Indiana Health Insurance Policy Requirements

Indiana has comprehensive health insurance regulations that work alongside federal requirements. The Indiana Department of Insurance (IDOI) regulates health coverage in the state.

Regulatory Structure

Indiana health coverage is regulated by a single agency:

HMO Regulation in Indiana

Indiana regulates Health Maintenance Organizations (HMOs):

• HMOs must be licensed by IDOI
• Must meet minimum net worth requirements ($1.5 million minimum)
• Must maintain fidelity bond of at least $250,000
• Required to have quality management programs
• Must have grievance and appeals processes
• Must maintain deposit of $500,000 with Commissioner

Free Look Period

Indiana provides a 10-day free look period for individual health insurance:

• Policyholder can return for full premium refund
• Begins when policy is delivered
• Applies to individual health policies
• No penalty for exercising this right

Exam Tip: Health insurance has a 10-day free look in Indiana, the same as life insurance.

Required Coverage

Indiana mandates coverage for numerous benefits in accordance with ACA requirements:

Essential Health Benefits

All individual and small group plans must cover:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

Mental Health Parity

Indiana requires mental health parity in health insurance:

• Mental health benefits must be equal to medical benefits
• Same copays, deductibles, and limits apply
• Covers mental illness and substance use disorders
• Applies to group and individual plans

Covered Conditions

Mental health parity applies to conditions including:

• Major depression
• Bipolar disorder
• Schizophrenia
• Anxiety disorders
• Substance use disorders
• Eating disorders

Pre-Existing Condition Protections

Indiana prohibits pre-existing condition exclusions in ACA-compliant plans:

Healthcare.gov Marketplace

Indiana uses the federal Healthcare.gov marketplace:

• Only place to get premium subsidies in Indiana
• Offers qualified health plans (QHPs)
• Open enrollment and special enrollment periods
• Subsidies based on income

Key Features

• Plans categorized by metal tiers (Bronze, Silver, Gold, Platinum)
• Premium tax credits based on income
• Cost-sharing reductions for Silver plans
• Special enrollment for qualifying life events

Guaranteed Issue and Renewal

Indiana requires for ACA-compliant plans:

Guaranteed Issue

• Insurers must accept all applicants during open enrollment
• Cannot deny coverage based on health status
• Applies to individual and small group markets

Guaranteed Renewal

• Insurers cannot cancel coverage except for:
  • Non-payment of premium
  • Fraud or misrepresentation
  • Plan discontinuation (with notice)