Ind. Code ch. 27-2-25

Ind. Code ch. 27-2-25
in effect

Ind. Code § 27-2-25-0.5 Provision of information by health benefit plans

Sec. 0.5. Nothing in this chapter prohibits: (1) a self-funded health benefit plan that complies with the federal Employee Retirement Income Security Act (ERISA) of 1974 (29 U.S.C. 1001 et seq.); or (2) a: (A) self-insurance program established to provide group health coverage as described in IC 5-10-8-7(b); or (B) contract for health services, as described in IC 5-10-8-7(c); from providing information requested by a practitioner or provider facility under this chapter. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-1 "Coverage"

Sec. 1. As used in this chapter, "coverage" means the right of an individual to receive: (1) health care services; or (2) payment or reimbursement for health care services; from a health carrier. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-2 "Covered individual"

Sec. 2. As used in this chapter, "covered individual" means an individual who is entitled to coverage from a health carrier. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-2.5 "Episode of care"

Sec. 2.5. As used in this chapter, "episode of care" means the medical care ordered to be provided for a specific medical procedure, condition, or illness. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-3 "Good faith estimate"

Sec. 3. As used in this chapter, "good faith estimate" means a health carrier's reasonable estimate of: (1) the amount of the cost of a nonemergency health care service that the health carrier will: (A) pay for; or (B) reimburse to; a covered individual; or (2) the applicable benefit limitations of the nonemergency health care service a covered individual is entitled to receive; that a health carrier provides upon request to a covered individual for whom a nonemergency health care service has been ordered. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-4 "Health carrier"

Sec. 4. (a) As used in this chapter, "health carrier" means an entity: (1) that is subject to this title and the administrative rules adopted under this title; and (2) that enters into a contract to: (A) provide health care services; (B) deliver health care services; (C) arrange for health care services; or (D) pay for or reimburse any of the costs of health care services. (b) The term includes the following: (1) An insurer, as defined in IC 27-1-2-3(x), that issues a policy of accident and sickness insurance, as defined in IC 27-8-5-1(a). (2) A health maintenance organization, as defined in IC 27-13-1-19. (3) An administrator (as defined in IC 27-1-25-1(a)) that is licensed under IC 27-1-25. (4) A state employee health plan offered under IC 5-10-8. (5) A short term insurance plan (as defined by IC 27-8-5.9-3). (6) Any other entity that provides a plan of health insurance, health benefits, or health care services. (c) The term does not include: (1) an insurer that issues a policy of accident and sickness insurance; (2) a limited service health maintenance organization (as defined in IC 27-13-34-4); or (3) an administrator; that only provides coverage for, or processes claims for, dental or vision care services. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-5 "In network"

Sec. 5. As used in this chapter, "in network", when used in reference to a practitioner, means that the health care services provided by the practitioner are subject to a health carrier's network plan. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-6 "Network"

Sec. 6. (a) As used in this chapter, "network" means a group of provider facilities and practitioners that: (1) provide health care services to covered individuals; and (2) have agreed to, or are otherwise subject to, maximum limits on the prices for the health care services to be provided to the covered individuals. (b) The term includes the following: (1) A network described in subsection (a) that is established pursuant to a contract between an insurer providing coverage under a group health policy and: (A) individual provider facilities and practitioners; (B) a preferred provider organization; or (C) an entity that employs or represents providers, including: (i) an independent practice association; and (ii) a physician-hospital organization. (2) A health maintenance organization, as defined in IC 27-13-1-19. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-7 "Network plan"

Sec. 7. As used in this chapter, "network plan" means a plan of a health carrier that: (1) requires a covered individual to receive; or (2) creates incentives, including financial incentives, for a covered individual to receive; health care services from one (1) or more providers that are under contract with, managed by, or owned by the health carrier. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-8 "Nonemergency health care service"

Sec. 8. As used in this chapter, "nonemergency health care service" means a discrete service or series of services ordered by a practitioner for an episode of care for the: (1) diagnosis; (2) prevention; (3) treatment; (4) cure; or (5) relief; of a physical, mental, or behavioral health condition, illness, injury, or disease that is not provided on an emergency or urgent care basis. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-9 "Practitioner"

Sec. 9. (a) As used in this chapter, "practitioner" means: (1) an individual who holds: (A) an unlimited license, certificate, or registration; (B) a limited or probationary license, certificate, or registration; (C) a temporary license, certificate, registration, or permit; (D) an intern permit; or (E) a provisional license; issued by the board (as defined in IC 25-0.5-11-1) regulating the profession in question; or (2) an entity that: (A) is owned by, or employs; or (B) performs billing for professional health care services rendered by; an individual described in subdivision (1). (b) The term does not include the following: (1) A dentist licensed under IC 25-14. (2) An optometrist licensed under IC 25-24. (3) A provider facility. As added by P.L.93-2020, SEC.13. Amended by P.L.202-2021, SEC.17.

Ind. Code § 27-2-25-9.5 "Price"

Sec. 9.5. As used in this chapter, "price" means the negotiated rate between the: (1) provider facility and practitioner; and (2) covered individual's primary health carrier; minus the amount that the health carrier will pay. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-10 "Provider"

Sec. 10. As used in this chapter, "provider" means: (1) a provider facility; or (2) a practitioner. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-11 "Provider facility"

Sec. 11. As used in this chapter, "provider facility" means any of the following: (1) A hospital licensed under IC 16-21-2. (2) An ambulatory outpatient surgical center licensed under IC 16-21-2. (3) A birthing center licensed under IC 16-21-2. (4) Except for an urgent care facility (as defined by IC 27-1-46-10.5), a facility that provides diagnostic services to the medical profession or the general public. (5) A laboratory where clinical pathology tests are carried out on specimens to obtain information about the health of a patient. (6) A facility where radiologic and electromagnetic images are made to obtain information about the health of a patient. (7) An infusion center that administers intravenous medications. As added by P.L.93-2020, SEC.13. Amended by P.L.9-2022, SEC.51; P.L.36-2022, SEC.12; P.L.179-2022(ss), SEC.44.

Ind. Code § 27-2-25-12 Request for good faith estimate; requirements; notice; provision of information from practitioner and provider facility

Sec. 12. (a) A covered individual may request from the health carrier a good faith estimate of: (1) the amount of the cost of the nonemergency health care service that the health carrier will: (A) pay for; or (B) reimburse to; the covered individual; or (2) the applicable benefit limitations of the ordered nonemergency health care service a covered individual is entitled to receive from the health carrier. (b) If: (1) a health carrier provides coverage to a covered individual through a network plan; and (2) the health carrier receives a request for a good faith estimate from a covered individual for whom a nonemergency health care service has been ordered; the health carrier shall inform the covered individual whether the provider facility in which the nonemergency health care service will be provided is in network and whether each scheduled practitioner who may provide the nonemergency health care service is in network. (c) A health carrier that receives a request from a covered individual patient under subsection (b) shall, not more than two (2) business days after receiving relevant information, provide to the individual a good faith estimate as described in section 14 of this chapter. (d) A health carrier must ensure that a good faith estimate states that the estimate provided under this section is only valid for thirty (30) days and that: (1) the amount that the health carrier will: (A) pay; or (B) reimburse; for or to the covered individual for the nonemergency health care services the individual receives; and (2) the applicable benefit limitations of the nonemergency health care services the individual will receive; may vary from the health carrier's good faith estimate based on the individual's medical needs. (e) A health carrier may not charge an individual for information provided under this section. (f) A practitioner and provider facility shall provide a health carrier with the information needed by the health carrier to comply with the requirements under this chapter not more than two (2) business days after receiving the request. As added by P.L.93-2020, SEC.13. Amended by P.L.215-2025, SEC.59.

Ind. Code § 27-2-25-13 Provision of good faith estimate; methods

Sec. 13. A health carrier may provide a good faith estimate to an individual under this chapter: (1) in a writing delivered to the individual; (2) by electronic mail; or (3) through a mobile application or other Internet web based method, if available; according to the preference expressed by the individual. As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-14 Requirements of good faith estimate; provision of information; exemption from penalties

Sec. 14. (a) A good faith estimate provided by a health carrier to an individual under this chapter must: (1) in the case of an insurer or another health carrier that pays or reimburses the cost of health care services: (A) provide a summary of the services and material items that the good faith estimate is based on; (B) include a total figure that is a sum of the amounts referred to in clause (A); and (C) state the out-of-pocket costs the covered individual will incur, if any, beyond the amount that the health carrier will pay or reimburse; and (2) in the case of a health maintenance organization or another health carrier that provides health care services: (A) provide a summary of the applicable benefit limitations of the health care services to which the covered individual is entitled; and (B) state the out-of-pocket costs the covered individual will incur, if any, beyond being provided the health care services referred to in clause (A). (b) A practitioner and provider facility shall provide a health carrier with the information needed by the health carrier to comply with the requirements under this chapter not more than two (2) business days after receiving the request. (c) A health carrier is not subject to the penalties under section 16 of this chapter if: (1) a provider facility or practitioner fails to provide the health carrier with the information as required under subsection (b); (2) the health carrier provides the individual with a good faith estimate based on any information that the health carrier has; and (3) the health carrier provides the individual with an updated good faith estimate after the provider facility or practitioner has provided the information required under subsection (b). As added by P.L.93-2020, SEC.13.

Ind. Code § 27-2-25-15 Notice on website

Sec. 15. A health carrier that provides a website for the use of its covered individuals shall ensure that the website includes a printed notice that: (1) is designed, lettered, and featured on the website so as to be conspicuous to and readable by any individual with normal vision who visits the website; and (2) states the following, or words to the same effect: "A covered individual may at any time ask the health carrier for an estimate of the amount the health carrier will pay for or reimburse to a covered individual for nonemergency health care services that have been ordered for the covered individual or the applicable benefit limitations of the ordered nonemergency health care services a covered individual is entitled to receive from the health carrier. The law requires that an estimate be provided within 2 business days.". As added by P.L.93-2020, SEC.13. Amended by P.L.215-2025, SEC.60.

Ind. Code § 27-2-25-16 Health carrier satisfaction of good faith estimate and web site notice requirements through compliance with federal law; civil penalty for noncompliance; civil penalty deposited in fund

Sec. 16. (a) If a health carrier fails or refuses: (1) to provide a good faith estimate as required by this chapter; or (2) to provide notice on the health carrier's Internet web site as required by section 15 of this chapter; the insurance commissioner may, after notice and hearing under IC 4-21.5, impose on the health carrier a civil penalty of not more than one thousand dollars ($1,000) for each day of noncompliance. (b) A health carrier may satisfy the requirements of this chapter described in subsection (a)(1) and (a)(2) by complying with the requirements set forth in Section 2799A–1 of the federal Public Health Service Act, as added by Public Law 116-260. (c) A civil penalty collected under subsection (a) shall be deposited in the department of insurance fund established by IC 27-1-3-28. As added by P.L.93-2020, SEC.13. Amended by P.L.202-2021, SEC.18.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/27Fetched: 10/17/2026

Starting a business in Indiana? Indiana LLC guide: costs and requirements