if the maximum coverage rates are met as described in section 10 of this chapter.
(b) An insurer or a health maintenance organization that has contracted with the office to provide health insurance under the program shall also offer to provide the same health insurance to the following:
(1) An individual who has an annual household income that is:
(A) not more than two hundred percent (200%) of the federal income poverty level but the individual is not eligible for the program because of the individual's income or because a slot is not available for the individual; or
(B) more than two hundred percent (200%) of the federal income poverty level.
allowed under subsection (c):
(1) remains in the account if the individual renews participation in the program, and the amount the individual needs to contribute to the account in the following program year is prorated based on the amount remaining in the account; or
(2) is forfeited by the individual and reverts back to the state for deposit in the healthier Indiana insurance trust fund if the individual:
(A) does not continue to participate in the program; or
(B) is terminated from the program under section 6 of this chapter.
Sec. 14. (a) The healthier Indiana insurance trust fund is established for the following purposes:
(1) Administering a program created by the general assembly to provide health insurance for low income residents of the state under this chapter.
(2) Providing copayments, preventative care services, and premiums for individuals enrolled in the program.
(3) Funding tobacco use prevention and cessation programs and programs designed to promote the general health and well being of Indiana residents.
(4) Promoting research in the health and life sciences field, including grants to universities for operating and capital expenses.
The fund is apart from the state general fund.
(b) The fund shall be administered by the office of the secretary of family and social services.
(c) The expenses of administering the fund shall be paid from money in the fund.
(d) The fund shall consist of the following:
(1) Cigarette tax revenues and tobacco products tax revenues designated by the general assembly to be part of the fund.
(2) Other funds designated by the general assembly to be part of the fund.
(3) Federal funds available for the purposes of the fund.
(4) Gifts or donations to the fund.
(e) The treasurer of state shall invest the money in the fund not currently needed to meet the obligations of the fund in the same manner as other public money may be invested.
(f) Money must be appropriated before funds are available for use.