Citations Affected: IC 12-7; IC 12-15; IC 27-1; IC 27-4; IC 27-8;
IC 27-19; noncode.
Synopsis: Federal health care reform. Defines populations that may be
subject to Medicaid resource requirements. Eliminates certain
Medicaid eligibility resource requirements. Specifies Medicaid
recipients who are eligible to receive payments related to certain
Medicare premium and cost sharing amounts. Provides for negotiations
between the office of Medicaid policy and planning (office) and the
United States Department of Health and Human Services (HHS)
concerning a block grant system related to Medicaid. Requires the
office to apply to HHS to amend the state Medicaid plan to require
Medicaid recipient cost sharing. Provides for implementation of the
federal Patient Protection and Affordable Care Act with respect to a
health benefit exchange (exchange) in Indiana. Specifies requirements
for health plans issued through an exchange, including application of
Indiana insurance law. Requires certification of navigators and
registration of application organizations related to an exchange.
Provides for dissolution of the Indiana comprehensive health insurance
association. Requires the office to present specified information to the
health finance commission (commission) before August 1, 2013.
Requires certain state agencies to report to the commission related to
an exchange in Indiana.
Effective: Upon passage; July 1, 2013.
January 14, 2013, read first time and referred to Committee on Health and Provider
Services.
February 14, 2013, amended, reported favorably _ Do Pass; reassigned to Committee on
Appropriations.
February 21, 2013, amended, reported favorably _ Do Pass.
February 25, 2013, read second time, amended, ordered engrossed.
A BILL FOR AN ACT to amend the Indiana Code concerning
health.
1, 2013]: Sec. 3.5. An individual:
(1) who is:
(A) at least sixty-five (65) years of age; or
(B) disabled, as determined by the Supplemental Security
Income program; and
(2) whose income and resources do not exceed those levels
established by the Supplemental Security Income program;
is eligible to receive Medicaid assistance if the individual's family
income does not exceed one hundred percent (100%) of the federal
income poverty level for the same size family.
income does not exceed one hundred fifty percent (150%) of the
federal income poverty level for the same size family.
(c) The office may apply a resource standard in determining the
eligibility of an individual described in this section. This subsection
expires December 31, 2013.
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) (d) Subject to subsection (d), (f), 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) (e) Except as provided in IC 12-15-3-7, if an applicant for or a
recipient of Medicaid owns resources described in subsection (a) (c)
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) (f) 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.
following:
(1) The date that the office is informed that the United States
Department of Health and Human Services has approved
Indiana's conversion to 1634 status within the Medicaid
program.
(2) January 1, 2014.
(b) As used in this section, "qualified Medicare beneficiary"
means an individual defined in 42 U.S.C. 1396d(p)(1).
(c) As used in this section, "qualifying individual" refers to an
individual described in 42 U.S.C. 1396a(a)(10)(E)(iv).
(d) As used in this section, "specified low-income Medicare
beneficiary" refers to an individual described in 42 U.S.C.
1396a(a)(10)(E)(iii).
(e) The following individuals are eligible for the specified
coverage under this section:
(1) A qualified Medicare beneficiary whose:
(A) income does not exceed one hundred fifty percent
(150%) of the federal income poverty level; and
(B) resources do not exceed the resource limits established
by the office;
is eligible for Medicare Part A and Medicare Part B
premiums, coinsurance, and deductibles.
(2) A specified low-income Medicare beneficiary whose:
(A) income does not exceed one hundred seventy percent
(170%) of the federal income poverty level; and
(B) resources do not exceed the resource limits set by the
office;
is eligible for coverage of Medicare Part B premiums.
(3) A qualifying individual whose:
(A) income does not exceed one hundred eighty-five
percent (185%) of the federal income poverty level; and
(B) resources do not exceed the resource limits set by the
office;
is eligible for coverage of Medicare Part B premiums.
(f) The office may adopt rules under IC 4-22-2 to implement this
section.
section 4 of this chapter as the woman's authorized representative
for purposes of completing all aspects of the Medicaid application
process;
the county office shall conduct any face-to-face interview that is
necessary to determine the woman's eligibility for Medicaid with the
woman's authorized representative.
(b) This section expires December 31, 2013.
applicant or Medicaid recipient who is aged, blind, or disabled
under IC 12-15-2-3.5.
(c) If an individual:
(1) resides in a nursing facility or another medical institution;
and
(2) has a spouse who does not reside in a nursing facility or
another medical institution;
the total cash value of money, stock, bonds, and life insurance that
may be owned by the couple to be eligible for Medicaid is
determined under IC 12-15-2-24.
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.
specified in the federal Patient Protection and Affordable
Care Act.
(3) Include, when appropriate, consumer driven principles.
(4) Include coverage for preventative care services provided
at no cost to the recipient and allow incentives for increasing
preventative care for recipients.
(5) Allow for personal responsibility requirements.
(6) Require a recipient to make out-of-pocket payments
related to coverage for health care expenses provided under
the program.
(7) Require a health care account to be used to pay the
recipient's out-of-pocket health care expenses associated with
health care coverage provided as part of the recipient's
participation in the program described in this section.
(8) Include health care initiatives designed to promote the
general health and well being of recipients and encourage an
understanding of the cost and quality of care.
(c) The office of the secretary may not implement a waiver or
Medicaid state plan amendment negotiated under this section until
the office of the secretary has developed a sustainable financing
plan for the Medicaid state plan amendment or waiver and the
plan has been reviewed by the state budget committee.
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.
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).
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.
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.
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.
(e) 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.
(f) The commissioner shall, after notice and hearing, approve a
plan of dissolution submitted under subsection (e) 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 (e).
(g) A plan of dissolution submitted under subsection (e) is
effective upon the written approval of the commissioner.
(h) 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).
(i) 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 (f).
(j) Funds remaining in the association on the date on which final
dissolution of the association occurs must be transferred into the
state general fund.
(k) The association, or the person to which the association
delegates powers under subsection (e), may implement this section
in accordance with the plan of dissolution approved by the
commissioner under subsection (f).
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. "Application organization" means an entity that:
(1) is a navigator described in Section 1311(i) of PPACA (42
U.S.C. 18031(i));
(2) assists individuals with application for and enrollment in
a health benefit exchange or public health insurance program,
including an entity that makes presumptive eligibility
determinations; and
(3) performs the functions of a navigator with respect to a
health benefit exchange as established by the commissioner.
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 an individual who:
(1) is described in Section 1311(i) of PPACA (42 U.S.C.
18031(i));
(2) assists other individuals with application for and
enrollment in a health benefit exchange or public health
insurance program, including an individual who makes
presumptive eligibility determinations; and
(3) performs the functions of a navigator with respect to a
health benefit exchange as established by the commissioner.
(b) The term does not include a representative authorized by an
individual to perform functions on behalf of the individual in
connection with Medicaid.
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 Application
Organizations
Sec. 1. (a) This chapter applies to a person that acts as a
navigator or an application organization 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 shall obtain
certification under this chapter before acting as a navigator.
(c) An entity that intends to act as an application organization
shall obtain registration under this chapter before acting as an
application organization.
(d) The following are subject to regulation by the commissioner
and the secretary:
(1) A navigator.
business of insurance.
(10) Shall not use fraudulent, coercive, or dishonest practices,
or demonstrate incompetence or untrustworthiness, in acting
as a navigator or an application organization.
(11) Shall not improperly use notes or other reference
material to complete an examination for certification under
this chapter.
(12) If the person is a navigator, 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 person is an application organization, shall not fail
to verify that each navigator working for the application
organization meets the following requirements:
(A) The navigator is certified under this chapter.
(B) The navigator has not committed an act that would be
grounds for denial, suspension, or revocation of
certification under this chapter.
(16) Shall not receive consideration from a health insurance
issuer (as defined in Section 2791 of the federal Public Health
Service Act (42 U.S.C. 300gg-91)) in connection with the
enrollment of an individual in a health plan.
(b) The commissioner may:
(1) reprimand a navigator or an application organization;
(2) levy a civil penalty against a navigator or an application
organization;
(3) place a navigator or an application organization on
probation;
(4) suspend a navigator's certification or an application
organization's registration;
(5) revoke a navigator's certification or an application
organization's registration for a period of years;
(6) permanently revoke a navigator's certification or an
application organization's registration;
(7) issue a cease and desist order to a navigator or an
application organization; or
(8) take any combination of the actions described in
subdivisions (1) through (7);
writing.
(b) If an application organization, because of a violation
described in section 3 of this chapter, revokes the appointment of
a navigator described in subsection (a) who works for the
application organization, the application organization 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 navigator at the
navigator'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 navigator 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 certification or registration under this chapter
must contain the navigator's or application organization's name
and address, the date of issuance, the expiration date, and any
other information the commissioner considers necessary.
(b) A navigator or an application organization 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 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;
(3) the insurance laws of Indiana that apply to the functions
of a navigator with respect to a health benefit exchange,
including rules related to public health insurance programs;
and
(4) the obligations of a navigator related to confidentiality of
information and conflicts of interest.
(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;
(3) insurance laws of Indiana that apply to the functions of a
navigator with respect to a health benefit exchange, including
rules related to public health insurance programs; and
(4) the obligations of a navigator related to confidentiality of
information and conflicts of interest.
(d) The commissioner:
(1) in consultation with the secretary, shall develop:
(A) a curriculum for a course of study for navigators; and
(B) policies and procedures to allow a registered
application organization to develop a training program
and a course curriculum that meets the requirements of
subsection (b) for use in training navigators who perform
the navigators' services on behalf of the registered
application organization; and
(2) may contract with one (1) or more third party
organizations to do any of the following with respect to the
course of study described in subdivision (1)(A):
(A) Develop examinations and course materials.
(B) Administer examinations and courses of study.
(C) Collect nonrefundable course and examination fees.
(e) All training programs, course curriculums, examinations,
course materials, and examination fees referred to in subsection (d)
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
(2) may contract with one (1) or more third party
organizations 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 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 unless the insurance producer
or insurance consultant has completed the continuing
education requirements that apply to a navigator; and
(2) shall receive a designation from the commissioner as a
navigator 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.
Medicare program (42 U.S.C. 1395 et seq.) and the
Medicaid program (IC 12-15).
(3) Information concerning the number of individuals
participating in a program described in subdivision (2)(A) and
(2)(B) who would be eligible for a tax credit under the federal
Patient Protection and Affordable Care Act (P.L. 111-148).
(c) This SECTION expires December 31, 2013.