Ind. Code ch. 27-1-46

Ind. Code ch. 27-1-46
in effect

Ind. Code § 27-1-46-0.5 Provision of information by certain health plans

Sec. 0.5. Nothing in this chapter prohibits: (1) a self-funded health benefit plan that complies with the federal Employee Retirement Income Security Act (ERISA) of 1974 (29 U.S.C. 1001 et seq.); or (2) a: (A) self-insurance program established to provide group health coverage as described in IC 5-10-8-7(b); or (B) contract for health services as described in IC 5-10-8-7(c); from providing information requested by a practitioner or provider facility under this chapter. As added by P.L.93-2020, SEC.12. Amended by P.L.11-2023, SEC.88.

Ind. Code § 27-1-46-1 "Covered individual"

Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to be provided health care services according to a health carrier's network plan. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-1.5 "Episode of care"

Sec. 1.5. As used in this chapter, "episode of care" means the medical care ordered to be provided for a specific medical procedure, condition, or illness. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-2 "Good faith estimate"

Sec. 2. As used in this chapter, "good faith estimate" means a reasonable estimate of the price each provider anticipates charging for an episode of care for nonemergency health care services that: (1) is made by a provider under this chapter upon the request of the individual for whom the nonemergency health care service has been ordered; and (2) is not binding upon the provider. As added by P.L.93-2020, SEC.12. Amended by P.L.202-2021, SEC.11.

Ind. Code § 27-1-46-3 "Health carrier"

Sec. 3. (a) As used in this chapter, "health carrier" means an entity: (1) that is subject to IC 27 and the administrative rules adopted under IC 27; and (2) that enters into a contract to: (A) provide health care services; (B) deliver health care services; (C) arrange for health care services; or (D) pay for or reimburse any of the costs of health care services. (b) The term includes the following: (1) An insurer, as defined in IC 27-1-2-3(x), that issues a policy of accident and sickness insurance, as defined in IC 27-8-5-1(a). (2) A health maintenance organization, as defined in IC 27-13-1-19. (3) An administrator (as defined in IC 27-1-25-1(a)) that is licensed under IC 27-1-25. (4) A state employee health plan offered under IC 5-10-8. (5) A short term insurance plan (as defined by IC 27-8-5.9-3). (6) Any other entity that provides a plan of health insurance, health benefits, or health care services. (c) The term does not include: (1) an insurer that issues a policy of accident and sickness insurance; (2) a limited service health maintenance organization (as defined in IC 27-13-34-4); or (3) an administrator; that only provides coverage for, or processes claims for, dental or vision care services. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-4 "In network"

Sec. 4. As used in this chapter, "in network", when used in reference to a provider, means that the health care services provided by the provider are subject to a health carrier's network plan. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-5 "Network"

Sec. 5. (a) As used in this chapter, "network" means a group of provider facilities and practitioners that: (1) provide health care services to covered individuals; and (2) have agreed to, or are otherwise subject to, maximum limits on the prices for the health care services to be provided to the covered individuals. (b) The term includes the following: (1) A network described in subsection (a) that is established pursuant to a contract between an insurer providing coverage under a group health policy and: (A) individual provider facilities and practitioners; (B) a preferred provider organization; or (C) an entity that employs or represents providers, including: (i) an independent practice association; and (ii) a physician-hospital organization. (2) A health maintenance organization, as defined in IC 27-13-1-19. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-6 "Network plan"

Sec. 6. As used in this chapter, "network plan" means a plan of a health carrier that: (1) requires a covered individual to receive; or (2) creates incentives, including financial incentives, for a covered individual to receive; health care services from one (1) or more providers that are under contract with, managed by, or owned by the health carrier. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-7 "Nonemergency health care service"

Sec. 7. As used in this chapter, "nonemergency health care service" means a discrete service or series of services ordered by a practitioner for an episode of care for the purpose of: (1) diagnosis; (2) prevention; (3) treatment; (4) cure; or (5) relief; of a physical, mental, or behavioral health condition, illness, injury, or disease that is not provided on an emergency or urgent care basis. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-8 "Practitioner"

Sec. 8. (a) As used in this chapter, "practitioner" means: (1) an individual who holds: (A) an unlimited license, certificate, or registration; (B) a limited or probationary license, certificate, or registration; (C) a temporary license, certificate, registration, or permit; (D) an intern permit; or (E) a provisional license; issued by the board (as defined in IC 25-0.5-11-1) regulating the profession in question; or (2) an entity that: (A) is owned by, or employs; or (B) performs billing for professional health care services rendered by; an individual described in subdivision (1). (b) The term does not include the following: (1) A dentist licensed under IC 25-14. (2) An optometrist licensed under IC 25-24. (3) A provider facility. As added by P.L.93-2020, SEC.12. Amended by P.L.202-2021, SEC.12.

Ind. Code § 27-1-46-8.5 "Price"

Sec. 8.5. As used in this chapter, "price" means the negotiated rate between the: (1) provider facility and practitioner; and (2) covered individual's primary health carrier. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-9 "Provider"

Sec. 9. As used in this chapter, "provider" means: (1) a provider facility; or (2) a practitioner. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-10 "Provider facility"

Sec. 10. (a) As used in this chapter, "provider facility" means any of the following: (1) A hospital licensed under IC 16-21-2. (2) An ambulatory outpatient surgical center licensed under IC 16-21-2. (3) A birthing center licensed under IC 16-21-2. (4) Except for an urgent care facility, a facility that provides diagnostic services to the medical profession or the general public, including outpatient facilities. (5) A laboratory where clinical pathology tests are carried out on specimens to obtain information about the health of a patient. (6) A facility where radiologic and electromagnetic images are made to obtain information about the health of a patient. (7) An infusion center that administers intravenous medications. (b) The term does not include the following: (1) A private mental health institution licensed under IC 12-25. (2) A Medicare certified, freestanding rehabilitation hospital. As added by P.L.93-2020, SEC.12. Amended by P.L.9-2022, SEC.49; P.L.36-2022, SEC.11; P.L.179-2022(ss), SEC.43.

Ind. Code § 27-1-46-10.5 "Urgent care facility"

Sec. 10.5. (a) As used in this chapter, "urgent care facility" means a freestanding health care facility that offers episodic, walk-in care for the treatment of acute, but not life threatening, health conditions. (b) The term does not include an emergency department of a hospital or a nonprofit or government operated health clinic. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-11 Right of individual to request good faith estimate from provider facility; duty of provider facility to provide estimate; required contents

Sec. 11. (a) This section does not: (1) apply to an individual who is a Medicaid recipient; or (2) limit the authority of a legal representative of the patient. (b) An individual for whom a nonemergency health care service has been ordered, scheduled, or referred may request from the provider facility in which the nonemergency health care service will be provided a good faith estimate of the price that will be charged for the nonemergency health care service. (c) A provider facility that receives a request from an individual under subsection (b) shall, not more than two (2) business days after receiving relevant information from the individual, provide to the individual a good faith estimate of: (1) the price that the provider facility in which the health care service will be performed will charge for: (A) the use of the provider facility to care for the individual for the nonemergency health care service; (B) the services rendered by the employed or contracted staff of the provider facility in connection with the nonemergency health care service; and (C) medication, supplies, equipment, and material items to be provided to or used by the individual while the individual is present in the provider facility in connection with the nonemergency health care service; and (2) the price charged for the services of all practitioners, support staff, and other persons who provide professional health services: (A) who may provide services to or for the individual during the individual's presence in the provider facility for the nonemergency health care service; and (B) for whose services the individual will be charged separately from the charge of the provider facility. (d) The price that must be included in a good faith estimate under this section includes all services under subsection (c)(1) or (c)(2) for imaging, laboratory services, diagnostic services, therapy, observation services, and other services expected to be provided to the individual for the episode of care. (e) A provider facility shall ensure that a good faith estimate states that: (1) an estimate provided under this section is not binding on the provider facility; (2) the price the provider facility charges the individual may vary from the estimate based on the individual's medical needs; and (3) the estimate provided under this section is only valid for thirty (30) days. (f) A provider facility may not charge a patient for information provided under this section. As added by P.L.93-2020, SEC.12. Amended by P.L.202-2021, SEC.13; P.L.215-2025, SEC.56.

Ind. Code § 27-1-46-12 In network good faith estimates; out of network good faith estimates

Sec. 12. (a) If: (1) the individual who requests a good faith estimate from a provider facility under this chapter and has been verified as a covered individual with respect to a network plan; and (2) the provider facility from which the individual requests the good faith estimate is in network with respect to the same network plan; the good faith estimate that the provider facility provides to the individual under this chapter must be based on the price to which the provider facility and any practitioners referred to in section 11(c)(2) of this chapter have agreed as in network providers. (b) If the individual who requests a good faith estimate from a provider facility under this chapter: (1) is not a covered individual with respect to any network plan; or (2) is not a covered individual with respect to a network plan with respect to which the provider facility is in network; the good faith estimate that the provider facility provides to the individual under this chapter must be based on the price that the provider facility and any practitioners referred to in section 11(c)(2) of this chapter charge for the nonemergency health care services in the absence of any network plan. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-13 Provision of good faith estimates

Sec. 13. A provider facility may provide a good faith estimate to an individual under this chapter: (1) in a writing delivered to the individual; (2) by electronic mail; or (3) through a mobile application or other Internet web based method, if available; according to the preference expressed by the individual. As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-14 Requirements of good faith estimates; provision of information by health carriers and practitioners to provider facility

Sec. 14. (a) A good faith estimate provided by a provider facility to an individual under this chapter must: (1) provide a summary of the services and material items that the good faith estimate is based on; and (2) include a total figure that is a sum of the estimated prices referred to in subdivision (1). (b) Subsection (a) does not prohibit a provider facility from providing to an individual a good faith estimate that indicates how much of the total figure stated under subsection (a)(2) will be the individual's out-of-pocket expense after the health carrier's payment of charges. (c) A health carrier or practitioner must provide a provider facility with the information needed by the provider facility to comply with the requirements under this chapter not more than two (2) business days after receiving the request. (d) A provider facility is not subject to the penalties under section 17 of this chapter if: (1) a health carrier or practitioner fails to provide the provider facility with the information as required under subsection (c); (2) the provider facility provides the individual with a good faith estimate based on any information that the provider facility has; and (3) the provider facility provides the individual with an updated good faith estimate after the health carrier or practitioner has provided the information required under subsection (c). As added by P.L.93-2020, SEC.12.

Ind. Code § 27-1-46-15 Provider facility or practitioner duty to communicate right to good faith estimate by at least three means

Sec. 15. (a) Each provider must make diligent attempts to ensure that the patient is aware of the patient's right to request a good faith estimate under this chapter. The communication by a provider to the patient concerning the right to a good faith estimate must be conspicuous and must be provided by at least three (3) of the following means: (1) Notice on the provider's website. (2) On hold messaging. (3) Waiting room notification. (4) Preappointment reminders, including through electronic mail (email) or text messaging. (5) During appointment or services check in. (6) During appointment or services check out. (7) During patient financial services or billing department inquiries. (8) Through an electronic medical and patient communication portal. (b) The communication required under subsection (a) must state the following, or words to the same effect: "A patient may ask for an estimate of the amount the patient will be charged for a nonemergency health care service provided in our facility. The law requires that an estimate be provided within 2 business days.". As added by P.L.93-2020, SEC.12. Amended by P.L.202-2021, SEC.14; P.L.215-2025, SEC.57.

Ind. Code § 27-1-46-16 Good faith estimate request from patient eligible for Medicare

Sec. 16. If: (1) a provider facility receives a request for a good faith estimate under this chapter; and (2) the patient is eligible for Medicare coverage; the provider facility shall provide a good faith estimate to the patient within two (2) business days based on available Medicare cost sharing rates. As added by P.L.93-2020, SEC.12. Amended by P.L.202-2021, SEC.15; P.L.215-2025, SEC.58.

Ind. Code § 27-1-46-17 Provider facility failure to provide estimate or communication about right to estimate; civil penalty

Sec. 17. (a) If a provider facility fails or refuses: (1) to provide a good faith estimate as required by this chapter; or (2) to provide communication to a patient of information concerning the patient's right to a good faith estimate as required under section 15 of this chapter; the insurance commissioner may, after notice and hearing under IC 4-21.5, impose on the provider facility a civil penalty of not more than one thousand dollars ($1,000) for each violation. (b) A civil penalty collected under this section shall be deposited in the department of insurance fund established by IC 27-1-3-28. As added by P.L.93-2020, SEC.12. Amended by P.L.202-2021, SEC.16.

Ind. Code § 27-1-46-18 Compliance with federal requirements

Sec. 18. The requirements of this chapter do not apply to a facility or practitioner that: (1) is required to comply with; and (2) is in compliance with; 45 CFR Part 149, Subparts E and G, as may be enforced and amended by the federal Department of Health and Human Services. As added by P.L.165-2022, SEC.10. Amended by P.L.190-2023, SEC.23.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/27Fetched: 10/17/2026

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