Introduced Version






SENATE BILL No. 551

_____


DIGEST OF INTRODUCED BILL



Citations Affected: IC 12-15; IC 27-1-3; IC 27-4-1-4; IC 27-8; IC 27-19.

Synopsis: Federal health care reform. Defines populations that may be subject to Medicaid resource requirements. Eliminates resource requirements in determining Medicaid eligibility for specified populations. Provides for implementation of the federal Patient Protection and Affordable Care Act with respect to a health benefit exchange in Indiana. Specifies requirements for health plans issued through a health benefit exchange. Requires a navigator or an assister to be certified or registered before providing services with respect to a health benefit exchange. Provides for dissolution of the Indiana comprehensive health insurance association.

Effective: Upon passage; July 1, 2013.





Miller Patricia




    January 14, 2013, read first time and referred to Committee on Health and Provider Services.







Introduced

First Regular Session 118th General Assembly (2013)


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.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts between statutes enacted by the 2012 Regular Session of the General Assembly.

SENATE BILL No. 551



    A BILL FOR AN ACT to amend the Indiana Code concerning health.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 12-15-2-13; (13)IN0551.1.1. -->     SECTION 1. IC 12-15-2-13, AS AMENDED BY P.L.218-2007, SECTION 9, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 13. (a) A pregnant woman:
        (1) who is not described in 42 U.S.C. 1396a(a)(10)(A)(i); and
        (2) whose family income does not exceed the income level established in subsection (b);
is eligible to receive Medicaid.
    (b) A pregnant woman described in this section is eligible to receive Medicaid, subject to subsections (c) and (d) and 42 U.S.C. 1396a et seq., if her family income does not exceed two hundred percent (200%) of the federal income poverty level for the same size family.
    (c) Medicaid made available to a pregnant woman described in this section is limited to medical assistance for services related to pregnancy, including prenatal, delivery, and postpartum services, and to other conditions that may complicate pregnancy.
    (d) Medicaid is available to a pregnant woman described in this section for the duration of the pregnancy and for the sixty (60) day

postpartum period that begins on the last day of the pregnancy, without regard to any change in income of the family of which she is a member during that time.
    (e) The office may apply a resource standard in determining the eligibility of a pregnant woman described in this section. This subsection expires December 31, 2013.

SOURCE: IC 12-15-2-17; (13)IN0551.1.2. -->     SECTION 2. IC 12-15-2-17, AS AMENDED BY P.L.196-2011, SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 17. (a) Beginning January 1, 2014, the office may apply this section only to the following Medicaid applicants or Medicaid recipients:
        (1) An individual whose eligibility for Medicaid does not require a determination of income by the office.
        (2) An individual who is at least sixty-five (65) years of age when age is a condition of eligibility.
        (3) An individual whose eligibility is being determined on the basis of being blind or disabled, or on the basis of being treated as blind or disabled.
        (4) An individual who requests coverage for long term care services and supports for the purpose of being evaluated for an eligibility group under which long term care services or supports are covered, including the following:
            (A) Nursing facility services.
            (B) Nursing facility level of care services provided in an institution.
            (C) Home and community based services.
            (D) Home health services.
            (E) Personal care services.
        (5) An individual applying for Medicare cost sharing assistance.

    (a) (b) Except as provided in subsections (b) (c) and (d), (e), if an applicant for or a recipient of Medicaid:
        (1) establishes one (1) irrevocable trust that has a value of not more than ten thousand dollars ($10,000), exclusive of interest, and is established for the sole purpose of providing money for the burial of the applicant or recipient;
        (2) enters into an irrevocable prepaid funeral agreement having a value of not more than ten thousand dollars ($10,000); or
        (3) owns a life insurance policy with a face value of not more than ten thousand dollars ($10,000) and with respect to which provision is made to pay not more than ten thousand dollars ($10,000) toward the applicant's or recipient's funeral expenses;
the value of the trust, prepaid funeral agreement, or life insurance policy may not be considered as a resource in determining the applicant's or recipient's eligibility for Medicaid.
    (b) (c) Subject to subsection (d), (e), if an applicant for or a recipient of Medicaid establishes an irrevocable trust or escrow under IC 30-2-13, the entire value of the trust or escrow may not be considered as a resource in determining the applicant's or recipient's eligibility for Medicaid.
    (c) (d) Except as provided in IC 12-15-3-7, if an applicant for or a recipient of Medicaid owns resources described in subsection (a) (b) and the total value of those resources is more than ten thousand dollars ($10,000), the value of those resources that is more than ten thousand dollars ($10,000) may be considered as a resource in determining the applicant's or recipient's eligibility for Medicaid.
    (d) (e) In order for a trust, an escrow, a life insurance policy, or a prepaid funeral agreement to be exempt as a resource in determining an applicant's or a recipient's eligibility for Medicaid under this section, the applicant or recipient must designate the office or the applicant's or recipient's estate to receive any remaining amounts after delivery of all services and merchandise under the contract as reimbursement for Medicaid assistance provided to the applicant or recipient after fifty-five (55) years of age. The office may receive funds under this subsection only to the extent permitted by 42 U.S.C. 1396p. The computation of remaining amounts shall be made as of the date of delivery of services and merchandise under the contract and must be the excess, if any, derived from:
        (1) growth in principal;
        (2) accumulation and reinvestment of dividends;
        (3) accumulation and reinvestment of interest; and
        (4) accumulation and reinvestment of distributions;
on the applicant's or recipient's trust, escrow, life insurance policy, or prepaid funeral agreement over and above the seller's current retail price of all services, merchandise, and cash advance items set forth in the applicant's or recipient's contract.
SOURCE: IC 12-15-44.2-9; (13)IN0551.1.3. -->     SECTION 3. IC 12-15-44.2-9, AS AMENDED BY P.L.160-2011, SECTION 9, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 9. (a) An individual is eligible for participation in the plan if the individual meets the following requirements:
        (1) The individual is at least eighteen (18) years of age and less than sixty-five (65) years of age.
        (2) The individual is a United States citizen and has been a resident of Indiana for at least twelve (12) months.
        (3) The individual has an annual household income of not more than the following:
            (A) Effective through December 31, 2013, two hundred percent (200%) of the federal income poverty level.
            (B) Beginning January 1, 2014, one hundred thirty-three percent (133%) of the federal income poverty level, based on the adjusted gross income provisions set forth in Section 2001(a)(1) of the federal Patient Protection and Affordable Care Act.
        (4) Effective through December 31, 2013, the individual is not eligible for health insurance coverage through the individual's employer.
        (5) Effective through December 31, 2013, the individual has:
             (A) not had health insurance coverage for at least six (6) months; or
            (B) had coverage under the Indiana comprehensive health insurance association (IC 27-8-10) within the immediately preceding six (6) months and the coverage no longer applies under IC 27-8-10-0.5.

    (b) The following individuals are not eligible for the plan:
        (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 otherwise eligible for medical assistance.
    (c) The eligibility requirements specified in subsection (a) are subject to approval for federal financial participation by the United States Department of Health and Human Services.
SOURCE: IC 12-15-46-1; (13)IN0551.1.4. -->     SECTION 4. IC 12-15-46-1, AS ADDED BY P.L.6-2012, SECTION 95, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 1. (a) As used in this section, "family planning services" does not include the performance of abortions or the use of a drug or device intended to terminate fertilization.
    (b) As used in this section, "fertilization" means the joining of a human egg cell with a human sperm cell.
    (c) As used in this section, "state plan amendment" refers to an amendment to Indiana's Medicaid State Plan as authorized by Section 1902(a)(10)(A)(ii)(XXI) of the federal Social Security Act (42 U.S.C. 1315).
    (d) Before January 1, 2012, 2014, the office shall do the following:
        (1) Apply to the United States Department of Health and Human Services for approval of a state plan amendment to expand the population eligible for family planning services and supplies as

permitted by Section 1902(a)(10)(A)(ii)(XXI) of the federal Social Security Act (42 U.S.C. 1315). In determining what population is eligible, for this expansion, the state must incorporate the following:
            (A) Inclusion of women and men.
            (B) Setting income eligibility at one hundred thirty-three percent (133%) of the federal income poverty level.
            (C) Adopting presumptive eligibility for services to this population.
        (2) Consider the inclusion of additional:
            (A) medical diagnosis; and
            (B) treatment services;
        that are provided for family planning services in a family planning setting for the population designated in subdivision (1) in the state plan amendment.
    (e) The office shall report concerning its proposed state plan amendment to the select joint commission on Medicaid oversight established by IC 2-5-26-3 during the commission's 2011 interim meetings. The select joint commission on Medicaid oversight shall review the proposed state plan amendment and may make an advisory recommendation to the office concerning the proposed state plan amendment.
    (f) (e) The office may adopt rules under IC 4-22-2 to implement this section.
    (g) This section expires January 1, 2016.

SOURCE: IC 27-1-3-7; (13)IN0551.1.5. -->         SECTION 5. IC 27-1-3-7 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 7. (a) The department may promulgate rules and regulations for any of the following enumerated purposes:
        (1) For the conduct of the work of the department.
        (2) Prescribing the methods and standards to be used in making the examinations and prescribing the forms of reports of the several insurance companies to which IC 27-1 is applicable.
        (3) Defining what is a safe or an unsafe manner and a safe or an unsafe condition for conducting business by any insurance company to which IC 27-1 is applicable.
        (4) For the establishment of safe and sound methods for the transaction of business by such insurance companies and for the purpose of safeguarding the interests of policyholders, creditors, and shareholders respecting the withdrawal or payment of funds by any life insurance company in times of emergency. Any rule or regulation promulgated under this subdivision may apply to one

(1) or more insurance companies as the department may determine.
        (5) For the administration and termination of the affairs of any such insurance company which is in involuntary liquidation or whose business and property have been taken possession of by the department for the purpose of rehabilitation, liquidation, conservation, or dissolution under IC 27-1.
        (6) For the regulation of the solicitation or use of proxies, in general and as they concern consents or authorizations, in respect of securities issued by any domestic stock company for the purpose of protecting investors by prescribing the form of proxies, including such consents or authorizations, and by requiring adequate disclosure of information relevant to such proxies, including such consents or authorizations, and relevant to the business to be transacted at any meeting of shareholders with respect to which such proxies, including such consents or authorizations, may be used, which regulations may, in general, conform to those prescribed by the National Association of Insurance Commissioners.
         (7) For regulation related to a health benefit exchange established under the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), and operating in Indiana.
    (b) The department may adopt a rule under IC 4-22-2 to provide reasonable simplification of the terms and coverage of individual and group Medicare supplement accident and sickness insurance policies and individual and group Medicare supplement subscriber contracts in order to facilitate public understanding and comparison and to eliminate provisions contained in those policies or contracts which may be misleading or confusing in connection either with the purchase of those coverages or with the settlement of claims and to provide for full disclosure in the sale of those coverages.

SOURCE: IC 27-1-3-10.5; (13)IN0551.1.6. -->     SECTION 6. IC 27-1-3-10.5 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 10.5. (a) As used in this section, "confidential information" means information that has been designated as confidential by statute, rule, or regulation issued under a statute.
    (b) The commissioner may not:
        (1) disclose; or
        (2) subject to subpoena;
financial information regarding material transactions disclosed by an

insurer under IC 27-2-18.
    (c) The commissioner may not disclose any information, including any document or report received from:
        (1) the National Association of Insurance Commissioners; or
        (2) an insurance department of another state;
if the information is designated as confidential information in the other jurisdiction.
    (d) The commissioner may share confidential information with:
        (1) the National Association of Insurance Commissioners; or
        (2) an insurance department of another state;
on the condition that the National Association of Insurance Commissioners and the other state agree to maintain the same level of confidentiality that is provided to the information under Indiana law.
     (e) The commissioner may share confidential information related to a health benefit exchange established under the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), with the health benefit exchange if the health benefit exchange:
        (1) agrees to maintain the same level of confidentiality that is provided to the confidential information under Indiana law; and
        (2) complies with all applicable confidentiality requirements under federal law.

SOURCE: IC 27-4-1-4; (13)IN0551.1.7. -->     SECTION 7. IC 27-4-1-4, AS AMENDED BY P.L.67-2011, SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 4. (a) The following are hereby defined as unfair methods of competition and unfair and deceptive acts and practices in the business of insurance:
        (1) Making, issuing, circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, or statement:
            (A) misrepresenting the terms of any policy issued or to be issued or the benefits or advantages promised thereby or the dividends or share of the surplus to be received thereon;
            (B) making any false or misleading statement as to the dividends or share of surplus previously paid on similar policies;
            (C) making any misleading representation or any misrepresentation as to the financial condition of any insurer, or as to the legal reserve system upon which any life insurer operates;
            (D) using any name or title of any policy or class of policies

misrepresenting the true nature thereof; or
            (E) making any misrepresentation to any policyholder insured in any company for the purpose of inducing or tending to induce such policyholder to lapse, forfeit, or surrender the policyholder's insurance.
        (2) Making, publishing, disseminating, circulating, or placing before the public, or causing, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public, in a newspaper, magazine, or other publication, or in the form of a notice, circular, pamphlet, letter, or poster, or over any radio or television station, or in any other way, an advertisement, announcement, or statement containing any assertion, representation, or statement with respect to any person in the conduct of the person's insurance business, which is untrue, deceptive, or misleading.
        (3) Making, publishing, disseminating, or circulating, directly or indirectly, or aiding, abetting, or encouraging the making, publishing, disseminating, or circulating of any oral or written statement or any pamphlet, circular, article, or literature which is false, or maliciously critical of or derogatory to the financial condition of an insurer, and which is calculated to injure any person engaged in the business of insurance.
        (4) Entering into any agreement to commit, or individually or by a concerted action committing any act of boycott, coercion, or intimidation resulting or tending to result in unreasonable restraint of, or a monopoly in, the business of insurance.
        (5) Filing with any supervisory or other public official, or making, publishing, disseminating, circulating, or delivering to any person, or placing before the public, or causing directly or indirectly, to be made, published, disseminated, circulated, delivered to any person, or placed before the public, any false statement of financial condition of an insurer with intent to deceive. Making any false entry in any book, report, or statement of any insurer with intent to deceive any agent or examiner lawfully appointed to examine into its condition or into any of its affairs, or any public official to which such insurer is required by law to report, or which has authority by law to examine into its condition or into any of its affairs, or, with like intent, willfully omitting to make a true entry of any material fact pertaining to the business of such insurer in any book, report, or statement of such insurer.
        (6) Issuing or delivering or permitting agents, officers, or employees to issue or deliver, agency company stock or other

capital stock, or benefit certificates or shares in any common law corporation, or securities or any special or advisory board contracts or other contracts of any kind promising returns and profits as an inducement to insurance.
        (7) Making or permitting any of the following:
            (A) Unfair discrimination between individuals of the same class and equal expectation of life in the rates or assessments charged for any contract of life insurance or of life annuity or in the dividends or other benefits payable thereon, or in any other of the terms and conditions of such contract. However, in determining the class, consideration may be given to the nature of the risk, plan of insurance, the actual or expected expense of conducting the business, or any other relevant factor.
            (B) Unfair discrimination between individuals of the same class involving essentially the same hazards in the amount of premium, policy fees, assessments, or rates charged or made for any policy or contract of accident or health insurance or in the benefits payable thereunder, or in any of the terms or conditions of such contract, or in any other manner whatever. However, in determining the class, consideration may be given to the nature of the risk, the plan of insurance, the actual or expected expense of conducting the business, or any other relevant factor.
            (C) Excessive or inadequate charges for premiums, policy fees, assessments, or rates, or making or permitting any unfair discrimination between persons of the same class involving essentially the same hazards, in the amount of premiums, policy fees, assessments, or rates charged or made for:
                (i) policies or contracts of reinsurance or joint reinsurance, or abstract and title insurance;
                (ii) policies or contracts of insurance against loss or damage to aircraft, or against liability arising out of the ownership, maintenance, or use of any aircraft, or of vessels or craft, their cargoes, marine builders' risks, marine protection and indemnity, or other risks commonly insured under marine, as distinguished from inland marine, insurance; or
                (iii) policies or contracts of any other kind or kinds of insurance whatsoever.
        However, nothing contained in clause (C) shall be construed to apply to any of the kinds of insurance referred to in clauses (A) and (B) nor to reinsurance in relation to such kinds of insurance.

Nothing in clause (A), (B), or (C) shall be construed as making or permitting any excessive, inadequate, or unfairly discriminatory charge or rate or any charge or rate determined by the department or commissioner to meet the requirements of any other insurance rate regulatory law of this state.
        (8) Except as otherwise expressly provided by law, knowingly permitting or offering to make or making any contract or policy of insurance of any kind or kinds whatsoever, including but not in limitation, life annuities, or agreement as to such contract or policy other than as plainly expressed in such contract or policy issued thereon, or paying or allowing, or giving or offering to pay, allow, or give, directly or indirectly, as inducement to such insurance, or annuity, any rebate of premiums payable on the contract, or any special favor or advantage in the dividends, savings, or other benefits thereon, or any valuable consideration or inducement whatever not specified in the contract or policy; or giving, or selling, or purchasing or offering to give, sell, or purchase as inducement to such insurance or annuity or in connection therewith, any stocks, bonds, or other securities of any insurance company or other corporation, association, limited liability company, or partnership, or any dividends, savings, or profits accrued thereon, or anything of value whatsoever not specified in the contract. Nothing in this subdivision and subdivision (7) shall be construed as including within the definition of discrimination or rebates any of the following practices:
            (A) Paying bonuses to policyholders or otherwise abating their premiums in whole or in part out of surplus accumulated from nonparticipating insurance, so long as any such bonuses or abatement of premiums are fair and equitable to policyholders and for the best interests of the company and its policyholders.
            (B) In the case of life insurance policies issued on the industrial debit plan, making allowance to policyholders who have continuously for a specified period made premium payments directly to an office of the insurer in an amount which fairly represents the saving in collection expense.
            (C) Readjustment of the rate of premium for a group insurance policy based on the loss or expense experience thereunder, at the end of the first year or of any subsequent year of insurance thereunder, which may be made retroactive only for such policy year.
            (D) Paying by an insurer or insurance producer thereof duly

licensed as such under the laws of this state of money, commission, or brokerage, or giving or allowing by an insurer or such licensed insurance producer thereof anything of value, for or on account of the solicitation or negotiation of policies or other contracts of any kind or kinds, to a broker, an insurance producer, or a solicitor duly licensed under the laws of this state, but such broker, insurance producer, or solicitor receiving such consideration shall not pay, give, or allow credit for such consideration as received in whole or in part, directly or indirectly, to the insured by way of rebate.
        (9) Requiring, as a condition precedent to loaning money upon the security of a mortgage upon real property, that the owner of the property to whom the money is to be loaned negotiate any policy of insurance covering such real property through a particular insurance producer or broker or brokers. However, this subdivision shall not prevent the exercise by any lender of the lender's right to approve or disapprove of the insurance company selected by the borrower to underwrite the insurance.
        (10) Entering into any contract, combination in the form of a trust or otherwise, or conspiracy in restraint of commerce in the business of insurance.
        (11) Monopolizing or attempting to monopolize or combining or conspiring with any other person or persons to monopolize any part of commerce in the business of insurance. However, participation as a member, director, or officer in the activities of any nonprofit organization of insurance producers or other workers in the insurance business shall not be interpreted, in itself, to constitute a combination in restraint of trade or as combining to create a monopoly as provided in this subdivision and subdivision (10). The enumeration in this chapter of specific unfair methods of competition and unfair or deceptive acts and practices in the business of insurance is not exclusive or restrictive or intended to limit the powers of the commissioner or department or of any court of review under section 8 of this chapter.
        (12) Requiring as a condition precedent to the sale of real or personal property under any contract of sale, conditional sales contract, or other similar instrument or upon the security of a chattel mortgage, that the buyer of such property negotiate any policy of insurance covering such property through a particular insurance company, insurance producer, or broker or brokers. However, this subdivision shall not prevent the exercise by any

seller of such property or the one making a loan thereon of the right to approve or disapprove of the insurance company selected by the buyer to underwrite the insurance.
        (13) Issuing, offering, or participating in a plan to issue or offer, any policy or certificate of insurance of any kind or character as an inducement to the purchase of any property, real, personal, or mixed, or services of any kind, where a charge to the insured is not made for and on account of such policy or certificate of insurance. However, this subdivision shall not apply to any of the following:
            (A) Insurance issued to credit unions or members of credit unions in connection with the purchase of shares in such credit unions.
            (B) Insurance employed as a means of guaranteeing the performance of goods and designed to benefit the purchasers or users of such goods.
            (C) Title insurance.
            (D) Insurance written in connection with an indebtedness and intended as a means of repaying such indebtedness in the event of the death or disability of the insured.
            (E) Insurance provided by or through motorists service clubs or associations.
            (F) Insurance that is provided to the purchaser or holder of an air transportation ticket and that:
                (i) insures against death or nonfatal injury that occurs during the flight to which the ticket relates;
                (ii) insures against personal injury or property damage that occurs during travel to or from the airport in a common carrier immediately before or after the flight;
                (iii) insures against baggage loss during the flight to which the ticket relates; or
                (iv) insures against a flight cancellation to which the ticket relates.
        (14) Refusing, because of the for-profit status of a hospital or medical facility, to make payments otherwise required to be made under a contract or policy of insurance for charges incurred by an insured in such a for-profit hospital or other for-profit medical facility licensed by the state department of health.
        (15) Refusing to insure an individual, refusing to continue to issue insurance to an individual, limiting the amount, extent, or kind of coverage available to an individual, or charging an individual a different rate for the same coverage, solely because of that

individual's blindness or partial blindness, except where the refusal, limitation, or rate differential is based on sound actuarial principles or is related to actual or reasonably anticipated experience.
        (16) Committing or performing, with such frequency as to indicate a general practice, unfair claim settlement practices (as defined in section 4.5 of this chapter).
        (17) Between policy renewal dates, unilaterally canceling an individual's coverage under an individual or group health insurance policy solely because of the individual's medical or physical condition.
        (18) Using a policy form or rider that would permit a cancellation of coverage as described in subdivision (17).
        (19) Violating IC 27-1-22-25, IC 27-1-22-26, or IC 27-1-22-26.1 concerning motor vehicle insurance rates.
        (20) Violating IC 27-8-21-2 concerning advertisements referring to interest rate guarantees.
        (21) Violating IC 27-8-24.3 concerning insurance and health plan coverage for victims of abuse.
        (22) Violating IC 27-8-26 concerning genetic screening or testing.
        (23) Violating IC 27-1-15.6-3(b) concerning licensure of insurance producers.
        (24) Violating IC 27-1-38 concerning depository institutions.
        (25) Violating IC 27-8-28-17(c) or IC 27-13-10-8(c) concerning the resolution of an appealed grievance decision.
        (26) Violating IC 27-8-5-2.5(e) through IC 27-8-5-2.5(j) (expired July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1, 2007, and repealed).
        (27) Violating IC 27-2-21 concerning use of credit information.
        (28) Violating IC 27-4-9-3 concerning recommendations to consumers.
        (29) Engaging in dishonest or predatory insurance practices in marketing or sales of insurance to members of the United States Armed Forces as:
            (A) described in the federal Military Personnel Financial Services Protection Act, P.L.109-290; or
            (B) defined in rules adopted under subsection (b).
        (30) Violating IC 27-8-19.8-20.1 concerning stranger originated life insurance.
        (31) Violating IC 27-2-22 concerning retained asset accounts.
         (32) Violating IC 27-8-5-29 concerning health plans offered through a health benefit exchange (as defined in

IC 27-19-2-8).
        (33) Violating a requirement of the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), that is enforceable by the state.

    (b) Except with respect to federal insurance programs under Subchapter III of Chapter 19 of Title 38 of the United States Code, the commissioner may, consistent with the federal Military Personnel Financial Services Protection Act (P.L.109-290), adopt rules under IC 4-22-2 to:
        (1) define; and
        (2) while the members are on a United States military installation or elsewhere in Indiana, protect members of the United States Armed Forces from;
dishonest or predatory insurance practices.

SOURCE: IC 27-8-5-1; (13)IN0551.1.8. -->     SECTION 8. IC 27-8-5-1, AS AMENDED BY P.L.160-2011, SECTION 17, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 1. (a) The term "policy of accident and sickness insurance", as used in this chapter, includes any policy or contract covering one (1) or more of the kinds of insurance described in Class 1(b) or 2(a) of IC 27-1-5-1. Such policies may be on the individual basis under this section and sections 2 through 9 of this chapter, on the group basis under this section and sections 16 through 19 of this chapter, on the franchise basis under this section and section 11 of this chapter, or on a blanket basis under section 15 of this chapter and (except as otherwise expressly provided in this chapter) shall be exclusively governed by this chapter.
    (b) No policy of accident and sickness insurance may be issued or delivered to any person in this state, nor may any application, rider, or endorsement be used in connection with an accident and sickness insurance policy, until a copy of the form of the policy and of the classification of risks and the premium rates, or, in the case of assessment companies, the estimated cost pertaining thereto, have been filed with and reviewed by the commissioner under section 1.5 of this chapter. This section is applicable also to assessment companies and fraternal benefit associations or societies.
    (c) This chapter shall be applied in conformity with the requirements of the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), as in effect on September 23, 2010.
     (d) A policy of accident and sickness insurance that is issued or

delivered through a health benefit exchange established under the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), is subject to the requirements of this chapter. The commissioner may adopt rules under IC 4-22-2 to implement this subsection, including rules concerning:
        (1) certification or decertification of a qualified health plan (as defined in IC 27-19-2-15); and
        (2) open enrollment.

SOURCE: IC 27-8-5-1.5; (13)IN0551.1.9. -->     SECTION 9. IC 27-8-5-1.5, AS AMENDED BY P.L.111-2008, SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 1.5. (a) This section applies to a policy of accident and sickness insurance issued on an individual, a group, a franchise, or a blanket basis, including a policy issued by an assessment company or a fraternal benefit society.
    (b) As used in this section, "commissioner" refers to the insurance commissioner appointed under IC 27-1-1-2.
    (c) As used in this section, "grossly inadequate filing" means a policy form filing:
        (1) that fails to provide key information, including state specific information, regarding a product, policy, or rate; or
        (2) that demonstrates an insufficient understanding of applicable legal requirements.
    (d) As used in this section, "policy form" means a policy, a contract, a certificate, a rider, an endorsement, an evidence of coverage, or any amendment that is required by law to be filed with the commissioner for approval before use in Indiana.
    (e) As used in this section, "type of insurance" refers to a type of coverage listed on the National Association of Insurance Commissioners Uniform Life, Accident and Health, Annuity and Credit Product Coding Matrix, or a successor document, under the heading "Continuing Care Retirement Communities", "Health", "Long Term Care", or "Medicare Supplement".
    (f) Each person having a role in the filing process described in subsection (i) shall act in good faith and with due diligence in the performance of the person's duties.
    (g) A policy form, including a policy form of a policy, contract, certificate, rider, endorsement, evidence of coverage, or amendment that is issued through a health benefit exchange (as defined in IC 27-19-2-8), may not be issued or delivered in Indiana unless the policy form has been filed with and approved by the

commissioner.
    (h) The commissioner shall do the following:
        (1) Create a document containing a list of all product filing requirements for each type of insurance, with appropriate citations to the law, administrative rule, or bulletin that specifies the requirement, including the citation for the type of insurance to which the requirement applies.
        (2) Make the document described in subdivision (1) available on 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 used for a policy of accident and sickness insurance unless the disapproval is overturned in a hearing conducted under this subsection.
        (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:
        (1) the filer has introduced a new provision in the resubmission;
        (2) the filer has materially modified a substantive provision of the policy form in the resubmission;
        (3) there has been a change in requirements applying to the policy form; or
        (4) there has been reviewer error and the written disapproval fails to state a specific requirement with which the policy form does not comply.
    (k) The commissioner may return a grossly inadequate filing to the filer without triggering a deadline set forth in this section.
    (l) The commissioner may disapprove a policy form if:
        (1) the benefits provided under the policy form are not reasonable in relation to the premium charged; or
        (2) the policy form contains provisions that are unjust, unfair, inequitable, misleading, or deceptive, or that encourage misrepresentation of the policy.
    (m) Upon disapproval of a filing under this section, the commissioner shall provide written notice to the filer or insurer of the right to a hearing within twenty (20) days of a request for a hearing.
    (n) Unless a policy form approved under this chapter contains a material error or omission, the commissioner may not:
        (1) retroactively disapprove the policy form; or
        (2) examine the filer of the policy form during a routine or targeted market conduct examination for compliance with a policy form filing requirement that was not in existence at the time the policy form was filed.

SOURCE: IC 27-8-5-29; (13)IN0551.1.10. -->     SECTION 10. IC 27-8-5-29 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 29. (a) The definitions in IC 27-19-2 apply throughout this section.
    (b) A health plan may not be offered to any person in Indiana through a health benefit exchange unless:
        (1) the form of the policy, classification of risks, and premium rates that apply to the health plan have been filed with and reviewed and approved by the commissioner under this chapter; and
        (2) the insurer is authorized under this title to engage in the business of insurance in Indiana.
    (c) An insurer that offers a multistate health plan under Section 1334 of PPACA through a health benefit exchange shall file, for review and approval, the form of the policy, classification of risks, and premium rates that apply to the multistate health plan with the commissioner and the federal government on the same business day.

SOURCE: IC 27-8-10-0.5; (13)IN0551.1.11. -->     SECTION 11. IC 27-8-10-0.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 0.5. (a) Except as provided in this section, the insurance operations of the association cease on the later of:
        (1) the date on which a health benefit exchange (as defined in IC 27-19-2-8) begins operating in Indiana; or
        (2) December 31, 2013.
    (b) Coverage under an association policy does not apply to a service provided after November 30, 2013.
    (c) A claim for payment under an association policy must be made to the association not later than the later of:
        (1) sixty (60) days after the date on which the insurance operations cease under subsection (a); or
        (2) March 1, 2014.
    (d) An appeal or grievance under this chapter must be resolved not later than ninety (90) days after the date on which the insurance operations cease under subsection (a).
    (e) Balance billing under this chapter by a health care provider that is not a member of a health care provider network arrangement used by the association is prohibited after the later of:
        (1) ninety (90) days after the date on which the insurance operations cease under subsection (a); or
        (2) March 30, 2014.
    (f) The association shall, not later than June 30, 2013, submit to the commissioner a plan of dissolution for the association. The following apply to a plan of dissolution submitted under this subsection:
        (1) The plan of dissolution must provide for the following:
            (A) Continuity of care for an individual who is covered under an association policy and is an inpatient on the date on which the insurance operations cease under subsection (a).
            (B) A final accounting described in section 2.1(g) of this chapter of the:
                (i) assessments; and
                (ii) cessation of the liability;
            of members of the association.
            (C) Resolution of any net asset deficiency.
            (D) Cessation of all liability of the association.
            (E) Final dissolution of the association.
        (2) The plan of dissolution may provide that, with the approval of the board and the commissioner, a power or duty of the association may be delegated to a person that is to perform functions similar to the functions of the association.
    (g) The commissioner shall, after notice and hearing, approve a plan of dissolution submitted under subsection (f) if the commissioner determines that the plan:
        (1) is suitable to assure the fair, reasonable, and equitable dissolution of the association; and
        (2) complies with subsection (f).
    (h) A plan of dissolution submitted under subsection (f) is effective upon the written approval of the commissioner.
    (i) An action by or against the association must be filed not more than one (1) year after the date on which the insurance operations cease under subsection (a).
    (j) This chapter expires on the date on which final dissolution of the association occurs under the plan of dissolution approved by the commissioner under subsection (g).
    (k) Funds remaining in the association on the date on which final dissolution of the association occurs must be transferred into the state general fund.
    (l) The association, or the person to which the association delegates powers under subsection (f), may implement this section in accordance with the plan of dissolution approved by the commissioner under subsection (g).

SOURCE: IC 27-19; (13)IN0551.1.12. -->     SECTION 12. IC 27-19 IS ADDED TO THE INDIANA CODE AS A NEW ARTICLE TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]:
     ARTICLE 19. HEALTH BENEFIT EXCHANGE
    Chapter 1. General Provisions
    Sec. 1. Except as otherwise provided in this title, a reference to a federal law in this article is a reference to the federal law as in effect on January 1, 2012.
    Sec. 2. This article applies to a state agency with respect to the state agency's interactions with a health benefit exchange operated in Indiana.
    Sec. 3. This article expires immediately upon the occurrence of any of the following events:
        (1) The complete repeal of PPACA.
        (2) The repeal of the PPACA requirement that one (1) or more health benefit exchanges be established in each state.
        (3) Any other congressional action, or federal court decision, rendering the establishment of a health benefit exchange unnecessary.
        (4) The issuance of an executive order by the governor specifying that the establishment of a health benefit exchange in Indiana is unnecessary or inappropriate.
    Sec. 4. The commissioner may do the following to implement this article:
        (1) Adopt rules under IC 4-22-2.
        (2) Enter into a contract, agreement, or memorandum of understanding with the following:
            (A) A health benefit exchange.
            (B) An entity that contracts with, or is a subcontractor of, a health benefit exchange.
            (C) A federal or state agency.
            (D) A health benefit exchange operating in another state.
            (E) An agency of another state.
            (F) A health plan.
            (G) Another person, for purposes of the performance of necessary functions, as determined by the commissioner.
    
         (3) Enter with a person described in subdivision (2) into an information sharing agreement:
            (A) that concerns the disclosure and receiving of data necessary to implement this article or PPACA; and
            (B) that:
                (i) includes adequate protections with respect to confidentiality of the shared information; and
                (ii) complies with applicable state and federal law.
    Chapter 2. Definitions
    Sec. 1. The definitions in this chapter apply throughout this article.
    Sec. 2. "Administrator" refers to the administrator of the office of Medicaid policy and planning appointed under IC 12-8-6.5-2.
    Sec. 3. (a) "Assister" means a person that:
        (1) does not meet the standards established for a navigator under Section 1311(i) of PPACA (42 U.S.C. 18031(i)); and
        (2) performs the functions of a navigator with respect to a

health benefit exchange as established by the commissioner.
    (b) The term does not include the following:
        (1) A Medicaid authorized representative.
        (2) A person that only provides assistance to consumers regarding public assistance that is unrelated to an application for participation in:
            (A) Medicaid; or
            (B) a health benefit exchange.
    Sec. 4. "CHIP office" refers to the office of the children's health insurance program established by IC 12-17.6-2-1.
    Sec. 5. "Commissioner" refers to the insurance commissioner appointed under IC 27-1-1-2.
    Sec. 6. "Department" refers to the department of insurance created by IC 27-1-1-1.
    Sec. 7. "Group health plan" means a group health plan (as defined in Section 2791 of the federal Public Health Service Act (42 U.S.C. 300gg-91)) that provides health insurance coverage.
    Sec. 8. "Health benefit exchange" means an American health benefit exchange operating in Indiana under PPACA.
    Sec. 9. "Health insurance coverage" has the meaning set forth in Section 2791 of the federal Public Health Service Act
(42 U.S.C. 300gg-91).
    Sec. 10. (a) "Health plan" means a policy or contract that provides health insurance coverage.
    (b) The term includes a group health plan.
    Sec. 11. (a) "Navigator" means a person that:
        (1) meets the grant funding requirements of Section 1311(i) of PPACA (42 U.S.C. 18031(i)); and
        (2) performs the functions of a navigator with respect to a health benefit exchange as established by the commissioner.
    (b) The term does not include the following:
        (1) A Medicaid authorized representative.
        (2) A person that only provides assistance to consumers regarding public assistance that is unrelated to an application for participation in:
            (A) Medicaid; or
            (B) a health benefit exchange.
    Sec. 12. "Person" means an individual or an entity.
    Sec. 13. "PPACA" refers to the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) .


    Sec. 14. (a) "Public health insurance program" refers to health coverage provided under a state or federal government program.
    (b) The term includes the following:
        (1) Medicaid (42 U.S. C. 1396 et seq.).
        (2) The Indiana check-up plan established by IC 12-15-44.2-3.
        (3) The children's health insurance program established under IC 12-17.6.
    Sec. 15."Qualified health plan" means a health plan that has been certified under Section 1301 of PPACA (42 U.S.C. 18021(a)) to meet the criteria for availability through a health benefit exchange operated in Indiana.
    Sec. 16. "Secretary" refers to the secretary of family and social services appointed under IC 12-8-1.5-2.
    Chapter 3. Health Benefit Exchange Authority
    Sec. 1. This chapter applies to a health benefit exchange operating in Indiana.
    Sec. 2. (a) The commissioner and department may implement and enforce the insurance law of this state in connection with a health benefit exchange.
    (b) A law of this state concerning a health benefit exchange does not preempt or supersede the authority of the commissioner or department to regulate the business of insurance in Indiana.
    (c) This section does not require the department to perform any function related to a health benefit exchange without being appropriately compensated for the performance of the function.
    Sec. 3. (a) The secretary, the administrator, and the CHIP office may implement and enforce the social services law of this state in connection with a health benefit exchange.
    (b) A law of this state concerning a health benefit exchange does not preempt or supersede the authority of the secretary, the administrator, or the CHIP office to administer and regulate social services in Indiana.
    (c) This section does not require the secretary, the administrator, or the CHIP office to perform any function related to a health benefit exchange without being appropriately compensated for the performance of the function.
    (d) The secretary may adopt rules under IC 4-22-2 to implement this section.
    (e) The administrator and the CHIP office may do the following to implement this section:
        (1) Enter into a contract, agreement, or memorandum of understanding with the following:
            (A) A health benefit exchange.
            (B) An entity that contracts with, or is a subcontractor of, a health benefit exchange.
            (C) A federal or state agency.
            (D) A health benefit exchange operating in another state.
            (E) An agency of another state.
            (F) A health plan.
    
         (2) Enter with a person described in subdivision (1) into an information sharing agreement:
            (A) that concerns the disclosure and receiving of data necessary to implement this section or PPACA; and
            (B) that:
                (i) includes adequate protections with respect to confidentiality of the shared information; and
                (ii) complies with applicable state and federal law.
    Chapter 4. Health Benefit Exchange Navigators and Assisters
    Sec. 1. (a) This chapter applies to a person that acts as a navigator or an assister for a health benefit exchange in Indiana. This chapter must be applied in conformity with PPACA.
    (b) An individual who intends to act as a navigator or an assister shall obtain certification under this chapter before acting as a navigator or an assister.
    (c) An entity that intends to act as a navigator or an assister shall obtain registration under this chapter before acting as a navigator or an assister.
    (d) An individual or entity that is a navigator or an assister is subject to regulation by the commissioner and the secretary.
    Sec. 2. A navigator or an assister is not subject to the licensing requirements of IC 27-1-15.6.
    Sec. 3. (a) A navigator or an assister must meet all of the following:
        (1) Shall not provide incorrect, misleading, incomplete, or materially untrue information in an application for certification or registration.
        (2) Shall not violate any of the following:
            (A) An insurance law.
            (B) A regulation.
            (C) A subpoena of the commissioner.
            (D) An order of the commissioner.
            (E) A rule of a health benefit exchange operating in Indiana.
            (F) A rule adopted under IC 27-19-3-3(d).
        (3) Shall not intentionally misrepresent the terms of an actual or proposed insurance contract or application for insurance.
        (4) Must not have had:
            (A) an insurance producer or consultant license;
            (B) a navigator or an assister certification or registration; or
            (C) an equivalent to a license, certification, or registration described in clause (A) or (B);
        denied, suspended, or revoked in any state, province, district, or territory.
        (5) Shall not fail to satisfy the continuing education requirements established under section 12 of this chapter.
        (6) Shall not obtain or attempt to obtain a license, certification, or registration through misrepresentation or fraud.
        (7) Shall not fail to disclose a conflict of interest to the commissioner:
            (A) in an application under this chapter; or
            (B) arising after application is made under this chapter.
        (8) Must not have been convicted of a felony or other crimes determined by the commissioner or secretary.
        (9) Must not have admitted to committing or have been found to have committed an unfair trade practice or fraud in the business of insurance.
        (10) Shall not use fraudulent, coercive, or dishonest practices, or demonstrate incompetence or untrustworthiness, in acting as a navigator or an assister.
        (11) Shall not improperly use notes or other reference material to complete an examination for certification as a navigator or an assister.
        (12) Must not have failed, and shall not fail, to comply with an administrative or court order imposing a child support obligation.
        (13) Must not have failed, and shall not fail, to pay state income tax or comply with any administrative or court order directing payment of state income tax.
        (14) Shall not fail to timely inform the commissioner of a change in legal name or address.
        (15) If the navigator or assister is an entity, shall not fail to verify that each navigator and assister who is an individual working for the entity meets the following requirements:
            (A) The navigator or assister is certified under this

chapter.
            (B) The navigator or assister has not committed an act that would be grounds for denial, suspension, or revocation of certification under this chapter.
    (b) The commissioner may:
        (1) reprimand a navigator or an assister;
        (2) levy a civil penalty against a navigator or an assister;
        (3) place a navigator or an assister on probation;
        (4) suspend a navigator's or an assister's certificate or registration;
        (5) revoke a navigator's or an assister's certificate or registration for a period of years;
        (6) permanently revoke a navigator's or an assister's certificate or registration;
        (7) issue a cease and desist order to a navigator or an assister; or
        (8) take any combination of the actions described in subdivisions (1) through (7);
for a violation described in subsection (a).
    Sec. 4. The commissioner shall, in consultation with the secretary, do the following to implement this chapter:
        (1) Develop a policy concerning conflicts of interest affecting navigators and assisters, including conflicts of interest involving financial and nonfinancial considerations.
        (2) Develop a consumer complaint procedure and applicable forms for filing a complaint.
        (3) Define a reasonable period for the duration of navigator or assister certification, after which the navigator or assister must pay a renewal fee, complete continuing education, and reapply for certification.
    Sec. 5. (a) Before acting as a navigator or an assister in Indiana, an individual must:
        (1) apply for certification as a navigator or an assister on a form prescribed by the commissioner; and
        (2) declare, under penalty of denial, suspension, or revocation of the certification, that the statements made in the application are true, correct, and complete to the best of the individual's knowledge and belief.
    (b) Before approving an application submitted under subsection (a), the commissioner shall determine whether the individual meets the following requirements:
        (1) The individual is at least eighteen (18) years of age.


        (2) The individual has not committed any act described in section 3 of this chapter that would be grounds for denial, suspension, or revocation of certification.
        (3) The individual has completed a precertification course of study prescribed by the commissioner.
        (4) The individual has paid the nonrefundable fees established under section 7 of this chapter.
        (5) The individual has successfully passed the examination required by section 11 of this chapter.
    Sec. 6. (a) Before acting as a navigator or assister in Indiana, an entity must be registered as a navigator or an assister as follows:
        (1) The entity must apply for registration as a navigator or an assister on a form prescribed by the commissioner.
        (2) The entity's application for registration:
            (A) must be signed by an individual who is an owner, partner, officer, director, member, or manager of the entity, under penalty of denial, suspension, or revocation of registration; and
            (B) must declare that the statements made in the application are true, correct, and complete to the best of the signing individual's knowledge and belief.
    (b) Before approving an application submitted under subsection (a), the commissioner shall:
        (1) verify that the entity is in good standing with the Indiana secretary of state; and
        (2) determine whether the entity meets the following requirements:
            (A) The entity has paid the nonrefundable fees established under section 7 of this chapter.
            (B) The entity has designated a certified individual navigator or assister to be responsible for the entity's compliance with this chapter.
            (C) The entity has not committed any act described in section 3 of this chapter that would be grounds for denial, suspension, or revocation of registration.
            (D) No owner, partner, officer, director, member, or manager of the entity has committed an act described in clause (C).
    Sec. 7. (a) The commissioner may require the production of any document that is reasonably necessary to verify the information contained in an application submitted under section 5 or 6 of this chapter.
    (b) The commissioner shall collect from each applicant for certification or registration under this chapter a nonrefundable application fee established by the commissioner in an amount expected to generate revenue sufficient to cover the costs incurred by the commissioner in implementing this chapter.
    Sec. 8. (a) An individual navigator or assister who works for an entity that is a navigator or an assister must be appointed by the entity in writing.
    (b) If an entity, because of a violation described in section 3 of this chapter, revokes the appointment of an individual navigator or assister described in subsection (a) who works for the entity, the entity shall, not more than thirty (30) days after the revocation occurs:
        (1) submit a written report to the commissioner concerning the revocation; and
        (2) provide a copy of the report to the individual at the individual's last known address by:
            (A) certified mail, return receipt requested, postage prepaid; or
            (B) overnight delivery using a nationally recognized carrier.
    Sec. 9. A certified individual navigator or assister who is unable to comply with the certification renewal procedures under this chapter due to military service or another extenuating circumstance may request from the commissioner:
        (1) a temporary waiver of:
            (A) the renewal procedure; or
            (B) an examination requirement; or
        (2) a waiver of a penalty or sanction that might otherwise be imposed for failure to comply with the renewal procedures.
    Sec. 10. (a) A navigator or an assister certification or registration must contain the navigator's or assister's name and address, the date of issuance, the expiration date, and any other information the commissioner considers necessary.
    (b) A navigator or an assister shall inform the commissioner of a change of address or legal name:
        (1) not more than thirty (30) days after the change occurs; and
        (2) by any means acceptable to the commissioner.
    Sec. 11. (a) An individual who applies for certification as a navigator or an assister in Indiana must complete a course of study and pass a written examination as prescribed by the commissioner

in consultation with the secretary.
    (b) The course of study required under subsection (a) must provide instruction in:
        (1) the functions of a health benefit exchange;
        (2) the duties and responsibilities of a navigator or an assister; and
        (3) the insurance laws of Indiana that apply to the functions of a navigator or an assister with respect to a health benefit exchange, including rules related to public health insurance programs.
    (c) The examination required by subsection (a) must test the knowledge of the individual concerning the applicable:
        (1) functions of a health benefit exchange;
        (2) duties and responsibilities of a navigator or assister; and
        (3) insurance laws of Indiana that apply to the functions of a navigator or an assister with respect to a health benefit exchange, including rules related to public health insurance programs.
    (d) The commissioner:
        (1) in consultation with the secretary, shall develop a curriculum for a course of study for navigators and assisters; and
        (2) may contract with a third party organization to:
            (A) develop examinations and course materials;
            (B) administer examinations and courses of study; and
            (C) collect nonrefundable course and examination fees;
        for the course of study for navigators and assisters.
    (e) All examinations, course materials, and examination fees referred to in subsection (d)(2) must be approved in advance by the commissioner in consultation with the secretary.
    Sec. 12. (a) The commissioner:
        (1) in consultation with the secretary, shall develop continuing education requirements for navigators and assisters; and
        (2) may contract with a third party organization to:
            (A) develop continuing education materials to meet the requirements developed under subdivision (1);
            (B) administer continuing education programs; and
            (C) collect nonrefundable continuing education program fees.
    (b) All continuing education materials, programs, and fees referred to in subsection (a)(2) must be approved in advance by the commissioner in consultation with the secretary.


    (c) The commissioner may require a navigator or an assister to complete specific continuing education requirements, as prescribed by the commissioner in consultation with the secretary, as a prerequisite to the authority to perform specific functions with respect to a health benefit exchange.
    Sec. 13. An individual who fails to:
        (1) appear for a scheduled examination required under section 11(a) of this chapter; or
        (2) pass the examination;
may not be rescheduled for the examination unless the individual reapplies for the examination and remits all required fees and forms.
    Sec. 14. (a) An insurance producer or insurance consultant:
        (1) may not act as a navigator or an assister unless the insurance producer or insurance consultant has completed the continuing education requirements that apply to a navigator or an assister; and
        (2) shall receive a designation from the commissioner as a navigator or an assister upon completion of the continuing education requirements;
under this chapter.
    (b) The commissioner may require an insurance producer or insurance consultant to complete specific continuing education requirements, as prescribed by the commissioner in consultation with the secretary, as a prerequisite to the authority to perform specific functions with respect to a health benefit exchange.

SOURCE: ; (13)IN0551.1.13. -->     SECTION 13. An emergency is declared for this act.