Introduced Version
SENATE BILL No. 372
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 27-8-17.5.
Synopsis: Health insurance preauthorization procedure. Requires the
department of insurance to prescribe a standard preauthorization
procedure that must be used by an insurer or a health maintenance
organization concerning whether a proposed health care service that a
provider proposes to provide to an insured or enrollee is covered.
Effective: July 1, 2007.
January 11, 2007, read first time and referred to Committee on Health and Provider
Services.
Introduced
First Regular Session 115th General Assembly (2007)
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SENATE BILL No. 372
A BILL FOR AN ACT to amend the Indiana Code concerning
insurance.
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: IC 27-8-17.5; (07)IN0372.1.1. -->
SECTION 1. IC 27-8-17.5 IS ADDED TO THE INDIANA CODE
AS A
NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2007]:
Chapter 17.5. Preauthorization for Reimbursement
Sec. 1. The definitions in IC 27-13-1 apply throughout this
chapter.
Sec. 2. As used in this chapter, "insurer" means an insurer (as
defined in IC 27-1-2-3) that issues a policy of accident and sickness
insurance.
Sec. 3. As used in this chapter, "policy of accident and sickness
insurance" has the meaning set forth in IC 27-8-5-1.
Sec. 4. As used in this chapter, "preauthorization" means a
determination by:
(1) an insurer concerning whether a proposed health care
service that a provider proposes to provide to an insured is
covered under the policy of accident and sickness insurance;
or
(2) a health maintenance organization concerning whether a
proposed health care service that a provider proposes to
provide to an enrollee is covered under the individual contract
or the group contract;
before the health care service is provided.
Sec. 5. (a) The department shall prescribe a standard
preauthorization procedure that must be used by an insurer or a
health maintenance organization.
(b) The procedure prescribed under subsection (a) must be
automated to the extent possible.
Sec. 6. The department may adopt rules under IC 4-22-2
necessary to implement this chapter.