Ind. Code § 25-1-9.8-1 "Covered individual"
Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to be provided health care services according to a health carrier's network plan.
As added by P.L.93-2020, SEC.7.
Ind. Code ch. 25-1-9.8
Ind. Code ch. 25-1-9.8
in effectInd. Code § 25-1-9.8-1.5 "Episode of care"
Sec. 1.5. 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.7.
Ind. Code § 25-1-9.8-2 "Good faith estimate"
Sec. 2. As used in this chapter, "good faith estimate" means a reasonable estimate of the price each provider anticipates charging for an episode of care for nonemergency health care services that:
(1) is made by a practitioner or provider facility under this chapter upon the request of:
(A) the individual for whom the nonemergency health care service has been ordered; or
(B) the provider facility in which the nonemergency health care service will be provided; and
(2) is not binding upon the provider.
As added by P.L.93-2020, SEC.7. Amended by P.L.202-2021, SEC.2.
Ind. Code § 25-1-9.8-3 "Health carrier"
Sec. 3. (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.93-2020, SEC.7.
Ind. Code § 25-1-9.8-4 "In network"
Sec. 4. 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.7.
Ind. Code § 25-1-9.8-5 "Network"
Sec. 5. (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.7.
Ind. Code § 25-1-9.8-6 "Network plan"
Sec. 6. 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.7.
Ind. Code § 25-1-9.8-7 "Nonemergency health care service"
Sec. 7. 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.7.
Ind. Code § 25-1-9.8-8 "Practitioner"
Sec. 8. (a) As used in this chapter, "practitioner" means the following:
(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.
(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.7. Amended by P.L.202-2021, SEC.3.
Ind. Code § 25-1-9.8-8.5 "Price"
Sec. 8.5. 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.
As added by P.L.93-2020, SEC.7.
Ind. Code § 25-1-9.8-9 "Provider"
Sec. 9. As used in this chapter, "provider" means:
(1) a provider facility; or
(2) a practitioner.
As added by P.L.93-2020, SEC.7.
Ind. Code § 25-1-9.8-10 "Provider facility"
Sec. 10. (a) 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.
(b) The term does not include the following:
(1) A private mental health institution licensed under IC 12-25.
(2) A Medicare certified, freestanding rehabilitation hospital.
As added by P.L.93-2020, SEC.7. Amended by P.L.9-2022, SEC.46; P.L.179-2022(ss), SEC.40.
Ind. Code § 25-1-9.8-11 Applicability; request for good faith estimate; requirements
Sec. 11. (a) This section does not apply to an individual who is a Medicaid recipient.
(b) An individual for whom a nonemergency health care service has been ordered, scheduled, or referred may request from the practitioner who may provide the nonemergency health care service a good faith estimate of the total price the practitioner will charge for providing the nonemergency health care service.
(c) A practitioner who receives a request from a patient under subsection (b) shall, not more than two (2) business days after receiving relevant information from the individual, provide to the individual a good faith estimate of the price that the practitioner will charge for providing the nonemergency health care service.
(d) A practitioner must ensure that a good faith estimate provided to an individual under this section is accompanied by a notice stating that:
(1) an estimate provided under this section is not binding on the practitioner;
(2) the price the practitioner charges the individual may vary from the estimate based on the individual's medical needs; and
(3) the estimate provided under this section is only valid for thirty (30) days.
(e) A practitioner may not charge an individual for information provided under this section.
As added by P.L.93-2020, SEC.7. Amended by P.L.215-2025, SEC.42.
Ind. Code § 25-1-9.8-12 In network good faith estimates; out of network good faith estimates
Sec. 12. (a) If:
(1) the individual who requests a good faith estimate from a practitioner under this chapter is a covered individual with respect to a network plan; and
(2) the practitioner from which the individual requests the good faith estimate is in network with respect to the same network plan;
the good faith estimate that the practitioner provides to the individual under this chapter must be based on the negotiated price to which the practitioner has agreed as an in network provider.
(b) If the individual who requests a good faith estimate from a practitioner under this chapter:
(1) is not a covered individual with respect to any network plan; or
(2) is not a covered individual with respect to a network plan with respect to which the practitioner is in network;
the good faith estimate that the practitioner provides to the individual under this chapter must be based on the price that the practitioner charges for the nonemergency health care service in the absence of any network plan.
As added by P.L.93-2020, SEC.7.
Ind. Code § 25-1-9.8-13 Provision of good faith estimate
Sec. 13. A practitioner 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.7.
Ind. Code § 25-1-9.8-14 Good faith estimate requirements; information health carrier and provider must provide to practitioner; when practitioner not subject to penalties
Sec. 14. (a) A good faith estimate provided by a practitioner to an individual under this chapter must meet the following requirements:
(1) Provide a summary of the services and material items that the good faith estimate is based on.
(2) Include:
(A) the price charged for the services and material items that the practitioner will provide and charge the individual; and
(B) the price that the provider facility in which the health care service will be performed charged for:
(i) the use of the provider facility to care for the individual for the nonemergency health care service;
(ii) the services rendered by the employed or contracted staff of the provider facility in connection with the nonemergency health care service; and
(iii) medication, supplies, equipment, and material items to be provided to or used by the individual while the individual is present in the provider facility in connection with the nonemergency health care service;
for imaging, laboratory services, diagnostic services, therapy, observation services, and other services expected to be provided to the individual for the episode of care.
(3) Include a total figure that is a sum of the estimated prices referred to in subdivisions (1) and (2).
(b) Subsection (a) does not prohibit a practitioner from providing to an individual a good faith estimate that indicates how much of the total figure stated under subsection (a)(2) will be the individual's out-of-pocket expense after the health carrier's payment of charges.
(c) A health carrier and a provider facility must provide a practitioner with the information needed by the practitioner to comply with the requirements under this chapter not more than two (2) business days after receiving the request. The provider facility shall provide the practitioner with all relevant information for services and costs for the good faith estimate that are to be provided by the provider facility for inclusion in a good faith estimate by the practitioner.
(d) A practitioner is not subject to the penalties under section 19 of this chapter if:
(1) a health carrier or provider facility fails to provide the practitioner with the information as required under subsection (c);
(2) the practitioner provides the individual with a good faith estimate based on any information that the practitioner has; and
(3) the practitioner provides the individual with an updated good faith estimate after the health carrier or provider facility has provided the information required under subsection (c).
As added by P.L.93-2020, SEC.7. Amended by P.L.202-2021, SEC.4.
Ind. Code § 25-1-9.8-15 Provision of information by practitioner to provider facility
Sec. 15. If:
(1) a practitioner is expected to provide a nonemergency health care service to an individual in a provider facility; and
(2) the provider facility receives a request from an individual for a good faith estimate under IC 27-1-46;
the practitioner, upon request from the provider facility, shall provide to the provider facility a good faith estimate of the practitioner's price for providing the nonemergency health care service to enable the provider facility to comply with IC 27-1-46-11.
As added by P.L.93-2020, SEC.7.
Ind. Code § 25-1-9.8-16 Practitioner duty to give written notice of individual's right to an estimate; rules
Sec. 16. (a) A practitioner that has scheduled or ordered for an individual a nonemergency health care service shall provide to the individual an electronic or paper copy of a written notice that states the following, or words to the same effect: "A patient may ask a health care provider for an estimate of the price the health care providers and health facility will charge for providing a nonemergency health care service. The law requires that the estimate be provided within 2 business days of scheduling the nonemergency health care service unless the nonemergency health care service is scheduled to be performed by the practitioner within 2 business days of the date of the patient's request.".
(b) The appropriate board (as defined in IC 25-1-9-1) may adopt rules under IC 4-22-2 to establish requirements for practitioners to provide additional charging information under this section.
As added by P.L.93-2020, SEC.7. Amended by P.L.32-2021, SEC.69; P.L.202-2021, SEC.5; P.L.215-2025, SEC.43.
Ind. Code § 25-1-9.8-17 Medicare good faith estimates
Sec. 17. If:
(1) a practitioner receives a request for a good faith estimate under this chapter; and
(2) the patient is eligible for Medicare coverage;
the practitioner shall provide a good faith estimate to the patient within two (2) business days based on available Medicare rates.
As added by P.L.93-2020, SEC.7. Amended by P.L.215-2025, SEC.44.
Ind. Code § 25-1-9.8-18 Practitioner or provider facility communication about right to good faith estimate by at least three means; required contents
Sec. 18. (a) Each provider must make diligent attempts to ensure that the patient is aware of the patient's right to request a good faith estimate under this chapter. The communication by each provider of information to the patient concerning the right to a good faith estimate must be conspicuous and must be provided by at least three (3) of the following means:
(1) Notice on the provider's website.
(2) On hold messaging.
(3) Waiting room notification.
(4) Preappointment reminders, including through electronic mail (email) or text messaging.
(5) During appointment or services check in.
(6) During appointment or services check out.
(7) During patient financial services or billing department inquiries.
(8) Through an electronic medical and patient communication portal.
(b) The communication required under subsection (a) must state the following, or words to the same effect: "A patient may ask for an estimate of the amount the patient will be charged for a nonemergency medical service provided in our office. The law requires that an estimate be provided within 2 business days of scheduling the nonemergency health care service unless the nonemergency health care service is scheduled to be performed by the practitioner within 2 business days of the date of the patient's request.".
As added by P.L.93-2020, SEC.7. Amended by P.L.202-2021, SEC.6; P.L.215-2025, SEC.45.
Ind. Code § 25-1-9.8-19 Action by appropriate board concerning good faith estimate or communication about right to estimate
Sec. 19. The appropriate board (as defined in IC 25-1-9-1) may take action against a practitioner:
(1) under IC 25-1-9-9(a)(3) or IC 25-1-9-9(a)(4) for an initial violation or isolated violations of this chapter; or
(2) under IC 25-1-9-9(a)(6) for repeated or persistent violations of this chapter;
concerning the providing of a good faith estimate to an individual for whom a nonemergency health care service has been ordered or the communication to a patient under section 18 of this chapter of information concerning the patient's right to a good faith estimate of the price that the patient will be charged for a medical service.
As added by P.L.93-2020, SEC.7. Amended by P.L.202-2021, SEC.7.
Ind. Code § 25-1-9.8-20 Compliance with federal requirements
Sec. 20. The requirements of this chapter do not apply to a practitioner who:
(1) is required to comply with; and
(2) is in compliance with;
45 CFR Part 149, Subparts E and G, as may be enforced and amended by the federal Department of Health and Human Services.
As added by P.L.165-2022, SEC.2. Amended by P.L.190-2023, SEC.9.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/25Fetched: 10/17/2026