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Indiana Code Title 27. Insurance § 27-8-6-8

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

Sec. 8. (a) As used in this section, “emergency medical services” has the meaning set forth in IC 16-18-2-110.

(b) 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.

(c) As used in this section, “policy of accident and sickness insurance” has the meaning set forth in IC 27-8-5-1.  However, for purposes of this section, the term 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 policy that provides a stipulated daily, weekly, or monthly payment to an insured without regard to the actual expense of the confinement.

(6) A short term insurance plan (as defined in IC 27-8-5.9-3).

(d) A policy of accident and sickness insurance that provides 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 policy 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 for an encounter, the insurer:

(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 for the patient.

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

(h) This section does not require a policy of accident and sickness insurance to provide coverage for emergency medical services.

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Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-8-6-8 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-8-6-8/

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