other of the terms and conditions of such contract; however, in
determining the class, consideration may be given to the
nature of the risk, plan of insurance, the actual or expected
expense of conducting the business, or any other relevant
factor.
(B) Unfair discrimination between individuals of the same
class involving essentially the same hazards in the amount of
premium, policy fees, assessments, or rates charged or made
for any policy or contract of accident or health insurance or in
the benefits payable thereunder, or in any of the terms or
conditions of such contract, or in any other manner whatever;
however, in determining the class, consideration may be given
to the nature of the risk, the plan of insurance, the actual or
expected expense of conducting the business, or any other
relevant factor.
(C) Excessive or inadequate charges for premiums, policy
fees, assessments, or rates, or making or permitting any unfair
discrimination between persons of the same class involving
essentially the same hazards, in the amount of premiums,
policy fees, assessments, or rates charged or made for:
(i) policies or contracts of reinsurance or joint reinsurance,
or abstract and title insurance;
(ii) policies or contracts of insurance against loss or damage
to aircraft, or against liability arising out of the ownership,
maintenance, or use of any aircraft, or of vessels or craft,
their cargoes, marine builders' risks, marine protection and
indemnity, or other risks commonly insured under marine,
as distinguished from inland marine, insurance; or
(iii) policies or contracts of any other kind or kinds of
insurance whatsoever.
However, nothing contained in clause (C) shall be construed to
apply to any of the kinds of insurance referred to in clauses (A)
and (B) nor to reinsurance in relation to such kinds of insurance.
Nothing in clause (A), (B), or (C) shall be construed as making or
permitting any excessive, inadequate, or unfairly discriminatory
charge or rate or any charge or rate determined by the department
or commissioner to meet the requirements of any other insurance
rate regulatory law of this state.
(8) Except as otherwise expressly provided by law, knowingly
permitting or offering to make or making any contract or policy
of insurance of any kind or kinds whatsoever, including but not in
limitation, life annuities, or agreement as to such contract or
policy other than as plainly expressed in such contract or policy
issued thereon, or paying or allowing, or giving or offering to pay,
allow, or give, directly or indirectly, as inducement to such
insurance, or annuity, any rebate of premiums payable on the
contract, or any special favor or advantage in the dividends,
savings, or other benefits thereon, or any valuable consideration
or inducement whatever not specified in the contract or policy; or
giving, or selling, or purchasing or offering to give, sell, or
purchase as inducement to such insurance or annuity or in
connection therewith, any stocks, bonds, or other securities of any
insurance company or other corporation, association, limited
liability company, or partnership, or any dividends, savings, or
profits accrued thereon, or anything of value whatsoever not
specified in the contract. Nothing in this subdivision and
subdivision (7) shall be construed as including within the
definition of discrimination or rebates any of the following
practices:
(A) Paying bonuses to policyholders or otherwise abating their
premiums in whole or in part out of surplus accumulated from
nonparticipating insurance, so long as any such bonuses or
abatement of premiums are fair and equitable to policyholders
and for the best interests of the company and its policyholders.
(B) In the case of life insurance policies issued on the
industrial debit plan, making allowance to policyholders who
have continuously for a specified period made premium
payments directly to an office of the insurer in an amount
which fairly represents the saving in collection expense.
(C) Readjustment of the rate of premium for a group insurance
policy based on the loss or expense experience thereunder, at
the end of the first year or of any subsequent year of insurance
thereunder, which may be made retroactive only for such
policy year.
(D) Paying by an insurer or insurance producer thereof duly
licensed as such under the laws of this state of money,
commission, or brokerage, or giving or allowing by an insurer
or such licensed insurance producer thereof anything of value,
for or on account of the solicitation or negotiation of policies
or other contracts of any kind or kinds, to a broker, an
insurance producer, or a solicitor duly licensed under the laws
of this state, but such broker, insurance producer, or solicitor
receiving such consideration shall not pay, give, or allow
credit for such consideration as received in whole or in part,
directly or indirectly, to the insured by way of rebate.
(9) Requiring, as a condition precedent to loaning money upon the
security of a mortgage upon real property, that the owner of the
property to whom the money is to be loaned negotiate any policy
of insurance covering such real property through a particular
insurance producer or broker or brokers. However, this
subdivision shall not prevent the exercise by any lender of the
lender's right to approve or disapprove of the insurance company
selected by the borrower to underwrite the insurance.
(10) Entering into any contract, combination in the form of a trust
or otherwise, or conspiracy in restraint of commerce in the
business of insurance.
(11) Monopolizing or attempting to monopolize or combining or
conspiring with any other person or persons to monopolize any
part of commerce in the business of insurance. However,
participation as a member, director, or officer in the activities of
any nonprofit organization of insurance producers or other
workers in the insurance business shall not be interpreted, in
itself, to constitute a combination in restraint of trade or as
combining to create a monopoly as provided in this subdivision
and subdivision (10). The enumeration in this chapter of specific
unfair methods of competition and unfair or deceptive acts and
practices in the business of insurance is not exclusive or
restrictive or intended to limit the powers of the commissioner or
department or of any court of review under section 8 of this
chapter.
(12) Requiring as a condition precedent to the sale of real or
personal property under any contract of sale, conditional sales
contract, or other similar instrument or upon the security of a
chattel mortgage, that the buyer of such property negotiate any
policy of insurance covering such property through a particular
insurance company, insurance producer, or broker or brokers.
However, this subdivision shall not prevent the exercise by any
seller of such property or the one making a loan thereon of the
right to approve or disapprove of the insurance company selected
by the buyer to underwrite the insurance.
(13) Issuing, offering, or participating in a plan to issue or offer,
any policy or certificate of insurance of any kind or character as
an inducement to the purchase of any property, real, personal, or
mixed, or services of any kind, where a charge to the insured is
not made for and on account of such policy or certificate of
insurance. However, this subdivision shall not apply to any of the
following:
(A) Insurance issued to credit unions or members of credit
unions in connection with the purchase of shares in such credit
unions.
(B) Insurance employed as a means of guaranteeing the
performance of goods and designed to benefit the purchasers
or users of such goods.
(C) Title insurance.
(D) Insurance written in connection with an indebtedness and
intended as a means of repaying such indebtedness in the
event of the death or disability of the insured.
(E) Insurance provided by or through motorists service clubs
or associations.
(F) Insurance that is provided to the purchaser or holder of an
air transportation ticket and that:
(i) insures against death or nonfatal injury that occurs during
the flight to which the ticket relates;
(ii) insures against personal injury or property damage that
occurs during travel to or from the airport in a common
carrier immediately before or after the flight;
(iii) insures against baggage loss during the flight to which
the ticket relates; or
(iv) insures against a flight cancellation to which the ticket
relates.
(14) Refusing, because of the for-profit status of a hospital or
medical facility, to make payments otherwise required to be made
under a contract or policy of insurance for charges incurred by an
insured in such a for-profit hospital or other for-profit medical
facility licensed by the state department of health.
(15) Refusing to insure an individual, refusing to continue to issue
insurance to an individual, limiting the amount, extent, or kind of
coverage available to an individual, or charging an individual a
different rate for the same coverage, solely because of that
individual's blindness or partial blindness, except where the
refusal, limitation, or rate differential is based on sound actuarial
principles or is related to actual or reasonably anticipated
experience.
(16) Committing or performing, with such frequency as to
indicate a general practice, unfair claim settlement practices (as
defined in section 4.5 of this chapter).
(17) Between policy renewal dates, unilaterally canceling an
individual's coverage under an individual or group health
insurance policy solely because of the individual's medical or
physical condition.
(18) Using a policy form or rider that would permit a cancellation
of coverage as described in subdivision (17).
(19) Violating IC 27-1-22-25, IC 27-1-22-26, or IC 27-1-22-26.1
concerning motor vehicle insurance rates.
(20) Violating IC 27-8-21-2 concerning advertisements referring
to interest rate guarantees.
(21) Violating IC 27-8-24.3 concerning insurance and health plan
coverage for victims of abuse.
(22) Violating IC 27-8-26 concerning genetic screening or testing.
(23) Violating IC 27-1-15.6-3(b) concerning licensure of
insurance producers.
(24) Violating IC 27-1-38 concerning depository institutions.
(25) Violating IC 27-8-28-17(c) or IC 27-13-10-8(c) concerning
the resolution of an appealed grievance decision.
the preceding twelve (12) months.
Sec. 12. In establishing a payment rate under section 11 of this
chapter, an insurer shall:
(1) not consider Medicaid and Medicare payment rates; and
(2) establish the payment rate at an amount equal to not less
than the greater of the following payment rates paid by the
insurer during the previous twelve (12) months:
(A) The highest payment rate paid to the dialysis treatment
provider for health care services rendered at a network
dialysis facility.
(B) The highest payment rate paid to the dialysis treatment
provider for health care services rendered at an out of
network dialysis facility.
(C) The highest payment rate paid to any dialysis
treatment provider for health care services rendered at a
network dialysis facility.
Sec. 13. An insurer may not do any of the following at any time
after an insured elects coverage under a policy of accident and
sickness insurance:
(1) Restrict benefits or increase costs to the insured in relation
to dialysis treatment, including the insured's out-of-pocket
expenses.
(2) Change coverage or benefits in any way that would affect
dialysis treatment provided at an out of network dialysis
facility.
Sec. 14. An insurer shall not do the following:
(1) Make changes in coverage under a policy of accident and
sickness in an attempt to cause an insured to elect Medicare
as the insured's primary coverage.
(2) Require an insured, as a condition of coverage, to travel
more than fifteen (15) miles or for longer than thirty (30)
minutes from the insured's home to obtain dialysis treatment,
regardless of whether the insured chooses to receive dialysis
treatment at a network dialysis facility or an out of network
dialysis facility.
Sec. 15. An insurer shall do the following:
(1) Make all claim payments for health care services provided
by a dialysis treatment provider payable only to the dialysis
treatment provider and not to the insured, regardless of
whether the health care services are rendered in a network
dialysis facility or an out of network dialysis facility.
(2) File with the department, not later than December 31 of
each year, an annual evaluation of the following:
(A) Whether the insurer's network of all dialysis treatment
providers is sufficient to provide health care services to
insureds covered under a policy of accident and sickness
insurance issued by the insurer.
provider by health maintenance organizations in the same
geographic area during the preceding twelve (12) months.
(f) In establishing a payment rate under subsection (e), a health
maintenance organization shall:
(1) not consider Medicaid and Medicare payment rates; and
(2) establish the payment rate at an amount equal to not less
than the greater of the following payment rates paid by the
health maintenance organization during the previous twelve
(12) months:
(A) The highest payment rate paid to the dialysis treatment
provider for health care services rendered at a dialysis
facility that is a participating provider.
(B) The highest payment rate paid to the dialysis treatment
provider for health care services rendered at a dialysis
facility that is not a participating provider.
(C) The highest payment rate paid to any dialysis
treatment provider for health care services rendered at a
dialysis facility that is a participating provider.
(g) A health maintenance organization may not do any of the
following at any time after an enrollee elects coverage under an
individual contract or a group contract:
(1) Restrict benefits or increase costs to the enrollee in
relation to dialysis treatment, including the enrollee's
out-of-pocket expenses.
(2) Change coverage or benefits in any way that would affect
dialysis treatment rendered at a dialysis facility that is not a
participating provider.
(h) A health maintenance organization shall not do the
following:
(1) Make changes in coverage under an individual contract or
a group contract in an attempt to cause an enrollee to elect
Medicare as the enrollee's primary coverage.
(2) Require an enrollee, as a condition of coverage, to travel
more than fifteen (15) miles or for longer than thirty (30)
minutes from the enrollee's home to obtain dialysis treatment,
regardless of whether the enrollee chooses to receive dialysis
treatment at a dialysis facility that is a participating provider
or a dialysis facility that is not a participating provider.
(i) A health maintenance organization shall do the following:
(1) Make all claim payments for health care services provided
by a dialysis treatment provider payable only to the dialysis
treatment provider and not to the enrollee, regardless of
whether the health care services are provided in a dialysis
facility that is a participating provider or a dialysis facility
that is not a participating provider.
(2) File with the department, not later than December 31 of
each year, an annual evaluation of the following: