CHAPTER 6. REIMBURSEMENT FOR CERTAIN MEDICAL SERVICES - Indiana Statutes

IC 27-8-6
     Chapter 6. Reimbursement for Certain Medical Services

IC 27-8-6-1
Professional services for which reimbursement authorized
     Sec. 1. Notwithstanding any provision of any individual or group policy of accident and health insurance, or any provision of a policy, contract, plan, or agreement for hospital or medical service or indemnity, wherever such policy, contract, plan, or agreement provides for reimbursement for any service which is in the lawful scope of practice of a duly licensed dentist, health service provider in psychology, podiatrist, osteopath, optometrist, or chiropractor, the person entitled to benefits or the person performing services under the policy, contract, plan, or agreement shall be entitled to reimbursement on an equal basis for such service, whether the service is performed by a physician, dentist, health service provider in psychology, podiatrist, osteopath, optometrist, or chiropractor duly licensed under the laws of this state.
(Formerly: Acts 1969, c.409, s.1; Acts 1974, P.L.126, SEC.1.) As amended by P.L.260-1985, SEC.1.

IC 27-8-6-2
Prior policies
     Sec. 2. The provisions of section 1 of this chapter shall not apply to any policy, contract, plan, or agreement in effect prior to May 1, 1969.
(Formerly: Acts 1969, c.409, s.2.) As amended by P.L.252-1985, SEC.311.

IC 27-8-6-3
Application of amendments by Acts 1974, P.L.126
     Sec. 3. The amendments to this chapter made by Acts 1974, P.L.126 do not apply to a policy, contract, plan, or agreement in effect before June 11, 1974.
As added by P.L.1-1989, SEC.55.

IC 27-8-6-4
Reimbursement for services; application of section; prohibitions excluded
     Sec. 4. (a) This section does not apply to any of the following:
        (1) A health maintenance organization (as defined in IC 27-13-1-19) or limited service health maintenance organization (as defined in IC 27-13-34-4).
        (2) A preferred provider plan (as defined in IC 27-8-11-1).
        (3) An employee benefit program that is subject to the federal Employee Retirement Income Security Act (29 U.S.C. 1001 et seq.).
        (4) Worker's compensation for an injury to or occupational disease of an employee under IC 22-3.
    (b) A group or individual policy or agreement providing

comprehensive accident and health benefits must reimburse an insured for services rendered by a provider licensed under IC 25-10 within the scope of that provider's license in the same manner as that policy or agreement reimburses an insured for services rendered by a provider licensed under IC 25-22.5 within the scope of that provider's license. The policy or agreement may not exclude or otherwise limit reimbursement for any service that a provider licensed under IC 25-10 renders under the scope of that provider's license in the diagnosis and treatment of any illness or injury. This section does not require that a health care policy or agreement cover a particular illness or injury.
    (c) This section does not prohibit the following:
        (1) The application of coinsurance and deductible provisions to providers licensed under IC 25-10 on the same basis as those provisions are applied to providers licensed under IC 25-22.5.
        (2) The application of cost containment or quality assurance measures to providers licensed under IC 25-10 on the same basis as those measures are applied to providers licensed under IC 25-22.5.
        (3) A review of the necessity of services that applies to services rendered by providers licensed under IC 25-10 on the same basis as the review applies to services provided by providers licensed under IC 25-22.5.
As added by P.L.153-1990, SEC.1. Amended by P.L.26-1994, SEC.12.

IC 27-8-6-5
Indemnity for services provided by certified registered nurse anesthetist
     Sec. 5. (a) As used in this section, "certified registered nurse anesthetist" has the meaning set forth in IC 25-23-1-1.4.
    (b) As used in this section, "insured" means an individual who is entitled to the benefits provided by a policy of accident and sickness insurance. The term includes the following:
        (1) The policyholder of an individual policy of accident and sickness insurance.
        (2) A member of the group covered by a group policy of accident and sickness insurance.
        (3) An individual who is entitled to coverage under a policy of accident and sickness insurance as a spouse or dependent of an individual referred to in subdivision (1) or (2).
    (c) As used in this section, "insurer" has the meaning set forth in IC 27-1-2-3.
    (d) As used in this section, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1.
    (e) An insurer that issued a policy of accident and sickness insurance that indemnifies an insured for anesthesiology services shall indemnify an insured under the policy for any covered anesthesiology services provided by a certified registered nurse anesthetist. As added by P.L.258-1995, SEC.1.