Ind. Code ch. 27-1-37

Ind. Code ch. 27-1-37
in effect

Ind. Code § 27-1-37-0.1 "Administrative denial"

Sec. 0.1. As used in this chapter, "administrative denial" means the denial by a health carrier for nonmedical reasons of a health provider facility's or provider's claim for reimbursement. As added by P.L.215-2025, SEC.48.

Ind. Code § 27-1-37-0.2 "Affiliate" defined

Sec. 0.2. As used in this chapter, "affiliate" means any person who, directly or indirectly through one (1) or more intermediaries, controls, is controlled by, or is under common control with, the person to whom affiliation is attributed. As added by P.L.198-2021, SEC.16.

Ind. Code § 27-1-37-1 "Emergency" defined

Sec. 1. As used in this chapter, "emergency" means a medical condition that arises suddenly and unexpectedly and manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent lay person who possesses an average knowledge of health and medicine to: (1) place an individual's health in serious jeopardy; (2) result in serious impairment to the individual's bodily functions; or (3) result in serious dysfunction of a bodily organ or part of the individual. As added by P.L.197-2001, SEC.1.

Ind. Code § 27-1-37-1.5 "Health carrier" defined

Sec. 1.5. (a) As used in this chapter, "health carrier" means an entity: (1) that is subject to IC 27 and the administrative rules adopted under IC 27; 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.198-2021, SEC.17.

Ind. Code § 27-1-37-2 "Health maintenance organization" defined

Sec. 2. As used in this chapter, "health maintenance organization" means a person that undertakes to provide or arrange for the delivery of health care services to individuals on a prepaid basis, except for the individual's responsibility for copayments or deductibles. The term includes a limited service health maintenance organization. The term does not include a staff-model health maintenance organization that employs a group of providers and that requires the providers to provide health care services solely to individuals who are entitled to coverage under a contract with the staff-model health maintenance organization or an affiliate of the staff-model health maintenance organization. As added by P.L.197-2001, SEC.1.

Ind. Code § 27-1-37-3 "Health provider contract" defined

Sec. 3. As used in this chapter, "health provider contract" means an agreement with a provider or a health provider facility relating to terms and conditions of reimbursement for health care services provided to an individual under: (1) an employee welfare benefit plan (as defined in 29 U.S.C. 1002 et seq.); (2) a policy of accident and sickness insurance (as defined in IC 27-8-5-1); (3) a contract with a health maintenance organization; (4) a self-insurance program established under IC 5-10-8-7(b); or (5) a prepaid health care delivery plan entered into under IC 5-10-8-7(c). As added by P.L.197-2001, SEC.1. Amended by P.L.198-2021, SEC.18.

Ind. Code § 27-1-37-3.2 "Health provider facility" defined

Sec. 3.2. As used in this chapter, "health provider facility" means any of the following: (1) A hospital, as defined in IC 16-18-2-179(a). (2) A hospital system. (3) An affiliate of a hospital or hospital system. As added by P.L.198-2021, SEC.19.

Ind. Code § 27-1-37-3.5 "Hospital system" defined

Sec. 3.5. As used in this chapter, "hospital system" means: (1) a parent corporation of at least one (1) hospital and any entity affiliated with the parent corporation through ownership, governance, or membership; or (2) a hospital and any entity affiliated with the hospital through ownership, governance, or membership. As added by P.L.198-2021, SEC.20.

Ind. Code § 27-1-37-4 "Person" defined

Sec. 4. (a) As used in this chapter, "person" means an individual, an agency, a political subdivision, a partnership, a corporation, an association, or any other entity. (b) The term does not include a health care provider described in IC 16-18-2-163(a)(1), IC 16-18-2-163(a)(2), IC 16-18-2-163(a)(3), or IC 16-18-2-163(a)(4). As added by P.L.197-2001, SEC.1.

Ind. Code § 27-1-37-5 "Provider" defined

Sec. 5. As used in this chapter, "provider" means an individual or entity licensed or legally authorized to provide health care services. As added by P.L.197-2001, SEC.1.

Ind. Code § 27-1-37-6 Requiring provider to provide health care services

Sec. 6. (a) Except as provided in subsection (b), a person may not require a provider, as a condition of entering into a health provider contract for the provision of health care services other than health care services to enrollees of a health maintenance organization, to provide health care services to enrollees of a health maintenance organization. (b) A person may require a provider, as a condition of entering into a health provider contract for the provision of health care services other than health care services to enrollees of a health maintenance organization, to provide health care services to enrollees of a health maintenance organization: (1) in an emergency; or (2) upon referral. (c) If a person requires a provider to provide health care services to enrollees of a health maintenance organization under subsection (b), the person: (1) shall reimburse the provider at rates established under the health provider contract; and (2) may not require the provider to comply with the terms and conditions of the health maintenance organization. As added by P.L.197-2001, SEC.1.

Ind. Code § 27-1-37-6.5 "Health plan"; study on commercial physician reimbursement rate requirement; report

Sec. 6.5. (a) As used in this section, "health plan" means any of the following that provides coverage for health care services: (1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1). However, the term does not include the coverages described in IC 27-8-5-2.5(a). (2) A contract with a health maintenance organization (as defined in IC 27-13-1-19) that provides coverage for basic health care services (as defined in IC 27-13-1-4). (b) Before July 1, 2026, the office of management and budget shall study the effect, including the fiscal impact, of requiring physician reimbursement rates under a commercial health plan to be at a minimum rate. (c) The office of management and budget shall report the findings of the study under this section to: (1) the governor; and (2) the general assembly in an electronic format under IC 5-14-6. (d) This section expires December 31, 2026. As added by P.L.216-2025, SEC.44.

Ind. Code § 27-1-37-7 Applicability; prohibition on preventing disclosure of health care service claims data; violation an unfair or deceptive act

Sec. 7. (a) This section applies to health provider contracts entered into or renewed after June 30, 2020. (b) A health provider contract, including a contract with a pharmacy benefit manager or a health facility, may not contain a provision that prohibits the disclosure of health care service claims data to: (1) employers providing the coverage; or (2) beginning July 1, 2021, another person for use in the all payer claims data base established by IC 27-1-44.5. However, any disclosure of claims data must comply with health privacy laws, including the federal Health Insurance Portability and Accountability Act (HIPAA) (P.L. 104-191). (c) A violation of this section constitutes an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4. As added by P.L.50-2020, SEC.5. Amended by P.L.93-2020, SEC.10; P.L.198-2021, SEC.21.

Ind. Code § 27-1-37-7.5 Required disclosures

Sec. 7.5. (a) This section applies to a health provider contract entered into, amended, or renewed after June 30, 2025. (b) When a health carrier is in the process of negotiating a health provider contract with a health provider facility or provider, the health carrier must provide to the health provider facility or provider the following: (1) A current fee schedule that must include the following information: (A) The proposed reimbursement for each covered service under the proposed health provider contract. (B) The twenty-fifth percentile, fiftieth percentile, and seventy-fifth percentile reimbursement amounts in Indiana for each covered service under the proposed health provider contract. (2) The current criteria that the health carrier uses when determining whether to issue an administrative denial. (c) When a health provider facility or provider is in the process of negotiating a health provider contract with a health carrier, the health provider facility or provider shall provide the health carrier with the twenty-fifth percentile, fiftieth percentile, and seventy-fifth percentile reimbursement amounts that the health provider facility or provider receives for each covered service under the proposed health provider contract. As added by P.L.215-2025, SEC.49.

Ind. Code § 27-1-37-8 Prohibited contract provisions; severable and void; investigative demand by attorney general

Sec. 8. (a) This section applies to a health provider contract entered into, amended, or renewed after June 30, 2025. (b) A health provider contract, including a contract with a pharmacy benefit manager, may not contain a provision that does any of the following: (1) Limits the ability of the health carrier, the health provider facility, or the provider to disclose the allowed amount and fees of services to any insured (as defined in IC 27-8-5.8-3) or enrollee (as defined in IC 27-13-1-12), or to the treating health provider facility or provider of the insured or enrollee. (2) Limits the ability of the health carrier, the health provider facility, or the provider to disclose out-of-pocket costs to an insured (as defined in IC 27-8-5.8-3) or an enrollee (as defined in IC 27-13-1-12). (3) Limits the ability of the health carrier to introduce or modify a select network plan or tiered network plan by granting the provider a guaranteed right of participation. (4) Requires the health carrier to place all facilities in the same tier of a tiered network plan. (5) Requires the health carrier to include all facilities in a select network plan on an all-or-nothing basis. (6) Requires a provider to participate in a new select network or tiered network plan that the health carrier introduces without granting the provider the right to opt out of the new plan at least sixty (60) days before the new plan is submitted to the commissioner for approval. (c) Any provision of a health provider contract that includes a provision described in subsection (b) in violation of this section is severable and the provision in violation is null and void. The remaining provisions of the health provider contract, excluding the provision in violation of this section, remain in effect and are enforceable. (d) The attorney general may issue a civil investigative demand to obtain information from a party of, or pertaining to, a health provider contract and compliance of this section. As added by P.L.198-2021, SEC.22. Amended by P.L.215-2025, SEC.50.

Ind. Code § 27-1-37-9 Notice of termination of health provider contract

Sec. 9. (a) This section applies to health provider contracts entered into or renewed after June 30, 2024. (b) If a party to a health provider contract intends to terminate the contractual relationship with another party to the health provider contract, the terminating party must provide written notice to the other party of the decision to terminate the contractual relationship not less than ninety (90) days before the health provider contract terminates. As added by P.L.158-2024, SEC.12.

Ind. Code § 27-1-37-10 Void and unenforceable contract provisions

Sec. 10. (a) This section applies to a health provider contract in which at least one (1) of the parties is a health provider facility. (b) A health provider contract that: (1) requires the parties to commence negotiations to amend the terms of the contract if there is a change in law; or (2) guarantees that the health carrier or provider will be made whole for the financial effects of a law or regulation; is against public policy and is void and unenforceable. As added by P.L.215-2025, SEC.51.

Ind. Code § 27-1-37-11 Network adequacy standards

Sec. 11. The department shall do the following: (1) Require health carriers to meet network adequacy standards that are no less stringent than the network adequacy standards established by the Centers for Medicare and Medicaid Services. (2) When assessing whether a health carrier has met the network adequacy standards, consider the availability and variety of independent specialty providers that provide services within in network provider facilities in the health carrier's network. As added by P.L.215-2025, SEC.52.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/27Fetched: 10/17/2026

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