IC 27-8-5-2.5 — Coverage under individual, and certain association group, policies of accident and sickness insurance; waivers
Chapter 5. Accident and Sickness Insurance─Policy Provisions
Bills citing this section
- SB 802026Signed into law
Code publication.
- SB 1892026Signed into law
Nonparticipating providers.
- HB 12012026In committee
Various mental health and insurance matters.
- HB 13732026In committee
Breast reconstruction coverage.
- HB 14122026In committee
Coverage for cognitive rehabilitation services.
- HB 12922026In committee
Automated traffic enforcement safety devices.
- HB 10492026In committee
Coverage for doula services.
- HB 10162026In committee
Selection of primary care provider.
Section text
Sec. 2.5. (a) As used in this section, the term "policy of accident and sickness insurance" does not include the following: (1) Accident only, credit, dental, vision, Medicare supplement, long term care, or disability income insurance. (2) Coverage issued as a supplement to liability insurance. (3) Automobile medical payment insurance. (4) A specified disease policy. (5) A short term insurance plan that: (A) may be renewed for the greater of: (i) thirty-six (36) months; or (ii) the maximum period permitted under federal law; (B) has a term of not more than three hundred sixty-four (364) days; and (C) has an annual limit of at least two million dollars ($2,000,000). (6) A policy that provides indemnity benefits not based on any expense incurred requirement, including a plan that provides coverage for: (A) hospital confinement, critical illness, or intensive care; or (B) gaps for deductibles or copayments. (7) Worker's compensation or similar insurance. (8) A student health plan. (9) A supplemental plan that always pays in addition to other coverage. (10) An employer sponsored health benefit plan that is: (A) provided to individuals who are eligible for Medicare; and (B) not marketed as, or held out to be, a Medicare supplement policy. (b) The benefits provided by: (1) an individual policy of accident and sickness insurance; or (2) a certificate of coverage that is issued under a nonemployer based association group policy of accident and sickness insurance to an individual who is a resident of Indiana; may not be excluded, limited, or denied for more than twelve (12) months after the effective date of the coverage because of a preexisting condition of the individual. (c) An individual policy of accident and sickness insurance or a certificate of coverage described in subsection (b) may not define a preexisting condition, a rider, or an endorsement more restrictively than as: (1) a condition that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment during the twelve (12) months immediately preceding the effective date of the plan; (2) a condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve (12) months immediately preceding the effective date of the plan; or (3) a pregnancy existing on the effective date of the plan. (d) An insurer shall reduce the period allowed for a preexisting condition exclusion described in subsection (b) by the amount of time the individual has continuously served under a preexisting condition clause for a policy of accident and sickness insurance issued under IC 27-8-15 if the individual applies for a policy under this chapter not more than thirty (30) days after coverage under a policy of accident and sickness insurance issued under IC 27-8-15 expires.
As added by P.L.93-1995, SEC.6. Amended by P.L.190-1996, SEC.1; P.L.211-2003, SEC.2; P.L.127-2006, SEC.1; P.L.173-2007, SEC.23; P.L.3-2008, SEC.212; P.L.288-2019, SEC.2.
Source: official publisher (2026 edition)