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sickness insurance that is issued, delivered, amended, or
renewed after June 30, 2006.
(13) The amendments made to section 3 of this chapter by
P.L.98-2007 apply to a policy of accident and sickness
insurance that is issued, delivered, amended, or renewed after
December 31, 2007.
(14) The amendments made to section 2 of this chapter by
P.L.218-2007 apply to a policy of accident and sickness
insurance that is issued, delivered, amended, or renewed after
June 30, 2007.
(15) The addition of section 28 of this chapter by P.L.218-2007
applies to a policy of accident and sickness insurance that is
issued, delivered, amended, or renewed after June 30, 2007.
As added by P.L.220-2011, SEC.435.
IC 27-8-5-1
Policy of accident and sickness insurance; filing; review;
conformity with federal act
Sec. 1. (a) The term "policy of accident and sickness insurance",
as used in this chapter, includes any policy or contract covering one
(1) or more of the kinds of insurance described in Class 1(b) or 2(a)
of IC 27-1-5-1. Such policies may be on the individual basis under
this section and sections 2 through 9 of this chapter, on the group
basis under this section and sections 16 through 19 of this chapter,
on the franchise basis under this section and section 11 of this
chapter, or on a blanket basis under section 15 of this chapter and
(except as otherwise expressly provided in this chapter) shall be
exclusively governed by this chapter.
(b) No policy of accident and sickness insurance may be issued or
delivered to any person in this state, nor may any application, rider,
or endorsement be used in connection with an accident and sickness
insurance policy, until a copy of the form of the policy and of the
classification of risks and the premium rates, or, in the case of
assessment companies, the estimated cost pertaining thereto, have
been filed with and reviewed by the commissioner under section 1.5
of this chapter. This section is applicable also to assessment
companies and fraternal benefit associations or societies.
(c) This chapter shall be applied in conformity with the
requirements of the federal Patient Protection and Affordable Care
Act (P.L. 111-148), as amended by the federal Health Care and
Education Reconciliation Act of 2010 (P.L. 111-152), as in effect on
September 23, 2010.
(Formerly: Acts 1953, c.15, s.169.1; Acts 1975, P.L.281, SEC.1.) As
amended by P.L.257-1985, SEC.1; P.L.7-1987, SEC.154;
P.L.173-2007, SEC.21; P.L.160-2011, SEC.17.
IC 27-8-5-1.5
Filing, review, approval, and disapproval process
Sec. 1.5. (a) This section applies to a policy of accident and
sickness insurance issued on an individual, a group, a franchise, or
a blanket basis, including a policy issued by an assessment company
or a fraternal benefit society.
(b) As used in this section, "commissioner" refers to the insurance
commissioner appointed under IC 27-1-1-2.
(c) As used in this section, "grossly inadequate filing" means a
policy form filing:
(1) that fails to provide key information, including state specific
information, regarding a product, policy, or rate; or
(2) that demonstrates an insufficient understanding of
applicable legal requirements.
(d) As used in this section, "policy form" means a policy, a
contract, a certificate, a rider, an endorsement, an evidence of
coverage, or any amendment that is required by law to be filed with
the commissioner for approval before use in Indiana.
(e) As used in this section, "type of insurance" refers to a type of
coverage listed on the National Association of Insurance
Commissioners Uniform Life, Accident and Health, Annuity and
Credit Product Coding Matrix, or a successor document, under the
heading "Continuing Care Retirement Communities", "Health",
"Long Term Care", or "Medicare Supplement".
(f) Each person having a role in the filing process described in
subsection (i) shall act in good faith and with due diligence in the
performance of the person's duties.
(g) A policy form may not be issued or delivered in Indiana unless
the policy form has been filed with and approved by the
commissioner.
(h) The commissioner shall do the following:
(1) Create a document containing a list of all product filing
requirements for each type of insurance, with appropriate
citations to the law, administrative rule, or bulletin that
specifies the requirement, including the citation for the type of
insurance to which the requirement applies.
(2) Make the document described in subdivision (1) available
on the department of insurance Internet site.
(3) Update the document described in subdivision (1) at least
annually and not more than thirty (30) days following any
change in a filing requirement.
(i) The filing process is as follows:
(1) A filer shall submit a policy form filing that:
(A) includes a copy of the document described in subsection
(h);
(B) indicates the location within the policy form or
supplement that relates to each requirement contained in the
document described in subsection (h); and
(C) certifies that the policy form meets all requirements of
state law.
(2) The commissioner shall review a policy form filing and, not
more than thirty (30) days after the commissioner receives the
filing under subdivision (1):
(A) approve the filing; or
subsection (m). A disapproved policy form filing may not be
used for a policy of accident and sickness insurance unless the
disapproval is overturned in a hearing conducted under this
subsection.
(6) If the commissioner does not take any action on a policy
form that is filed or resubmitted under this subsection in
accordance with any applicable period specified in subdivision
(2), (3), or (4), the policy form filing is considered to be
approved.
(j) Except as provided in this subsection, the commissioner may
not disapprove a policy form resubmitted under subsection (i)(3) or
(i)(4) for a reason other than a reason specified in the original notice
of determination under subsection (i)(2)(B). The commissioner may
disapprove a resubmitted policy form for a reason other than a reason
specified in the original notice of determination under subsection
(i)(2) if:
(1) the filer has introduced a new provision in the resubmission;
(2) the filer has materially modified a substantive provision of
the policy form in the resubmission;
(3) there has been a change in requirements applying to the
policy form; or
(4) there has been reviewer error and the written disapproval
fails to state a specific requirement with which the policy form
does not comply.
(k) The commissioner may return a grossly inadequate filing to
the filer without triggering a deadline set forth in this section.
(l) The commissioner may disapprove a policy form if:
(1) the benefits provided under the policy form are not
reasonable in relation to the premium charged; or
(2) the policy form contains provisions that are unjust, unfair,
inequitable, misleading, or deceptive, or that encourage
misrepresentation of the policy.
(m) Upon disapproval of a filing under this section, the
commissioner shall provide written notice to the filer or insurer of
the right to a hearing within twenty (20) days of a request for a
hearing.
(n) Unless a policy form approved under this chapter contains a
material error or omission, the commissioner may not:
(1) retroactively disapprove the policy form; or
(2) examine the filer of the policy form during a routine or
targeted market conduct examination for compliance with a
policy form filing requirement that was not in existence at the
time the policy form was filed.
As added by P.L.173-2007, SEC.22. Amended by P.L.111-2008,
SEC.3.
IC 27-8-5-2
Requirements for issuance and delivery of policy
Sec. 2. (a) No individual policy of accident and sickness insurance
shall be delivered or issued for delivery to any person in this state
unless it complies with each of the following:
(1) The entire money and other considerations for the policy are
expressed in the policy.
(2) The time at which the insurance takes effect and terminates
is expressed in the policy.
(3) The policy purports to insure only one (1) person, except
that a policy must insure, originally or by subsequent
amendment, upon the application of any member of a family
who shall be deemed the policyholder and who is at least
eighteen (18) years of age, any two (2) or more eligible
members of that family, including husband, wife, dependent
children, or any children who are less than twenty-six (26) years
of age, and any other person dependent upon the policyholder.
(4) The style, arrangement, and overall appearance of the policy
give no undue prominence to any portion of the text, and unless
every printed portion of the text of the policy and of any
endorsements or attached papers is plainly printed in lightface
type of a style in general use, the size of which shall be uniform
and not less than ten point with a lower-case unspaced alphabet
length not less than one hundred and twenty point (the "text"
shall include all printed matter except the name and address of
the insurer, name or title of the policy, the brief description if
any, and captions and subcaptions).
(5) The exceptions and reductions of indemnity are set forth in
the policy and, except those which are set forth in section 3 of
this chapter, are printed, at the insurer's option, either included
with the benefit provision to which they apply, or under an
appropriate caption such as "EXCEPTIONS", or
"EXCEPTIONS AND REDUCTIONS", provided that if an
exception or reduction specifically applies only to a particular
benefit of the policy, a statement of such exception or reduction
shall be included with the benefit provision to which it applies.
(6) Each such form of the policy, including riders and
endorsements, shall be identified by a form number in the lower
left-hand corner of the first page of the policy.
(7) The policy contains no provision purporting to make any
portion of the charter, rules, constitution, or bylaws of the
insurer a part of the policy unless such portion is set forth in full
in the policy, except in the case of the incorporation of or
reference to a statement of rates or classification of risks, or
short-rate table filed with the commissioner.
(8) If an individual accident and sickness insurance policy or
hospital service plan contract or medical service plan contract
provides that hospital or medical expense coverage of a
dependent child terminates upon attainment of the limiting age
for dependent children specified in such policy or contract, the
policy or contract must also provide that attainment of such
limiting age does not operate to terminate the hospital and
medical coverage of such child while the child is and continues
to be both:
IC 27-8-5-2.5
Coverage under individual, and certain association group, policies
of accident and sickness insurance; waivers
Sec. 2.5. (a) As used in this section, the term "policy of accident
and sickness insurance" does not include the following:
(1) Accident only, credit, dental, vision, Medicare supplement,
long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Automobile medical payment insurance.
IC 27-8-5-3
Required provisions; statutory option provisions; inapplicable or
inconsistent provisions; order of provisions; third party
ownership; requirements of other jurisdictions; filing procedure
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 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.
The policy provision under this subdivision may not be used with
respect to a policy that provides coverage for hospital, medical, or
surgical expenses.
(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.
(Formerly: Acts 1953, c.15, s.169.3; Acts 1971, P.L.392, SEC.1; Acts
1973, P.L.275, SEC.4; Acts 1974, P.L.1, SEC.13.) As amended by
P.L.28-1988, SEC.104; P.L.93-1995, SEC.8; P.L.91-1998, SEC.10;
P.L.162-2001, SEC.2; P.L.178-2003, SEC.60; P.L.98-2007, SEC.1.
IC 27-8-5-4
Effect of other policy provisions or policy conflicting with chapter
Sec. 4. (a) No policy provision which is not subject to section 3
of this chapter shall make a policy, or any portion thereof, less
favorable in any respect to the insured or the beneficiary than the
provisions thereof which are subject to this chapter.
(b) A policy delivered or issued for delivery to any person in this
state in violation of this chapter shall be held valid but shall be
construed as provided in this chapter. When any provision in a policy
subject to this chapter is in conflict with any provision of this
chapter, the rights, duties, and obligations of the insurer, the insured,
and the beneficiary shall be governed by the provisions of this
chapter.
(Formerly: Acts 1953, c.15, s.169.4.) As amended by P.L.252-1985,
SEC.303.
IC 27-8-5-5
Application; attaching copy to policy; furnishing copy to insured;
alterations; effect of false statements
Sec. 5. (a) The insured shall not be bound by any statement made
in an application for a policy unless a copy of such application is
attached to or endorsed on the policy when issued as a part thereof.
If any such policy delivered or issued for delivery to any person in
this state shall be reinstated or renewed, and the insured or the
beneficiary or assignee of such policy shall make written request to
the insurer for a copy of the application, if any, for such
reinstatement or renewal, the insurer shall within fifteen (15) days
after the receipt of such request at its home office or any branch
office of the insurer, deliver or mail to the person making such
request, a copy of such application. If such copy shall not be so
delivered or mailed, the insurer shall be precluded from introducing
such application as evidence in any action or proceeding based upon
or involving such policy or its reinstatement or renewal.
IC 27-8-5-6
Defenses of insurer; acts not constituting waiver
Sec. 6. The acknowledgment by any insurer of the receipt of
notice given under any policy covered by this chapter, or the
furnishing of forms for filing proofs of loss, or the acceptance of
such proofs, or the investigation of any claim thereunder shall not
operate as a waiver of any of the rights of the insurer in defense of
any claim arising under such policy.
(Formerly: Acts 1953, c.15, s.169.6.) As amended by P.L.252-1985,
SEC.305.
IC 27-8-5-7
Acceptance of premium for period beyond termination date; effect;
misstatement of age
Sec. 7. If any such policy contains a provision establishing, as an
age limit or otherwise, a date after which the coverage provided by
the policy will not be effective, and if such date falls within a period
for which premium is accepted by the insurer or if the insurer accepts
a premium after such date, the coverage provided by the policy will
continue in force subject to any right of cancellation until the end of
the period for which premium has been accepted. In the event the age
of the insured has been misstated and if, according to the correct age
of the insured, the coverage provided by the policy would not have
become effective, or would have ceased prior to the acceptance of
such premium or premiums, then the liability of the insurer shall be
limited to the refund, upon request, of all premiums paid for the
period not covered by the policy.
(Formerly: Acts 1953, c.15, s.169.7.)
IC 27-8-5-8
Exemption of accident and sickness coverage incidental to
designated other forms of insurance
Sec. 8. Except as otherwise expressly indicated in this section,
nothing contained in sections 1 through 7 of this chapter shall apply
to or affect:
(1) any policy of worker's compensation insurance or any policy
of liability insurance with or without supplementary coverage
in the policy;
IC 27-8-5-9
Exemption of certain individual policies
Sec. 9. An individual accident and sickness insurance policy form
or any form of rider or endorsement appertaining to such a policy
form, which could have been lawfully used or delivered or issued for
delivery to any person in this state immediately before February 20,
1953, may be used or delivered or issued for delivery to any such
person at any time prior to January 1, 1956, without being subject to
the provisions of sections 2, 3, and 4 of this chapter.
(Formerly: Acts 1953, c.15, s.169.9.) As amended by P.L.252-1985,
SEC.307.
IC 27-8-5-10
Repealed
(Repealed by P.L.257-1985, SEC.6.)
IC 27-8-5-11
Franchise plan; accident and sickness insurance; definitions,
limitations, requirements, and standards
Sec. 11. No policy of accident and sickness insurance on a
franchise plan shall be delivered or issued for delivery to any person
in this state unless it conforms to the definitions, limitations,
requirements and standards in this section prescribed:
(A) Qualified Groups.
(1) Two (2) or more employees of any employer, inclusive of any
governmental division, department or agency.
IC 27-8-5-12
Supplementary character of chapter
Sec. 12. This chapter while independent in its enactment of any
other statute, is nevertheless a supplement to IC 27-1 and shall be so
considered and construed. Accordingly, all general provisions of
IC 27-1 shall be fully and completely applicable to the sections of
this chapter in the same manner as though such sections were part of
IC 27-1.
(Formerly: Acts 1953, c.15, s.169.12.) As amended by P.L.252-1985,
SEC.308.
IC 27-8-5-13
Repeal of 1935 act
Sec. 13. Acts 1935, c.162, s.174 is hereby expressly repealed
except as to policies issued before February 20, 1953, and except as
to policies which under section 9 of this chapter continue to be
issued under said section 174 prior to January 1, 1956.
(Formerly: Acts 1953, c.15, s.169.13.) As amended by P.L.252-1985,
SEC.309.
IC 27-8-5-14
Exception of fraternal benefit associations
Sec. 14. The provisions of sections 2 and 3 of this chapter shall
not be applicable to fraternal benefit associations or societies.
IC 27-8-5-15
Blanket accident and sickness insurance; qualification of groups;
policy provisions; payment of benefits
Sec. 15. (a) No policy of blanket accident and sickness insurance
shall be delivered or issued for delivery in this state unless it
conforms to the requirements of this section.
(1) A policy may be issued to any common carrier or to any
operator, owner or lessee of a means of transportation, who or
which shall be deemed the policyholder, covering a group of
persons who may become passengers defined by reference to
their travel status on such common carrier or such means of
transportation.
(2) A policy may be issued to an employer, who shall be
deemed the policyholder, covering any group of employees,
dependents or guests, defined by reference to specified hazards
incident to an activity or activities or operations of the
policyholder.
(3) A policy may be issued to a college, school, or other
institution of learning, a school district or districts, or school
jurisdictional unit, or to the head, principal, or governing board
of any such educational unit, who or which shall be deemed the
policyholder, covering students, teachers, or employees.
(4) A policy may be issued to any religious, charitable,
recreational, educational, or civic organization, or branch
thereof, which shall be deemed the policyholder, covering any
group of members or participants defined by reference to
specified hazards incident to any activity or activities or
operations sponsored or supervised by such policyholder.
(5) A policy may be issued to a sports team, camp, or sponsor
thereof, which shall be deemed the policyholder, covering
members, campers, employees, officials, or supervisors.
(6) A policy may be issued to any volunteer fire department,
first aid, emergency management, or other such volunteer
organization, which shall be deemed the policyholder, covering
any group of members or participants defined by reference to
specified hazards incident to an activity or activities or
operations sponsored or supervised by such policyholder.
(7) A policy may be issued to a newspaper or other publisher,
which shall be deemed the policyholder, covering its carriers.
(8) A policy may be issued to an association, including a labor
union, which shall have a constitution and bylaws and which
has been organized and is maintained in good faith for purposes
other than that of obtaining insurance, which shall be deemed
the policyholder, covering any group of members or participants
defined by reference to specified hazards incident to an activity
or activities or operations sponsored or supervised by such
policyholder.
within ninety (90) days after the date of such loss. Failure to
furnish such proof within such time shall not invalidate nor
reduce any claim if it shall be shown not to have been
reasonably possible to furnish such proof and that such proof
was furnished as soon as was reasonably possible.
(5) A provision that all benefits payable under the policy other
than benefits for loss of time will be payable:
(A) immediately upon receipt of due written proof of such
loss; or
(B) in accordance with IC 27-8-5.7;
whichever is more favorable to the policyholder, and that,
subject to due proof of loss, all accrued benefits payable under
the policy for loss of time will be paid not less frequently than
monthly during the continuance of the period for which the
insurer is liable, and that any balance remaining unpaid at the
termination of such period will be paid immediately upon
receipt of such proof.
(6) A provision that the insurer at its own expense, shall have
the right and opportunity to examine the person of the injured
or sick individual when and so often as it may reasonably
require during the pendency of claim under the policy and also
the right and opportunity to make an autopsy where it is not
prohibited by law.
(7) A provision that no action at law or in equity shall be
brought to recover under the policy prior to the expiration of
sixty (60) days after written proof of loss has been furnished in
accordance with the requirements of the policy and that 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.
The insurer may omit from a policy any portion of any of the above
provisions which is not applicable to that policy. An individual
application need not be required from a person covered under a
blanket accident and sickness policy, nor shall it be necessary for the
insurer to furnish each person a certificate.
(c) All benefits under any blanket accident and sickness policy
shall be payable to the person insured, or to the insured's designated
beneficiary or beneficiaries, or to the insured's estate, except that if
the person insured be a minor or otherwise not competent to give a
valid release, such benefits may be made payable to the insured's
parent, guardian, or other person actually supporting the insured.
However, the policy may provide in substance that all or any portion
of any benefits provided by any such policy on account of hospital,
nursing, medical, or surgical services may, at the option of the
insurer 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, the policy may not
require that the service be rendered by a particular hospital or person.
Payment so made shall discharge the insurer's obligations with
respect to the amount of insurance so paid.
(d) This section applies only to policies delivered or issued for
delivery in Indiana after August 19, 1975.
(Formerly: Acts 1975, P.L.281, SEC.2.) As amended by P.L.5-1988,
SEC.146; P.L.21-1991, SEC.24; P.L.162-2001, SEC.3.
IC 27-8-5-15.5
Inpatient services for treatment of mental illness or substance
abuse
Sec. 15.5. (a) As used in this section:
"Alcohol abuse" has the meaning set forth in IC 12-7-2-10.
"Community mental health center" has the meaning set forth in
IC 12-7-2-38 and IC 12-7-2-39.
"Division of mental health and addiction" refers to the division
created under IC 12-21-1-1.
"Drug abuse" has the meaning set forth in IC 12-7-2-72.
"Inpatient services" means services that require the beneficiary of
the services to remain overnight in the facility in which the services
are offered.
"Mental illness" has the meaning set forth in IC 12-7-2-130(1).
"Psychiatric hospital" has the meaning set forth in IC 12-7-2-151.
"State department of health" refers to the department established
under IC 16-19-1-1.
"Substance abuse" means drug abuse or alcohol abuse.
(b) An insurance policy that provides coverage for inpatient
services for the treatment of:
(1) mental illness;
(2) substance abuse; or
(3) both mental illness and substance abuse;
may not exclude coverage for inpatient services for the treatment of
mental illness or substance abuse that are provided by a community
mental health center or by any psychiatric hospital licensed by the
state department of health or the division of mental health and
addiction to offer those services.
As added by P.L.258-1985, SEC.1. Amended by P.L.2-1992,
SEC.784; P.L.2-1993, SEC.150; P.L.215-2001, SEC.104.
IC 27-8-5-15.6
Treatment limitations or financial requirements on coverage of
services for mental illness
Sec. 15.6. (a) As used in this section, "coverage of services for a
mental illness" includes the services defined under the policy of
accident and sickness insurance. However, the term does not include
services for the treatment of substance abuse or chemical
dependency.
(b) This section applies to a policy of accident and sickness
insurance that:
(1) is issued on an individual basis or a group basis;
(2) is issued, entered into, or renewed after December 31, 1999;
and
(3) is issued to an employer that employs more than fifty (50)
full-time employees.
IC 27-8-5-15.7
Exemption of policies or contracts from laws resulting in certain
annual premium increases
Sec. 15.7. (a) The department shall exempt a policy or contract
issued by an insurer or health maintenance organization under
IC 5-10-8-9, section 15.6 of this chapter, or IC 27-13-7-14.8 by
documenting to the department that compliance with the
requirements of IC 5-10-8-9(c), section 15.6(d) of this chapter, or
IC 27-13-7-14.8(d) have increased the annual premium or rates
charged for the policy or health maintenance organization contract
by more than four percent (4%) per year. An insurer or a health
maintenance organization that applies for an exemption under this
section shall provide documentation that is certified by an
independent member of the American Academy of Actuaries of
actual mental health claims incurred for a period of not less than six
(6) months to substantiate the insurer's or health maintenance
organization's assertion of increased claims and administrative costs
by more than four percent (4%) per year.
(b) Documents submitted under this section must be available for
public inspection.
As added by P.L.81-1999, SEC.4.
IC 27-8-5-16
Policy of group accident and sickness insurance; requirements
Sec. 16. Except as provided in sections 17 and 24 of this chapter,
no policy of group accident and sickness insurance may be delivered
or issued for delivery to a group that has a legal situs in Indiana
unless it conforms to one (1) of the following descriptions:
(1) A policy issued to an employer or to the trustees of a fund
established by an employer (which employer or trustees must be
deemed the policyholder) to insure employees of the employer
for the benefit of persons other than the employer, subject to the
following requirements:
(A) The employees eligible for insurance under the policy
must be all of the employees of the employer, or all of any
class or classes of employees. The policy may provide that
the term "employees" includes the employees of one (1) or
more subsidiary corporations and the employees, individual
proprietors, members, and partners of one (1) or more
affiliated corporations, proprietorships, limited liability
companies, or partnerships if the business of the employer
and of the affiliated corporations, proprietorships, limited
liability companies, or partnerships is under common
control. The policy may provide that the term "employees"
includes retired employees, former employees, and directors
of a corporate employer. A policy issued to insure the
employees of a public body may provide that the term
"employees" includes elected or appointed officials.
(B) The premium for the policy must be paid either from the
employer's funds, from funds contributed by the insured
employees, or from both sources of funds. Except as
provided in clause (C), a policy on which no part of the
premium is to be derived from funds contributed by the
insured employees must insure all eligible employees, except
those who reject the coverage in writing.
made on the loan.
(3) A policy issued to a labor union or similar employee
organization (which must be deemed to be the policyholder) to
insure members of the union or organization for the benefit of
persons other than the union or organization or any of its
officials, representatives, or agents, subject to the following
requirements:
(A) The members eligible for insurance under the policy
must be all of the members of the union or organization, or
all of any class or classes of members.
(B) The premium for the policy must be paid either from
funds of the union or organization, from funds contributed
by the insured members specifically for their insurance, or
from both sources of funds. Except as provided in clause
(C), a policy on which no part of the premium is to be
derived from funds contributed by the insured members
specifically for their insurance must insure all eligible
members, except those who reject the coverage in writing.
(C) An insurer may exclude or limit the coverage on any
person as to whom evidence of individual insurability is not
satisfactory to the insurer.
(4) A policy issued to a trust or to one (1) or more trustees of a
fund established or adopted by two (2) or more employers, or
by one (1) or more labor unions or similar employee
organizations, or by one (1) or more employers and one (1) or
more labor unions or similar employee organizations (which
trust or trustees must be deemed the policyholder) to insure
employees of the employers or members of the unions or
organizations for the benefit of persons other than the
employers or the unions or organizations, subject to the
following requirements:
(A) The persons eligible for insurance must be all of the
employees of the employers or all of the members of the
unions or organizations, or all of any class or classes of
employees or members. The policy may provide that the
term "employees" includes the employees of one (1) or more
subsidiary corporations and the employees, individual
proprietors, and partners of one (1) or more affiliated
corporations, proprietorships, limited liability companies, or
partnerships if the business of the employer and of the
affiliated corporations, proprietorships, limited liability
companies, or partnerships is under common control. The
policy may provide that the term "employees" includes
retired employees, former employees, and directors of a
corporate employer. The policy may provide that the term
"employees" includes the trustees or their employees, or
both, if their duties are principally connected with the
trusteeship.
(B) The premium for the policy must be paid from funds
contributed by the employer or employers of the insured
persons, by the union or unions or similar employee
organizations, or by both, or from funds contributed by the
insured persons or from both the insured persons and one (1)
or more employers, unions, or similar employee
organizations. Except as provided in clause (C), a policy on
which no part of the premium is to be derived from funds
contributed by the insured persons specifically for their
insurance must insure all eligible persons, except those who
reject the coverage in writing.
(C) An insurer may exclude or limit the coverage on any
person as to whom evidence of individual insurability is not
satisfactory to the insurer.
(5) A policy issued to an association or to a trust or to one (1)
or more trustees of a fund established, created, or maintained
for the benefit of members of one (1) or more associations. The
association or associations must have at the outset a minimum
of one hundred (100) persons, must have been organized and
maintained in good faith for purposes other than that of
obtaining insurance, must have been in active existence for at
least one (1) year, and must have a constitution and bylaws that
provide that the association or associations hold regular
meetings not less than annually to further purposes of the
members, that, except for credit unions, the association or
associations collect dues or solicit contributions from members,
and that the members have voting privileges and representation
on the governing board and committees. The policy must be
subject to the following requirements:
(A) The policy may insure members or employees of the
association or associations, employees of members, one (1)
or more of the preceding, or all of any class or classes of
members, employees, or employees of members for the
benefit of persons other than the employee's employer.
(B) The premium for the policy must be paid from funds
contributed by the association or associations, by employer
members, or by both, from funds contributed by the covered
persons, or from both the covered persons and the
association, associations, or employer members.
(C) Except as provided in clause (D), a policy on which no
part of the premium is to be derived from funds contributed
by the covered persons specifically for the insurance must
insure all eligible persons, except those who reject such
coverage in writing.
(D) An insurer may exclude or limit the coverage on any
person as to whom evidence of individual insurability is not
satisfactory to the insurer.
(6) A policy issued to a credit union, or to one (1) or more
trustees or an agent designated by two (2) or more credit unions
(which credit union, trustee, trustees, or agent must be deemed
the policyholder) to insure members of the credit union or credit
unions for the benefit of persons other than the credit union or
credit unions, trustee, trustees, or agent, or any of their officials,
subject to the following requirements:
(A) The members eligible for insurance must be all of the
members of the credit union or credit unions, or all of any
class or classes of members.
(B) The premium for the policy shall be paid by the
policyholder from the credit union's funds and, except as
provided in clause (C), must insure all eligible members.
(C) An insurer may exclude or limit the coverage on any
member as to whom evidence of individual insurability is
not satisfactory to the insurer.
(7) A policy issued to cover persons in a group specifically
described by another law of Indiana as a group that may be
covered for group life insurance. The provisions of the group
life insurance law relating to eligibility and evidence of
insurability apply to a group health policy to which this
subdivision applies.
(8) A policy issued to a trustee or agent designated by two (2)
or more small employers (as defined in IC 27-8-15-14) as
determined by the commissioner under rules adopted under
IC 4-22-2.
As added by P.L.257-1985, SEC.2. Amended by P.L.19-1986,
SEC.47; P.L.125-1992, SEC.1; P.L.8-1993, SEC.429; P.L.185-1996,
SEC.11; P.L.218-2007, SEC.46.
IC 27-8-5-16.3
"Small employer"; implementation of program for joint purchase
of health insurance; rules
Sec. 16.3. (a) As used in this section, "small employer" has the
meaning set forth in IC 27-8-15-14.
(b) The commissioner and the office of the secretary of family and
social services may implement a program to allow two (2) or more
small employers to join together to purchase health insurance, as
described in section 16(8) of this chapter.
(c) The commissioner shall adopt rules under IC 4-22-2 necessary
to implement this section.
As added by P.L.16-2009, SEC.29.
IC 27-8-5-16.5
Conditions for issuance of certificate to resident of Indiana under
group policy delivered or issued in another state
Sec. 16.5. (a) As used in this section, "delivery state" means any
state other than Indiana in which a policy is delivered or issued for
delivery.
(b) Except as provided in subsection (c), (d), or (e), a certificate
may not be issued to a resident of Indiana pursuant to a group policy
that is delivered or issued for delivery in a state other than Indiana.
(c) A certificate may be issued to a resident of Indiana pursuant
to a group policy not described in subsection (d) that is delivered or
issued for delivery in a state other than Indiana if:
to a group policy that is delivered or issued for delivery in a state
other than Indiana if the commissioner determines that the policy
pursuant to which the certificate is issued meets the requirements set
forth in section 17(a) of this chapter.
(f) This section does not affect any other provision of Indiana law
governing the terms or benefits of coverage provided to a resident of
Indiana under any certificate or policy of insurance.
As added by P.L.185-1996, SEC.12. Amended by P.L.96-2002,
SEC.1; P.L.211-2003, SEC.3; P.L.127-2006, SEC.2; P.L.11-2011,
SEC.30.
IC 27-8-5-17
Exceptions; discretionary groups; group accident and sickness
insurance
Sec. 17. (a) A group accident and sickness insurance policy shall
not be delivered or issued for delivery in Indiana to a group that is
not described in section 16(1)(A), 16(2)(A), 16(3)(A), 16(4)(A),
16(5)(A), 16(6)(A), 16(7), or 16(8) of this chapter unless:
(1) the group applies to the commissioner for approval as a
discretionary group;
(2) the commissioner reviews the group according to the same
standards as a group described in section 16 of this chapter; and
(3) the commissioner finds that:
(A) the issuance of the policy is not contrary to the best
interest of the public;
(B) the issuance of the policy would result in economies of
acquisition or administration; and
(C) the benefits of the policy are reasonable in relation to the
premiums charged.
(b) Except as otherwise provided in this chapter, an insurer may
exclude or limit the coverage under a policy described in subsection
(a) on any person as to whom evidence of individual insurability is
not satisfactory to the insurer.
As added by P.L.257-1985, SEC.3. Amended by P.L.268-1987,
SEC.2; P.L.125-1992, SEC.2; P.L.185-1996, SEC.13; P.L.218-2007,
SEC.47; P.L.11-2011, SEC.31.
IC 27-8-5-18
Extension to family members or dependents; premiums;
exclusions; group accident and sickness insurance
Sec. 18. (a) Except for a policy that conforms to the description
in section 16(2) of this chapter, a group accident and sickness
insurance policy may be extended to insure the employees or
members, or any class or classes of employees or members, with
respect to their family members or dependents, subject to subsections
(b) and (c).
(b) The premium for the insurance must be paid from funds
contributed by the employer, union, association, or other person to
whom the policy has been issued or from funds contributed by the
covered persons, or from both sources of funds. Except as provided
in subsection (c), a policy on which no part of the premium for the
coverage of family members or dependents is to be derived from
funds contributed by the covered persons must insure all eligible
employees or members, or any class or classes of eligible employees
or members, with respect to their spouses and dependent children.
(c) Except as provided in section 24 of this chapter, an insurer
may exclude or limit the coverage on any family member or
dependent as to whom evidence of individual insurability is not
satisfactory to the insurer.
As added by P.L.257-1985, SEC.4. Amended by P.L.125-1992,
SEC.3.
IC 27-8-5-19
Contents; group accident and sickness insurance
Sec. 19. (a) As used in this chapter, "late enrollee" has the
meaning set forth in 26 U.S.C. 9801(b)(3).
(b) A policy of group accident and sickness insurance may not be
issued to a group that has a legal situs in Indiana unless it contains in
substance:
(1) the provisions described in subsection (c); or
(2) provisions that, in the opinion of the commissioner, are:
(A) more favorable to the persons insured; or
(B) at least as favorable to the persons insured and more
favorable to the policyholder;
than the provisions set forth in subsection (c).
(c) The provisions referred to in subsection (b)(1) are as follows:
(1) A provision that the policyholder is entitled to a grace
period of thirty-one (31) days for the payment of any premium
due except the first, during which grace period the policy will
continue in force, unless the policyholder has given the insurer
written notice of discontinuance in advance of the date of
discontinuance and in accordance with the terms of the policy.
The policy may provide that the policyholder is liable to the
insurer for the payment of a pro rata premium for the time the
policy was in force during the grace period. A provision under
this subdivision may provide that the insurer is not obligated to
pay claims incurred during the grace period until the premium
due is received.
(2) A provision that the validity of the policy may not be
contested, except for nonpayment of premiums, after the policy
has been in force for two (2) years after its date of issue, and
that no statement made by a person covered under the policy
relating to the person's insurability may be used in contesting
the validity of the insurance with respect to which the statement
was made, unless:
(A) the insurance has not been in force for a period of two
(2) years or longer during the person's lifetime; or
(B) the statement is contained in a written instrument signed
by the insured person.
However, a provision under this subdivision may not preclude
the assertion at any time of defenses based upon a person's
ineligibility for coverage under the policy or based upon other
provisions in the policy.
(3) A provision that a copy of the application, if there is one, of
the policyholder must be attached to the policy when issued,
that all statements made by the policyholder or by the persons
insured are to be deemed representations and not warranties,
and that no statement made by any person insured may be used
in any contest unless a copy of the instrument containing the
statement is or has been furnished to the insured person or, in
the event of death or incapacity of the insured person, to the
insured person's beneficiary or personal representative.
(4) A provision setting forth the conditions, if any, under which
the insurer reserves the right to require a person eligible for
insurance to furnish evidence of individual insurability
satisfactory to the insurer as a condition to part or all of the
person's coverage.
(5) A provision specifying any additional exclusions or
limitations applicable under the policy with respect to a disease
or physical condition of a person that existed before the
effective date of the person's coverage under the policy and that
is not otherwise excluded from the person's coverage by name
or specific description effective on the date of the person's loss.
An exclusion or limitation that must be specified in a provision
under this subdivision:
(A) may apply only to a disease or physical condition for
which medical advice, diagnosis, care, or treatment was
received by the person or recommended to the person during
the six (6) months before the effective date of the person's
coverage; and
(B) may not apply to a loss incurred or disability beginning
after the earlier of:
(i) the end of a continuous period of twelve (12) months
beginning on or after the effective date of the person's
coverage; or
(ii) the end of a continuous period of eighteen (18) months
beginning on the effective date of the person's coverage if
the person is a late enrollee.
This subdivision applies only to group policies of accident and
sickness insurance other than those described in section
2.5(a)(1) through 2.5(a)(8) and 2.5(b)(2) of this chapter.
(6) A provision specifying any additional exclusions or
limitations applicable under the policy with respect to a disease
or physical condition of a person that existed before the
effective date of the person's coverage under the policy. An
exclusion or limitation that must be specified in a provision
under this subdivision:
(A) may apply only to a disease or physical condition for
which medical advice or treatment was received by the
person during a period of three hundred sixty-five (365) days
before the effective date of the person's coverage; and
(B) may not apply to a loss incurred or disability beginning
after the earlier of the following:
(i) The end of a continuous period of three hundred
sixty-five (365) days, beginning on or after the effective
date of the person's coverage, during which the person did
not receive medical advice or treatment in connection with
the disease or physical condition.
(ii) The end of the two (2) year period beginning on the
effective date of the person's coverage.
This subdivision applies only to group policies of accident and
sickness insurance described in section 2.5(a)(1) through
2.5(a)(8) of this chapter.
(7) If premiums or benefits under the policy vary according to
a person's age, a provision specifying an equitable adjustment
of:
(A) premiums;
(B) benefits; or
(C) both premiums and benefits;
to be made if the age of a covered person has been misstated. A
provision under this subdivision must contain a clear statement
of the method of adjustment to be used.
(8) A provision that the insurer will issue to the policyholder,
for delivery to each person insured, a certificate, in electronic
or paper form, setting forth a statement that:
(A) explains the insurance protection to which the person
insured is entitled;
(B) indicates to whom the insurance benefits are payable;
and
(C) explains any family member's or dependent's coverage
under the policy.
The provision must specify that the certificate will be provided
in paper form upon the request of the insured.
(9) A provision stating that written notice of a claim must be
given to the insurer within twenty (20) days after the occurrence
or commencement of any loss covered by the policy, but that a
failure to give notice within the twenty (20) day period does not
invalidate or reduce any claim if it can be shown that it was not
reasonably possible to give notice within that period and that
notice was given as soon as was reasonably possible.
(10) A provision stating that:
(A) the insurer will furnish to the person making a claim, or
to the policyholder for delivery to the person making a
claim, forms usually furnished by the insurer for filing proof
of loss; and
(B) if the forms are not furnished within fifteen (15) days
after the insurer received notice of a claim, the person
making the claim will be deemed to have complied with the
requirements of the policy as to proof of loss upon
submitting, within the time fixed in the policy for filing
proof of loss, written proof covering the occurrence,
character, and extent of the loss for which the claim is made.
(11) A provision stating that:
(A) in the case of a claim for loss of time for disability,
written proof of the loss must be furnished to the insurer
within ninety (90) days after the commencement of the
period for which the insurer is liable, and that subsequent
written proofs of the continuance of the disability must be
furnished to the insurer at reasonable intervals as may be
required by the insurer;
(B) in the case of a claim for any other loss, written proof of
the loss must be furnished to the insurer within ninety (90)
days after the date of the loss; and
(C) the failure to furnish proof within the time required
under clause (A) or (B) does not invalidate or reduce any
claim if it was not reasonably possible to furnish proof
within that time, and if proof is furnished as soon as
reasonably possible but (except in case of the absence of
legal capacity of the claimant) no later than one (1) year
from the time proof is otherwise required under the policy.
(12) A provision that:
(A) all benefits payable under the policy (other than benefits
for loss of time) will be paid:
(i) not more than forty-five (45) days after the insurer's (as
defined in IC 27-8-5.7-3) receipt of written proof of loss if
the claim is filed by the policyholder; or
(ii) in accordance with IC 27-8-5.7 if the claim is filed by
the provider (as defined in IC 27-8-5.7-4); and
(B) subject to due proof of loss, all accrued benefits under
the policy for loss of time will be paid not less frequently
than monthly during the continuance of the period for which
the insurer is liable, and any balance remaining unpaid at the
termination of the period for which the insurer is liable will
be paid as soon as possible after receipt of the proof of loss.
(13) A provision that benefits for loss of life of the person
insured are payable to the beneficiary designated by the person
insured. However, if the policy contains conditions pertaining
to family status, the beneficiary may be the family member
specified by the policy terms. In either case, payment of
benefits for loss of life is subject to the provisions of the policy
if no designated or specified beneficiary is living at the death of
the person insured. All other benefits of the policy are payable
to the person insured. The policy may also provide that if any
benefit is payable to the estate of a person or to a person who is
a minor or otherwise not competent to give a valid release, the
insurer may pay the benefit, up to an amount of five thousand
dollars ($5,000), to any relative by blood or connection by
marriage of the person who is deemed by the insurer to be
equitably entitled to the benefit.
(14) A provision that the insurer, at the insurer's expense, has
the right and must be allowed the opportunity to:
(A) examine the person of the individual for whom a claim
is made under the policy when and as often as the insurer
reasonably requires during the pendency of the claim; and
(B) conduct an autopsy in case of death if it is not prohibited
by law.
(15) A provision that no action at law or in equity may be
brought to recover on the policy less than sixty (60) days after
proof of loss is filed in accordance with the requirements of the
policy and that no action may be brought at all more than three
(3) years after the expiration of the time within which proof of
loss is required by the policy.
(16) In the case of a policy insuring debtors, a provision that the
insurer will furnish to the policyholder, for delivery to each
debtor insured under the policy, a certificate of insurance
describing the coverage and specifying that the benefits payable
will first be applied to reduce or extinguish the indebtedness.
(17) If the policy provides that hospital or medical expense
coverage of a dependent child of a group member terminates
upon the child's attainment of the limiting age for dependent
children set forth in the policy, a provision that the child's
attainment of the limiting age does not terminate the hospital
and medical coverage of the child while the child is:
(A) incapable of self-sustaining employment because of
mental retardation or mental or physical disability; and
(B) chiefly dependent upon the group member for support
and maintenance.
A provision under this subdivision may require that proof of the
child's incapacity and dependency be furnished to the insurer by
the group member within one hundred twenty (120) days of the
child's attainment of the limiting age and, subsequently, at
reasonable intervals during the two (2) years following the
child's attainment of the limiting age. The policy may not
require proof more than once per year in the time more than two
(2) years after the child's attainment of the limiting age. This
subdivision does not require an insurer to provide coverage to
a child who has mental retardation or a mental or physical
disability who does not satisfy the requirements of the group
policy as to evidence of insurability or other requirements for
coverage under the policy to take effect. In any case, the terms
of the policy apply with regard to the coverage or exclusion
from coverage of the child.
(18) A provision that complies with the group portability and
guaranteed renewability provisions of the federal Health
Insurance Portability and Accountability Act of 1996
(P.L.104-191).
(d) Subsection (c)(5), (c)(8), and (c)(13) do not apply to policies
insuring the lives of debtors. The standard provisions required under
section 3(a) of this chapter for individual accident and sickness
insurance policies do not apply to group accident and sickness
insurance policies.
(e) If any policy provision required under subsection (c) is in
whole or in part inapplicable to or inconsistent with the coverage
provided by an insurer under a particular form of policy, the insurer,
with the approval of the commissioner, shall delete the provision
from the policy or modify the provision in such a manner as to make
it consistent with the coverage provided by the policy.
(f) An insurer that issues a policy described in this section shall
include in the insurer's enrollment materials information concerning
the manner in which an individual insured under the policy may:
(1) obtain a certificate described in subsection (c)(8); and
(2) request the certificate in paper form.
As added by P.L.257-1985, SEC.5. Amended by P.L.165-1986,
SEC.1; P.L.23-1993, SEC.154; P.L.185-1996, SEC.14; P.L.91-1998,
SEC.11; P.L.207-1999, SEC.4; P.L.233-1999, SEC.10; P.L.14-2000,
SEC.58; P.L.162-2001, SEC.4; P.L.125-2005, SEC.3; P.L.127-2006,
SEC.3; P.L.99-2007, SEC.193; P.L.173-2007, SEC.25.
IC 27-8-5-19.2
Repealed
(Repealed by P.L.3-2008, SEC.269.)
IC 27-8-5-19.3
Association and discretionary group policies of accident and
sickness insurance; waiver of coverage
Sec. 19.3. (a) This section applies to an association or a
discretionary group policy of accident and sickness insurance:
(1) under which a certificate of coverage is issued after June 30,
2005, to an individual member of the association or
discretionary group;
(2) under which a member of the association or discretionary
group is individually underwritten; and
(3) that is not employer based.
(b) Notwithstanding sections 19 and 19.2 of this chapter and any
other law, and except as provided in subsection (e), a policy
described in subsection (a) may contain a waiver of coverage for a
specified condition and any complications that arise from the
specified condition if:
(1) the waiver period does not exceed ten (10) years; and
(2) all of the following conditions are met:
(A) The insurer provides to the applicant before issuance of
the certificate written notice explaining the waiver of
coverage for the specified condition and complications
arising from the specified condition.
(B) The:
(i) offer of coverage; and
(ii) certificate of coverage;
include the waiver in a separate section stating in bold print
that the applicant is receiving coverage with an exception for
the waived condition.
IC 27-8-5-21
Adopted children
Sec. 21. (a) Any individual or group policy or plan of health and
accident insurance regulated under this chapter or any health
maintenance organization or limited service health maintenance
organization regulated under IC 27-13 that provides coverage under
a policy issued for delivery in Indiana must cover newly adopted
children of the insured or enrollee. The coverage for newly adopted
children will be the same as for other dependents. No policy or plan
provision concerning preexisting condition limitations, insurability,
eligibility, or health underwriting approval may be applied to newly
adopted children when they are enrolled in accordance with this
section.
(b) The coverage required by this section:
(1) is effective upon the earlier of:
(A) the date of placement for the purpose of adoption; or
(B) the date of the entry of an order granting the adoptive
parent custody of the child for purposes of adoption;
(2) continues unless the placement is disrupted prior to legal
adoption and the child is removed from placement; and
(3) continues unless required action as described in subsection
(c) is not taken.
(c) If the payment of a specific premium or subscription fee is
required to provide coverage for an adopted child, the policy or
contract may require that notification of the adoption of the child as
described in subsection (b) and the payment of the required premium
or fees must be furnished to the insurer or nonprofit service or
indemnity corporation within thirty-one (31) days after the adoption
of the child in order to have the coverage continue beyond the
thirty-one (31) day period.
As added by P.L.251-1989, SEC.1. Amended by P.L.98-1990, SEC.2;
P.L.26-1994, SEC.11; P.L.116-1994, SEC.59; P.L.2-1995, SEC.106.
IC 27-8-5-22
Refund of unused premiums
Sec. 22. (a) All individual policies of accident and sickness
insurance issued for delivery in Indiana after June 30, 1990, must
provide for the refund of unused premiums upon the death of the
insured during the contract period.
(b) The amount of premium refund shall be prorated from the date
following the date of death of the insured to the end of the contract
period for which the premium has been paid.
(c) The refund required by this section shall be paid as follows:
(1) If a person other than the insured paid the premium, to that
person. A person entitled to a refund under this subdivision
must furnish proof of payment to the insurer.
(2) If the insured paid the premium, to the surviving spouse of
the insured. If there is no surviving spouse, the premium shall
be paid in the same manner as distributions of the net estate of
a person who dies intestate under IC 29-1-2-1(d). A parent
disqualified under IC 29-1-2-1(e) from receiving an intestate
share of the parent's child's estate is not entitled to a refund
under this section of insurance premiums paid by the child.
(d) A person entitled to receive a refund under this section must
do the following:
(1) Submit a written request for the refund.
(2) Furnish proof of the insured's death.
(e) This section does not affect the rights of a dependent under a
policy covered by this section to obtain a conversion policy upon the
death of the insured.
IC 27-8-5-23
Statute or rule mandating particular types of health care coverage;
applications to insurer
Sec. 23. (a) This section does not apply to IC 27-8-6.
(b) A statute or rule mandating that one (1) or more particular
types of health care coverage be provided does not apply to an
insurer unless the statute or rule applies equally to employee welfare
benefit plans described in 29 U.S.C. 1001 et seq.
As added by P.L.152-1990, SEC.1. Amended by P.L.119-1991,
SEC.2.
IC 27-8-5-24
Insured issued new policy within year after cancellation or
nonrenewal; mandatory coverage
Sec. 24. If an insurer cancels or declines to renew a group
accident and sickness policy for reasons other than fraud or
nonpayment of a premium and issues a new policy to the
policyholder within one (1) year after the effective date of
cancellation of the policy, the insurer must accept for coverage under
the new policy an individual who:
(1) was covered under the old policy; and
(2) has continued to meet the requirements for membership in
the group that applied to the old policy.
However, the insurer may not exclude or limit the coverage to the
individual or individual's dependent due to evidence of insurability.
As added by P.L.125-1992, SEC.4.
IC 27-8-5-25
Maternity benefits; replacement of discontinued policy;
prohibition on preexisting condition limitation or exclusion of
coverage
Sec. 25. (a) As used in this section, "employer" means an
employer who offers health insurance to the employer's employees.
(b) As used in this section, "insurer" means an insurer subject to
IC 27.
(c) When an employer that has a group policy issued by an insurer
that contains maternity benefits:
(1) discontinues the group health policy provided by the insurer;
and
(2) replaces the discontinued policy with coverage through a
succeeding insurer;
the succeeding insurer's policy may not contain a preexisting
condition limitation for maternity or exclude coverage due to
pregnancy for employees or spouses of employees who were covered
under the prior policy on the date the prior plan was discontinued.
(d) Subsection (c) only applies if the employer obtains a new
group insurance policy within thirty-one (31) days after the
discontinuance of an insurance policy.
As added by P.L.116-1994, SEC.60.
IC 27-8-5-26
Post-mastectomy coverage
Sec. 26. (a) As used in this section, "mastectomy" means the
removal of all or part of the breast for reasons that are determined by
a licensed physician to be medically necessary.
(b) A policy of accident and sickness insurance that provides
coverage for a mastectomy may not be issued, amended, delivered,
or renewed in Indiana unless the policy provides coverage as
required under 29 U.S.C. 1185b, including coverage for:
(1) prosthetic devices; and
(2) reconstructive surgery incident to a mastectomy including:
(A) all stages of reconstruction of the breast on which the
mastectomy has been performed; and
(B) surgery and reconstruction of the other breast to produce
symmetry;
in the manner determined by the attending physician and the
patient to be appropriate.
(c) Coverage required under this section is subject to:
(1) the deductible and coinsurance provisions applicable to a
mastectomy; and
(2) all other terms and conditions applicable to other benefits.
(d) An insurer that issues a policy of accident and sickness
insurance shall provide to an insured, at the time the policy is issued
and annually thereafter, written notice of the coverage required under
this section. Notice that is sent by the insurer that meets the
requirements set forth in 29 U.S.C. 1185b constitutes compliance
with this subsection.
(e) The coverage required under this section applies to a policy of
accident and sickness insurance that provides coverage for a
mastectomy, regardless of whether an individual who:
(1) underwent a mastectomy; and
(2) is covered under the policy;
was covered under the policy at the time of the mastectomy.
(f) This section does not require an insurer to provide coverage
related to post mastectomy care that exceeds the coverage required
for post mastectomy care under federal law.
As added by P.L.150-1997, SEC.3. Amended by P.L.96-2002, SEC.2;
P.L.204-2003, SEC.1.
IC 27-8-5-27
Dental care provisions required
Sec. 27. (a) As used in this section, "accident and sickness
insurance policy" means an insurance policy that provides at least
one (1) of the types of insurance described in IC 27-1-5-1, Classes
1(b) and 2(a), and is issued on a group basis. The term does not
include the following:
(1) Accident only, credit, dental, vision, Medicare supplement,
long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Automobile medical payment insurance.
(4) A specified disease policy.
(5) A short term insurance plan that:
(A) may not be renewed; and
(B) has a duration of not more than six (6) months.
(6) A policy that provides indemnity benefits not based on any
expense incurred requirement, including a plan that provides
coverage for:
(A) hospital confinement, critical illness, or intensive care;
or
(B) gaps for deductibles or copayments.
(7) Worker's compensation or similar insurance.
(8) A student health plan.
(9) A supplemental plan that always pays in addition to other
coverage.
(10) An employer sponsored health benefit plan that is:
(A) provided to individuals who are eligible for Medicare;
and
(B) not marketed as, or held out to be, a Medicare
supplement policy.
(b) As used in this section, "insured" means a child or an
individual with a disability who is entitled to coverage under an
accident and sickness insurance policy.
(c) As used in this section, "child" means an individual who is less
than nineteen (19) years of age.
(d) As used in this section, "individual with a disability" means an
individual:
(1) with a physical or mental impairment that substantially
limits one (1) or more of the major life activities of the
individual; and
(2) who:
(A) has a record of; or
(B) is regarded as;
having an impairment described in subdivision (1).
(e) A policy of accident and sickness insurance must include
coverage for anesthesia and hospital charges for dental care for an
insured if the mental or physical condition of the insured requires
dental treatment to be rendered in a hospital or an ambulatory
outpatient surgical center. The Indications for General Anesthesia,
as published in the reference manual of the American Academy of
Pediatric Dentistry, are the utilization standards for determining
whether performing dental procedures necessary to treat the insured's
condition under general anesthesia constitutes appropriate treatment.
(f) An insurer that issues a policy of accident and sickness
insurance may:
(1) require prior authorization for hospitalization or treatment
in an ambulatory outpatient surgical center for dental care
procedures in the same manner that prior authorization is
required for hospitalization or treatment of other covered
medical conditions; and
(2) restrict coverage to include only procedures performed by
a licensed dentist who has privileges at the hospital or
ambulatory outpatient surgical center.
(g) This section does not apply to treatment rendered for temporal
mandibular joint disorders (TMJ).
As added by P.L.189-1999, SEC.2. Amended by P.L.173-2007,
SEC.27.
IC 27-8-5-28
Coverage of child to 26 years of age
Sec. 28. A policy of accident and sickness insurance may not be
issued, delivered, amended, or renewed unless the policy provides
for coverage of a child of the policyholder or certificate holder, upon
request of the policyholder or certificate holder, until the date that
the child becomes twenty-six (26) years of age.
As added by P.L.218-2007, SEC.48. Amended by P.L.160-2011,
SEC.19.