First Regular Session 115th General Assembly (2007)


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    SENATE ENROLLED ACT No. 114



     AN ACT to amend the Indiana Code concerning insurance.

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

SOURCE: IC 27-8-11-9; (07)SE0114.1.1. -->
    SECTION 1. IC 27-8-11-9 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 9. (a) As used in this section, "insurer" includes the following:
        (1) An administrator licensed under IC 27-1-25.
        (2) A person that pays or administers claims on behalf of an insurer.
    (b) An agreement between an insurer and a provider under this chapter may not contain a provision that:
        (1) prohibits, or grants the insurer an option to prohibit, the provider from contracting with another insurer to accept lower payment for health care services than the payment specified in the agreement;
        (2) requires, or grants the insurer an option to require, the provider to accept a lower payment from the insurer if the provider agrees with another insurer to accept lower payment for health care services;
        (3) requires, or grants the insurer an option of, termination or renegotiation of the agreement if the provider agrees with another insurer to accept lower payment for health care services; or
        (4) requires the provider to disclose the provider's

reimbursement rates under contracts with other insurers.
    (c) A provision that:
        (1) is contained in an agreement between an insurer and a provider under this chapter; and
        (2) violates this section;
is void.

SOURCE: IC 27-13-15-4; (07)SE0114.1.2. -->     SECTION 2. IC 27-13-15-4 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 4. (a) As used in this section, "health maintenance organization" includes the following:
        (1) A limited service health maintenance organization.
        (2) A person that pays or administers claims on behalf of a health maintenance organization or a limited service health maintenance organization.
    (b) An agreement between a health maintenance organization and a participating provider under this chapter may not contain a provision that:
        (1) prohibits, or grants the health maintenance organization an option to prohibit, the participating provider from contracting with another health maintenance organization to accept lower payment for health care services than the payment specified in the agreement;
        (2) requires, or grants the health maintenance organization an option to require, the participating provider to accept a lower payment from the health maintenance organization if the participating provider agrees with another health maintenance organization to accept lower payment for health care services;
        (3) requires, or grants the health maintenance organization an option of, termination or renegotiation of the agreement if the participating provider agrees with another health maintenance organization to accept lower payment for health care services; or
        (4) requires the participating provider to disclose the participating provider's reimbursement rates under contracts with other health maintenance organizations.
    (c) A contract provision that violates this section is void.

SOURCE: ; (07)SE0114.1.3. -->     SECTION 3. [EFFECTIVE UPON PASSAGE] (a) IC 27-8-11-9, as added by this act, applies to an agreement between an insurer and a provider that is entered into, amended, or renewed on or after the effective date of this act.
    (b) IC 27-13-15-4, as added by this act, applies to a contract

between a health maintenance organization and a participating provider that is entered into, amended, or renewed on or after the effective date of this act.

SOURCE: ; (07)SE0114.1.4. -->     SECTION 4. An emergency is declared for this act.


SEA 114

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