Ind. Code ch. 27-13-8

in effect

Ind. Code § 27-13-8-0.1 Application of certain amendments to chapter

Sec. 0.1. The amendments made to section 2 of this chapter by P.L.133-1999 apply to external grievances filed by enrollees after January 1, 2000. As added by P.L.220-2011, SEC.458.

Ind. Code § 27-13-8-1 Filing

Sec. 1. On or before March 1 of each year, a health maintenance organization must file with the commissioner a report that covers the preceding calendar year. The report must be: (1) made on forms prescribed by the commissioner; and (2) verified by at least two (2) principal officers of the health maintenance organization. As added by P.L.26-1994, SEC.25.

Ind. Code § 27-13-8-1.5 Preparation of annual statement

Sec. 1.5. (a) Each health maintenance organization authorized to conduct business in Indiana and required to file an Annual Statement Blank with the department under this chapter shall prepare the health maintenance organization's statement: (1) on the Annual Statement Blank; (2) in accordance with Annual Statement Instructions; and (3) following practices and procedures prescribed by the Accounting Practices and Procedures Manual. (b) To the extent that the Annual Statement Instructions require disclosure under subsection (a) of compensation paid to or on behalf of a health maintenance organization's officers, directors, or employees, the information may be filed with the department as an exhibit separate from the Annual Statement Blank. The compensation information described under this subsection shall be maintained by the department as confidential and may not be disclosed to the public under IC 5-14-3. As added by P.L.203-2001, SEC.20. Amended by P.L.124-2018, SEC.91.

Ind. Code § 27-13-8-2 Filings with commissioner; complaint analysis and reporting

Sec. 2. (a) In addition to the report required by section 1 of this chapter, a health maintenance organization shall each year file with the commissioner the following: (1) Audited financial statements of the health maintenance organization for the preceding calendar year prepared in conformity with statutory accounting practices prescribed or otherwise permitted by the department. (2) A list of participating providers who provide health care services to enrollees or subscribers of the health maintenance organization. (3) A description of the grievance procedure of the health maintenance organization: (A) established under IC 27-13-10, including: (i) the total number of grievances handled through the procedure during the preceding calendar year; (ii) a compilation of the causes underlying those grievances; and (iii) a summary of the final disposition of those grievances; and (B) established under IC 27-13-10.1, including: (i) the total number of external grievances handled through the procedure during the preceding calendar year; (ii) a compilation of the causes underlying those grievances; and (iii) a summary of the final disposition of those grievances; for each independent review organization used by the health maintenance organization during the reporting year. (4) The percentage of providers credentialed by the health maintenance organization according to the National Committee on Quality Assurance standards or guidelines. (5) The RBC report required under IC 27-1-36-25. (6) The health maintenance organization's Health Plan Employer Data and Information Set (HEDIS) data. (b) The information required by subsection (a)(2) through (a)(5) must be filed with the commissioner on or before March 1 of each year. The audited financial statements required by subsection (a)(1) must be filed with the commissioner on or before June 1 of each year. The health maintenance organization's HEDIS data required by subsection (a)(6) must be filed with the commissioner on or before July 1 of each year. The commissioner shall: (1) make the information required to be filed under this section available to the public; and (2) prepare an annual compilation of the data required under subsection (a)(3), (a)(4), and (a)(6) that allows for comparative analysis. (c) Upon a determination by a health maintenance organization's auditor that the health maintenance organization: (1) does not meet the requirements of IC 27-13-12-3; or (2) is in the condition described in IC 27-13-24-1(a)(5); the health maintenance organization shall notify the commissioner within five (5) business days after the auditor's determination. (d) The commissioner may require any additional reports as are necessary and appropriate for the commissioner to carry out the commissioner's duties under this article. (e) The commissioner shall do the following: (1) Compile and analyze complaints received by the department concerning a denial of coverage under an individual contract or a group contract for: (A) an investigational or experimental treatment; or (B) a treatment not considered to be medically necessary for an enrollee. (2) If the commissioner determines that a pattern of denials of coverage is evident through the analysis performed under subdivision (1), report the pattern to the legislative council in an electronic format under IC 5-14-6. (3) Remove from a report made under subdivision (2) any information that could be used to identify an individual. As added by P.L.26-1994, SEC.25. Amended by P.L.195-1996, SEC.5; P.L.191-1997, SEC.2; P.L.133-1999, SEC.1; P.L.133-1999, SEC.2; P.L.203-2001, SEC.21; P.L.51-2002, SEC.10; P.L.18-2016, SEC.4; P.L.124-2018, SEC.92.

Ind. Code § 27-13-8-3 Annual Statement Blank; quarterly reports

Sec. 3. (a) This section applies to a domestic health maintenance organization that is authorized to transact business in Indiana. (b) On or before March 1 of each year, a health maintenance organization shall file with the NAIC and with the department a copy of the health maintenance organization's Annual Statement Blank and additional filings prescribed by the commissioner for the preceding year. A health maintenance organization shall also file quarterly statements with the NAIC and with the department, on or before May 15, August 15, and November 15 of each year, in a form prescribed by the commissioner. The information filed with the NAIC under this subsection: (1) must be: (A) in the same format; and (B) of the same scope; as is required by the commissioner under section 1 of this chapter; (2) to the extent required by the NAIC, must include the signed jurat page and the actuarial certification; and (3) must be filed electronically in accordance with NAIC electronic filing specifications. The commissioner may, for good cause shown, grant an exemption from the requirement of this section to domestic health maintenance organizations that operate only in Indiana. If a health maintenance organization files any amendment or addendum to the health maintenance organization's Annual Statement Blank or quarterly statement with the commissioner, the health maintenance organization shall also file a copy of the amendment or addendum with the NAIC. Annual Statement Blanks and quarterly financial statements are considered filed with the NAIC when delivered to the address designated by the NAIC for the filings, regardless of whether the filing is accompanied by any applicable fee. (c) The commissioner may, for good cause shown, grant a health maintenance organization an extension of time for the filing required by subsection (b). (d) In the absence of actual malice: (1) members of the NAIC; (2) duly authorized committees, subcommittees, and task forces of members of the NAIC; (3) delegates of members of the NAIC; (4) employees of the NAIC; and (5) other persons responsible for collecting, reviewing, analyzing, and disseminating information developed from the filing of Annual Statement Blanks under this section; shall be considered to be acting as agents of the commissioner under the authority of this section and are not subject to civil liability for libel, slander, or any other cause of action by virtue of the collection, review, analysis, or dissemination of the data and information collected from the filings required by this section. (e) The commissioner may suspend, revoke, or refuse to renew the certificate of authority of a health maintenance organization that fails to file the health maintenance organization's Annual Statement Blank or quarterly statements with the NAIC or with the department within the time allowed by subsection (b) or (c). As added by P.L.203-2001, SEC.22. Amended by P.L.124-2018, SEC.93.

Ind. Code § 27-13-8-4 Civil penalties

Sec. 4. (a) The commissioner may impose a civil penalty of five hundred dollars ($500), after notice and hearing under IC 4-21.5-3, on a health maintenance organization that fails to file an annual statement under this chapter. (b) A domestic health maintenance organization that fails to file an audited annual financial statement under section 2(a)(1) of this chapter before June 1 of each year without obtaining an extension is subject to a civil penalty of fifty dollars ($50) per day until the report is received by the commissioner. As added by P.L.203-2001, SEC.23.

Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/27Fetched: 10/17/2026