HB 1407-1_ Filed 04/24/2003, 15:15
CONFERENCE COMMITTEE REPORT
DIGEST FOR EHB 1407
Citations Affected:
IC 4-1-8-1
;
IC 9-25-5-5
;
IC 12-17.6-4-5
;
IC 16-21-2-16
;
IC 16-25-3-11
;
IC 16-27-1-17
;
IC 16-28-2-10
;
IC 22-2-2-3
;
IC 22-3-3-13
;
IC 22-4-8-3
;
IC 24-4.5-6-201
;
IC 25-1-9-19
; IC 27-1;
IC 27-2-17-3
;
IC 27-2-17-6
;
IC 27-4-1-2
;
IC 27-4-1-4
;
IC 27-4-3
;
IC 27-5-4-2
;
IC 27-6-9-5
; IC 27-7; IC 27-8; IC 27-9;
IC 27-10-3-1
;
IC 27-10-3-3
;
IC 27-11-8-9
;
IC 27-13;
IC 28-1-11-2
;
IC 28-1-11-2.5
;
IC 28-5-1-6.5
;
IC 28-6.1-6-14
;
IC 28-7-1-9.1
;
IC 28-14-3-10
;
IC 28-14-3-11
;
IC 34-18-5-3
;
IC 35-43-9-4.
Synopsis: Insurance matters. Replaces references to insurance agents and limited insurance
representatives with insurance producer. Provides that in certain circumstances a life insurance
company may issue or issue for delivery in Indiana funding agreements. Allows the insurance
commissioner to waive requirements related to accident and sickness insurer and health
maintenance organization processing of paper claims under certain circumstances. Provides that
an accident and sickness insurer or a health maintenance organization that does not resolve an
appeal within the statutory time frame commits an unfair and deceptive act or practice in the
business of insurance. Requires quarterly reporting regarding resolution of grievance appeals.
Specifies certain requirements for health care providers concerning notice to patients of third
party billings. (This conference committee report provides that an accident and sickness
insurer or a health maintenance organization that does not resolve an appeal within the
statutory time frame commits an unfair and deceptive act or practice in the business of
insurance. Requires quarterly reporting regarding resolution of grievance appeals.
Specifies certain requirements for health care providers concerning notice to patients of
third party billings.)
Effective: Upon passage; July 1, 2003; January 1, 2004.
CONFERENCE COMMITTEE REPORT
MR. PRESIDENT:
Your Conference Committee appointed to confer with a like committee from the House
upon Engrossed Senate Amendments to Engrossed House Bill No. 1407 respectfully reports
that said two committees have conferred and agreed as follows to wit:
that the House recede from its dissent from all Senate amendments and that
the House now concur in all Senate amendments to the bill and that the bill
be further amended as follows:
Delete everything after the enacting clause and insert:
SOURCE: IC 4-1-8-1; (03)CC140701.1.1. -->
SECTION 1.
IC 4-1-8-1
, AS AMENDED BY HEA 1935-2003,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 1. (a) No individual may be compelled by any
state agency, board, commission, department, bureau, or other entity of
state government (referred to as "state agency" in this chapter) to
provide the individual's Social Security number to the state agency
against the individual's will, absent federal requirements to the
contrary. However, the provisions of this chapter do not apply to the
following:
(1) Department of state revenue.
(2) Department of workforce development.
(3) The programs administered by:
(A) the division of family and children;
(B) the division of mental health and addiction;
(C) the division of disability, aging, and rehabilitative services;
and
(D) the office of Medicaid policy and planning;
of the office of the secretary of family and social services.
(4) Auditor of state.
(5) State personnel department.
(6) Secretary of state, with respect to the registration of
broker-dealers, agents, and investment advisors.
(7) The legislative ethics commission, with respect to the
registration of lobbyists.
(8) Indiana department of administration, with respect to bidders
on contracts.
(9) Indiana department of transportation, with respect to bidders on
contracts.
(10) Health professions bureau.
(11) Indiana professional licensing agency.
(12) Indiana department of insurance, with respect to licensing of
insurance agents. producers.
(13) A pension fund administered by the board of trustees of the
public employees' retirement fund.
(14) The Indiana state teachers' retirement fund.
(15) The state police benefit system.
(b) The bureau of motor vehicles may, notwithstanding this chapter,
require the following:
(1) That an individual include the individual's Social Security
number in an application for an official certificate of title for any
vehicle required to be titled under IC 9-17.
(2) That an individual include the individual's Social Security
number on an application for registration.
(3) That a corporation, limited liability company, firm, partnership,
or other business entity include its federal tax identification
number on an application for registration.
(c) The Indiana department of administration, the Indiana department
of transportation, the health professions bureau, and the Indiana
professional licensing agency may require an employer to provide its
federal employer identification number.
(d) The department of correction may require a committed offender
to provide the offender's Social Security number for purposes of
matching data with the Social Security Administration to determine
benefit eligibility.
(e) The Indiana gaming commission may, notwithstanding this
chapter, require the following:
(1) That an individual include the individual's Social Security
number in any application for a riverboat owner's license,
supplier's license, or occupational license.
(2) That a sole proprietorship, a partnership, an association, a
fiduciary, a corporation, a limited liability company, or any other
business entity include its federal tax identification number on an
application for a riverboat owner's license or supplier's license.
(f) Notwithstanding this chapter, the professional standards board
established by
IC 20-1-1.4-2
may require an individual who applies to
the board for a license or an endorsement to provide the individual's
Social Security number. The Social Security number may be used by
the board only for conducting a background investigation, if the board
is authorized by statute to conduct a background investigation of an
individual for issuance of the license or endorsement.
SOURCE: IC 9-25-5-5; (03)CC140701.1.2. -->
SECTION 2.
IC 9-25-5-5
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 5. (a) A person who receives a
request for evidence of financial responsibility under section 3 of this
chapter shall set forth in the certificate of compliance the following
information concerning the form of financial responsibility that was in
effect with respect to the motor vehicle on the date in question:
(1) If a motor vehicle liability policy was in effect, the following:
(A) The name and address of the insurer.
(B) The limits of coverage of the policy.
(C) The identification number applying to the policy.
(2) If a bond was in effect, the following:
(A) The name and address of the bond company or surety.
(B) The face amount of the bond.
(3) If self-insurance was in effect under
IC 9-25-4-11
, the
following:
(A) The date on which the certificate of self-insurance was
issued by the bureau.
(B) The name of the person to whom the certificate of
self-insurance was issued.
(b) A person who requests information or verification of coverage to
complete a certificate of compliance under subsection (a) from:
(1) an insurance company; or
(2) an insurance agent; producer;
is not required to give the company or the agent producer a reason for
requesting the information unless the person has been involved in an
accident.
SOURCE: IC 12-17.6-4-5; (03)CC140701.1.3. -->
SECTION 3.
IC 12-17.6-4-5
, AS ADDED BY P.L.273-1999,
SECTION 177, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 5. (a) It is a violation of
IC 27-4-1-4
if an insurer, or an insurance agent producer or insurance broker
compensated by the insurer, knowingly or intentionally refers an
insured or the dependent of an insured to the program for health
insurance coverage when the insured already receives health insurance
coverage through an employer's health care plan that is underwritten by
the insurer.
(b) The office shall coordinate with the children's health policy board
under
IC 4-23-27
to evaluate the need for mechanisms that minimize
the incentive for an employer to eliminate or reduce health care
coverage for an employee's dependents.
SOURCE: IC 16-21-2-16; (03)CC140701.1.4. -->
SECTION 4.
IC 16-21-2-16
IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2004]: Sec. 16. A hospital or an ambulatory
outpatient surgical center that provides to a patient notice
concerning a third party billing for a service provided to the
patient shall ensure that the notice:
(1) conspicuously states that the notice is not a bill;
(2) does not include a tear-off portion; and
(3) is not accompanied by a return mailing envelope.
SOURCE: IC 16-25-3-11; (03)CC140701.1.5. -->
SECTION 5.
IC 16-25-3-11
IS ADDED TO THE INDIANA CODE
AS A
NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2004]:
Sec. 11. A hospice that provides to a hospice
program patient notice concerning a third party billing for a
hospice service provided to the hospice program patient shall
ensure that the notice:
(1) conspicuously states that the notice is not a bill;
(2) does not include a tear-off portion; and
(3) is not accompanied by a return mailing envelope.
SOURCE: IC 16-27-1-17; (03)CC140701.1.6. -->
SECTION 6.
IC 16-27-1-17
IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2004]: Sec. 17. A home health agency that provides
to a patient notice concerning a third party billing for a home
health service provided to the patient shall ensure that the notice:
(1) conspicuously states that the notice is not a bill;
(2) does not include a tear-off portion; and
(3) is not accompanied by a return mailing envelope.
SOURCE: IC 16-28-2-10; (03)CC140701.1.7. -->
SECTION 7.
IC 16-28-2-10
IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2004]: Sec. 10. A health facility that provides to a
patient notice concerning a third party billing for a service
provided to the patient shall ensure that the notice:
(1) conspicuously states that the notice is not a bill;
(2) does not include a tear-off portion; and
(3) is not accompanied by a return mailing envelope.
SOURCE: IC 22-2-2-3; (03)CC140701.1.8. -->
SECTION 8.
IC 22-2-2-3
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 3. As used in this chapter:
"Commissioner" means the commissioner of labor or the
commissioner's authorized representative.
"Department" means the department of labor.
"Occupation" means an industry, trade, business, or class of work in
which employees are gainfully employed.
"Employer" means any individual, partnership, association, limited
liability company, corporation, business trust, the state, or other
governmental agency or political subdivision during any work week in
which they have two (2) or more employees. However, it shall not
include any employer who is subject to the minimum wage provisions
of the federal Fair Labor Standards Act of 1938, as amended (29 U.S.C.
201-209).
"Employee" means any person employed or permitted to work or
perform any service for remuneration or under any contract of hire,
written or oral, express or implied by an employer in any occupation,
but shall not include any of the following:
(a) Persons less than sixteen (16) years of age.
(b) Persons engaged in an independently established trade,
occupation, profession, or business who, in performing the services
in question, are free from control or direction both under a contract
of service and in fact.
(c) Persons performing services not in the course of the employing
unit's trade or business.
(d) Persons employed on a commission basis.
(e) Persons employed by their own parent, spouse, or child.
(f) Members of any religious order performing any service for that
order, any ordained, commissioned, or licensed minister, priest,
rabbi, sexton, or Christian Science reader, and volunteers
performing services for any religious or charitable organization.
(g) Persons performing services as student nurses in the employ of
a hospital or nurses training school while enrolled and regularly
attending classes in a nurses training school chartered or approved
under law, or students performing services in the employ of
persons licensed as both funeral directors and embalmers as a part
of their requirements for apprenticeship to secure an embalmer's
license or a funeral director's license from the state, or during their
attendance at any schools required by law for securing an
embalmer's or funeral director's license.
(h) Persons who have completed a four (4) year course in a
medical school approved by law when employed as interns or
resident physicians by any accredited hospital.
(i) Students performing services for any school, college, or
university in which they are enrolled and are regularly attending
classes.
(j) Persons with physical or mental disabilities performing services
for nonprofit organizations organized primarily for the purpose of
providing employment for persons with disabilities or for assisting
in their therapy and rehabilitation.
(k) Persons employed as insurance
agents, producers, insurance
solicitors, and outside salesmen, if all their services are performed
for remuneration solely by commission.
(l) Persons performing services for any camping, recreational, or
guidance facilities operated by a charitable, religious, or
educational nonprofit organization.
(m) Persons engaged in agricultural labor. The term shall include
only services performed:
(1) on a farm, in connection with cultivating the soil, or in
connection with raising or harvesting any agricultural or
horticultural commodity, including the raising, shearing, feeding,
caring for, training, and management of livestock, bees, poultry,
and furbearing animals and wildlife;
(2) in the employ of the owner or tenant or other operator of a
farm, in connection with the operation, management,
conservation, improvement, or maintenance of the farm and its
tools and equipment if the major part of the service is performed
on a farm;
(3) in connection with:
(A) the production or harvesting of maple sugar or maple
syrup or any commodity defined as an agricultural commodity
in the Agricultural Marketing Act, as amended (12 U.S.C.
1141j);
(B) the raising or harvesting of mushrooms;
(C) the hatching of poultry; or
(D) the operation or maintenance of ditches, canals, reservoirs,
or waterways used exclusively for supplying and storing water
for farming purposes; and
(4) in handling, planting, drying, packing, packaging, processing,
freezing, grading, storing, or delivering to storage, to market, or
to a carrier for transportation to market, any agricultural or
horticultural commodity, but only if service is performed as an
incident to ordinary farming operation or, in the case of fruits
and vegetables, as an incident to the preparation of fruits and
vegetables for market. However, this exception shall not apply
to services performed in connection with any agricultural or
horticultural commodity after its delivery to a terminal market or
processor for preparation or distribution for consumption.
As used in this subdivision, "farm" includes stock, dairy, poultry,
fruit, furbearing animals, and truck farms, nurseries, orchards, or
greenhouses or other similar structures used primarily for the
raising of agricultural or horticultural commodities.
(n) Those persons employed in executive, administrative, or
professional occupations who have the authority to employ or
discharge and who earn one hundred fifty dollars ($150) or more
a week, and outside salesmen.
(o) Any person not employed for more than four (4) weeks in any
four (4) consecutive three (3) month periods.
(p) Any employee with respect to whom the Interstate Commerce
Commission has power to establish qualifications and maximum
hours of service under the federal Motor Carrier Act of 1935 (49
U.S.C. 304(3)) or any employee of a carrier subject to IC 8-2.1.
SOURCE: IC 22-3-3-13; (03)CC140701.1.9. -->
SECTION 9.
IC 22-3-3-13
, AS AMENDED BY P.L.202-2001,
SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 13. (a) As used in this section, "board" refers to
the worker's compensation board created under
IC 22-3-1-1.
(b) If an employee who from any cause, had lost, or lost the use of,
one (1) hand, one (1) arm, one (1) foot, one (1) leg, or one (1) eye, and
in a subsequent industrial accident becomes permanently and totally
disabled by reason of the loss, or loss of use of, another such member
or eye, the employer shall be liable only for the compensation payable
for such second injury. However, in addition to such compensation and
after the completion of the payment therefor, the employee shall be
paid the remainder of the compensation that would be due for such
total permanent disability out of a special fund known as the second
injury fund, and created in the manner described in subsection (c).
(c) Whenever the board determines under the procedures set forth in
subsection (d) that an assessment is necessary to ensure that fund
beneficiaries, including applicants under section 4(e) of this chapter,
continue to receive compensation in a timely manner for a reasonable
prospective period, the board shall send notice not later than October
1 in any year to:
(1) all insurance carriers and other entities insuring or providing
coverage to employers who are or may be liable under this article
to pay compensation for personal injuries to or the death of their
employees under this article; and
(2) each employer carrying the employer's own risk;
stating that an assessment is necessary. After June 30, 1999, the board
may conduct an assessment under this subsection not more than one (1)
time annually. Every insurance carrier and other entity insuring or
providing coverage to employers who are or may be liable under this
article to pay compensation for personal injuries to or death of their
employees under this article and every employer carrying the
employer's own risk, shall, within thirty (30) days of the board sending
notice under this subsection, pay to the worker's compensation board
for the benefit of the fund an assessed amount that may not exceed two
and one-half percent (2.5%) of the total amount of all worker's
compensation paid to injured employees or their beneficiaries under
IC 22-3-2
through
IC 22-3-6
for the calendar year next preceding the
due date of such payment. For the purposes of calculating the
assessment under this subsection, the board may consider payments for
temporary total disability, temporary partial disability, permanent total
impairment, permanent partial impairment, or death of an employee.
The board may not consider payments for medical benefits in
calculating an assessment under this subsection. If the amount to the
credit of the second injury fund on or before October 1 of any year
exceeds one million dollars ($1,000,000), the assessment allowed
under this subsection shall not be assessed or collected during the
ensuing year. But when on or before October 1 of any year the amount
to the credit of the fund is less than one million dollars ($1,000,000),
the payments of not more than two and one-half percent (2.5%) of the
total amount of all worker's compensation paid to injured employees or
their beneficiaries under
IC 22-3-2
through
IC 22-3-6
for the calendar
year next preceding that date shall be resumed and paid into the fund.
The board may not use an assessment rate greater than twenty-five
hundredths of one percent (0.25%) above the amount recommended by
the study performed before the assessment.
(d) The board shall enter into a contract with an actuary or another
qualified firm that has experience in calculating worker's compensation
liabilities. Not later than September 1 of each year, the actuary or other
qualified firm shall calculate the recommended funding level of the
fund based on the previous year's claims and inform the board of the
results of the calculation. If the amount to the credit of the fund is less
than the amount required under subsection (c), the board may conduct
an assessment under subsection (c). The board shall pay the costs of the
contract under this subsection with money in the fund.
(e) An assessment collected under subsection (c) on an employer
who is not self-insured must be assessed through a surcharge based on
the employer's premium. An assessment collected under subsection (c)
does not constitute an element of loss, but for the purpose of collection
shall be treated as a separate cost imposed upon insured employers. A
premium surcharge under this subsection must be collected at the same
time and in the same manner in which the premium for coverage is
collected, and must be shown as a separate amount on a premium
statement. A premium surcharge under this subsection must be
excluded from the definition of premium for all purposes, including the
computation of agent insurance producer commissions or premium
taxes. However, an insurer may cancel a worker's compensation policy
for nonpayment of the premium surcharge. A cancellation under this
subsection must be carried out under the statutes applicable to the
nonpayment of premiums.
(f) The sums shall be paid by the board to the treasurer of state, to be
deposited in a special account known as the second injury fund. The
funds are not a part of the general fund of the state. Any balance
remaining in the account at the end of any fiscal year shall not revert
to the general fund. The funds shall be used only for the payment of
awards of compensation and expense of medical examinations or
treatment made and ordered by the board and chargeable against the
fund pursuant to this section, and shall be paid for that purpose by the
treasurer of state upon award or order of the board.
(g) If an employee who is entitled to compensation under
IC 22-3-2
through
IC 22-3-6
either:
(1) exhausts the maximum benefits under section 22 of this chapter
without having received the full amount of award granted to the
employee under section 10 of this chapter; or
(2) exhausts the employee's benefits under section 10 of this
chapter;
then such employee may apply to the board, who may award the
employee compensation from the second injury fund established by this
section, as follows under subsection (h).
(h) An employee who has exhausted the employee's maximum
benefits under section 10 of this chapter may be awarded additional
compensation equal to sixty-six and two-thirds percent (66 2/3%) of the
employee's average weekly wage at the time of the employee's injury,
not to exceed the maximum then applicable under section 22 of this
chapter, for a period of not to exceed one hundred fifty (150) weeks
upon competent evidence sufficient to establish:
(1) that the employee is totally and permanently disabled from
causes and conditions of which there are or have been objective
conditions and symptoms proven that are not within the physical
or mental control of the employee; and
(2) that the employee is unable to support the employee in any
gainful employment, not associated with rehabilitative or
vocational therapy.
(i) The additional award may be renewed during the employee's total
and permanent disability after appropriate hearings by the board for
successive periods not to exceed one hundred fifty (150) weeks each.
The provisions of this section apply only to injuries occurring
subsequent to April 1, 1950, for which awards have been or are in the
future made by the board under section 10 of this chapter. Section 16
of this chapter does not apply to compensation awarded from the
second injury fund under this section.
(j) All insurance carriers subject to an assessment under this section
are required to provide to the board:
(1) not later than January 31 each calendar year; and
(2) not later than thirty (30) days after a change occurs;
the name, address, and electronic mail address of a representative
authorized to receive the notice of an assessment.
SOURCE: IC 22-4-8-3; (03)CC140701.1.10. -->
SECTION 10.
IC 22-4-8-3
, AS AMENDED BY P.L.1-2003,
SECTION 70, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 3. "Employment" shall not include the following:
(a) Except as provided in section 2(i) of this chapter, service
performed prior to January 1, 1978, in the employ of this state, any
other state, any town or city, or political subdivision, or any
instrumentality of any of them, other than service performed in the
employ of a municipally owned public utility as defined in this article;
or service performed in the employ of the United States of America, or
an instrumentality of the United States immune under the Constitution
of the United States from the contributions imposed by this article,
except that to the extent that the Congress of the United States shall
permit states to require any instrumentalities of the United States to
make payments into an unemployment fund under a state
unemployment compensation statute, all of the provisions of this article
shall be applicable to such instrumentalities, in the same manner, to the
same extent, and on the same terms as to all other employers,
employing units, individuals, and services. However, if this state shall
not be certified for any year by the Secretary of Labor under Section
3304 of the Internal Revenue Code the payments required of such
instrumentalities with respect to such year shall be refunded by the
commissioner from the fund in the same manner and within the same
period as is provided in
IC 22-4-32-19
with respect to contribution
erroneously paid or wrongfully assessed.
(b) Service with respect to which unemployment compensation is
payable under an unemployment compensation system established by
an Act of Congress; however, the board is authorized to enter into
agreements with the proper agencies under such Act of Congress,
which agreements shall become effective ten (10) days after
publication thereof in the manner provided in
IC 22-4-19-2
for rules of
the board, to provide reciprocal treatment to individuals who have,
after acquiring potential rights to benefits under this article, acquired
rights to unemployment compensation under such Act of Congress, or
who have, after having acquired potential rights to unemployment
compensation under such Act of Congress, acquired rights to benefits
under this article.
(c) "Agricultural labor" as provided in section 2(l)(1) of this chapter
shall include only services performed:
(i) on a farm, in the employ of any person, in connection with
cultivating the soil or in connection with raising or harvesting any
agricultural or horticultural commodity, including the raising,
shearing, feeding, caring for, training, and management of
livestock, bees, poultry, and furbearing animals and wildlife;
(ii) in the employ of the owner or tenant or other operator of a
farm, in connection with the operation, management, conservation,
improvement, or maintenance of such farm and its tools and
equipment, or in salvaging timber or clearing land of brush and
other debris left by a hurricane, if the major part of such service is
performed on a farm;
(iii) in connection with the production or harvesting of any
commodity defined as an agricultural commodity in Section 15(g)
of the Agricultural Marketing Act, as amended, or in connection
with the operation or maintenance of ditches, canals, reservoirs, or
waterways, not owned or operated for profit, used exclusively for
supplying and storing water for farming purposes;
(iv)(A) in the employ of the operator of a farm in handling,
planting, drying, packing, packaging, processing, freezing, grading,
storing, or delivering to storage or to market or to a carrier for
transportation to market, in its unmanufactured state, any
agricultural or horticultural commodity; but only if such operator
produced more than one-half (1/2) of the commodity with respect
to which such service is performed;
(B) in the employ of a group of operators of farms (or a cooperative
organization of which such operators are members) in the
performance of service described in subdivision (A), but only if
such operators produce more than one-half (1/2) of the commodity
with respect to which such service is performed;
(C) the provisions of subdivisions (A) and (B) shall not be deemed
to be applicable with respect to service performed in connection
with commercial canning or commercial freezing or in connection
with any agricultural or horticultural commodity after its delivery
to a terminal market for distribution for consumption; or
(v) on a farm operated for profit if such service is not in the course
of the employer's trade or business or is domestic service in a
private home of the employer.
As used in this subsection, "farm" includes stock, dairy, poultry, fruit,
furbearing animals, and truck farms, nurseries, orchards, greenhouses,
or other similar structures used primarily for the raising of agricultural
or horticultural commodities.
(d) Domestic service in a private home, local college club, or local
chapter of a college fraternity or sorority, except as provided in section
2(m) of this chapter.
(e) Service performed on or in connection with a vessel or aircraft not
an American vessel or American aircraft, if the employee is employed
on and in connection with such vessel or aircraft when outside the
United States.
(f) Service performed by an individual in the employ of child or
spouse, and service performed by a child under the age of twenty-one
(21) in the employ of a parent.
(g) Service not in the course of the employing unit's trade or business
performed in any calendar quarter by an individual, unless the cash
remuneration paid for such service is fifty dollars ($50) or more and
such service is performed by an individual who is regularly employed
by such employing unit to perform such service. For the purposes of
this subsection, an individual shall be deemed to be regularly employed
to perform service not in the course of an employing unit's trade or
business during a calendar quarter only if:
(i) on each of some of twenty-four (24) days during such quarter
such individual performs such service for some portion of the day;
or
(ii) such individual was regularly employed (as determined under
clause (i)) by such employing unit in the performance of such
service during the preceding calendar quarter.
(h) Service performed by an individual in any calendar quarter in the
employ of any organization exempt from income tax under Section 501
of the Internal Revenue Code (except those services included in
sections 2(i) and 2(j) of this chapter if the remuneration for such
service is less than fifty dollars ($50).
(i) Service performed in the employ of a hospital, if such service is
performed by a patient of such hospital.
(j) Service performed in the employ of a school, college, or university
if such service is performed:
(i) by a student who is enrolled and is regularly attending classes
at such school, college, or university; or
(ii) by the spouse of such a student, if such spouse is advised, at the
time such spouse commences to perform such service, that:
(A) the employment of such spouse to perform such service is
provided under a program to provide financial assistance to such
student by such school, college, or university; and
(B) such employment will not be covered by any program of
unemployment insurance.
(k) Service performed by an individual who is enrolled at a nonprofit
or public educational institution which normally maintains a regular
faculty and curriculum and normally has a regularly organized body of
students in attendance at the place where its educational activities are
carried on as a student in a full-time program, taken for credit at such
institution, which combines academic instruction with work
experience, if such service is an integral part of such program, and such
institution has so certified to the employer, except that this subsection
shall not apply to service performed in a program established for or on
behalf of an employer or group of employers.
(l) Service performed in the employ of a government foreign to the
United States of America, including service as a consular or other
officer or employee or a nondiplomatic representative.
(m) Service performed in the employ of an instrumentality wholly
owned by a government foreign to that of the United States of America,
if the service is of a character similar to that performed in foreign
countries by employees of the United States of America or of an
instrumentality thereof, and if the board finds that the Secretary of State
of the United States has certified to the Secretary of the Treasury of the
United States that the government, foreign to the United States, with
respect to whose instrumentality exemption is claimed, grants an
equivalent exemption with respect to similar service performed in such
country by employees of the United States and of instrumentalities
thereof.
(n) Service performed as a student nurse in the employ of a hospital
or nurses' training school by an individual who is enrolled and is
regularly attending classes in a nurses' training school chartered or
approved pursuant to state law; and service performed as an intern in
the employ of a hospital by an individual who has completed a four (4)
year course in a medical school chartered or approved pursuant to state
law.
(o) Service performed by an individual as an insurance agent
producer or as an insurance solicitor, if all such service performed by
such individual is performed for remuneration solely by way of
commission.
(p)(A) Service performed by an individual under the age of eighteen
(18) in the delivery or distribution of newspapers or shopping news, not
including delivery or distribution to any point for subsequent delivery
or distribution.
(B) Services performed by an individual in, and at the time of, the
sale of newspapers or magazines to ultimate consumers, under an
arrangement under which the newspapers or magazines are to be sold
by him at a fixed price, his compensation being based on the retention
of the excess of such price over the amount at which the newspapers or
magazines are charged to him, whether or not he is guaranteed a
minimum amount of compensation for such service, or is entitled to be
credited with the unsold newspapers or magazines turned back.
(q) Service performed in the employ of an international organization.
(r) Except as provided in
IC 22-4-7-1
, services covered by an election
duly approved by the agency charged with the administration of any
other state or federal unemployment compensation law in accordance
with an arrangement pursuant to
IC 22-4-22-1
through
IC 22-4-22-5
,
during the effective period of such election.
(s) If the service performed during one-half (1/2) or more of any pay
period by an individual for an employing unit constitutes employment,
all the services of such individual for such period shall be deemed to
be employment; but if the services performed during more than
one-half (1/2) of any pay period by such an individual do not constitute
employment, then none of the services of such individual for such
period shall be deemed to be employment. As used in this subsection,
"pay period" means a period of not more than thirty-one (31)
consecutive days for which a payment of remuneration is ordinarily
made to the individual by the employing unit. This subsection shall not
be applicable with respect to services performed in a pay period by any
such individual where any such service is excepted by subsection (b).
(t) Service performed by an inmate of a custodial or penal institution.
(u) Service performed as a precinct election officer (as defined in
IC 3-5-2-40.1
).
SOURCE: IC 24-4.5-6-201; (03)CC140701.1.11. -->
SECTION 11.
IC 24-4.5-6-201
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 201. (1) This section,
IC 24-4.5-6-202
, and
IC 24-4.5-6-203
apply to a person, including a
supervised financial organization, engaged in Indiana in any of the
following:
(a) Making consumer credit sales, consumer leases, or consumer
loans.
(b) Taking assignments of rights against debtors that arise from
sales, leases, or loans by a person having an office or a place of
business in Indiana, and undertaking direct collection of payments
from the debtors or enforcement of rights against the debtors.
(c) Placing consumer credit insurance, receiving commissions for
consumer credit insurance, or acting as an agent a limited line
credit insurance producer in the sale of consumer credit
insurance.
(2) This section,
IC 24-4.5-6-202
, and
IC 24-4.5-6-203
are not
applicable to a seller whose credit sales consist entirely of sales made
pursuant to a seller credit card issued by a person other than the seller
if the issuer of the card has complied with the provisions of this
section,
IC 24-4.5-6-202
, and
IC 24-4.5-6-203.
(3) This section,
IC 24-4.5-6-202
, and
IC 24-4.5-6-203
apply to a
seller whose credit sales are made using credit cards that:
(a) are issued by a lender;
(b) are in the name of the seller; and
(c) can be used by the buyer or lessee only for purchases or leases
at locations of the named seller.
SOURCE: IC 25-1-9-19; (03)CC140701.1.12. -->
SECTION 12.
IC 25-1-9-19
IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2004]: Sec. 19. A practitioner that provides to a
patient notice concerning a third party billing for a health care
service provided to the patient shall ensure that the notice:
(1) conspicuously states that the notice is not a bill;
(2) does not include a tear-off portion; and
(3) is not accompanied by a return mailing envelope.
SOURCE: IC 27-1-2-3; (03)CC140701.1.13. -->
SECTION 13.
IC 27-1-2-3
, AS AMENDED BY P.L.48-2000,
SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 3. As used in this article, and unless a different
meaning appears from the context: (a) "Insurance" means a contract of
insurance or an agreement by which one (1) party, for a consideration,
promises to pay money or its equivalent or to do an act valuable to the
insured upon the destruction, loss or injury of something in which the
other party has a pecuniary interest, or in consideration of a price paid,
adequate to the risk, becomes security to the other against loss by
certain specified risks; to grant indemnity or security against loss for a
consideration.
(b) "Commissioner" means the "insurance commissioner" of this
state.
(c) "Department" means "the department of insurance" of this state.
(d) The term "company" or "corporation" means an insurance
company and includes all persons, partnerships, corporations,
associations, orders or societies engaged in or proposing to engage in
making any kind of insurance authorized by the laws of this state.
(e) The term "domestic company" or "domestic corporation" means
an insurance company organized under the insurance laws of this state.
(f) The term "foreign company" or "foreign corporation" means an
insurance company organized under the laws of any state of the United
States other than this state or under the laws of any territory or insular
possession of the United States or the District of Columbia.
(g) The term "alien company" or "alien corporation" means an
insurance company organized under the laws of any country other than
the United States or territory or insular possession thereof or of the
District of Columbia.
(h) The term "person" includes individuals, corporations,
associations, and partnerships; personal pronoun includes all genders;
the singular includes the plural and the plural includes the singular.
(k) The term "insurance solicitor" means any natural person
employed to aid an insurance
agent producer in any manner in
soliciting, negotiating, or effecting contracts of insurance or indemnity
other than life.
(l) The term "principal office" means that office maintained by the
corporation in this state, the address of which is required by the
provisions of this article to be kept on file in the office of the
department.
(m) The term "articles of incorporation" includes both the original
articles of incorporation and any and all amendments thereto, except
where the original articles of incorporation only are expressly referred
to, and includes articles of merger, consolidation and reinsurance, and
in case of corporations, heretofore organized, articles of reorganization
filed in the office of the secretary of state, and all amendments thereto.
(n) The term "shareholder" means one who is a holder of record of
shares of stock in a corporation, unless the context otherwise requires.
(o) The term "policyholder" means one who is a holder of a contract
of insurance in an insurance company.
(p) The term "member" means one who holds a contract of insurance
or is insured in an insurance company other than a stock corporation.
(q) The term "capital stock" means the aggregate amount of the par
value of all shares of capital stock.
(r) The term "capital" means the aggregate amount paid in on the
shares of capital stock of a corporation issued and outstanding.
(s) The term "life insurance company" means any company making
one or more of the kinds of insurance set out and defined in class 1(a)
of
IC 27-1-5-1.
(t) The term "casualty insurance company" means any company
making the kind or kinds of insurance set out and defined in class 2 of
IC 27-1-5-1.
(u) The term "fire and marine insurance company" means any
company making the kind or kinds of insurance set out and defined in
class 3 of
IC 27-1-5-1.
(v) The term "certificate of authority" means an instrument in writing
issued by the department to an insurer, which sets out the authority of
such insurer to engage in the business of insurance or activities
connected therewith.
(w) The term "premium" means money or any other thing of value
paid or given in consideration to an insurer,
agent, insurance
producer, or solicitor on account of or in connection with a contract of
insurance and shall include as a part but not in limitation of the above,
policy fees, admission fees, membership fees and regular or special
assessments and payments made on account of annuities.
(x) The term "insurer" means a company, firm, partnership,
association, order, society or system making any kind or kinds of
insurance and shall include associations operating as Lloyds, reciprocal
or inter-insurers, or individual underwriters.
(y) The terms "assessment plan" and "assessment insurance" mean
the mode or plan and the business of a corporation, association or
society organized and limited to the making of insurance on the lives
of persons and against disability from disease, bodily injury or death by
accident, and which provides for the payment of policy claims,
accumulation of reserve or emergency funds, and the expenses of the
management and prosecution of its business by payments to be made
either at stated periods named in the contract or upon assessments, and
wherein the insured's liability to contribute is not limited to a fixed
sum.
(z) "Agency billed" refers to a system in which an insured pays a
premium directly to an insurance agency.
SOURCE: IC 27-1-6-17; (03)CC140701.1.14. -->
SECTION 14.
IC 27-1-6-17
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 17. The commissioner
may, personally or through his the commissioner's deputies and
assistants, examine into the affairs of any such proposed company and
inspect its books and papers, and may summon and examine under oath
any officer or agent insurance producer or any person who is or has
been connected with such company, and if he the commissioner finds
the company is violating the law, or if the company shall not be
qualified for a certificate of authority within one (1) year from date of
its permit, he the commissioner may revoke its permit; and if he the
commissioner finds an agent insurance producer of such company
has violated the law, he the commissioner may revoke his the
insurance producer's authority, and he the commissioner may for
such agent's the insurance producer's violation revoke the company's
permit. Any revocation shall be after notice and hearing. The
commissioner may renew any company's permit or agent's authority
which he the commissioner has revoked.
SOURCE: IC 27-1-6.5-5; (03)CC140701.1.15. -->
SECTION 15.
IC 27-1-6.5-5
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 5. When any insurer
admitted to transact business in this state transfers its domicile to this
or any other state, its certificate of authority, agents' insurance
producers' appointments and licenses, policy forms, rates,
authorizations, and other filings and approvals which existed at the
time of the transfer, remain in effect after the transfer of domicile
occurs.
SOURCE: IC 27-1-12-43; (03)CC140701.1.16. -->
SECTION 16.
IC 27-1-12-43
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 43. (a) As used in this
section, "life insurance policy" means:
(1) an individual life insurance policy other than a credit life
insurance policy; or
(2) an individual policy of variable life insurance;
that is sold after June 30, 1994.
(b) No life insurance policy may be issued in Indiana or issued for
delivery in Indiana unless it contains a provision allowing the
policyholder to return the policy to:
(1) the insurer;
(2) the agent insurance producer through whom the policy was
purchased; or
(3) any agent of the insurer;
within ten (10) days after the policy is received by the policyholder for
a full refund of all money paid by the policyholder.
(c) Each life insurance policy must have prominently printed on its
first page a notice setting forth in substance the provisions of
subsection (b).
SOURCE: IC 27-1-12.6-5; (03)CC140701.1.17. -->
SECTION 17.
IC 27-1-12.6-5
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 5. Each annuity
contract shall contain a provision giving the purchaser an unrestricted
right to return the contract to the company or to the agent insurance
producer through whom it was purchased, on or before the tenth day
after it is received by the purchaser, such return entitling the purchaser
to a return of the value of a variable annuity account or the monies paid
by the purchaser to a fixed account in connection with the issuance of
the contract. This provision shall be conspicuously placed on the face
of the contract. This provision does not apply to contracts issued in
connection with a pension, annuity, or profit-sharing plan qualified or
exempt under Sections 401, 403, 404, or 501 of the Internal Revenue
Code, if participation in the plan is a condition of employment.
SOURCE: IC 27-1-12.7; (03)CC140701.1.18. -->
SECTION 18.
IC 27-1-12.7
IS ADDED TO THE INDIANA CODE
AS A
NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]:
Chapter 12.7. Funding Agreements
Sec. 1. As used in this chapter, "funding agreement" means an
agreement that:
(1) is issued by a life insurance company to a holder;
(2) authorizes a life insurance company to accept funds; and
(3) provides for an accumulation of the funds for the purpose
of making one (1) or more payments at future dates in amounts
that are not based on mortality or morbidity contingencies of
the holder of the funding agreement.
Sec. 2. As used in this chapter, "holder" means a person
described in section 5 of this chapter that is issued a funding
agreement by a life insurance company.
Sec. 3. As used in this chapter, "life insurance company" means
a life insurance company authorized to issue a product described
in Class 1(c) of
IC 27-1-5-1.
Sec. 4. As used in this chapter, "optional modes of settlement"
means the manner in which the funding agreement is structured to
repay interest and principal to the holder.
Sec. 5. A life insurance company may issue or issue for delivery
in Indiana a funding agreement to the following:
(1) A person authorized by a state or foreign country to engage
in an insurance business or a subsidiary of an insurance
business.
(2) A person who uses the funding agreement for the purpose
of funding:
(A) benefits under an employee benefit plan (as defined in
the federal Employee Retirement Security Act of 1974, 29
U.S.C. 1001 et seq.);
(B) the activities of a nonprofit organization exempt from
federal income taxation under Section 501(c)(3) of the
Internal Revenue Code or a similar nonprofit organization
domiciled in a foreign country;
(C) a program of:
(i) the United States government;
(ii) a state government;
(iii) a political subdivision;
(iv) a foreign country; or
(v) an agency or instrumentality of the United States or a
state government, a political subdivision, or a foreign
country;
(D) an agreement providing for periodic payments in
satisfaction of a claim;
(E) a program of an institution with assets exceeding
twenty-five million dollars ($25,000,000);
(F) a program in which a business entity, including a trust:
(i) purchases and holds funding agreements; and
(ii) issues securities by using the funding agreement to
finance or collateralize the securities; or
(G) any program or activity substantially similar to a
program or an activity described in clauses (A) through (F)
that is first authorized by the commissioner.
Sec. 6. The issuance of a funding agreement:
(1) constitutes an activity necessary, convenient, or expedient
to the business of a life insurance company under
IC 27-1-7-2
;
(2) is not insurance under
IC 27-1-5-1
;
(3) is not a security (as defined in
IC 23-2-1-1
(k)); and
(4) does not constitute gross premium for taxation purposes
under
IC 27-1-18-2.
Sec. 7. An amount may not be guaranteed or credited under a
funding agreement except:
(1) upon reasonable assumptions as to investment income and
expenses; and
(2) on a basis equitable to all holders of funding agreements of
a given class.
Sec. 8. An amount paid to a life insurance company and proceeds
applied to amounts paid under optional modes of settlement under
a funding agreement may be allocated by the insurer to one (1) or
more segregated asset accounts in the manner described in Class
1(c) of
IC 27-1-5-1.
Sec. 9. The commissioner may establish reasonable conditions or
adopt rules under
IC 4-22-2
regarding:
(1) reserve amounts to be maintained by a life insurance
company for funding agreements;
(2) accounting and reporting of funds credited under funding
agreements; and
(3) other matters regarding funding agreements the
commissioner considers necessary, proper, and advisable.
Sec. 10. Notwithstanding any other provision of law:
(1) the commissioner has the sole authority to regulate the
issuance and sale of funding agreements;
(2) a funding agreement is not considered a covered policy
under
IC 27-8-8-1
(a); and
(3) a claim for payments under a funding agreement must be
treated as a loss claim described in Class 2 of
IC 27-9-3-40.
SOURCE: IC 27-1-13-11; (03)CC140701.1.19. -->
SECTION 19.
IC 27-1-13-11
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 11. At all such
meetings of the governing body held at Indianapolis, Indiana, as set out
in section 10 of this chapter, any aggrieved policyholder,
agent,
insurance producer, company, representative, or any other aggrieved
person may appear before such meeting to have complaints heard in
full, and it shall be the duty of such rating bureau to rectify such
conditions as are justly complained of in such manner as is reasonably
possible.
SOURCE: IC 27-1-20-30; (03)CC140701.1.20. -->
SECTION 20.
IC 27-1-20-30
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 30. (a) No company
acting through its officers or members, attorney-in-fact, or by any other
party, no officer of a company acting on his the officer's own behalf
and no insurance agent, producer, broker, or solicitor, personally or by
any other party, shall offer, promise, allow, give, set off or pay, directly
or indirectly, any rebate of or part of the premium payable on a policy,
or any agent's insurance producer's commission thereon, or earnings,
profits, dividends or other benefits founded, arising, accruing, or to
accrue thereon or therefrom, or any special advantage in date of policy
or age of issue, or any paid employment or contract for services of any
kind, or any other valuable consideration or inducement, to or for
insurance on any risk in this state, now or hereafter to be written, or for
or upon any renewal of any such insurance, which is not specified in
the policy contract of insurance, or offer, promise, give, option, sell or
purchase any stocks, bonds, securities, or property, or any dividends or
profits accruing or to accrue thereon, or other thing of value whatsoever
as inducement to insurance or in connection therewith, or any renewal
thereof, which is not specified in the policy. Nothing in this section
shall prevent a company which transacts industrial life insurance on a
weekly payment plan from returning to policyholders who have made
a premium payment for a period of at least one (1) year directly to the
company at its home or district office a percentage of premium which
the company would otherwise have paid for the weekly collection of
such premium, nor shall this section be construed to prevent the taking
of a bona fide obligation, with legal interest, in payment of any
premium.
(b) No insured person or party or applicant for insurance shall
directly or indirectly, receive or accept, or agree to receive or accept,
any rebate of premium or of any part thereof, or all or any part of any
agent's insurance producer's or broker's commission thereon, or any
favor or advantage, or share in any benefit to accrue under any policy
of insurance, or any valuable consideration or inducement, other than
such as are specified in the policy.
SOURCE: IC 27-1-22-2.5; (03)CC140701.1.21. -->
SECTION 21.
IC 27-1-22-2.5
, AS AMENDED BY P.L.132-2001,
SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 2.5.
(a) As used in this chapter, "exempt
commercial policyholder" means an entity that:
(1) makes written certification to the entity's insurer on a form
prescribed by the department that the entity is an exempt
commercial policyholder;
(2) has purchased the policy of insurance through an insurance
agent producer licensed under
IC 27-1-15.6
or
IC 27-1-15.8
; and
(3) meets any three (3) of the following criteria:
(A) Has a net worth of more than twenty-five million dollars
($25,000,000) at the time the policy of insurance is issued.
(B) Has a net revenue or sales of more than fifty million dollars
($50,000,000) in the preceding fiscal year.
(C) Has more than twenty-five (25) employees per individual
company or fifty (50) employees per holding company aggregate
at the time the policy of insurance is issued.
(D) Has aggregate annual commercial insurance premiums,
excluding any worker's compensation and professional liability
insurance premiums, of more than seventy-five thousand dollars
($75,000) in the preceding fiscal year.
(E) Is a nonprofit or a public entity with an annual budget of at
least twenty-five million dollars ($25,000,000) or assets of at
least twenty-five million dollars ($25,000,000) in the preceding
fiscal year.
(F) Procures commercial insurance with the services of a risk
manager.
An entity meets the written certification requirement under subdivision
(1) if the entity provides a copy of a certification previously submitted
under subdivision (1) and if there has been no significant material
change in the entity's status.
(b) As used in this chapter, "risk manager" means a person qualified
to assess an exempt commercial policyholder's insurance needs and
analyze and negotiate a policy of insurance on behalf of an exempt
commercial policyholder. A risk manager may be:
(1) a full-time employee of an exempt commercial policyholder
who is qualified through education and experience or training and
experience; or
(2) a person retained by an exempt commercial policyholder who
holds a professional designation relevant to the type of insurance
to be purchased by the exempt commercial policyholder.
SOURCE: IC 27-1-22-4; (03)CC140701.1.22. -->
SECTION 22.
IC 27-1-22-4
, AS AMENDED BY P.L.268-1999,
SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 4. (a) Every insurer shall file with the
commissioner every manual of classifications, rules, and rates, every
rating schedule, every rating plan, and every modification of any of the
foregoing which it proposes to use.
(b) The following types of insurance are exempt from the
requirements of subsections (a) and (j):
(1) Inland marine risks, which by general custom of the business
are not written according to manual rates or rating plans.
(2) Insurance, other than workers compensation insurance or
professional liability insurance, issued to exempt commercial
policyholders.
(c) Every such filing shall indicate the character and extent of the
coverage contemplated and shall be accompanied by the information
upon which the filer supports such filing.
(d) The information furnished in support of a filing may include:
(1) the experience and judgment of the insurer or rating
organization making the filing;
(2) its interpretation of any statistical data it relies upon;
(3) the experience of other insurers or rating organizations; or
(4) any other relevant factors.
The commissioner shall have the right to request any additional
relevant information. A filing and any supporting information shall be
open to public inspection as soon as stamped "filed" within a
reasonable time after receipt by the commissioner, and copies may be
obtained by any person on request and upon payment of a reasonable
charge therefor.
(e) Filings shall become effective upon the date of filing by delivery
or upon date of mailing by registered mail to the commissioner, or on
a later date specified in the filing.
(f) Specific inland marine rates on risks specially rated, made by a
rating organization, shall be filed with the commissioner.
(g) Any insurer may satisfy its obligation to make any such filings by
becoming a member of, or a subscriber to, a licensed rating
organization which makes such filings and by authorizing the
commissioner to accept such filings on its behalf, provided that nothing
contained in this chapter shall be construed as requiring any insurer to
become a member of or a subscriber to any rating organization or as
requiring any member or subscriber to authorize the commissioner to
accept such filings on its behalf.
(h) Every insurer which is a member of or a subscriber to a rating
organization shall be deemed to have authorized the commissioner to
accept on its behalf all filings made by the rating organization which
are within the scope of its membership or subscribership, provided:
(1) that any subscriber may withdraw or terminate such
authorization, either generally or for individual filings, by written
notice to the commissioner and to the rating organization and may
then make its own independent filings for any kinds of insurance,
or subdivisions, or classes of risks, or parts or combinations of any
of the foregoing, with respect to which it has withdrawn or
terminated such authorization, or may request the rating
organization, within its discretion, to make any such filing on an
agency basis solely on behalf of the requesting subscriber; and
(2) that any member may proceed in the same manner as a
subscriber unless the rating organization shall have adopted a rule,
with the approval of the commissioner:
(A) requiring a member, before making an independent filing,
first to request the rating organization to make such filing on its
behalf and requiring the rating organization, within thirty (30)
days after receipt of such request, either:
(i) to make such filing as a rating organization filing;
(ii) to make such filing on an agency basis solely on behalf of
the requesting member; or
(iii) to decline the request of such member; and
(B) excluding from membership any insurer which elects to
make any filing wholly independently of the rating organization.
(i) Under such rules as he the commissioner shall adopt, the
commissioner may, by written order, suspend or modify the
requirement of filing as to any kinds of insurance, or subdivision, or
classes of risk, or parts or combinations of any of the foregoing, the
rates for which can not practicably be filed before they are used. Such
orders and rules shall be made known to insurers and rating
organizations affected thereby. The commissioner may make such
examination as he the commissioner may deem advisable to ascertain
whether any rates affected by such order are excessive, inadequate, or
unfairly discriminatory.
(j) Upon the written application of the insured, stating his the
insured's reasons therefor, filed with the commissioner, a rate in
excess of that provided by a filing otherwise applicable may be used on
any specific risk.
(k) An insurer shall not make or issue a policy or contract except in
accordance with filings which are in effect for that insurer or in
accordance with the provisions of this chapter. Subject to the
provisions of section 6 of this chapter, any rates, rating plans, rules,
classifications, or systems in effect on May 31, 1967, shall be
continued in effect until withdrawn by the insurer or rating
organization which filed them.
(l) The commissioner shall have the right to make an investigation
and to examine the pertinent files and records of any insurer, insurance
agent, producer, or insured in order to ascertain compliance with any
filing for rate or coverage which is in effect. He The commissioner
shall have the right to set up procedures necessary to eliminate
noncompliance, whether on an individual policy, or because of a
system of applying charges or discounts which results in failure to
comply with such filing.
(m) The department may adopt rules to:
(1) implement the exemption under subsection (b);
(2) impose disclosure requirements the commissioner determines
are necessary to adequately protect exempt commercial
policyholders; and
(3) establish the form of the report required by subsection (n).
(n) Each insurer who issues insurance to an exempt commercial
policyholder shall file an annual report with the department by
February 1 of each year. The annual report may not disclose the
identity of an exempt commercial policyholder and must include only
the following information regarding each exempt commercial
policyholder:
(1) The account number, policy number, or other number used by
the insurer to identify the insured.
(2) The amount of aggregate annual commercial premium.
(3) The inception date and expiration date of commercial insurance
coverage provided by the insurer.
(4) The criteria in section 2.5(a)(3) of this chapter used to establish
the entity as an exempt commercial policyholder.
(o) The annual report filed under subsection (n) must be
accompanied by the fee prescribed by
IC 27-1-3-15
(e). For purposes of
calculating the required fee, each policy purchased by an exempt
commercial policyholder shall be considered a product filing under
IC 27-1-3-15
(e).
SOURCE: IC 27-1-22-5; (03)CC140701.1.23. -->
SECTION 23.
IC 27-1-22-5
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 5. (a) Upon
his own the
commissioner's motion, or upon written request by any insured
affected thereby or by any licensed insurance
agent producer or
broker, if such request is made in good faith and states reasonable
grounds, the commissioner, if he the commissioner shall have reason
to believe that any filing is not in compliance with the applicable
provisions of section 3 of this chapter, or in the case of an alleged
violation of section 6 of the chapter if he the commissioner finds on
the basis of the information on file with the department that there has
been a prima facie showing of a violation of that section, shall hold a
hearing upon not less than ten (10) days written notice to the rating
organization or insurer which made the filing in issue, specifying the
items and matters to be considered and stating in what manner and to
what extent noncompliance is alleged to exist. No other matter or
subject shall be considered at such hearing. Only the rating
organization or insurer which made such filing and the commissioner
may be parties to any hearing or to any judicial appeal resulting
therefrom. Within a reasonable time, the commissioner shall notify
every person making request as to his the decision as to the validity of
the request and subsequently shall notify every such person of any
action which may thereafter be taken with reference to such request.
(b) If, after such hearing, the commissioner finds, based upon a
preponderance of the evidence adduced at such hearing and made a
part of the record thereof, that such filing is not in compliance with the
provisions of section 3 of this chapter, he the commissioner shall
immediately issue a written order to the parties specifying in detail in
what respects and upon what evidence such noncompliance exists and
stating when, within a reasonable period thereafter, such filing shall be
deemed no longer effective. Said order shall not affect any contract
policy made or issued prior to the expiration of the period set forth in
said order.
(c) If after such hearing the commissioner finds that such filing does
not violate the provisions of section 3 of this chapter, he the
commissioner shall immediately issue a written order to the parties
dismissing the proceedings.
(d) The finding and order of the commissioner shall be made within
ninety (90) days after the close of such hearing or within such
reasonable time extensions as may be fixed by the commissioner.
(e) No manual of classifications, rule, rate, rating schedule, rating
plan, or any modification of any of the foregoing which establishes
standards for measuring variations in hazards or expense provisions, or
both, which has been filed pursuant to section 4 of this chapter shall be
disapproved if the rates produced thereby meet the requirements of
section 3 of this chapter.
(f) All actions of the commissioner under this chapter and all appeals
from his the commissioner's action shall be governed by IC 4-21.5,
except where a different specific provision is made in this chapter.
SOURCE: IC 27-1-22-7; (03)CC140701.1.24. -->
SECTION 24.
IC 27-1-22-7
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 7. (a) When a filing or
deviation involving a rate adjustment depends upon a change in the
relationship between the proposed rates and the anticipated production
expense portion thereof from the relationship anticipated under any
rates previously filed and currently in effect for the company or rating
organization involved, such filing or deviation shall be subject to the
provisions of subsection (b).
(b) Each filing or deviation subject to this section shall be on file for
a waiting period of twenty (20) days before it becomes effective. If
within such waiting period or after hearing as provided in this section,
the commissioner finds that the filing or deviation does not meet the
requirements of this chapter, he the commissioner shall send to the
insurer or rating organization which made the filing or to the insurer
which filed the deviation written notice of disapproval specifying
therein in what respects the filing or deviation fails to meet the
requirements of this chapter and stating that the same shall not become
effective. Such filing or deviation shall be deemed to meet the
requirements of this act unless disapproved:
(1) within such waiting period; or
(2) if a hearing has been called and written notice thereof given by
the commissioner during such waiting period, then within ten (10)
days after the date of commencement of such hearing.
Upon his the commissioner's own motion, or upon timely written
request by any agent insurance producer or broker of the company or
companies to which such filing or deviation is applicable, if such
request is in good faith and states reasonable grounds, the
commissioner may at any time within the waiting period call a hearing
upon not less than ten (10) nor more than fifteen (15) days written
notice to the company or rating organization making the filing or to the
company filing the deviation. Within ten (10) days after the
commencement of such hearing, the commissioner shall in writing
either approve such filing or deviation or shall disapprove the same as
provided in this section.
SOURCE: IC 27-1-22-18; (03)CC140701.1.25. -->
SECTION 25.
IC 27-1-22-18
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 18. No insurer, broker,
or agent insurance producer shall knowingly charge, demand, or
receive a premium for any policy of insurance except in accordance
with the provisions of this chapter. No insurer or employee thereof, and
no broker or agent insurance producer shall pay, allow, or give,
directly or indirectly, as an inducement to insurance, or after insurance
has been effected, any rebate, discount, abatement, credit, or reduction
of the premium named in a policy of insurance, or any special favor or
advantage in the dividends or other benefits to accrue thereon, or any
valuable consideration or inducement whatever, not specified in the
policy of insurance, except to the extent provided for in applicable
filings. No insured named in any policy of insurance shall knowingly
receive or accept, directly or indirectly, any such rebate, discount,
abatement, credit or reduction of premium, or any such special favor or
advantage or valuable consideration or inducement. Nothing in this
section shall be construed as prohibiting the payment of, nor permitting
the regulation of the payment of, commissions or other compensation
to duly licensed agents insurance producers and brokers, nor as
prohibiting, or permitting the regulation of, any insurer from allowing
or returning to its participating policyholders or members, dividends or
savings.
SOURCE: IC 27-1-22-19; (03)CC140701.1.26. -->
SECTION 26.
IC 27-1-22-19
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 19. Nothing in this
chapter abridges or restricts the freedom of contract of insurers,
agents,
insurance producers, or brokers with reference to the amount of
commission to be paid to agents insurance producers or brokers by
insurers, and such payments are expressly authorized.
SOURCE: IC 27-1-25-1; (03)CC140701.1.27. -->
SECTION 27.
IC 27-1-25-1
, AS AMENDED BY P.L.132-2001,
SECTION 7, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 1. As used in this chapter:
(a) "Administrator", except as provided in section 7.5 of this chapter,
means a person who collects charges or premiums from, or who adjusts
or settles claims on, residents of Indiana in connection with life or
health coverage or annuities, whether provided for by an insurer or a
self-funded plan. The term "administrator" does not include the
following persons:
(1) An employer for its employees or for the employees of a
subsidiary or affiliated corporation of the employer.
(2) A union for its members.
(3) An insurer, including:
(A) an insurer operating a health maintenance organization or a
limited service health maintenance organization; and
(B) the sales representative of an insurer operating a health
maintenance organization or a limited service health
maintenance organization when that sales representative is
licensed in Indiana and when it is engaged in the performance of
its duties as the sales representative.
(4) A life or health insurance agent producer licensed under
IC 27-1-15.6
whose activities are limited exclusively to the sale of
insurance.
(5) A creditor for its debtors regarding insurance covering a debt
between them.
(6) A trust established under 29 U.S.C. 186 and the trustees,
agents, and employees acting pursuant to that trust.
(7) A trust that is exempt from taxation under Section 501(a) of the
Internal Revenue Code and:
(A) the trustees and employees acting pursuant to that trust; or
(B) a custodian and the agents and employees of the custodian
acting pursuant to a custodian account that meets the
requirements of Section 401(f) of the Internal Revenue Code.
(8) A financial institution that is subject to supervision or
examination by federal or state banking authorities.
(9) A credit card issuing company that advances for and collects
premiums or charges from its credit cardholders as long as that
company does not adjust or settle claims.
(10) An individual who adjusts or settles claims in the normal
course of his the individual's practice or employment as an
attorney at law, and who does not collect charges or premiums in
connection with life or health insurance coverage or annuities.
(11) A health maintenance organization that has a certificate of
authority issued under IC 27-13.
(12) A limited service health maintenance organization that has a
certificate of authority issued under IC 27-13.
(b) "Certificate of registration" refers to the certificate required by
section 11 of this chapter.
(c) "Commissioner" refers to the commissioner of insurance.
(d) "Financial institution" means a bank, savings association, credit
union, or any other institution regulated under IC 28 or federal law.
(e) "Insurer" means a person who obtains a certificate of authority
under
IC 27-1-3-20.
(f) "Person" means an individual, a corporation, a partnership, a
limited liability company, or an unincorporated association.
(g) "Self-funded plan" means a plan for providing benefits for life,
health, or annuity coverage by a person who is not an insurer.
SOURCE: IC 27-1-27-1; (03)CC140701.1.28. -->
SECTION 28.
IC 27-1-27-1
, AS AMENDED BY HEA 1692-2003,
SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 1. (a) The term "public adjuster" shall include
every individual or corporation who, or which, for compensation or
reward, renders advice or assistance to the insured in the adjustment of
a claim or claims for loss or damages under any policy of insurance
covering real or personal property and any person or corporation who,
or which, advertises, solicits business, or holds itself out to the public
as an adjuster of such claims. However, no public adjuster shall:
(1) act in any manner in relation to claims for personal injury or
automobile property damage; or
(2) bind the insured in the settlement of claims.
(b) This chapter does not apply to, and the following are not included
in the term "public adjuster":
(1) An attorney at law admitted to practice in the state of Indiana
who adjusts insurance losses in the course of the practice of his the
attorney's profession.
(2) An officer, regular salaried employee, or other representative
of an insurer or of an attorney in fact of any reciprocal insurer of
Lloyd's underwriter licensed to do business in Indiana who adjusts
losses arising under his an employer's or principal's own policies.
(3) An adjustment bureau or association owned and maintained by
insurers to adjust or investigate losses of such insurers, or any
regular salaried employee who devotes substantially all of his the
employee's time to the business of such bureau or association.
(4) Any licensed agent insurance producer or an authorized
insurer or officer or employee of the same who adjusts losses for
such insurer, and any agent insurance producer or representative
of a farm mutual insurance company operating under the farm
mutual insurance laws of this state on behalf of an insurer.
(5) Any independent adjuster representing an insurer.
SOURCE: IC 27-1-27-4; (03)CC140701.1.29. -->
SECTION 29.
IC 27-1-27-4
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 4. (a) Each applicant
for a certificate of authority as a public adjuster shall file with the
commissioner of insurance
his, or its, an application therefor on forms
furnished by the commissioner of insurance, which application shall set
forth:
(1) the name and address of the applicant, and if the applicant be
a corporation, the name and address of each of its officers and
directors;
(2) whether the person is applying as a resident or nonresident;
(3) whether any license or certificate of authority as
agent,
insurance producer, broker, public adjuster, or independent
adjuster has been issued previously by the commissioner of
insurance of the state of Indiana or by the insurance department of
any other state, any territorial possession of the United States, or
any foreign country to the applicant; and
(4) the business or employment in which the applicant has been
engaged for the five (5) years next preceding the date of the
application, and the name and address of such business and the
name or names and addresses of his the applicant's employer or
employers.
(b) An application for any certificate of authority must be signed and
verified under oath by the applicant.
(c) An annual fee of fifty dollars ($50) is to be paid to the
commissioner of insurance by the applicant for such public adjuster's
certificate of authority before the application or annual renewal thereof
is granted. However, the commissioner may, by rule adopted under
IC 4-22-2
, change the amount of the fee to an amount necessary to pay
all of the direct and indirect costs of administering this chapter. Fees
collected shall be used by the department to administer this chapter.
(d) Every public adjuster's certificate of authority shall expire on
December 31 of the calendar year in which the same shall have been
issued, but if an application for the renewal of such certificate shall
have been filed with the commissioner of insurance before January 1
of any year, the certificate of authority sought to be renewed shall
continue in full force and effect until the issuance by the commissioner
of insurance of the new certificate applied for or until five (5) days
after the commissioner of insurance shall have refused to issue such
new certificate and shall have served notice of such refusal on the
applicant therefor. Service of such notice shall be made by registered
mail directed to the applicant at the place of business specified in the
application.
(e) The applicant shall file with the commissioner of insurance a
surety bond in a sum equal to ten thousand dollars ($10,000) payable
to the state of Indiana and conditioned on the principal's faithful
performance and discharge of his the principal's duties under this title
and under any rule of the department of insurance. The bond must be
renewed annually.
SOURCE: IC 27-1-34-8; (03)CC140701.1.30. -->
SECTION 30.
IC 27-1-34-8
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 8. (a) A reinsurer may
not issue a policy of insurance to a multiple employer welfare
arrangement that does not have a certificate of registration from the
department.
(b) An agent insurance producer licensed by the department may
not solicit, offer, or provide coverage through a multiple employer
welfare arrangement that does not have a certificate of registration
from the department.
(c) A reinsurer or agent insurance producer who knows or
reasonably should have known that the arrangement does not have a
current certificate of registration is liable for any claims for benefits
that are due and unpaid.
SOURCE: IC 27-1-36-46; (03)CC140701.1.31. -->
SECTION 31.
IC 27-1-36-46
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 46. (a) The comparison
of an insurer's total adjusted capital to any of its RBC levels is a
regulatory tool that may indicate the need for possible corrective action
with respect to the insurer and it is not intended as a means to rank
insurers generally. Except as provided in subsection (b), the action of
an insurer, an agent, insurance producer, a broker, or other person
engaged in any manner in the insurance business, in:
(1) making, publishing, disseminating, circulating, or placing
before the public; or
(2) 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, an announcement, or a statement containing an
assertion, a representation, or a statement regarding the RBC level of
an insurer or any component derived in the calculation of the RBC
level of an insurer is misleading and is prohibited.
(b) If:
(1) a materially false statement with respect to the comparison
regarding an insurer's total adjusted capital to an RBC level of the
insurer or an inappropriate comparison of any other amount to the
insurer's RBC levels is published in any written publication; and
(2) the insurer is able to demonstrate to the commissioner with
substantial proof the:
(A) falsity; or
(B) inappropriateness;
of the statement;
the insurer may publish an announcement in a written publication if the
sole purpose of the announcement is to rebut the materially false
statement.
SOURCE: IC 27-2-17-3; (03)CC140701.1.32. -->
SECTION 32.
IC 27-2-17-3
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 3. As used in this
chapter, "independent agent" insurance producer" means an agent
insurance producer who:
(1) represents an insurer in the sale of insurance as an independent
contractor rather than as an employee; and
(2) is not limited to representing:
(A) one (1) insurer; or
(B) several insurers that are under common management.
SOURCE: IC 27-2-17-6; (03)CC140701.1.33. -->
SECTION 33.
IC 27-2-17-6
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 6. (a) An insurance
company that issues property or casualty insurance shall not
discriminate in the appointment of an independent
agent insurance
producer on the basis of race, color, national origin, or gender.
(b) Except as provided in subsection (c), the department has
exclusive jurisdiction to investigate any complaints of discrimination
in the appointment of independent
agents insurance producers in
violation of subsection (a).
(c) If the commissioner of the department determines after a hearing
that an insurance company has violated subsection (a), the
commissioner may order one (1) of the following remedies:
(1) Payment of a civil penalty of not more than two thousand
dollars ($2,000) for each violation.
(2) Suspension or revocation of the insurance company's certificate
of authority if the commissioner determines that the violation was
willful or wanton and that similar violations have been committed
by that company with a frequency that constitutes a general
business practice.
(3) Any other remedy agreed to by the department and the
insurance company.
(d) Any determination made by the commissioner under this section
is subject to IC 4-21.5.
(e) Findings of the department under this section may not be
considered as evidence in any civil action other than an appeal as
provided under IC 4-21.5.
SOURCE: IC 27-4-1-2; (03)CC140701.1.34. -->
SECTION 34.
IC 27-4-1-2
, AS AMENDED BY HEA 1692-2003,
SECTION 7, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 2. When and as used in this chapter:
(a) The term "person" shall mean any individual, corporation,
company including any farm mutual insurance company, association,
partnership, firm, reciprocal exchange, inter-insurer, Lloyds insurers,
society, fraternal benefit society, lodge, order, council, corps, and any
other association or legal entity, engaged in the business of insurance,
including but not in limitation of the foregoing, agents, insurance
producers, brokers, solicitors, advisors, auditors, and adjusters.
(b) "Department" shall mean the department of insurance of this state
created and defined as a department in the state government of the state
of Indiana by IC 27-1.
(c) "Commissioner" shall mean the insurance commissioner of this
state appointed pursuant to, and on and in whom the powers, duties,
management, and control of the department are conferred and vested
by, the provisions of IC 27-1.
SOURCE: IC 27-4-1-4; (03)CC140701.1.35. -->
SECTION 35.
IC 27-4-1-4
, AS AMENDED BY P.L.130-2002,
SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 4. 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 his 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 his 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 agent 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 agent 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,
agent, insurance producer, or solicitor duly licensed under the
laws of this state, but such broker, agent, 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 agent producer or broker or brokers. However, this
subdivision shall not prevent the exercise by any lender of its or his
the 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 agents 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, agent, 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
his, her, or its 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
or
IC 27-1-22-26
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.
SOURCE: IC 27-4-3-1; (03)CC140701.1.36. -->
SECTION 36.
IC 27-4-3-1
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 1. It is hereby declared unlawful for
any two (2) or more insurance companies writing the same class, or
classes, of risks and doing business in this state, directly or indirectly,
to enter into any arrangement, contract, agreement, understanding,
combination or association to require, coerce or induce any agent
insurance producer or representative of any two (2) or more of such
insurance companies within the state of Indiana to refrain from
representing other such insurance companies, or to afford any
advantage to any such agent insurance producer to refrain from
representing other such insurance companies or to impose upon such
agent the insurance producer any disadvantage by reason of his the
insurance producer's acting as representative of other such insurance
companies.
SOURCE: IC 27-4-3-2; (03)CC140701.1.37. -->
SECTION 37.
IC 27-4-3-2
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 2. (a) It shall be is unlawful for any
insurance agent producer representing or acting for two (2) or more
insurance companies writing the same class or classes, of risks to enter,
either directly or indirectly, into any agreement, arrangement, contract
or understanding with one (1) or more of such companies that he the
insurance producer will refrain from representing any other like
company or companies, and it shall be is unlawful for any such
insurance company, not having a contract requiring an agent insurance
producer to represent it the insurance company alone, in any manner
to require, coerce, or induce any agent insurance producer to refrain
from representing any other like company or companies.
Provided, however, That this shall not be construed to (b) This
section does not prevent any insurance company or agent insurance
producer from at any time entering into a bona fide contract whereby
such agent an insurance producer agrees that he the insurance
producer will thereafter represent a single company exclusively.
SOURCE: IC 27-4-3-3; (03)CC140701.1.38. -->
SECTION 38.
IC 27-4-3-3
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 3. For violation of any provision of
this chapter, the license of the offending company or agent insurance
producer to transact the business of insurance within the state of
Indiana shall be suspended for a period of three (3) years. Whenever
information of any such violation shall come to the knowledge of the
commissioner of insurance, he the commissioner shall issue an order
fixing a day certain, not more than thirty (30) nor less than twenty (20)
days from the making thereof, upon which the offender shall appear
and show cause why such penalty should not be enforced, such order
specifying with reasonable certainty the violation charged, and if, after
hearing, the commissioner shall determine that the company or agent
insurance producer is guilty of such violation, he the commissioner
shall forthwith suspend the license of the offender for a period of three
(3) years. Such hearing shall be public, and at any such hearing any
person or corporation having lodged information of such violation with
the commissioner shall be entitled to be present and submit evidence.
Within thirty (30) days after the suspension of any such license, the
agent insurance producer or company whose license has been
suspended may appeal from the ruling of the commissioner of
insurance to the circuit or superior court of the county in which such
agent the insurance producer resides or in which such company has
its principal place of business, and if such company be a foreign
insurance company then such appeal may be taken by such company
to the circuit or superior court of Marion County.
SOURCE: IC 27-5-3-3; (03)CC140701.1.39. -->
SECTION 39.
IC 27-5-3-3
, AS AMENDED BY P.L.132-2001,
SECTION 9, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 3.
(a) With respect to writing, making, or taking
the kinds of insurance specifically excepted in
IC 27-5-2-1
(1)(B) and
with respect to writing, making, or taking liability insurance, worker's
compensation, fidelity, and surety insurance such farmers' mutual
insurance company shall be subject to the following statutes, anything
in IC 27-1 or
IC 27-5-1
to the contrary notwithstanding:
(1)
IC 27-1-3
, IC 27-9,
IC 27-1-5-3
,
IC 27-1-6-15
,
IC 27-1-7-14
,
IC 27-1-7-15
,
IC 27-1-7-16
,
IC 27-6-1.1-2
,
IC 27-1-7-21
,
IC 27-1-7-22
,
IC 27-1-7-23
,
IC 27-1-9
,
IC 27-1-13-3
,
IC 27-1-13-4
,
IC 27-1-13-6
,
IC 27-1-13-7
,
IC 27-1-13-8
,
IC 27-1-13-9
,
IC 27-1-20-1
,
IC 27-1-20-4
,
IC 27-1-20-6
,
IC 27-1-20-9
,
IC 27-1-20-10
,
IC 27-1-20-11
,
IC 27-1-20-14
,
IC 27-1-20-19
,
IC 27-1-20-20
,
IC 27-1-20-21
,
IC 27-1-20-23
,
IC 27-1-20-24, and
IC 27-1-20-30.
(2) All of
IC 27-1-22.
(3)
IC 27-1-13-7.
(4) All of
IC 27-7-2.
(b) An
agent insurance producer representing a farmers' mutual
insurance company with respect to insurance authorized to be written
by this chapter and not authorized before March 13, 1953, to be written
by a farmers' mutual insurance company shall comply with
IC 27-1-15.6.
SOURCE: IC 27-5-4-2; (03)CC140701.1.40. -->
SECTION 40.
IC 27-5-4-2
, AS AMENDED BY P.L.132-2001,
SECTION 10, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 2. Any such farmers' mutual insurance company
may elect to become subject to the provisions of IC 27-1 as provided
by
IC 27-1-11-1
and thereafter may avail itself of all rights, privileges,
and franchises provided by IC 27-1 in accordance with IC 27-1.
Nothing contained in IC 27-1 shall affect or invalidate any policies
issued or bound by such company and in full force and effect at the
time said election becomes effective, but any such policy or contract of
insurance and the rights and obligations thereunder may continue in
full force and effect until expiration or termination; provided, that not
later than five (5) years following the effective date of said election, all
such policies or contracts of insurance shall be subject to the provisions
of IC 27-1. Any agent insurance producer or representative of such
company who is exempt from the provisions of
IC 27-1-15.6
at the time
said election becomes effective may continue to represent such
company only within the scope of such existing representation without
compliance with the provisions of
IC 27-1-15.6
for a period not to
exceed one (1) year following the effective date of said election, but
thereafter such representation shall be subject to compliance with
IC 27-1-15.6.
Such election provided for in this section shall become
effective upon the date of issuance of the new certificate of authority
pursuant to
IC 27-1-11-7.
SOURCE: IC 27-6-8-9; (03)CC140701.1.41. -->
SECTION 41.
IC 27-6-8-9
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 9. (a) The commissioner shall:
(i) Notify the association of the existence of an insolvent insurer
not later than three (3) working days after
he the commissioner
receives an order of liquidation.
(ii) Upon request of the board of directors, provide the association
with a statement of the net direct written premiums of each
member insurer.
(b) The commissioner may:
(i) Require that the association notify the insureds of the insolvent
insurer and any other interested parties of the order of liquidation
and of their rights under this chapter. This notification shall be by
mail at their last known address, where available, but if sufficient
information for notification by mail is not available, notice by
publication in a newspaper of general circulation in all counties in
which the insolvent insurer transacted insurance business shall be
sufficient.
(ii) Require each
agent insurance producer of the insolvent
insurer to give prompt written notice by first class mail of such
insolvency and the rights of the insured under this chapter to each
insured of the insolvent insurer for whom
he the insurance
producer is
agent insurance producer of record, at such insured's
last known address.
(iii) Suspend or revoke, after notice and hearing, the certificate of
authority to transact insurance in this state of any member insurer
which fails to pay an assessment when due or fails to comply with
the plan of operation. As an alternative, the commissioner may
levy a fine on any member insurer which fails to pay an assessment
when due. The fine shall not exceed five percent (5%) of the
unpaid assessment per month, except that no fine shall be less than
one hundred dollars ($100) per month.
(iv) Revoke the designation of any servicing facility if he the
commissioner finds claims are being handled unsatisfactorily.
(v) Any final action or order of the commissioner under this
chapter shall be subject to judicial review in a court of competent
jurisdiction.
SOURCE: IC 27-6-8-10; (03)CC140701.1.42. -->
SECTION 42.
IC 27-6-8-10
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 10. (Effect of Paid
Claims) (a) Any person recovering under this chapter shall be deemed
to have assigned his the person's rights under the policy to the
association to the extent of his the person's recovery from the
association. Every insured or claimant seeking the protection of this
chapter shall cooperate with the association to the same extent as the
person would have been required to cooperate with the insolvent
insurer. The association shall have no cause of action against the
insured of the insolvent insurer for any sums it has paid out except such
causes of action as the insolvent insurer would have had if such sums
had been paid by the insolvent insurer. In the case of an insolvent
insurer operating on a plan with assessment liability, payments of
claims of the association shall not operate to reduce the liability of
insureds to the receiver, liquidator, or statutory successor for unpaid
assessments previously made and no assessment shall be thereafter
made for the purpose of reimbursing the association.
(b) The receiver, liquidator, or statutory successor of an insolvent
insurer shall be bound by settlements of covered claims by the
association or a similar organization in another state functioning
pursuant to
IC 27-6-8-8
(d). The court having jurisdiction shall grant
such claims priority equal to that which the claimant would have been
entitled in the absence of this chapter against the assets of the insolvent
insurer. The expenses of the association or similar organization in
handling claims shall be accorded the same priority as the liquidator's
expenses.
(c) The association shall periodically file with the receiver or
liquidator of the insolvent insurer statements of the covered claims paid
by the association and estimates of anticipated claims on the
association which shall preserve the rights of the association against
the assets of the insolvent insurer.
(d) The association shall have a right to recover from the agent
insurance producer of record any part of the paid claim for unearned
premium that represents unearned commission to the agent. insurance
producer.
SOURCE: IC 27-6-8-19; (03)CC140701.1.43. -->
SECTION 43.
IC 27-6-8-19
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 19. No person,
including an insurer,
agent, insurance producer, or affiliate of an
insurer, shall make, publish, disseminate, circulate, or place before the
public, or cause, directly or indirectly, to be made, published,
disseminated, circulated or placed before the public, in any newspaper,
magazine or other publication, or in the form of a notice, circular,
pamphlet, letter or poster, or over any radio station or television station,
or in any other way, any advertisement, announcement or statement
which uses the existence of the insurance guaranty association of this
state for the purpose of sales, solicitation, or inducement to purchase
any form of insurance covered by the Indiana insurance guaranty
association law. Provided, However, this section does not apply to
Indiana insurance guaranty association or to any other entity which
does not sell or solicit insurance.
SOURCE: IC 27-6-9-5; (03)CC140701.1.44. -->
SECTION 44.
IC 27-6-9-5
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 5. As used in this chapter, "licensed
producer" means an agent, insurance producer, broker, or reinsurance
intermediary licensed pursuant to the applicable provision of the
insurance law.
SOURCE: IC 27-7-6-5; (03)CC140701.1.45. -->
SECTION 45.
IC 27-7-6-5
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 5. No notice of cancellation of a
policy to which section 4 of this chapter applies shall be effective
unless mailed or delivered by the insurer to the named insured at least
twenty (20) days prior to the effective date of cancellation; provided,
however, that where cancellation is for nonpayment of premium at least
ten (10) days notice of cancellation accompanied by the reason therefor
shall be given. In the event such policy was procured by an agent
insurance producer duly licensed by the state of Indiana, notice of
intent to cancel shall be mailed or delivered to such agent the
insurance producer at least ten (10) days prior to such mailing or
delivery to the named insured unless such notice of intent is or has
been waived in writing by such agent. the insurance producer. Unless
the reason accompanies or is included in the notice of cancellation, the
notice of cancellation shall state or be accompanied by a statement that
upon written request of the named insured, mailed or delivered to the
insurer not less than fifteen (15) days prior to the effective date of
cancellation, the insurer will specify the reason for such cancellation.
This section shall not apply to nonrenewal.
SOURCE: IC 27-7-6-6; (03)CC140701.1.46. -->
SECTION 46.
IC 27-7-6-6
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 6.
(a) No insurer shall fail to renew
a policy unless it shall mail or deliver to the named insured, at the
address shown in the policy, at least twenty (20) days' advance notice
of its intention not to renew. In the event such policy was procured by
an
agent insurance producer duly licensed by the state of Indiana
notice of intent not to renew shall be mailed or delivered to
such agent
the insurance producer at least ten (10) days prior to such mailing or
delivery to the named insured unless such notice of intent is or has
been waived in writing by
such agent. the insurance producer.
(b) This section shall not apply:
(a) (1) if the insurer has manifested its willingness to renew;
nor or
(b) (2) in case of nonpayment of premium.
Provided, That, However, notwithstanding the failure of an insurer to
comply with this section, the policy shall terminate on the effective
date of any other insurance policy with respect to any automobile
designated in both policies.
(c) Renewal of a policy shall not constitute a waiver or estoppel with
respect to grounds for cancellation which existed before the effective
date of such renewal.
SOURCE: IC 27-7-6-10; (03)CC140701.1.47. -->
SECTION 47.
IC 27-7-6-10
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 10. There shall be no
liability on the part of and no cause of action of any nature shall arise
against the commissioner of insurance or against any insurer, its
authorized representative, its agents, insurance producers, its
employees, or any firm, person, limited liability company, or
corporation furnishing to the insurer information as to reasons for
cancellation, for any statement made by any of them in any written
notice of cancellation, or in any other communication, oral or written
specifying the reasons for cancellation, or the providing of information
pertaining thereto, or for statements made or evidence submitted at any
hearings conducted in connection therewith.
SOURCE: IC 27-7-9-9; (03)CC140701.1.48. -->
SECTION 48.
IC 27-7-9-9
, AS AMENDED BY P.L.182-2001,
SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 9. (a) An insurer making the type of insurance
described in Class 3(a) of
IC 27-1-5-1
shall enter into a reinsurance
agreement with the commissioner. The reinsurance agreement must
include the following terms:
(1) The insurer agrees to cede to the commissioner one hundred
percent (100%) of any mine subsidence coverage issued under this
chapter, subject to a maximum limit of two hundred thousand
dollars ($200,000) per structure insured.
(2) The insurer shall collect the premiums for mine subsidence
insurance, may retain a ceding commission in an amount set by the
commissioner, and shall remit the remainder of the premiums to
the commissioner for deposit in the mine subsidence insurance
fund.
(3) The insurer, in consideration of the ceding commission, shall:
(A) undertake the adjustment of losses under the mine
subsidence coverage issued under this chapter by the insurer,
with technical assistance provided under section 9.5 of this
chapter; and
(B) pay the taxes and absorb all other expenses necessarily
incurred by the insurer in the sale of policies and the
administration of the mine subsidence insurance program under
this chapter.
(4) The commissioner shall reimburse the insurer from the mine
subsidence insurance fund for all amounts paid to policyholders for
mine subsidence insurance claims.
(5) The insurer is not required to pay a claim for any mine
subsidence loss insured under this chapter if the amount available
in the mine subsidence insurance fund is insufficient to reimburse
the insurer for the claim.
(b) The determination of the commissioner as to the amount of the
ceding commission that an insurer may retain under subsection (a)(2)
must be based on a consideration of the insurer's reasonable
administrative costs (including agents' insurance producers'
commissions).
SOURCE: IC 27-7-10-15; (03)CC140701.1.49. -->
SECTION 49.
IC 27-7-10-15
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 15. (a) A risk retention
group is liable for the payment of premium taxes and taxes on
premiums of direct business for risks resident or located within
Indiana, and shall report to the commissioner of this state the net
premiums written for risks resident or located within Indiana. A risk
retention group that is chartered and licensed in a state other than
Indiana is subject to taxation, and any applicable fines and penalties
related thereto, on the same basis as a foreign admitted insurer.
(b) A licensed agent insurance producer who is utilized under
section 30 of this chapter in soliciting, negotiating, or procuring
liability insurance from a risk retention group that is chartered and
licensed in a state other than Indiana shall report to the commissioner
the premiums for direct business for risks resident or located within
Indiana that the agent insurance producer has placed with or on
behalf of a risk retention group that is not chartered in Indiana.
(c) A licensed agent insurance producer who is utilized under
section 30 of this chapter in soliciting, negotiating, or procuring
liability insurance from a risk retention group that is chartered and
licensed in a state other than Indiana shall keep a complete and
separate record of all policies procured from each such risk retention
group. The record kept under this subsection must be open to
examination by the commissioner and must, for each policy and each
kind of insurance provided, include the following information:
(1) The limit of liability.
(2) The time period covered.
(3) The effective date.
(4) The name of the risk retention group that issued the policy.
(5) The gross premium charged.
(6) The amount of return premiums, if any.
SOURCE: IC 27-7-10-27; (03)CC140701.1.50. -->
SECTION 50.
IC 27-7-10-27
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 27. (a) A purchasing
group may not purchase insurance from a risk retention group that is
not chartered in a state or from an insurer not admitted in the state in
which the purchasing group is located, unless the purchase is effected
through a licensed
agent insurance producer or broker acting under
the surplus lines laws and regulations of that state.
(b) A purchasing group that obtains liability insurance from an
insurer that is not admitted in Indiana or from a risk retention group
shall inform each of the members of the group who have a risk resident
or located in Indiana that the risk is not protected by an insurance
insolvency guaranty fund in Indiana and that the risk retention group
or insurer may not be subject to all insurance laws and rules of Indiana.
(c) No purchasing group may purchase insurance providing for a
deductible or self-insured retention applicable to the group as a whole.
However, coverage may provide for a deductible or self-insured
retention applicable to individual members of the purchasing group.
(d) Purchases of insurance by purchasing groups are subject to the
same standards regarding aggregate limits that are applicable to all
purchases of group insurance.
SOURCE: IC 27-7-10-28; (03)CC140701.1.51. -->
SECTION 51.
IC 27-7-10-28
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 28. Premium taxes and
taxes on premiums paid for coverage of risks resident or located in
Indiana by a purchasing group or any member of a purchasing group
shall be:
(1) imposed at the same rate and subject to the same interest, fines,
and penalties that apply to premium taxes and taxes on premiums
paid for similar coverage from a similar insurance source by other
insureds; and
(2) paid first by the insurance source, and if not by the insurance
source, then by the agent insurance producer or broker for the
purchasing group, and if not by the agent insurance producer or
broker, then by the purchasing group, and if not by the purchasing
group, then by each of its members.
SOURCE: IC 27-7-10-30; (03)CC140701.1.52. -->
SECTION 52.
IC 27-7-10-30
, AS AMENDED BY P.L.132-2001,
SECTION 11, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 30. No individual, firm, association, limited
liability company, or corporation may act or aid in any manner in
soliciting, negotiating, or procuring liability insurance in Indiana from
a risk retention group unless the individual, firm, association, or
corporation is licensed as an insurance agent producer under
IC 27-1-15.6.
SOURCE: IC 27-7-10-31; (03)CC140701.1.53. -->
SECTION 53.
IC 27-7-10-31
, AS AMENDED BY P.L.132-2001,
SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 31. (a) No individual, firm, association, or
corporation may act or aid in any manner in soliciting, negotiating, or
procuring liability insurance in Indiana for a purchasing group from an
authorized insurer or a risk retention group chartered in a state unless
the individual, firm, association, or corporation is licensed as an
insurance agent producer under
IC 27-1-15.6.
(b) No individual, firm, association, or corporation may act or aid in
any manner in soliciting, negotiating, or procuring liability insurance
coverage in Indiana for any member of a purchasing group under a
purchasing group's policy unless the individual, firm, association, or
corporation is licensed as an insurance agent producer under
IC 27-1-15.6.
(c) No individual, firm, association, or corporation may act or aid in
any manner in soliciting, negotiating, or procuring liability insurance
from an insurer not authorized to do business in Indiana on behalf of a
purchasing group located in Indiana unless the individual, firm,
association, or corporation is licensed as a surplus lines agent
producer under
IC 27-1-15.8.
SOURCE: IC 27-7-10-32; (03)CC140701.1.54. -->
SECTION 54.
IC 27-7-10-32
, AS AMENDED BY P.L.132-2001,
SECTION 13, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 32.
(a) For purposes of acting as an
agent
insurance producer for a risk retention group or purchasing group
under section 30 or 31 of this chapter, the requirement of residence in
Indiana does not apply.
(b) Every individual, firm, association, or corporation licensed under
IC 27-1-15.6
, in regard to business placed with risk retention groups or
written through a purchasing group, shall inform each prospective
insured of the provisions of the notice required by section 18 of this
chapter in the case of a risk retention group and section 27(c) of this
chapter in the case of a purchasing group.
SOURCE: IC 27-7-12-3; (03)CC140701.1.55. -->
SECTION 55.
IC 27-7-12-3
, AS ADDED BY P.L.203-2001,
SECTION 10, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 3. (a) Notice of cancellation of property insurance
coverage by an insurer must:
(1) be in writing;
(2) be delivered or mailed to the named insured at the last known
address of the named insured;
(3) state the effective date of the cancellation; and
(4) upon request of the named insured, be accompanied by a
written explanation of the specific reasons for the cancellation.
(b) An insurer shall provide written notice of cancellation to the
named insured at least:
(1) ten (10) days before canceling a policy, if the cancellation is for
nonpayment of a premium;
(2) twenty (20) days before canceling a policy, if the cancellation
occurs more than sixty (60) days after the date of issuance of the
policy; and
(3) ten (10) days before canceling a policy, if the cancellation
occurs not more than sixty (60) days after the date of issuance of
the policy.
(c) If the policy was procured by an independent agent insurance
producer licensed in Indiana, the insurer shall deliver or mail notice
of cancellation to the agent insurance producer not less than ten (10)
days before the insurer delivers or mails the notice to the named
insured, unless the obligation to notify the agent insurance producer
is waived in writing by the agent. insurance producer.
SOURCE: IC 27-7-12-4; (03)CC140701.1.56. -->
SECTION 56.
IC 27-7-12-4
, AS ADDED BY P.L.203-2001,
SECTION 10, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 4.
(a) Notice of nonrenewal by an insurer must:
(1) be in writing;
(2) be delivered or mailed to the named insured at the last known
address of the named insured;
(3) state the insurer's intention not to renew the policy upon
expiration of the current policy period;
(4) upon request of the named insured, be accompanied by a
written explanation of the specific reasons for the nonrenewal; and
(5) be provided to the named insured at least twenty (20) days
before the expiration of the current policy period.
(b) If the policy was procured by an independent
agent insurance
producer licensed in Indiana, the insurer shall deliver or mail notice
of nonrenewal to the
agent insurance producer not less than ten (10)
days before the insurer delivers or mails the notice to the named
insured, unless the obligation to notify the
agent insurance producer
is waived in writing by the
agent. insurance producer.
(c) If an insurer mails or delivers to an insured a renewal notice, bill,
certificate, or policy indicating the insurer's willingness to renew a
policy and the insured does not respond, the insurer is not required to
provide to the insured notice of intention not to renew.
SOURCE: IC 27-7-12-9; (03)CC140701.1.57. -->
SECTION 57.
IC 27-7-12-9
, AS ADDED BY P.L.203-2001,
SECTION 10, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 9. (a) The following persons are immune from
civil liability for any communication giving notice of or specifying the
reasons for a termination or for any statement made in connection with
an attempt to discover or verify the existence of conditions that would
be a reason for a termination under this chapter:
(1) Employees of the department of insurance.
(2) An insurer or its authorized representative, agent, or employee.
(3) A licensed insurance agent. producer.
(4) A person furnishing information to an insurer as to reasons for
a termination.
(b) This section does not apply to statements made in bad faith with
malice in fact.
SOURCE: IC 27-8-1-18; (03)CC140701.1.58. -->
SECTION 58.
IC 27-8-1-18
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 18. The provisions of
this chapter shall in no way apply to any secret or fraternal society or
lodge or association which, under the supervision of a grand or
supreme lodge, secures membership through the lodge system
exclusively, and provides insurance to its members, nor to insurance
organizations of a purely benevolent character which pay no
commission nor employ any paid agent, insurance producer,
organized under the laws of this or any other state.
SOURCE: IC 27-8-3-25; (03)CC140701.1.59. -->
SECTION 59.
IC 27-8-3-25
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 25. The fees to be paid
by each such corporation, association, or society to the insurance
commissioner for the authority to such corporation, association, or
society, and its
agents insurance producers under the license granted
by him to each corporation, association, or society, to transact business
in the state of Indiana shall be as follows:
For filing copy of charter or articles of incorporation, twenty-five
dollars ($25).
For filing each annual statement, twenty dollars ($20).
For issuing certificate of authority or license to company,
corporation, association or society, one dollar ($1).
For issuing license to each
agent, insurance producer, one dollar
($1).
For affixing seal and certifying to any paper, one dollar ($1).
For renewal of license, each such corporation, association, or
society shall file with the commissioner its annual statement, for
which it shall pay the sum of twenty dollars ($20).
For issuing license to each agent, one dollar ($1).
For affixing seal and certifying any paper, one dollar ($1).
For the privilege of transacting business in this state, a foreign or alien
company, association, or society, admitted and licensed under this
chapter, shall pay an annual tax upon premiums or assessments derived
from business written within this state, such tax to be as defined and
determined under
IC 27-1-18-2
, which is declared to be applicable in
its terms and provisions to such a company, association, or society;
provided also, that when any other state or country shall impose any
obligations in excess of those imposed by this chapter upon any such
corporation, association, or society of this state, a like obligation shall
be imposed on similar corporations and their agents of such state or
country doing business in this state; and provided also, that such
corporation, association, or society, in transacting business in this state,
shall be subject only to the provisions of this chapter.
SOURCE: IC 27-8-5-3; (03)CC140701.1.60. -->
SECTION 60.
IC 27-8-5-3
, AS AMENDED BY P.L.162-2001,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 3. (a) Except as provided in subsection (c), each
policy delivered or issued for delivery to any person in this state shall
contain the provisions specified in this subsection in the words in
which the same appear in this section. However, the insurer may, at its
option, substitute for one (1) or more of the provisions corresponding
provisions of different wording approved by the commissioner that are
in each instance no less favorable in any respect to the insured or the
beneficiary. The provisions shall be preceded individually by the
caption appearing in this subsection or, at the option of the insurer, by
appropriate individual or group captions or subcaptions as the
commissioner may approve.
(1) A provision as follows: ENTIRE CONTRACT; CHANGES: This
policy, including the endorsements and the attached papers, if any,
constitutes the entire contract of insurance. No change in this policy
shall be valid until approved by an executive officer of the insurer and
unless such approval be endorsed hereon or attached hereto. No
agent
insurance producer has authority to change this policy or to waive any
of its provisions.
(2) A provision as follows: TIME LIMIT ON CERTAIN
DEFENSES: (A) After two (2) years from the date of issue of this
policy no misstatements, except fraudulent misstatements, made by the
applicant in the application for such policy shall be used to void the
policy or to deny a claim for loss incurred or disability (as defined in
the policy) commencing after the expiration of such two (2) year
period.
The foregoing policy provision shall not be so construed as to affect
any legal requirement for avoidance of a policy of denial of a claim
during such initial two (2) year period, nor to limit the application of
subsection (b), (1), (2), (3), (4), and (5) in the event of misstatement
with respect to age or occupation or other insurance.
A policy which the insured has the right to continue in force subject
to its terms by the timely payment of premium:
(1) until at least age fifty (50); or
(2) in the case of a policy issued after forty-four (44) years of age,
for at least five (5) years from its date of issue;
may contain in lieu of the foregoing the following provision (from
which the clause in parentheses may be omitted at the insurer's option)
under the caption "INCONTESTABLE": After this policy has been in
force for a period of two (2) years during the lifetime of the insured
(excluding any period during which the insured is disabled), it shall
become incontestable as to the statements contained in the application.
(B) No claim for loss incurred or disability (as defined in the policy)
commencing after two (2) years from the date of issue of this policy
shall be reduced or denied on the ground that a disease or physical
condition, not excluded from coverage by name or specific description
effective on the date of loss, had existed prior to the effective date of
coverage of this policy.
(3) A provision as follows: GRACE PERIOD: A grace period of
(insert a number not less than "7" for weekly premium policies, "10"
for monthly premium policies and "31" for all other policies) days will
be granted for the payment of each premium falling due after the first
premium, during which grace period the policy shall continue in force.
A policy in which the insurer reserves the right to refuse renewal
shall have, at the beginning of the above provision: "Unless not less
than thirty (30) days prior to the premium due date the insurer has
delivered to the insured or has mailed to the insured's last address as
shown by the records of the insurer written notice of its intention not
to renew this policy beyond the period for which the premium has been
accepted.".
Each policy in which the insurer reserves the right to refuse renewal
on an individual basis shall provide, in substance, in a provision of the
policy, in an endorsement on the policy, or in a rider attached to the
policy, that subject to the right to terminate the policy upon
non-payment of premium when due, such right to refuse renewal shall
not be exercised before the renewal date occurring on, or after and
nearest, each anniversary, or in the case of lapse and reinstatement at
the renewal date occurring on, or after and nearest, each anniversary of
the last reinstatement, and that any refusal or renewal shall be without
prejudice to any claim originating while the policy is in force. The
preceding sentence shall not apply to accident insurance only policies.
(4) A provision as follows: REINSTATEMENT: If any renewal
premium is not paid within the time granted the insured for payment,
a subsequent acceptance of premium by the insurer or by any agent
authorized by the insurer to accept such premium, without requiring in
connection therewith an application for reinstatement, shall reinstate
the policy. Provided, that if the insurer or such agent requires an
application for reinstatement and issues a conditional receipt for the
premium tendered, the policy will be reinstated upon approval of such
application by the insurer or, lacking such approval, upon the forty-fifth
day following the date of such conditional receipt unless the insurer has
previously notified the insured in writing of its disapproval of such
application. The reinstated policy shall cover only loss resulting from
such accidental injury as may be sustained after the date of
reinstatement and loss due to such sickness as may begin more than ten
(10) days after such date. In all other respects the insured and insurer
shall have the same rights as they had under the policy immediately
before the due date of the defaulted premium, subject to any provisions
endorsed hereon or attached hereto in connection with the
reinstatement. Any premium accepted in connection with a
reinstatement shall be applied to a period for which premium has not
been previously paid, but not to any period more than sixty (60) days
prior to the date of reinstatement.
The last sentence of the above provision may be omitted from any
policy which the insured has the right to continue in force subject to its
terms by the timely payment of premiums:
(1) until at least fifty (50) years of age; or
(2) in the case of a policy issued after forty-four (44) years of age,
for at least five (5) years from its date of issue.
(5) A provision as follows: NOTICE OF CLAIM: Written notice of
claim must be given to the insurer within twenty (20) days after the
occurrence or commencement of any loss covered by the policy, or as
soon thereafter as is reasonably possible. Notice given by or on behalf
of the insured or the beneficiary to the insurer at _______ (insert the
location of such office as the insurer may designate for the purpose), or
to any authorized agent of the insurer, with information sufficient to
identify the insured, shall be deemed notice to the insurer.
In a policy providing a loss-of-time benefit which may be payable for
at least two (2) years, an insurer may insert the following between the
first and second sentences of the above provision:
Subject to the qualifications set forth below, if the insured suffers
loss of time on account of disability for which indemnity may be
payable for at least two (2) years, the insured shall, at least once in
every six (6) months after having given notice of claim, give to the
insurer notice of continuance of said disability, except in the event of
legal incapacity. The period of six (6) months following any filing of
proof by the insured or any payment by the insurer on account of such
claim or any denial of liability in whole or in part by the insurer shall
be excluded in applying this provision. Delay in the giving of such
notice shall not impair the insurer's right to any indemnity which would
otherwise have accrued during the period of six (6) months preceding
the date on which such notice is actually given.
(6) A provision as follows: CLAIM FORMS: The insurer, upon
receipt of a notice of claim, will furnish to the claimant such forms as
are usually furnished by it for filing proofs of loss. If such forms are not
furnished within fifteen (15) days after the giving of such notice, the
claimant shall be deemed to have complied with the requirements of
this policy as to proof of loss upon submitting, within the time fixed in
the policy for filing proofs of loss, written proof covering the
occurrence, the character, and the extent of the loss for which claim is
made.
(7) A provision as follows: PROOFS OF LOSS: Written proof of loss
must be furnished to the insurer at its said office in case of claim for
loss for which this policy provides any periodic payment contingent
upon continuing loss within ninety (90) days after the termination of
the period for which the insurer is liable and in case of claim for any
other loss within ninety (90) days after the date of such loss. Failure to
furnish such proof within the time required shall not invalidate nor
reduce any claim if it was not reasonably possible to give proof within
such time, provided such proof is furnished as soon as reasonably
possible and in no event, except in the absence of legal capacity, later
than one (1) year from the time proof is otherwise required.
(8) A provision as follows: TIME OF PAYMENT OF CLAIMS:
Indemnities payable under this policy for any loss other than loss for
which this policy provides any periodic payment will be paid:
(1) immediately upon receipt of due written proof of such loss; or
(2) in accordance with
IC 27-8-5.7
;
whichever is more favorable to the policyholder. Subject to due written
proof of loss, all accrued indemnities for loss for which this policy
provides periodic payment will be paid _______ (insert period for
payment which must not be less frequently than monthly) and any
balance remaining unpaid upon the termination of liability will be paid
immediately upon receipt of due written proof. This provision must
reflect compliance with
IC 27-8-5.7.
(9) A provision as follows: PAYMENT OF CLAIMS: Indemnity for
loss of life will be payable in accordance with the beneficiary
designation and the provisions respecting such payment which may be
prescribed herein and effective at the time of payment. If no such
designation or provision is then effective, such indemnity shall be
payable to the estate of the insured. Any other accrued indemnities
unpaid at the insured's death may, at the option of the insurer, be paid
either to such beneficiary or to such estate. All other indemnities will
be payable to the insured.
The following provisions, or either of them, may be included with the
foregoing provision at the option of the insurer:
If any indemnity of this policy shall be payable to the estate of the
insured, or to an insured or beneficiary who is a minor or otherwise not
competent to give a valid release, the insurer may pay such indemnity,
up to an amount not exceeding $ _______ (insert an amount which
shall not exceed $1,000), to any relative by blood or connection by
marriage of the insured or beneficiary who is deemed by the insurer to
be equitably entitled thereto. Any payment made by the insurer in good
faith pursuant to this provision shall fully discharge the insurer to the
extent of such payment.
Subject to any written direction of the insured in the application or
otherwise all or a portion of any indemnities provided by this policy on
account of hospital, nursing, medical, or surgical services may, at the
insurer's option and unless the insured requests otherwise in writing not
later than the time of filing proofs of such loss, be paid directly to the
hospital or person rendering such services; but it is not required that the
service be rendered by a particular hospital or person.
For the purposes of this section a "minor" is a person under the age
of eighteen (18) years. A person eighteen (18) years of age or over is
competent, insofar as the person's age is concerned, to sign a valid
release.
(10) A provision as follows: PHYSICAL EXAMINATIONS AND
AUTOPSY: The insurer at its own expense shall have the right and
opportunity to examine the person of the insured when and as often as
it may reasonably require during the pendency of a claim hereunder
and to make an autopsy in case of death where it is not forbidden by
law.
(11) A provision as follows: LEGAL ACTIONS: No action at law or
in equity shall be brought to recover on this policy prior to the
expiration of sixty (60) days after written proof of loss has been
furnished in accordance with the requirements of this policy. No such
action shall be brought after the expiration of three (3) years after the
time written proof of loss is required to be furnished.
(12) A provision as follows: CHANGE OF BENEFICIARY: Unless
the insured makes an irrevocable designation of beneficiary, the right
to change of beneficiary is reserved to the insured and the consent of
the beneficiary or beneficiaries shall not be requisite to surrender or
assignment of this policy or to any change of beneficiary or
beneficiaries, or to any other changes in this policy.
The first clause of this provision, relating to the irrevocable
designation of beneficiary, may be omitted at the insurer's option.
(13) A provision as follows: GUARANTEED RENEWABILITY: In
compliance with the federal Health Insurance Portability and
Accountability Act of 1996 (P.L.104-191), renewability is guaranteed.
(b) Except as provided in subsection (c), no policy delivered or
issued for delivery to any person in Indiana shall contain provisions
respecting the matters set forth below unless the provisions are in the
words in which the provisions appear in this section. However, the
insurer may use, instead of any provision, a corresponding provision of
different wording approved by the commissioner which is not less
favorable in any respect to the insured or the beneficiary. Any
substitute provision contained in the policy shall be preceded
individually by the appropriate caption appearing in this subsection or,
at the option of the insurer, by appropriate individual or group captions
or subcaptions as the commissioner may approve.
(1) A provision as follows: CHANGE OF OCCUPATION: If the
insured be injured or contract sickness after having changed the
insured's occupation to one classified by the insurer as more hazardous
than that stated in this policy or while doing for compensation anything
pertaining to an occupation so classified, the insurer will pay only such
portion of the indemnities provided in this policy as the premium paid
would have purchased at the rates and within the limits fixed by the
insurer for such more hazardous occupation. If the insured changes the
insured's occupation to one classified by the insurer as less hazardous
than that stated in this policy, the insurer, upon receipt of proof of such
change of occupation, will reduce the premium rate accordingly, and
will return the excess pro rata unearned premium from the date of
change of occupation or from the policy anniversary date immediately
preceding receipt of such proof, whichever is the more recent. In
applying this provision, the classification of occupational risk and the
premium rates shall be such as have been last filed by the insurer prior
to the occurrence of the loss for which the insurer is liable or prior to
date of proof of change in occupation with the state official having
supervision of insurance in the state where the insured resided at the
time this policy was issued; but if such filing was not required, then the
classification of occupational risk and the premium rates shall be those
last made effective by the insurer in such state prior to the occurrence
of the loss or prior to the date of proof of change in occupation.
(2) A provision as follows: MISSTATEMENT OF AGE: If the age
of the insured has been misstated, all amounts payable under this policy
shall be such as the premium paid would have purchased at the correct
age.
(3) A provision as follows: OTHER INSURANCE IN THIS
INSURER: If an accident or sickness or accident and sickness policy
or policies previously issued by the insurer to the insured are in force
concurrently herewith, making the aggregate indemnity for _______
(insert type of coverage or coverages) in excess of $ _______ (insert
maximum limit of indemnity or indemnities) the excess insurance shall
be void and all premiums paid for such excess shall be returned to the
insured or to the insured's estate. Or, instead of that provision:
Insurance effective at any one (1) time on the insured under a like
policy or policies, in this insurer is limited to the one (1) such policy
elected by the insured, the insured's beneficiary or the insured's estate,
as the case may be, and the insurer will return all premiums paid for all
other such policies.
(4) A provision as follows: INSURANCE WITH OTHER INSURER:
If there is other valid coverage, not with this insurer, providing benefits
for the same loss on a provision of service basis or on an expense
incurred basis and of which this insurer has not been given written
notice prior to the occurrence or commencement of loss, the only
liability under any expense incurred coverage of this policy shall be for
such proportion of the loss as the amount which would otherwise have
been payable hereunder plus the total of the like amounts under all
such other valid coverages for the same loss of which this insurer had
notice bears to the total like amounts under all valid coverages for such
loss, and for the return of such portion of the premiums paid as shall
exceed the pro-rata portion of the amount so determined. For the
purpose of applying this provision when other coverage is on a
provision of service basis, the "like amount" of such other coverage
shall be taken as the amount which the services rendered would have
cost in the absence of such coverage.
If the foregoing policy provision is included in a policy which also
contains the next following policy provision there shall be added to the
caption of the foregoing provision the phrase "EXPENSE INCURRED
BENEFITS". The insurer may, at its option, include in this provision
a definition of "other valid coverage," approved as to form by the
commissioner, which definition shall be limited in subject matter to
coverage provided by organizations subject to regulation by insurance
law or by insurance authorities of this or any other state of the United
States or any province of Canada, and by hospital or medical service
organizations, and to any other coverage the inclusion of which may be
approved by the commissioner. In the absence of such definition such
term shall not include group insurance, automobile medical payments
insurance, or coverage provided by hospital or medical service
organizations or by union welfare plans or employer or employee
benefit organizations. For the purpose of applying the foregoing policy
provision with respect to any insured, any amount of benefit provided
for such insured pursuant to any compulsory benefit statute (including
any worker's compensation or employer's liability statute) whether
provided by a governmental agency or otherwise shall in all cases be
deemed to be "other valid coverage" of which the insurer has had
notice. In applying the foregoing policy provision no third party
liability coverage shall be included as "other valid coverage".
(5) A provision as follows: INSURANCE WITH OTHER
INSURERS: If there is other valid coverage, not with this insurer,
providing benefits for the same loss on other than an expense incurred
basis and of which this insurer has not been given written notice prior
to the occurrence or commencement of loss, the only liability for such
benefits under this policy shall be for such proportion of the
indemnities otherwise provided hereunder for such loss as the like
indemnities of which the insurer had notice (including the indemnities
under this policy) bear to the total amount of all like indemnities for
such loss, and for the return of such portion of the premium paid as
shall exceed the pro-rata portion for the indemnities thus determined.
If the foregoing policy provision is included in a policy which also
contains the next preceding policy provision, there shall be added to the
caption of the foregoing provision the phrase "-OTHER BENEFITS".
The insurer may, at its option, include in this provision a definition of
"other valid coverage," approved as to form by the commissioner,
which definition shall be limited in subject matter to coverage provided
by organizations subject to regulation by insurance law or by insurance
authorities of this or any other state of the United States or any
province of Canada, and to any other coverage to the inclusion of
which may be approved by the commissioner. In the absence of such
definition such term shall not include group insurance or benefits
provided by union welfare plans or by employer or employee benefit
organizations. For the purpose of applying the foregoing policy
provision with respect to any insured, any amount of benefit provided
for such insured pursuant to any compulsory benefit statute (including
any worker's compensation or employer's liability statute) whether
provided by a governmental agency or otherwise shall in all cases be
deemed to be "other valid coverage" of which the insurer has had
notice. In applying the foregoing policy provision no third party
liability coverage shall be included as "other valid coverage".
(6) A provision as follows: RELATION OF EARNINGS TO
INSURANCE: If the total monthly amount of loss of time benefits
promised for the same loss under all valid loss of time coverage upon
the insured, whether payable on a weekly or monthly basis, shall
exceed the monthly earnings of the insured at the time disability
commenced or the insured's average monthly earnings for the period of
two (2) years immediately preceding a disability for which claim is
made, whichever is the greater, the insurer will be liable only for such
proportionate amount of such benefits under this policy as the amount
of such monthly earnings or such average monthly earnings of the
insured bears to the total amount of monthly benefits for the same loss
under all such coverage upon the insured at the time such disability
commences and for the return of such part of the premiums paid during
such two (2) years as shall exceed the pro rata amount of the premiums
for the benefits actually paid; but this shall not operate to reduce the
total monthly amount of benefits payable under all such coverage upon
the insured below the sum of two hundred dollars ($200) or the sum of
the monthly benefits specified in such coverages, whichever is the
lesser, nor shall it operate to reduce benefits other than those payable
for loss of time.
The foregoing policy provision may be inserted only in a policy
which the insured has the right to continue in force subject to its terms
by the timely payment of premiums:
(1) until at least fifty (50) years of age; or
(2) in the case of a policy issued after forty-four (44) years of age,
for at least five (5) years from its date of issue.
The insurer may, at its option, include in this provision a definition of
"valid loss of time coverage", approved as to form by the
commissioner, which definition shall be limited in subject matter to
coverage provided by governmental agencies or by organizations
subject to regulation by insurance law or by insurance authorities of
this or any other state of the United States or any province of Canada,
or to any other coverage the inclusion of which may be approved by the
commissioner or any combination of such coverages. In the absence of
such definition the term shall not include any coverage provided for the
insured pursuant to any compulsory benefit statute (including any
worker's compensation or employer's liability statute), or benefits
provided by union welfare plans or by employer or employee benefit
organizations.
(7) A provision as follows: UNPAID PREMIUM: Upon the payment
of a claim under this policy, any premium then due and unpaid or
covered by any note or written order may be deducted therefrom.
(8) A provision as follows: CONFORMITY WITH STATE
STATUTES: Any provision of this policy which, on its effective date,
is in conflict with the statutes of the state in which the insured resides
on such date is hereby amended to conform to the minimum
requirements of such statutes.
(9) A provision as follows: ILLEGAL OCCUPATION: The insurer
shall not be liable for any loss to which a contributing cause was the
insured's commission of or attempt to commit a felony or to which a
contributing cause was the insured's being engaged in an illegal
occupation.
(10) A provision as follows: INTOXICANTS AND NARCOTICS:
The insurer shall not be liable for any loss sustained or contracted in
consequence of the insured's being intoxicated or under the influence
of any narcotic unless administered on the advice of a physician.
(c) If any provision of this section is in whole or in part inapplicable
to or inconsistent with the coverage provided by a particular form of
policy the insurer, with the approval of the commissioner, shall omit
from such policy any inapplicable provision or part of a provision, and
shall modify any inconsistent provision or part of the provision in such
manner as to make the provision as contained in the policy consistent
with the coverage provided by the policy.
(d) The provisions which are the subject of subsections (a) and (b),
or any corresponding provisions which are used in lieu thereof in
accordance with such subsections, shall be printed in the consecutive
order of the provisions in such subsections or, at the option of the
insurer, any such provision may appear as a unit in any part of the
policy, with other provisions to which it may be logically related,
provided the resulting policy shall not be in whole or in part
unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a
person to whom the policy is offered, delivered, or issued.
(e) "Insured", as used in this chapter, shall not be construed as
preventing a person other than the insured with a proper insurable
interest from making application for and owning a policy covering the
insured or from being entitled under such a policy to any indemnities,
benefits, and rights provided therein.
(f)(1) Any policy of a foreign or alien insurer, when delivered or
issued for delivery to any person in this state, may contain any
provision which is not less favorable to the insured or the beneficiary
than is provided in this chapter and which is prescribed or required by
the law of the state under which the insurer is organized.
(f)(2) Any policy of a domestic insurer may, when issued for delivery
in any other state or country, contain any provision permitted or
required by the laws of such other state or country.
(g) The commissioner may make reasonable rules under
IC 4-22-2
concerning the procedure for the filing or submission of policies
subject to this chapter as are necessary, proper, or advisable to the
administration of this chapter. This provision shall not abridge any
other authority granted the commissioner by law.
SOURCE: IC 27-8-5.7-9; (03)CC140701.1.61. -->
SECTION 61.
IC 27-8-5.7-9
IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 9. (a) Beginning on the effective date of the
date referred to in Section 262 of the federal Health Insurance
Portability and Accountability Act (42 U.S.C. 1320d-4), an insurer
may request from the commissioner appointed under
IC 27-1-1-2
a waiver from the requirements of this chapter that apply to claims
filed on paper.
(b) The commissioner may grant a waiver under this section if,
not more than six (6) months after the effective date described in
subsection (a), the requesting insurer experiences an increase of the
lesser of:
(1) ten thousand (10,000); or
(2) at least twenty percent (20%);
in the volume of claims filed on paper.
(c) A waiver granted under this section is effective for a set
period determined by the commissioner.
(d) This section expires December 31, 2005.
SOURCE: IC 27-8-8-18; (03)CC140701.1.62. -->
SECTION 62.
IC 27-8-8-18
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 18. A person, including
an insurer, agent insurance producer, or affiliate of an insurer shall
not place before the public, directly or indirectly, an announcement or
statement that uses the existence of the association for the purpose of
sales, solicitation, or inducement to purchase any form of insurance
covered by this chapter. This section does not apply to the association
or any other entity that does not sell or solicit insurance.
SOURCE: IC 27-8-10-2.1; (03)CC140701.1.63. -->
SECTION 63.
IC 27-8-10-2.1
, AS AMENDED BY P.L.192-2002(ss),
SECTION 169, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 2.1. (a) There is established a
nonprofit legal entity to be referred to as the Indiana comprehensive
health insurance association, which must assure that health insurance
is made available throughout the year to each eligible Indiana resident
applying to the association for coverage. All carriers, health
maintenance organizations, limited service health maintenance
organizations, and self-insurers providing health insurance or health
care services in Indiana must be members of the association. The
association shall operate under a plan of operation established and
approved under subsection (c) and shall exercise its powers through a
board of directors established under this section.
(b) The board of directors of the association consists of seven (7)
members whose principal residence is in Indiana selected as follows:
(1) Three (3) members to be appointed by the commissioner from
the members of the association, one (1) of which must be a
representative of a health maintenance organization.
(2) Two (2) members to be appointed by the commissioner shall be
consumers representing policyholders.
(3) Two (2) members shall be the state budget director or designee
and the commissioner of the department of insurance or designee.
The commissioner shall appoint the chairman of the board, and the
board shall elect a secretary from its membership. The term of office
of each appointed member is three (3) years, subject to eligibility for
reappointment. Members of the board who are not state employees may
be reimbursed from the association's funds for expenses incurred in
attending meetings. The board shall meet at least semiannually, with
the first meeting to be held not later than May 15 of each year.
(c) The association shall submit to the commissioner a plan of
operation for the association and any amendments to the plan necessary
or suitable to assure the fair, reasonable, and equitable administration
of the association. The plan of operation becomes effective upon
approval in writing by the commissioner consistent with the date on
which the coverage under this chapter must be made available. The
commissioner shall, after notice and hearing, approve the plan of
operation if the plan is determined to be suitable to assure the fair,
reasonable, and equitable administration of the association and
provides for the sharing of association losses on an equitable,
proportionate basis among the member carriers, health maintenance
organizations, limited service health maintenance organizations, and
self-insurers. If the association fails to submit a suitable plan of
operation within one hundred eighty (180) days after the appointment
of the board of directors, or at any time thereafter the association fails
to submit suitable amendments to the plan, the commissioner shall
adopt rules under
IC 4-22-2
necessary or advisable to implement this
section. These rules are effective until modified by the commissioner
or superseded by a plan submitted by the association and approved by
the commissioner. The plan of operation must:
(1) establish procedures for the handling and accounting of assets
and money of the association;
(2) establish the amount and method of reimbursing members of
the board;
(3) establish regular times and places for meetings of the board of
directors;
(4) establish procedures for records to be kept of all financial
transactions, and for the annual fiscal reporting to the
commissioner;
(5) establish procedures whereby selections for the board of
directors will be made and submitted to the commissioner for
approval;
(6) contain additional provisions necessary or proper for the
execution of the powers and duties of the association; and
(7) establish procedures for the periodic advertising of the general
availability of the health insurance coverages from the association.
(d) The plan of operation may provide that any of the powers and
duties of the association be delegated to a person who will perform
functions similar to those of this association. A delegation under this
section takes effect only with the approval of both the board of
directors and the commissioner. The commissioner may not approve a
delegation unless the protections afforded to the insured are
substantially equivalent to or greater than those provided under this
chapter.
(e) The association has the general powers and authority enumerated
by this subsection in accordance with the plan of operation approved
by the commissioner under subsection (c). The association has the
general powers and authority granted under the laws of Indiana to
carriers licensed to transact the kinds of health care services or health
insurance described in section 1 of this chapter and also has the
specific authority to do the following:
(1) Enter into contracts as are necessary or proper to carry out this
chapter, subject to the approval of the commissioner.
(2) Sue or be sued, including taking any legal actions necessary or
proper for recovery of any assessments for, on behalf of, or against
participating carriers.
(3) Take legal action necessary to avoid the payment of improper
claims against the association or the coverage provided by or
through the association.
(4) Establish a medical review committee to determine the
reasonably appropriate level and extent of health care services in
each instance.
(5) Establish appropriate rates, scales of rates, rate classifications
and rating adjustments, such rates not to be unreasonable in
relation to the coverage provided and the reasonable operational
expenses of the association.
(6) Pool risks among members.
(7) Issue policies of insurance on an indemnity or provision of
service basis providing the coverage required by this chapter.
(8) Administer separate pools, separate accounts, or other plans or
arrangements considered appropriate for separate members or
groups of members.
(9) Operate and administer any combination of plans, pools, or
other mechanisms considered appropriate to best accomplish the
fair and equitable operation of the association.
(10) Appoint from among members appropriate legal, actuarial,
and other committees as necessary to provide technical assistance
in the operation of the association, policy and other contract
design, and any other function within the authority of the
association.
(11) Hire an independent consultant.
(12) Develop a method of advising applicants of the availability of
other coverages outside the association and may promulgate a list
of health conditions the existence of which would deem an
applicant eligible without demonstrating a rejection of coverage by
one (1) carrier.
(13) Provide for the use of managed care plans for insureds,
including the use of:
(A) health maintenance organizations; and
(B) preferred provider plans.
(14) Solicit bids directly from providers for coverage under this
chapter.
(f) Rates for coverages issued by the association may not be
unreasonable in relation to the benefits provided, the risk experience,
and the reasonable expenses of providing the coverage. Separate scales
of premium rates based on age apply for individual risks. Premium
rates must take into consideration the extra morbidity and
administration expenses, if any, for risks insured in the association. The
rates for a given classification may not be more than one hundred fifty
percent (150%) of the average premium rate for that class charged by
the five (5) carriers with the largest premium volume in the state during
the preceding calendar year. In determining the average rate of the five
(5) largest carriers, the rates charged by the carriers shall be actuarially
adjusted to determine the rate that would have been charged for
benefits identical to those issued by the association. All rates adopted
by the association must be submitted to the commissioner for approval.
(g) Following the close of the association's fiscal year, the association
shall determine the net premiums, the expenses of administration, and
the incurred losses for the year. Any net loss shall be assessed by the
association to all members in proportion to their respective shares of
total health insurance premiums, excluding premiums for Medicaid
contracts with the state of Indiana, received in Indiana during the
calendar year (or with paid losses in the year) coinciding with or ending
during the fiscal year of the association or any other equitable basis as
may be provided in the plan of operation. For self-insurers, health
maintenance organizations, and limited service health maintenance
organizations that are members of the association, the proportionate
share of losses must be determined through the application of an
equitable formula based upon claims paid, excluding claims for
Medicaid contracts with the state of Indiana, or the value of services
provided. In sharing losses, the association may abate or defer in any
part the assessment of a member, if, in the opinion of the board,
payment of the assessment would endanger the ability of the member
to fulfill its contractual obligations. The association may also provide
for interim assessments against members of the association if necessary
to assure the financial capability of the association to meet the incurred
or estimated claims expenses or operating expenses of the association
until the association's next fiscal year is completed. Net gains, if any,
must be held at interest to offset future losses or allocated to reduce
future premiums. Assessments must be determined by the board
members specified in subsection (b)(1), subject to final approval by the
commissioner.
(h) The association shall conduct periodic audits to assure the general
accuracy of the financial data submitted to the association, and the
association shall have an annual audit of its operations by an
independent certified public accountant.
(i) The association is subject to examination by the department of
insurance under
IC 27-1-3.1.
The board of directors shall submit, not
later than March 30 of each year, a financial report for the preceding
calendar year in a form approved by the commissioner.
(j) All policy forms issued by the association must conform in
substance to prototype forms developed by the association, must in all
other respects conform to the requirements of this chapter, and must be
filed with and approved by the commissioner before their use.
(k) The association may not issue an association policy to any
individual who, on the effective date of the coverage applied for, does
not meet the eligibility requirements of section 5.1 of this chapter.
(l) The association shall pay an
agent's insurance producer's referral
fee of twenty-five dollars ($25) to each insurance
agent producer who
refers an applicant to the association if that applicant is accepted.
(m) The association and the premium collected by the association
shall be exempt from the premium tax, the adjusted gross income tax,
or any combination of these upon revenues or income that may be
imposed by the state.
(n) Members who after July 1, 1983, during any calendar year, have
paid one (1) or more assessments levied under this chapter may either:
(1) take a credit against premium taxes, adjusted gross income
taxes, or any combination of these, or similar taxes upon revenues
or income of member insurers that may be imposed by the state, up
to the amount of the taxes due for each calendar year in which the
assessments were paid and for succeeding years until the aggregate
of those assessments have been offset by either credits against
those taxes or refunds from the association; or
(2) any member insurer may include in the rates for premiums
charged for insurance policies to which this chapter applies
amounts sufficient to recoup a sum equal to the amounts paid to
the association by the member less any amounts returned to the
member insurer by the association, and the rates shall not be
deemed excessive by virtue of including an amount reasonably
calculated to recoup assessments paid by the member.
(o) The association shall provide for the option of monthly collection
of premiums.
SOURCE: IC 27-8-10-10; (03)CC140701.1.64. -->
SECTION 64.
IC 27-8-10-10
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 10. Before January 1,
1996, the board of directors of the association shall establish eligibility
guidelines for the issuance of an association policy under this chapter
to prohibit an:
(1) employer;
(2) insurance agent; producer; or
(3) insurance broker;
from placing in or referring to the association an individual who works
for an employer who offers employees an employee welfare benefit
plan (as defined in 29 U.S.C. 1002).
SOURCE: IC 27-8-12-7; (03)CC140701.1.65. -->
SECTION 65.
IC 27-8-12-7
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 7. (a) The insurance
commissioner shall adopt rules under
IC 4-22-2
establishing standards
of full and fair disclosure concerning long term care insurance policies.
The standards must require disclosure of information concerning the
following:
(1) The sale of the policies.
(2) Terms of renewability.
(3) Initial and subsequent terms of eligibility.
(4) Nonduplication of coverage provisions.
(5) Coverage of dependents.
(6) Preexisting conditions.
(7) Termination of insurance coverage.
(8) Probationary periods.
(9) Limitations on coverage.
(10) Exceptions to coverage.
(11) Reductions from coverage.
(12) Elimination periods.
(13) Requirements for replacement.
(14) Recurrent conditions.
(15) Definitions of terms.
(16) Continuation or conversion of coverage.
(b) The insurance commissioner shall adopt rules under
IC 4-22-2
to
establish minimum standards concerning:
(1) marketing practices;
(2) agent insurance producer continuing education;
(3) penalties; and
(4) reporting practices;
for long term care insurance.
(c) Rules adopted by the insurance commissioner under this section
must:
(1) recognize the unique, developing, and experimental nature of
long term care insurance; and
(2) where necessary or appropriate, recognize the distinctions
between group insurance policies and individual insurance
policies.
SOURCE: IC 27-8-12-14; (03)CC140701.1.66. -->
SECTION 66.
IC 27-8-12-14
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 14. (a) The insurer
shall deliver an outline of the coverage provided by an individual long
term care insurance policy to the prospective applicant at the time of
initial solicitation through means that prominently direct the attention
of the recipient to the document and the document's purpose.
(b) The commissioner shall prescribe a standard format regarding:
(1) style;
(2) arrangement;
(3) overall appearance; and
(4) content;
for an outline of coverage.
(c) An agent insurance producer who solicits a long term care
insurance policy shall deliver the outline of coverage before the
presentation of an application or enrollment form.
(d) The outline of coverage must be presented in conjunction with
any application or enrollment form when there is a direct response
solicitation of long term care insurance.
(e) An outline of coverage required under this section must include
the following:
(1) A description of the principal benefits and coverage provided
in the policy.
(2) A statement of the principal exclusions, reductions, and
limitations set forth in the policy.
(3) A statement of the policy's renewal provisions, including any
reservation by the insurer of a right to change premiums.
(4) A statement that the outline of coverage is a summary of the
policy issued or applied for, and that the policy should be
consulted to determine the exact terms of the coverage provided by
the policy.
(5) A description of the terms under which the policy may be
returned and the premium refunded.
(6) A brief description of the relationship of the cost of care and
benefits.
(7) A statement of the terms under which the policy or certificate
may continue or be discontinued, including any reservation in the
policy of the right to change the premium.
(8) A specific statement of the provisions for continuation or
conversion of group coverage.
SOURCE: IC 27-8-12-18; (03)CC140701.1.67. -->
SECTION 67.
IC 27-8-12-18
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 18. (a) As used in this
section, "compensation" includes pecuniary and nonpecuniary
remuneration of any kind relating to the sale or renewal of the policy
or certificate including, but not limited to, the following:
(1) Bonuses.
(2) Gifts.
(3) Prizes.
(4) Awards.
(5) Finders fees.
(b) An insurer or other entity that provides a commission or other
compensation to an
agent insurance producer or other representative
for the sale of a long term care insurance policy may not violate the
following conditions:
(1) The amount of the first year commission or first year
compensation for selling or servicing the policy may not exceed
two hundred percent (200%) of the amount of the commission or
other compensation paid in the second year.
(2) The amount of commission or other compensation provided in
years after the second year must be equal to the amount provided
in the second year.
(3) A commission or other compensation must be provided each
year for at least five (5) years after the first year.
(c) If an existing long term care policy or certificate is replaced, the
insurer or other entity that issues the replacement policy may not
provide, and its
agent insurance producer may not accept,
compensation in an amount greater than the renewal compensation
payable by the replacing insurer on renewal policies, unless the
benefits of the replacement policy or certificate are clearly and
substantially greater than the benefits under the replaced policy or
certificate.
(d) This section does not apply to the following:
(1) Life insurance policies and certificates.
(2) A policy or certificate that is sponsored by an employer for the
benefit of:
(A) the employer's employees; or
(B) the employer's employees and their dependents.
SOURCE: IC 27-8-12-19; (03)CC140701.1.68. -->
SECTION 68.
IC 27-8-12-19
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 19. (a) In addition to
any other sanction provided under this article, the commissioner may
impose a civil penalty against an insurer who has violated this chapter
or rules adopted under this chapter. A penalty imposed under this
section must be the greater of:
(1) three (3) times the amount of the commissions paid for each
policy involved in the violation; or
(2) ten thousand dollars ($10,000).
(b) In addition to any other sanction provided under this title, the
commissioner may impose a penalty against an insurance agent
producer who has violated this chapter or rules adopted under this
chapter. The penalty must be the greater of:
(1) up to three (3) times the amount of the commissions paid to
that insurance producer for each policy involved in the violation;
or
(2) twenty-five hundred dollars ($2,500).
SOURCE: IC 27-8-13-2; (03)CC140701.1.69. -->
SECTION 69.
IC 27-8-13-2
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 2. As used in this
chapter, "Medicare supplement insurance solicitation" means a meeting
between an insurance agent producer and another individual at which
the agent insurance producer discusses the possible issuance of a
medicare supplement policy to the other individual.
SOURCE: IC 27-8-13-4; (03)CC140701.1.70. -->
SECTION 70.
IC 27-8-13-4
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 4. (a) Following a
Medicare supplement insurance solicitation, an agent insurance
producer shall give the individual involved in the solicitation a receipt
for materials received by the agent insurance producer as a result of
the solicitation.
(b) The receipt required under subsection (a) must be dated and
signed by the agent insurance producer and must set forth the
following:
(1) An itemized list of the materials received by the agent.
insurance producer.
(2) The agent's insurance producer's name.
(3) The address and telephone number of the agent's insurance
producer's office.
(c) As used in this section, "materials" includes any:
(1) document;
(2) cash;
(3) money order; or
(4) check or draft;
received by the agent. insurance producer. The term does not include
an application for a policy.
SOURCE: IC 27-8-19.8-8.5; (03)CC140701.1.71. -->
SECTION 71.
IC 27-8-19.8-8.5
, AS AMENDED BY P.L.132-2001,
SECTION 14, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 8.5. The following must be licensed as a life
insurance agent an insurance producer with a life qualification
under IC 27-1-15.6:
IC 27-1-15.6-7
:
(1) A viatical settlement broker.
(2) A person who solicits, offers, or attempts to negotiate a viatical
settlement contract with a viator.
SOURCE: IC 27-8-28-17; (03)CC140701.1.72. -->
SECTION 72.
IC 27-8-28-17
, AS AMENDED BY P.L.1-2002,
SECTION 116, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 17. (a) An insurer shall establish
written policies and procedures for the timely resolution of appeals of
grievance decisions. The procedures for registering and responding to
oral and written appeals of grievance decisions must include the
following:
(1) Written or oral acknowledgment of the appeal not more than
five (5) business days after the appeal is filed.
(2) Documentation of the substance of the appeal and the actions
taken.
(3) Investigation of the substance of the appeal, including any
aspects of clinical care involved.
(4) Notification to the covered individual:
(A) of the disposition of an appeal; and
(B) that the covered individual may have the right to further
remedies allowed by law.
(5) Standards for timeliness in:
(A) responding to an appeal; and
(B) providing notice to covered individuals of:
(i) the disposition of an appeal; and
(ii) the right to initiate an external grievance review under
IC 27-8-29
;
that accommodate the clinical urgency of the situation.
(b) In the case of an appeal of a grievance decision described in
section 6(1) or 6(2) of this chapter, an insurer shall appoint a panel of
one (1) or more qualified individuals to resolve an appeal. The panel
must include one (1) or more individuals who:
(1) have knowledge of the medical condition, procedure, or
treatment at issue;
(2) are licensed in the same profession and have a similar specialty
as the provider who proposed or delivered the health care
procedure, treatment, or service;
(3) are not involved in the matter giving rise to the appeal or in the
initial investigation of the grievance; and
(4) do not have a direct business relationship with the covered
individual or the health care provider who previously
recommended the health care procedure, treatment, or service
giving rise to the grievance.
(c) An appeal of a grievance decision must be resolved:
(1) as expeditiously as possible, reflecting the clinical urgency of
the situation; and
(2) not later than forty-five (45) days after the appeal is filed.
An insurer that violates this subsection commits an unfair and
deceptive act or practice in the business of insurance under
IC 27-4-1-4.
(d) If an insurer violates subsection (c), the insurer shall file a
report with the department during the quarter in which the
violation occurred concerning the insurer's compliance with
subsection (c). The report must include the following:
(1) The number of appealed grievance decisions that were not
resolved as required under subsection (c).
(2) The reason each appeal described in subdivision (1) was not
resolved.
(d) (e) An insurer shall allow a covered individual the opportunity to:
(1) appear in person before; or
(2) if unable to appear in person, otherwise appropriately
communicate with;
the panel appointed under subsection (b).
(e) (f) An insurer shall notify a covered individual in writing of the
resolution of an appeal of a grievance decision within five (5) business
days after completing the investigation. The appeal resolution notice
must include the following:
(1) A statement of the decision reached by the insurer.
(2) A statement of the reasons, policies, and procedures that are the
basis of the decision.
(3) Notice of the covered individual's right to further remedies
allowed by law, including the right to external grievance review by
an independent review organization under
IC 27-8-29.
(4) The department, address, and telephone number through which
a covered individual may contact a qualified representative to
obtain more information about the decision or the right to an
external grievance review.
SOURCE: IC 27-9-1-3; (03)CC140701.1.73. -->
SECTION 73.
IC 27-9-1-3
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 3. (a) A delinquency proceeding
under this chapter may only be commenced by the commissioner. A
court may not entertain, hear, or determine a proceeding commenced
by any other person.
(b) A court may not entertain, hear, or determine any complaint
requesting:
(1) the dissolution, liquidation, rehabilitation, sequestration,
conservation, or receivership of any insurer; or
(2) an injunction, restraining order, or other relief preliminary to,
incidental to, or relating to those proceedings other than in
accordance with this article.
(c) In addition to other grounds for jurisdiction provided by the law,
an Indiana court having jurisdiction of the subject matter has
jurisdiction over a person served under the Indiana rules of court or
other applicable law in an action brought by the receiver of a domestic
insurer or an alien insurer domiciled in Indiana if the person served is:
(1) obligated to the insurer in any way as an incident to any agency
or brokerage arrangement that may exist or has existed between the
insurer and the agent insurance producer or broker, in any action
on or incident to the obligation;
(2) a reinsurer who:
(A) has at any time written a policy of reinsurance for an insurer
against which a rehabilitation or liquidation order is in effect
when the action is commenced; or
(B) is an agent insurance producer or broker of, or for, the
reinsurer in any action on or incident to the reinsurance contract;
or
(3) or has been an officer, manager, trustee, organizer, promoter,
or person in a position of comparable authority or influence in an
insurer against which a rehabilitation or liquidation order is in
effect when the action is commenced in any action resulting from
such a relationship with the insurer.
(d) If it appears to a receiver appointed in a proceeding under this
article that there has been criminal or tortious conduct, breach of any
contractual or fiduciary obligation, or other unlawful conduct
detrimental to the insurer by any director, officer, manager, agent,
insurance producer, broker, employee, or other person or entity, the
receiver may pursue all appropriate legal remedies on behalf of the
insurer.
(e) If the court on motion of any party finds that any action should as
a matter of substantial justice be tried in a forum outside Indiana, the
court may enter an order to stay further proceedings on the action in
Indiana.
(f) All action authorized by this section must be brought in the
Marion County circuit court.
SOURCE: IC 27-9-1-5; (03)CC140701.1.74. -->
SECTION 74.
IC 27-9-1-5
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 5. (a) An officer, manager, director,
trustee, owner, employee, or agent insurance producer of any insurer,
or any other persons with authority over or in charge of any segment of
the insurer's affairs, shall cooperate with the commissioner in any
proceeding under IC 27-9 or any investigation preliminary to the
proceeding. The term "person", as used in this section, includes any
person who exercises control, directly or indirectly, over activities of
an insurer through any holding company or other affiliate of the
insurer. "To cooperate" includes:
(1) replying promptly in writing to any inquiry from the
commissioner requesting such a reply; and
(2) making available to the commissioner all books, accounts,
documents, or other records, information, or property of or
pertaining to the insurer and in his the insurer's possession,
custody, or control.
(b) A person may not obstruct or interfere with the commissioner in
the conduct of any delinquency proceeding or any investigation
preliminary to or incidental to an investigation.
(c) This section does not abridge existing legal rights, including the
right to resist a petition for liquidation, other delinquency proceedings,
or other orders.
(d) A person who:
(1) is included within subsection (a) and who fails to cooperate
with the commissioner;
(2) obstructs or interferes with the commissioner in the conduct of
any delinquency proceeding or any investigation preliminary or
incidental to a delinquency proceeding; or
(3) violates any order of the commissioner under IC 27-9;
commits a Class A infraction.
SOURCE: IC 27-9-3-9; (03)CC140701.1.75. -->
SECTION 75.
IC 27-9-3-9
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 9. (a) The commissioner may
petition for an order dissolving the corporate existence of a domestic
insurer, or the United States branch of an alien insurer domiciled in
Indiana, at the time
he the commissioner applies for a liquidation
order. The Marion County circuit court shall order dissolution of the
corporation upon petition by the commissioner upon or after the
granting of a liquidation order. If the dissolution has not previously
been ordered, the dissolution shall be effected by operation of law upon
the discharge of the liquidator if the insurer is insolvent but may be
ordered by the court upon the discharge of the liquidator if the insurer
is under a liquidation order for some other reason.
(b) The liquidator may do all acts necessary or appropriate for the
accomplishment of the liquidation, including the following:
(1) Appoint a special deputy to act for
him the liquidator under
this article, and determine a reasonable compensation for that
special deputy.
(2) Employ employees and
agents, insurance producers, legal
counsel, actuaries, accountants, appraisers, consultants, and other
personnel as
he the liquidator considers necessary to assist in the
liquidation.
(3) Fix the reasonable compensation of employees and
agents,
insurance producers, legal counsel, actuaries, accountants,
appraisers, and consultants with the approval of the court.
(4) Pay reasonable compensation to persons appointed and defray
from the funds or assets of the insurer all expenses of taking
possession of, conserving, conducting, liquidating, disposing of, or
otherwise dealing with the business and property of the insurer.
(5) Hold hearings, subpoena witnesses to compel their attendance,
administer oaths, examine any person under oath, and compel any
person to subscribe to
his the person's testimony after it has been
correctly reduced to writing, and in connection with hearings and
the examination of witnesses require the production of any books,
papers, records, or other documents which
he the liquidator
deems relevant to the inquiry.
(6) Collect all debts and moneys due and claims belonging to the
insurer, wherever located, and for this purpose:
(A) institute timely action in other jurisdictions, in order to
forestall garnishment and attachment proceedings against those
debts;
(B) do other acts necessary or expedient to collect, conserve, or
protect its assets or property, including the power to sell,
compound, compromise, or assign debts for purposes of
collection upon terms and conditions as he the liquidator
considers best; and
(C) pursue any creditor's remedies available to enforce his the
liquidator's claims.
(7) Conduct public and private sales of the property of the insurer.
(8) Use assets of the estate of an insurer under a liquidation order
to transfer policy obligations to a solvent assuming insurer, if the
transfer can be arranged without prejudice to applicable priorities
under section 40 of this chapter.
(9) Acquire, hypothecate, encumber, lease, improve, sell, transfer,
abandon, or otherwise dispose of or deal with, any property of the
insurer at its market value or upon such terms and conditions as are
fair and reasonable.
(10) Borrow money on the security of the insurer's assets or
without security and execute and deliver all documents necessary
to that transaction for the purpose of facilitating the liquidation.
(11) Enter into contracts that are necessary to carry out the order
to liquidate, and affirm or disavow any contracts to which the
insurer is a party.
(12) Continue to prosecute and to institute in the name of the
insurer, or in his the liquidator's own name, all suits and other
legal proceedings, in Indiana or elsewhere, and abandon the
prosecution of claims he the liquidator considers unprofitable to
pursue further.
(13) Prosecute any action that may exist in behalf of the creditors,
members, policyholders, or shareholders of the insurer against any
director or officer of the insurer, or any other person.
(14) Remove all records and property of the insurer to the offices
of the commissioner or to some other place as may be convenient
for the purposes of efficient and orderly execution of the
liquidation.
(15) Deposit in one (1) or more banks in Indiana sums required for
meeting current administration expenses and dividend
distributions.
(16) Invest all sums not currently needed, unless the court orders
otherwise.
(17) File any necessary documents for record in the office of any
recorder of deeds or record office in Indiana or elsewhere where
property of the insurer is located.
(18) Assert all defenses available to the insurer as against third
persons, including statutes of limitation, statutes of frauds, and the
defense of usury.
(19) Exercise and enforce all the rights, remedies, and powers of
any creditor, shareholder, policyholder, or member, including any
power to avoid any transfer or lien that may be given by the
general law and that is not included in sections 14 through 16 of
this chapter.
(20) Intervene in any proceeding wherever instituted that might
lead to the appointment of a receiver or trustee, and act as the
receiver or trustee whenever the appointment is offered.
(21) Enter into agreements with any receiver or commissioner of
any other state relating to the rehabilitation, liquidation,
conservation, or dissolution of an insurer doing business in both
states.
(22) Exercise all powers conferred upon receivers by the laws of
Indiana not inconsistent with this article.
SOURCE: IC 27-9-3-10; (03)CC140701.1.76. -->
SECTION 76.
IC 27-9-3-10
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 10. (a) Unless the
Marion County circuit court otherwise directs, the liquidator shall give
notice of the liquidation order as soon as possible by:
(1) first-class mail and either by telegram or telephone to the
insurance commissioner of each jurisdiction in which the insurer
is doing business;
(2) first-class mail to any guaranty association or foreign guaranty
association that is or may become obligated as a result of the
liquidation;
(3) first-class mail to all insurance agents producers of the insurer;
(4) first-class mail to all persons known or reasonably expected to
have claims against the insurer, including all policyholders, at their
last known address as indicated by the records of the insurer;
(5) first-class mail to the secretary of state's office; and
(6) publication in a newspaper of general circulation in the county
in which the insurer has its principal place of business and in all
other locations the liquidator considers appropriate.
(b) Notice to potential claimants under subsection (a) must require
claimants to file with the liquidator their claims, together with proper
proof of those claims under section 34 of this chapter, before a date the
liquidator specifies in the notice. The liquidator need not require
persons claiming cash surrender values or other investment values in
life insurance and annuities to file a claim. All claimants must keep the
liquidator informed of any changes of address.
(c) If notice is given in accordance with this section, the distribution
of assets of the insurer under this chapter shall be conclusive with
respect to all claimants, whether or not they received notice.
SOURCE: IC 27-9-3-11; (03)CC140701.1.77. -->
SECTION 77.
IC 27-9-3-11
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 11. (a) Every person
who receives notice in the form prescribed in section 10 of this chapter
that an insurer whom
he the person represents as an
agent insurance
producer is the subject of a liquidation order must, within fifteen (15)
days of that notice, give notice of the liquidation order to each
policyholder as provided by subsection (b).
(b) The notice must be sent by first class mail to the last address
contained in the
agent's insurance producer's records to each
policyholder or other person named in any policy issued through that
agent insurance producer by the insurer, if
he the insurance
producer has a record of the address of the policyholder or other
person.
(c) A policy shall be treated as though it were issued through an
agent insurance producer if the
agent insurance producer has a
property interest in the expiration of the policy, or if the
agent
insurance producer has had in
his the insurance producer's
possession a copy of the declarations of the policy at any time during
the life of the policy, except where the ownership of the expiration of
the policy has been transferred to another.
(d) The written notice must include:
(1) the name and address of the insurer;
(2) the name and address of the agent; insurance producer; and
(3) identification of the policy impaired and the nature of the
impairment, including termination of coverage as described in
section 8 of this chapter.
(e) Notice by a general agent satisfies the notice requirement for any
agents insurance producers under contract to him. the general agent.
Each agent insurance producer obligated to give notice under this
section shall file a report of compliance with the liquidator.
(f) After a hearing under
IC 4-21.5-3
, an agent insurance producer
failing to give notice or file a report of compliance as required by
subsection (e) may be subject to payment of a penalty of not more than
one thousand dollars ($1,000) and may have his the insurance
producer's license suspended.
(g) The liquidator may waive the duties imposed by this section if he
the liquidator determines that other notice to the policyholders of the
insurer under liquidation is adequate.
SOURCE: IC 27-9-3-31; (03)CC140701.1.78. -->
SECTION 78.
IC 27-9-3-31
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 31. (a) An
agent,
insurance producer, a broker, an agency, a premium finance
company, an insured, or any other person responsible for the payment
of a premium shall be obligated to pay any earned but unpaid premium
for any policy that is due the insurer for coverage provided before the
declaration of insolvency. However, an
agent, insurance producer, a
broker, an agency, a premium finance company, an insured, or any
other person responsible for the payment of a premium shall not be
responsible for any unpaid premium unearned as of the time of the
declaration of insolvency.
(b) In addition to the obligation owed under subsection (a), an
agent,
insurance producer, broker, agency, premium finance company, or
any other person, other than the insured, responsible for the payment
of a premium to the insurance company or any holding company shall
pay any unearned premium collected from the insured before the
declaration of insolvency. The commissioner may also recover from
that person any part of an unearned premium that represents a
commission of that person.
(c) Credits or setoffs or both may not be allowed to an
agent,
insurance producer, broker, or premium finance company for any
amounts advanced to the insurer by the
agent, insurance producer,
broker, or premium finance company on behalf of, but in the absence
of a payment by, the insured.
(d) Upon satisfactory evidence of a violation of this section, the
commissioner may pursue the following courses of action against those
parties licensed by the department of insurance:
(1) Suspend, revoke, or refuse to renew the licenses of the
offending party.
(2) Impose a penalty of not more than one thousand dollars
($1,000) for each and every act in violation of this article by the
party.
These penalties are in addition to and not in lieu of the obligations
owed under subsections (a) and (b).
(e) Before the commissioner may take any action as provided in
subsection (d), he the commissioner shall give written notice to the
person accused of violating the law, stating specifically the nature of
the alleged violation, and fixing a time (at least ten (10) days after the
notice is sent) and place when a hearing on the matter is to be held.
After the hearing, if the commissioner finds a violation, or upon failure
of the accused to appear at the hearing, the commissioner shall impose
whatever penalties allowed under subsection (d) as he the
commissioner considers advisable.
(f) Subsection (a) does not relieve an insured of any obligation that
may exist to reimburse any agency, agent, insurance producer, broker,
premium finance company, or other person for amounts advanced to
the insurer on behalf of the insured.
SOURCE: IC 27-9-4-3; (03)CC140701.1.79. -->
SECTION 79.
IC 27-9-4-3
IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 3. (a) The domiciliary liquidator of
an insurer domiciled in a reciprocal state shall, except as to special
deposits and security on secured claims under section 4(c) of this
chapter, be vested by operation of law with the title to all of the assets,
property, contracts, and rights of action, agents' insurance producers'
balances, and all of the books, accounts, and other records of the
insurer located in Indiana. The date of vesting shall be the date of the
filing of the petition, if that date is specified by the domiciliary law for
the vesting of property in the domiciliary state. Otherwise, the date of
vesting shall be the date of entry of the order directing possession to be
taken. The domiciliary liquidator shall have the immediate right to
recover balances due from agents insurance producers and to obtain
possession of the books, accounts, and other records of the insurer
located in Indiana. He The domiciliary liquidator also shall have the
right to recover all other assets of the insurer located in Indiana, subject
to section 4 of this chapter.
(b) If a domiciliary liquidator is appointed for an insurer not
domiciled in a reciprocal state, the commissioner shall be vested by
operation of law with the title to all of the property, contracts and rights
of action, and all of the books, accounts, and other records of the
insurer located in Indiana, at the same time that the domiciliary
liquidator is vested with title in the domicile. The Indiana insurance
commissioner may petition for a conservation or liquidation order
under sections section 1 or 2 of this chapter, or for an ancillary
receivership under section 4 of this chapter, or after approval by the
Marion County circuit court may transfer title to the domiciliary
liquidator, as the interests of justice and the equitable distribution of
the assets require.
(c) Claimants residing in Indiana may file claims with the liquidator
or ancillary receiver, if any, in Indiana or with the domiciliary
liquidator, if the domiciliary law permits. The claims must be filed on
or before the last date fixed for the filing of claims in the domiciliary
liquidation proceedings.
SOURCE: IC 27-10-1-2; (03)CC140701.1.80. -->
SECTION 80.
IC 27-10-1-2
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 2. "All lines fire and
casualty agent" insurance producer" means an agent insurance
producer who holds a valid license issued by the department of
insurance to engage in the writing and transacting of all of the
following lines and kinds of insurance:
(1) Property insurance.
(2) Casualty insurance.
(3) Surety insurance.
(4) Disability insurance.
(5) Inland marine insurance.
SOURCE: IC 27-10-3-1; (03)CC140701.1.81. -->
SECTION 81.
IC 27-10-3-1
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 1. (a) A person may not
act in the capacity of a bail agent or recovery agent or perform any of
the functions, duties, or powers prescribed for bail agents or recovery
agents under this article unless the person is qualified and licensed as
provided in this article. However, none of the terms of this section shall
prohibit any individual or individuals from:
(1) pledging real or other property as security for a bail bond in
judicial proceedings and where the individual does not receive, or
is not promised, money or other things of value; or
(2) executing any bail bond for an insurer, pursuant to a bail bond
service agreement entered into between the insurer and any
automobile club or association, financing institution, insurance
company, or other organization or association, and on behalf of a
person required to furnish bail in connection with any violation of
law arising out of the use of a motor vehicle.
(b) A license:
(1) may not be issued except in compliance with this article; and
(2) may only be issued to an individual.
However, upon an affirmative showing to the commissioner in writing
by an individual that the individual is an all lines fire and casualty
agent, insurance producer, a surety bail agent license shall be issued
to the individual without further qualification or fee to represent an
insurer the individual is licensed to represent. The individual shall be
subject to and governed by laws and rules relating to bail agents when
engaged in the activities of a bail agent.
(c) A firm, a partnership, an association, a limited liability company,
or a corporation may not be licensed.
(d) The applicant must apply in writing, on forms prepared and
supplied by the commissioner, and the commissioner may propound
any reasonable interrogatories to an applicant for a license under this
article or on any renewal of a license relating to the applicant's
qualifications, residence, prospective place of business, and any other
matters which, in the opinion of the commissioner, are deemed
necessary or expedient in order to protect the public and ascertain the
qualifications of the applicant. The commissioner may also conduct any
reasonable inquiry or investigation the commissioner sees fit, relative
to the determination of the applicant's fitness to be licensed or to
continue to be licensed.
(e) The failure of the applicant to secure approval of the
commissioner shall not preclude the applicant from applying as many
times as the applicant desires. However, an applicant's application may
not be considered by the commissioner within one (1) year subsequent
to the date upon which the commissioner denied the applicant's last
application.
SOURCE: IC 27-10-3-3; (03)CC140701.1.82. -->
SECTION 82.
IC 27-10-3-3
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 3. (a) The application
for license, in addition to the matters set out in section 1 of this chapter,
to serve as a bail agent must affirmatively show that:
(1) the applicant is at least eighteen (18) years of age and is of
good moral character;
(2) the applicant has never been convicted of a disqualifying
offense, notwithstanding
IC 25-1-1.1
, or:
(A) in the case of a felony conviction, at least ten (10) years have
passed since the date of the applicant's conviction or release
from imprisonment, parole, or probation, whichever is later; or
(B) in the case of a misdemeanor disqualifying offense, at least
five (5) years have passed since the date of the applicant's
conviction or release from imprisonment, parole, or probation,
whichever is later; and
(3) the applicant has knowledge, experience, or instruction in the
bail bond business, or has held a valid all lines fire and casualty
agent's insurance producer's license for one (1) year within the
last five (5) years, or has been employed by a company engaged in
writing bail bonds in which field the applicant has actively
engaged for at least one (1) year of the last five (5) years.
(b) The application must affirmatively show that the applicant has
been a bona fide resident of the state Indiana for one (1) year
immediately preceding the date of application. However, the
commissioner may waive this requirement.
SOURCE: IC 27-11-8-9; (03)CC140701.1.83. -->
SECTION 83.
IC 27-11-8-9
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 9. (a) Agents
Insurance producers of societies shall be licensed in accordance with
the laws regulating the licensing and the revocation, suspension, or
termination of license of resident and nonresident agents. insurance
producers.
(b) No examination or license shall be required of any regular
salaried officer, employee, or member of a licensed society who
devotes substantially all of the officer's, employee's or member's
services to activities other than the solicitation of fraternal insurance
contracts from the public and who receives for the solicitation of those
contracts no commission or other compensation directly dependent
upon the amount of business obtained.
SOURCE: IC 27-13-1-3; (03)CC140701.1.84. -->
SECTION 84.
IC 27-13-1-3
, AS AMENDED BY P.L.132-2001,
SECTION 15, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 3.
"Agent" "Insurance producer" means a
person who is a licensed insurance
agent producer under
IC 27-1-15.6
and who:
(1) solicits, negotiates, effects, procures, delivers, renews, or
continues a policy or contract for membership in a health
maintenance organization or a prepaid limited health service
organization;
(2) takes or transmits a membership fee or premium for the policy
or contract other than for the agent insurance producer; or
(3) causes the agent insurance producer to be held out to the
public, through advertising or otherwise, as a producer for a health
maintenance organization or a prepaid limited health service
organization.
SOURCE: IC 27-13-10-8; (03)CC140701.1.85. -->
SECTION 85.
IC 27-13-10-8
, AS AMENDED BY P.L.133-1999,
SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 8. (a) A health maintenance organization shall
establish written policies and procedures for the timely resolution of
appeals of grievance decisions. The procedures for registering and
responding to oral and written appeals of grievance decisions must
include the following:
(1) Acknowledgment of the appeal, orally or in writing, within
three (3) business days after receipt of the appeal being filed.
(2) Documentation of the substance of the appeal and the actions
taken.
(3) Investigation of the substance of the appeal, including any
aspects of clinical care involved.
(4) Notification to enrollees or subscribers of the disposition of the
appeal and that the enrollee or subscriber may have the right to
further remedies allowed by law.
(5) Standards for timeliness in responding to appeals and providing
notice to enrollees or subscribers of the disposition of the appeal
and the right to initiate an external appeals process that
accommodate the clinical urgency of the situation.
(b) The health maintenance organization shall appoint a panel of
qualified individuals to resolve an appeal. An individual may not be
appointed to the panel who has been involved in the matter giving rise
to the complaint or in the initial investigation of the complaint. Except
for grievances that have previously been appealed under
IC 27-8-17
, in
the case of an appeal from the proposal, refusal, or delivery of a health
care procedure, treatment, or service, the health maintenance
organization shall appoint one (1) or more individuals to the panel to
resolve the appeal. The panel must include one (1) or more individuals
who:
(1) have knowledge in the medical condition, procedure, or
treatment at issue;
(2) are in the same licensed profession as the provider who
proposed, refused, or delivered the health care procedure,
treatment, or service;
(3) are not involved in the matter giving rise to the appeal or the
previous grievance process; and
(4) do not have a direct business relationship with the enrollee or
the health care provider who previously recommended the health
care procedure, treatment, or service giving rise to the grievance.
(c) An appeal of a grievance decision must be resolved as
expeditiously as possible and with regard to the clinical urgency of the
appeal. However, an appeal must be resolved not later than forty-five
(45) days after the appeal is filed.
A health maintenance organization
that violates this subsection commits an unfair and deceptive act or
practice in the business of insurance under
IC 27-4-1-4.
(d) If a health maintenance organization violates subsection (c),
the health maintenance organization shall file a report with the
department during the quarter in which the violation occurred
concerning the insurer's compliance with subsection (c). The report
must include the following:
(1) The number of appealed grievance decisions that were not
resolved as required under subsection (c).
(2) The reason each appeal described in subdivision (1) was not
resolved.
(e) A health maintenance organization shall allow enrollees and
subscribers the opportunity to appear in person at the panel or to
communicate with the panel through appropriate other means if the
enrollee or subscriber is unable to appear in person.
(e) (f) A health maintenance organization shall notify the enrollee or
subscriber in writing of the resolution of the appeal of a grievance
within five (5) business days after completing the investigation. The
grievance resolution notice must contain the following:
(1) The decision reached by the health maintenance organization.
(2) The reasons, policies, or procedures that are the basis of the
decision.
(3) Notice of the enrollee's or subscriber's right to further remedies
allowed by law, including the right to review by an independent
review organization under
IC 27-13-10.1.
(4) The department, address, and telephone number through which
an enrollee may contact a qualified representative to obtain more
information about the decision or the right to an appeal.
SOURCE: IC 27-13-21-1; (03)CC140701.1.86. -->
SECTION 86.
IC 27-13-21-1
, AS AMENDED BY P.L.132-2001,
SECTION 18, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 1. To qualify to represent a health maintenance
organization or a limited service health maintenance organization, an
agent insurance producer shall be licensed and regulated as with an
accident and health insurance agent or sickness qualification under
IC 27-1-15.6.
IC 27-1-15.6-7.
SOURCE: IC 27-13-34-18; (03)CC140701.1.87. -->
SECTION 87.
IC 27-13-34-18
, AS AMENDED BY P.L.132-2001,
SECTION 19, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 18.
(a) Except as provided in subsection (c), a
limited service health maintenance organization shall maintain in force
a fidelity bond in its own name on its officers and employees:
(1) in an amount not less than fifty thousand dollars ($50,000); or
(2) in any other amount prescribed by the commissioner.
(b) The fidelity bond required by this section must be issued by an
insurance company not affiliated in any way with the limited service
health maintenance organization, that is licensed to do business in
Indiana. However, if a fidelity bond is not available from an insurance
company that holds a certificate of authority in Indiana, a limited
service health maintenance organization may satisfy the requirement
of this section by maintaining a fidelity bond procured by a surplus
lines insurance
agent producer not affiliated in any way with the
limited service health maintenance organization who holds a license
issued under
IC 27-1-15.8.
(c) Instead of maintaining a fidelity bond under subsection (a), a
limited service health maintenance organization may deposit with the
commissioner:
(1) cash;
(2) certificates of deposit;
(3) United States government obligations acceptable to the
commissioner;
(4) any other securities acceptable to the commissioner of the types
referred to in
IC 27-13-11-1
; or
(5) a combination of the items described in subdivisions (1)
through (4).
A deposit made under this subsection is in addition to any other
required deposit, and must also be maintained in joint custody with the
commissioner in the amount and subject to the same conditions
required for a fidelity bond under this section.
SOURCE: IC 27-13-36.2-7; (03)CC140701.1.88. -->
SECTION 88.
IC 27-13-36.2-7
IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 7. (a) Beginning on the
effective date of the date referred to in Section 262 of the federal
Health Insurance Portability and Accountability Act (42 U.S.C.
1320d-4), a health maintenance organization may request from the
insurance commissioner appointed under
IC 27-1-1-2
a waiver
from the requirements of this chapter that apply to claims filed on
paper.
(b) The commissioner may grant a waiver under this section if,
not more than six (6) months after the effective date described in
subsection (a), the requesting health maintenance organization
experiences an increase of the lesser of:
(1) ten thousand (10,000); or
(2) at least twenty percent (20%);
in the volume of claims filed on paper.
(c) A waiver granted under this section is effective for a set
period determined by the commissioner.
(d) This section expires December 31, 2005.
SOURCE: IC 28-1-11-2; (03)CC140701.1.89. -->
SECTION 89.
IC 28-1-11-2
, AS AMENDED BY P.L.134-2001,
SECTION 7, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 2. Any bank or trust company shall have power to
act as fiscal or transfer agent of the United States or of any state,
municipality, body politic or corporation; and in such capacity to
receive and disburse money; to transfer, register and countersign
certificates of stock, bonds or other evidence of indebtedness; to
authenticate and certify any such bonds and certificates of
indebtedness; to act as agent to buy and sell domestic and foreign
transportation; to solicit and write insurance as agent an insurance
producer or broker for any insurance company authorized to do
business in the state or states where the agent insurance producer or
broker operates; and to act as attorney in fact or agent of any person or
corporation, foreign or domestic, for any lawful purpose.
SOURCE: IC 28-1-11-2.5; (03)CC140701.1.90. -->
SECTION 90.
IC 28-1-11-2.5
, AS AMENDED BY HEA 1653-2003,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 2.5. (a) A bank or trust company may act as an
agent insurance producer for the sale of any life insurance policy or
annuity contract issued by a life insurance company authorized to do
business in any state in which the agent operates.
(b) A bank or trust company that acts as an agent insurance
producer for the sale of a life insurance policy or an annuity contract
in Indiana:
(1) is subject to all requirements of IC 27; and
(2) must comply with the disclosure requirements under
IC 27-1-38.
(c) A bank or trust company may not condition:
(1) an extension of credit;
(2) a lease or sale of real or personal property;
(3) the performance of services; or
(4) the amount charged for:
(A) extending credit;
(B) leasing or selling real or personal property; or
(C) performing services;
upon a person's purchase of a life insurance policy or an annuity
contract from the bank or trust company or an affiliate (as defined in
IC 28-2-13-3
) of the bank or trust company.
(d) This section does not prohibit a bank or trust company from
requiring that a person, as a condition to a transaction, obtain a life
insurance policy from an insurance company acceptable to the bank or
trust company.
SOURCE: IC 28-5-1-6.5; (03)CC140701.1.91. -->
SECTION 91.
IC 28-5-1-6.5
, AS AMENDED BY P.L.130-2002,
SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 6.5. (a) Notwithstanding any other provision of
this title, an industrial loan and investment company may act as an
agent insurance producer for the sale of any annuity contract issued
by a life insurance company (as defined in
IC 27-1-2-3
) authorized to
do business in Indiana under IC 27-1.
(b) An industrial loan and investment company that acts as an agent
insurance producer for the sale of an annuity contract:
(1) is subject to all requirements of IC 27 relating to the sale and
solicitation of insurance, including licensing as an agent insurance
producer under
IC 27-1-15.6
; and
(2) must comply with the disclosure requirements under
IC 27-1-38.
(c) This section does not give power to, or otherwise affect the power
of, an industrial loan and investment company to act as an agent
insurance producer for the sale of life insurance other than an annuity
contract.
SOURCE: IC 28-6.1-6-14; (03)CC140701.1.92. -->
SECTION 92.
IC 28-6.1-6-14
, AS AMENDED BY P.L.130-2002,
SECTION 7, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 14. (a) A savings bank may solicit and write
insurance as an
agent insurance producer or a broker for any
insurance company authorized to do business in the state or states
where the
agent insurance producer or broker operates.
(b) A savings bank or its affiliate (as defined in
IC 28-6.2-1-4
) may
act as an agent insurance producer for the sale of any life insurance
policy or annuity contract issued by a life insurance company (as
defined in
IC 27-1-2-3
) authorized to do business in the state or states
where the agent insurance producer operates.
(c) A savings bank or its affiliate that acts as an agent insurance
producer for the sale of a life insurance policy or an annuity contract
under subsection (b):
(1) is subject to all requirements of IC 27 with respect to the
agent's insurance producer's activity in Indiana; and
(2) must comply with the disclosure requirements under
IC 27-1-38.
(d) A savings bank or its affiliate may not condition:
(1) an extension of credit;
(2) a lease or sale of real or personal property;
(3) the performance of a service; or
(4) the amount charged for:
(A) extending credit;
(B) leasing or selling real or personal property; or
(C) performing services;
upon a person's purchase of a life insurance policy or an annuity
contract from the savings bank or its affiliate.
(e) This section does not prohibit a savings bank or its affiliate from
requiring that a person, as a condition to a transaction, obtain a life
insurance policy from an insurance company acceptable to the savings
bank or its affiliate.
SOURCE: IC 28-7-1-9.1; (03)CC140701.1.93. -->
SECTION 93.
IC 28-7-1-9.1
, AS AMENDED BY P.L.130-2002,
SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 9.1. (a) A credit union or a related credit union
service organization (as defined in section 0.5(7) of this chapter) that
acts as an agent insurance producer for the sale of a life insurance
policy or an annuity contract issued by a life insurance company (as
defined in
IC 27-1-2-3
):
(1) is subject to the requirements of IC 27; and
(2) must comply with the disclosure requirements of
IC 27-1-38.
(b) A credit union or credit union service organization may not
condition:
(1) an extension of credit;
(2) a lease or sale of real or personal property;
(3) the performance of a service; or
(4) the amount charged for:
(A) extending credit;
(B) leasing or selling real or personal property; or
(C) performing services;
upon a person's purchase of a life insurance policy or an annuity
contract from the credit union or related credit union service
organization.
(c) This section does not prohibit a credit union or a credit union
service organization from requiring that a person, as a condition to a
transaction, obtain a life insurance policy from an insurance company
acceptable to the credit union or credit union service organization.
SOURCE: IC 28-14-3-10; (03)CC140701.1.94. -->
SECTION 94.
IC 28-14-3-10
, AS AMENDED BY P.L.215-1999,
SECTION 13, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 10. A corporate fiduciary has the power to act as
fiscal or transfer agent of the United States or any state, municipality,
body politic, or corporation, and may, in that capacity:
(1) receive and disburse money;
(2) transfer, register, and countersign certificates of stocks, bonds,
and other evidence of indebtedness;
(3) authenticate and certify bonds and certificates of indebtedness
referred to in subdivision (2);
(4) act as agent to buy and sell domestic and foreign transportation;
(5) solicit and write insurance as agent insurance producer or
broker for any insurance company authorized to do business in
Indiana; and
(6) act as attorney in fact or agent of any person or corporation,
foreign or domestic, for any lawful purpose.
SOURCE: IC 28-14-3-11; (03)CC140701.1.95. -->
SECTION 95.
IC 28-14-3-11
, AS AMENDED BY P.L.130-2002,
SECTION 9, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 11. (a) Notwithstanding any other provision of this
title, a corporate fiduciary may act as an agent insurance producer for
the sale of any annuity contract or any life insurance policy issued by
a life insurance company (as defined in
IC 27-1-2-3
) authorized to do
business in Indiana under IC 27-1.
(b) A corporate fiduciary that acts as an agent for the sale of an
annuity contract or a life insurance policy:
(1) is subject to all requirements of IC 27 relating to the sale and
solicitation of insurance, including licensing as an agent insurance
producer under
IC 27-1-15.6
; and
(2) must comply with the disclosure requirements under
IC 27-1-38.
SOURCE: IC 34-18-5-3; (03)CC140701.1.96. -->
SECTION 96.
IC 34-18-5-3
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 3. (a) The surcharge
shall be collected on the same basis as premiums by each insurer, risk
manager, or surplus lines agent. producer.
(b) The surcharge is due and payable within thirty (30) days after the
premium for malpractice liability insurance has been received by the
insurer, risk manager, or surplus lines agent producer from a health
care provider in Indiana. If a surcharge is not paid as required by this
section, the insurer, risk manager, or surplus lines agent producer
responsible for the delinquency is liable for the surcharge plus a
penalty equal to ten percent (10%) of the amount of the surcharge.
(c) If the annual premium surcharge is not paid within the time limit
specified in subsection (b), the certificate of authority of the insurer,
risk manager, and surplus lines agents producer shall be suspended
until the annual premium surcharge is paid.
SOURCE: IC 35-43-9-4; (03)CC140701.1.97. -->
SECTION 97.
IC 35-43-9-4
, AS AMENDED BY P.L.132-2001,
SECTION 25, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]: Sec. 4. As used in this chapter, "title insurance agent"
means a person who holds a limited insurance representative's lines
producer's license issued under
IC 27-1-15.6-18
(4) and disburses
funds from a title insurance escrow account to a party in connection
with a residential real property transaction.
SOURCE: ; (03)CC140701.1.98. -->
SECTION 98. [EFFECTIVE JULY 1, 2003] (a)
IC 27-8-28-17
and
IC 27-13-10-8
, both as amended by this act, apply to an appeal of
a grievance that is filed after June 30, 2003.
(b) This SECTION expires June 30, 2006.
SOURCE: ; (03)CC140701.1.99. -->
SECTION 99.
An emergency is declared for this act.
(Reference is to EHB 1407 as reprinted April 10, 2003.)
Conference Committee Report
on
Engrossed House
Bill 1407
Text Box
S
igned by:
____________________________ ____________________________
Representative Fry Senator Paul
Chairperson
____________________________ ____________________________
Representative Ripley Senator Lewis
House Conferees Senate Conferees