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Indiana Code Title 27. Insurance § 27-13-36-6

Current as of January 02, 2024 | Updated by Findlaw Staff

Sec. 6. (a) A health maintenance organization shall include provisions in the health maintenance organization's contracts with providers to provide for continuation of care in the event that a provider's contract with the health maintenance organization is terminated, provided that the termination is not due to a quality of care issue.

(b) The contract provisions under subsection (a) shall require that the provider, upon the request of the enrollee, continue to treat the enrollee for up to sixty (60) days following the termination of the provider's contract with the health maintenance organization or, in the case of a pregnant enrollee in the third trimester of pregnancy, throughout the term of the enrollee's pregnancy.  If the provider is a hospital, the contract shall provide for continuation of treatment until the earlier of the following:

(1) Sixty (60) days following the termination of the provider's contract with the health maintenance organization.

(2) The enrollee is released from inpatient status at the hospital.

(c) During a continuation period under this section, the provider:

(1) shall agree to continue accepting the contract terms and conditions, together with applicable deductibles and copayments, as payment in full;  and

(2) is prohibited from billing the enrollee for any amounts in excess of the enrollee's applicable deductible or copayment.

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Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-13-36-6 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-13-36-6/

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