individual entitled to coverage under a group health arrangement.
Sec. 4. As used in this chapter, "department" refers to the department of insurance created by IC 27-1-1-1.
Sec. 5. As used in this chapter, "group health arrangement" means an arrangement to pool risks of members and provide insured or self-insured health benefits to individuals through a:
(2) multiple employer welfare arrangement described in IC 27-1-34;
(3) fraternal benefit society; or
(4) nonemployer based association other than an association of governmental entities;
that does not possess a certificate of authority under IC 27-1-3 and is subject to regulation by the department of insurance
Sec. 6. (a) As used in this chapter, "medical expense" means the financial obligation of a group health arrangement to pay for direct health care services and products provided to covered individuals.
(b) The term includes group health arrangement payments to health care providers for quality or efficiency enhancing initiatives.
(c) The term does not include:
(1) administrative expenses; or
(2) amounts that are the financial responsibility of a covered individual or a party other than the group health arrangement.
Sec. 7. As used in this chapter, "medical loss ratio" means the quotient of:
(1) actual claim expenses; divided by
(2) earned premiums or assessments;
in a calendar year.
Sec. 8. (a) A group health arrangement shall, before March 1 of each year, file with the department a report containing group health arrangement information specific to each of the following categories for the immediately preceding calendar year:
(1) Health coverage provided by the group health arrangement under a self-insured arrangement that does not use a provider network.
(2) Health coverage provided by the group health arrangement under a self-insured arrangement that uses a provider network.
(b) The report for each category specified in subsection (a) must include the following information:
(1) A specific breakdown of administrative expenses as follows:
(A) Trustee, officer, and director salaries and benefits.
(B) Commissions and other broker fees.
(C) Utilization and other benefit management expenses.
this chapter available to the public upon request.
(b) A report filed under section 8 of this chapter is a public record.
Sec. 10. The commissioner shall adopt rules under IC 4-22-2 to implement this chapter.
Sec. 11. (a) The commissioner may audit a group health arrangement at any time to determine compliance with this chapter.
(b) If the commissioner, after notice and hearing under IC 4-21.5, determines that a group health arrangement has violated this chapter, the commissioner may impose a civil penalty equal to:
(1) at least one thousand dollars ($1,000); and
(2) not more than ten thousand dollars ($10,000);
for each day of noncompliance.
(c) Civil penalties collected under this section must be deposited in the state general fund.
(2) The name, official title, and contact information for the individual who will conduct the meeting.
(3) A statement of the factual basis for the proposed assessment or premium increase along with any supporting information from the commissioner and the group health arrangement.
(4) A reference to the specific statutes and administrative rules that relate to the proposed assessment or premium increase.
(5) A solicitation of oral or written comment from the public.
(6) The procedure to be followed during the meeting.
Sec. 4. An individual who is a trustee, an officer, a director of a group health arrangement shall annually file with the commissioner of insurance a statement describing any financial interest that the individual or a member of the individual's immediate family has in an insurer doing business in Indiana.".
Renumber all SECTIONS consecutively.
(Reference is to ESB 357 as printed February 22, 2010.)