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Ind. Code § 27-1-15.6-13.5

Applicability; disclosure to policyholder or subscriber; acknowledgment; submission to all payer claims data base; examination

As added by P.L.50-2020, SEC.4

Sec. 13.5. (a) This section applies only to the following:

(1) An individual, group, franchise, or blanket policy of accident and sickness insurance, as defined in IC 27-8-5-1. However, this section does not apply to the types of insurance and coverage described in IC 27-8-5-2.5(a).

(2) An individual or group health maintenance organization contract entered into under IC 27-13.

(b) As used in this section, "third party administrator" means a person who:

(1) is licensed under IC 27-1-25; and

(2) administers a policy of accident and sickness insurance described in subsection (a)(1) or a health maintenance organization contract described in subsection (a)(2).

(c) Except as provided in subsection (f), an insurer that issues an insurance policy, a health maintenance organization that enters into a health maintenance organization contract, or a third party administrator shall disclose to the policyholder or subscriber in a separate written notification:

(1) any commission, service fee, or brokerage fee that has been or will be paid to an insurance producer for selling, soliciting, or negotiating the policy or contract; and

(2) whether the amount disclosed under subdivision (1) is based on a percentage of total plan premiums or a flat per member fee.

(d) An insurer, a health maintenance organization, or a third party administrator shall provide a copy of the written notification described in subsection (c) to the policyholder or subscriber:

(1) when the insurance policy is issued or the contract is entered into; and

(2) each time the insurance policy or contract is renewed.

(e) Each copy of a written notification described in subsection (c) must include a signature line on which the policyholder may sign to acknowledge receiving the written notification.

(f) This section does not require the disclosure to the policyholder of a commission, service fee, or brokerage fee in connection with the issuance of an insurance policy if a federal law or regulation requires disclosure of the commission, service fee, or brokerage fee to the policyholder.

(g) An insurer, a health maintenance organization, and a third party administrator shall submit the information described in subsection (c) to the executive director of the all payer claims data base established under IC 27-1-44.5 for inclusion in the data base.

(h) The department shall perform an examination under IC 27-1-3.1 for any alleged violation of this section.

Official source: Indiana General Assembly. Reproduced from public-domain Indiana statutes; confirm against the official source for the current text. Not legal advice.