Sec. 19. (a) An insurer shall each year file with the commissioner a description of the grievance procedure of the insurer established under this chapter, including:

(1) the total number of grievances handled through the procedure during the preceding calendar year;

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Terms Used In Indiana Code 27-8-28-19

  • accident and sickness insurance policy: means an insurance policy that provides one (1) or more of the kinds of insurance described in Class 1(b) and 2(a) of IC 27-1-5-1. See Indiana Code 27-8-28-1
  • commissioner: refers to the insurance commissioner appointed under IC 27-1-1-2. See Indiana Code 27-8-28-2
  • covered individual: means an individual who is covered under an accident and sickness insurance policy. See Indiana Code 27-8-28-3
  • department: refers to the department of insurance. See Indiana Code 27-8-28-4
  • grievance: means any dissatisfaction expressed by or on behalf of a covered individual regarding:

    Indiana Code 27-8-28-6

  • insurer: means any person who delivers or issues for delivery an accident and sickness insurance policy or certificate in Indiana. See Indiana Code 27-8-28-9
  • Year: means a calendar year, unless otherwise expressed. See Indiana Code 1-1-4-5
(2) a compilation of the causes underlying those grievances; and

(3) a summary of the final disposition of those grievances.

     (b) The information required by subsection (a) must be filed with the commissioner on or before March 1 of each year. The commissioner shall:

(1) make the information required to be filed under this section available to the public; and

(2) prepare an annual compilation of the data required under subsection (a) that allows for comparative analysis.

     (c) The commissioner may require any additional reports as are necessary and appropriate for the commissioner to carry out the commissioner’s duties under this article.

     (d) The commissioner shall do the following:

(1) Compile and analyze complaints received by the department concerning a denial of coverage under an accident and sickness insurance policy for:

(A) an investigational or experimental treatment; or

(B) a treatment not considered to be medically necessary for a covered individual.

(2) If the commissioner determines that a pattern of denials of coverage is evident through the analysis performed under subdivision (1), report the pattern to the legislative council in an electronic format under IC 5-14-6.

(3) Remove from a report made under subdivision (2) any information that could be used to identify an individual.

As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.18-2016, SEC.3.

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