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Indiana Code Title 27. Insurance § 27-13-7-27

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

Sec. 27. (a) This section applies to each of the following:

(1) An individual contract.

(2) A group contract.

(b) As used in this section, “emergency medical services” has the meaning set forth in IC 16-18-2-110.

(c) As used in this section, “emergency medical services provider organization” means a provider of emergency medical services that is certified by the Indiana emergency medical services commission as an advanced life support provider organization under rules adopted under IC 16-31-3.

(d) An individual contract and a group contract that provide coverage for emergency medical services must provide reimbursement for emergency medical services that are:

(1) rendered by an emergency medical services provider organization;

(2) within the emergency medical services provider organization's scope of practice;

(3) performed or provided as advanced life support services;  and

(4) performed or provided:

(A) during a response initiated through the 911 system;  or

(B) as part of a mobile integrated healthcare program described in IC 16-31-12; regardless of whether the patient is transported.

(e) Reimbursement for basic and advanced life support services through a contract to which this section applies must be provided on an equal basis regardless of whether the services involve transportation of the patient by ambulance.

(f) If multiple emergency medical services provider organizations qualify and submit a claim for reimbursement under this section, the health maintenance organization:

(1) may reimburse under this section only for one (1) claim per patient encounter;  and

(2) shall reimburse the claim submitted by the emergency medical services provider organization that performed or provided the majority of advanced life support services.

(g) The department may adopt rules under IC 4-22-2 to implement this section.

(h) This section does not require an individual contract or a group contract to provide coverage for emergency medical services.

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Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-13-7-27 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-13-7-27/

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