Citations Affected: IC 27-1; IC 27-8; IC 27-13.
Synopsis: Insurance. Exempts a commissioner of insurance request for
certain information from the requirement to issue an examination
warrant. Allows certain kinds of insurance to be provided on a group
basis in certain circumstances. Permits a group life insurance policy to
cover a spouse or dependent child for more than 50% of the amount
provided for the insured. Revises the accident and sickness insurance
form filing requirements concerning commissioner actions. Requires
an accident and sickness insurer and a health maintenance organization
to take certain actions with regard to providing coverage for certain
individuals less than 24 years of age.
Effective: July 1, 2008.
January 15, 2008, read first time and referred to Committee on Insurance.
January 24, 2008, amended, reported _ Do Pass.
A BILL FOR AN ACT to amend the Indiana Code concerning
or other recordings relating to the property, assets, business, and affairs
of the company being examined. The officers, directors, employees,
and agents of the company or person must facilitate the examination
and aid in the examination so far as it is in their power to do so. The
refusal of any company, by its officers, directors, employees, or agents
within the company's control, to submit to examination or to comply
with any reasonable written request of the examiners, or the failure of
any company to make a good faith effort to require compliance with
such a request, is grounds for:
(2) refusal; or
of any license or authority held by the company to engage in an insurance or other business subject to the commissioner's jurisdiction. The commissioner may proceed to suspend or revoke a license or authority upon the grounds set forth in this subsection under IC 27-1-3-10 or IC 27-1-3-19.
(c) The commissioner and the commissioner's examiners may issue subpoenas, administer oaths, and examine under oath any person as to any matter pertinent to an examination conducted under this chapter. Upon the failure or refusal of any person to obey a subpoena, the commissioner may petition a court of competent jurisdiction, and upon proper showing, the court may enter any order compelling the witness to appear and testify or produce documentary evidence. Failure to obey the court order is punishable as contempt of court.
(d) When making an examination under this chapter, the commissioner may retain attorneys, appraisers, independent actuaries, independent certified public accountants, or other professionals and specialists as examiners. The cost of retaining these examiners shall be borne by the company that is the subject of the examination.
(e) This chapter does not limit the commissioner's authority to terminate or suspend any examination in order to pursue other legal or regulatory action pursuant to this title. Findings of fact and conclusions made pursuant to any examination shall be prima facie evidence in any legal or regulatory action.
of insurance issued to each member of the group;
(2) the policyholder has a direct contractual relationship with each certificate holder; and
(3) the insurance coverage provided under the policy protects the policyholder and each certificate holder.
(b) If another provision of state law:
(1) specifies requirements for issuance of an insurance policy on a group basis; and
(2) conflicts with subsection (a);
the other provision is controlling.
(c) An insurer shall not issue the following on a group basis:
(1) A personal policy that insures loss of or damage to:
(A) real property consisting of not more than four (4) residential units, one (1) of which is the principal place of residence of the named insured; or
(B) personal property:
(i) in which the named insured has an insurable interest; and
(ii) that is used within a residential dwelling for personal, family, or household purposes.
(2) A personal policy that provides any type of insurance described in IC 27-1-5-1, Class 2(f).
(d) The commissioner may adopt rules under IC 4-22-2 to implement this section.
or dependent child as to whom evidence of individual insurability
is not satisfactory to the insurer.
(3) The amounts of insurance for any covered spouse or
dependent child under the policy may not exceed fifty percent
(50%) of the amount of insurance for which the employee or
member is insured.
the department of insurance Internet site.
(3) Update the document described in subdivision (1) at least annually and not more than thirty (30) days following any change in a filing requirement.
(i) The filing process is as follows:
(1) A filer shall submit a policy form filing that:
(A) includes a copy of the document described in subsection (h);
(B) indicates the location within the policy form or supplement that relates to each requirement contained in the document described in subsection (h); and
(C) certifies that the policy form meets all requirements of state law.
(2) The commissioner shall review a policy form filing and, not more than thirty (30) days after the commissioner receives the filing under subdivision (1):
(A) approve the filing; or
(B) provide written notice of a determination:
(i) that deficiencies exist in the filing; or
(ii) that the commissioner disapproves the filing.
A written notice provided by the commissioner under clause (B) must be based only on the requirements set forth in the document described in subsection (h) and must cite the specific requirements not met by the filing. A written notice provided by the commissioner under clause (B)(i) must state the reasons for the commissioner's determination in sufficient detail to enable the filer to bring the policy form into compliance with the requirements not met by the filing.
(3) A filer may resubmit a policy form that:
(A) was determined deficient under subdivision (2) and has been amended to correct the deficiencies; or
(B) was disapproved under subdivision (2) and has been revised.
A policy form resubmitted under this subdivision must meet the requirements set forth as described in subdivision (1) and must be resubmitted not more than thirty (30) days after the filer receives the commissioner's written notice of deficiency or disapproval. If a policy form is not resubmitted within thirty (30) days after receipt of the written notice, the commissioner's determination regarding the policy form is final.
(4) The commissioner shall review a policy form filing resubmitted under subdivision (3) and, not more than thirty (30)
days after the commissioner receives the resubmission:
(A) approve the resubmitted policy form; or
(B) provide written notice that the commissioner disapproves the resubmitted policy form.
A written notice of disapproval provided by the commissioner under clause (B) must be based only on the requirements set forth in the document described in subsection (h), must cite the specific requirements not met by the filing, and must state the reasons for the commissioner's determination in detail. The commissioner's approval or disapproval of a resubmitted policy form under this subdivision is final, except that the commissioner may allow the filer to resubmit a further revised policy form if the filer, in the filer's resubmission under subdivision (3), introduced new provisions or materially modified a substantive provision of the policy form. If the commissioner allows a filer to resubmit a further revised policy form under this subdivision, the filer must resubmit the further revised policy form not more than thirty (30) days after the filer receives notice under clause (B), and the commissioner shall issue a final determination on the further revised policy form not more than thirty (30) days after the commissioner receives the further revised policy form.
(5) If the commissioner disapproves a policy form filing under this subsection, the commissioner shall notify the filer, in writing, of the filer's right to a hearing as described in subsection (m).
A disapproved policy form filing may not be disapproved used
for a policy of accident and sickness insurance unless it
contains a material error or omission. At any the disapproval is
overturned in a hearing conducted under this subsection. the
commissioner must prove that the policy form contains a material
error or omission.
(6) If the commissioner does not take any action on a policy form that is filed or resubmitted under this subsection in accordance with any applicable period specified in subdivision (2), (3), or (4), the policy form filing is considered to be approved.
(j) Except as provided in this subsection, the commissioner may not disapprove a policy form resubmitted under subsection (i)(3) or (i)(4) for a reason other than a reason specified in the original notice of determination under subsection (i)(2)(B). The commissioner may disapprove a resubmitted policy form for a reason other than a reason specified in the original notice of determination under subsection (i)(2) if:
dependent upon the policyholder.
(4) The style, arrangement, and overall appearance of the policy give no undue prominence to any portion of the text, and unless every printed portion of the text of the policy and of any endorsements or attached papers is plainly printed in lightface type of a style in general use, the size of which shall be uniform and not less than ten point with a lower-case unspaced alphabet length not less than one hundred and twenty point (the "text" shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description if any, and captions and subcaptions).
(5) The exceptions and reductions of indemnity are set forth in the policy and, except those which are set forth in section 3 of this chapter, are printed, at the insurer's option, either included with the benefit provision to which they apply, or under an appropriate caption such as "EXCEPTIONS", or "EXCEPTIONS AND REDUCTIONS", provided that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of such exception or reduction shall be included with the benefit provision to which it applies.
(6) Each such form of the policy, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page of the policy.
(7) The policy contains no provision purporting to make any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of or reference to a statement of rates or classification of risks, or short-rate table filed with the commissioner.
(8) If an individual accident and sickness insurance policy or hospital service plan contract or medical service plan contract provides that hospital or medical expense coverage of a dependent child terminates upon attainment of the limiting age for dependent children specified in such policy or contract, the policy or contract must also provide that attainment of such limiting age does not operate to terminate the hospital and medical coverage of such child while the child is and continues to be both:
(A) incapable of self-sustaining employment by reason of mental retardation or mental or physical disability; and
(B) chiefly dependent upon the policyholder for support and maintenance.
Proof of such incapacity and dependency must be furnished to the
insurer by the policyholder within thirty-one (31) days of the
child's attainment of the limiting age. The insurer may require at
reasonable intervals during the two (2) years following the child's
attainment of the limiting age subsequent proof of the child's
disability and dependency. After such two (2) year period, the
insurer may require subsequent proof not more than once each
year. The foregoing provision shall not require an insurer to
insure a dependent who is a child who has mental retardation or
a mental or physical disability where such dependent does not
satisfy the conditions of the policy provisions as may be stated in
the policy or contract required for coverage thereunder to take
effect. In any such case the terms of the policy or contract shall
apply with regard to the coverage or exclusion from coverage of
such dependent. This subsection applies only to policies or
contracts delivered or issued for delivery in this state more than
one hundred twenty (120) days after August 18, 1969.
(b) If any policy is issued by an insurer domiciled in this state for delivery to a person residing in another state, and if the official having responsibility for the administration of the insurance laws of such other state shall have advised the commissioner that any such policy is not subject to approval or disapproval by such official, the commissioner may by ruling require that such policy meet the standards set forth in subsection (a) and in section 3 of this chapter.
(c) An insurer may issue a policy described in this section in electronic or paper form. However, the insurer shall:
(1) inform the insured that the insured may request the policy in paper form; and
(2) issue the policy in paper form upon the request of the insured.
(d) An insurer shall, for purposes of coverage of a child who is less than twenty-four (24) years of age and not dependent on the policyholder as described in subsection (a)(3), do all of the following:
(1) Provide to each policyholder at the time of application, amendment, or renewal of a policy of accident and sickness insurance written notice that:
(A) is provided in a document that is separate from any other document provided to the policyholder; and
(B) clearly explains:
(i) that a child who is less than twenty-four (24) years of age and not dependent on the policyholder will be covered upon the request of the policyholder; and
(ii) the manner and form in which the policyholder must
request the coverage.
(2) Allow at least thirty (30) days after a policyholder receives the notice required by subdivision (1) for the policyholder to make a request for the coverage.
(3) Immediately provide the coverage to the individual for whom a request for coverage is made, without any limitation or exclusion of coverage related to a preexisting condition.
JULY 1, 2008]: Sec. 3. (a) A contract referred to in section 1 of this
chapter must clearly state the following:
(1) The name and address of the health maintenance organization.
(2) Eligibility requirements.
(3) Benefits and services within the service area.
(4) Emergency care benefits and services.
(5) Any out-of-area benefits and services.
(6) Copayments, deductibles, and other out-of-pocket costs.
(7) Limitations and exclusions.
(8) Enrollee termination provisions.
(9) Any enrollee reinstatement provisions.
(10) Claims procedures.
(11) Enrollee grievance procedures.
(12) Continuation of coverage provisions.
(13) Conversion provisions.
(14) Extension of benefit provisions.
(15) Coordination of benefit provisions.
(16) Any subrogation provisions.
(17) A description of the service area.
(18) The entire contract provisions.
(19) The term of the coverage provided by the contract.
(20) Any right of cancellation of the group or individual contract holder.
(21) Right of renewal provisions.
(22) Provisions regarding reinstatement of a group or an individual contract holder.
(23) Grace period provisions.
(24) A provision on conformity with state law.
(25) A provision or provisions that comply with the:
(A) guaranteed renewability; and
(B) group portability;
requirements of the federal Health Insurance Portability and Accountability Act of 1996 (26 U.S.C. 9801(c)(1)).
(26) That the contract provides, upon request of the subscriber, coverage for a child of the subscriber until the date the child becomes twenty-four (24) years of age.
(b) For purposes of subsection (a), an evidence of coverage which is filed with a contract may be considered part of the contract.
(c) A health maintenance organization shall, for purposes of coverage of a child as described in subsection (a)(26), do all of the following:
(1) Provide to each subscriber at the time of application,
amendment, or renewal of an individual contract or a group
contract written notice that:
(A) is provided in a document that is separate from any other document provided to the subscriber; and
(B) clearly explains:
(i) that a child who is less than twenty-four (24) years of age will be covered upon the request of the subscriber; and
(ii) the manner and form in which the subscriber must request the coverage.
(2) Allow at least thirty (30) days after a subscriber receives the notice required by subdivision (1) for the subscriber to make a request for the coverage.
(3) Immediately provide the coverage to the child for whom a request for coverage is made, without any:
(A) limitation or exclusion of coverage related to a preexisting condition; or
(B) requirement that the child:
(i) wait for an open enrollment period; or
(ii) be otherwise treated as a late enrollee (as defined in 26 U.S.C. 9801(b)(3)).