1. (a)

   1. (1) "Specified disease coverage" pays benefits for the diagnosis and treatment of a specifically named disease or diseases.

   2. (2)

      1. (A) Any such policy must meet the following general rules and one (1) of the following sets of minimum standards for benefits.
      2. (B) Such insurance covering cancer, whether cancer only or in conjunction with other condition or conditions or disease or diseases, must meet the standards of subsection (d) or (e) of this section.
      3. (C) Insurance covering a specific disease or diseases other than cancer must meet the standards of subsection (c) of this section.

2. (b) General rules.

   1. (1) The following rules shall apply to specified disease coverages in addition to all other rules imposed by this part.

   2. (2) In cases of conflict between the following and other rules, the following ones shall govern:

      1. (A) Policies covering a single specified disease or combination of specified diseases may not be sold or offered for sale other than as specified disease coverage under this section;
      2. (B) Any policy issued pursuant to this section that conditions payment upon pathological diagnosis of a covered disease shall also provide that if such a pathological diagnosis is medically inappropriate, a clinical diagnosis will be accepted in lieu thereof;
      3. (C) Notwithstanding any other provision of this part, specified disease policies shall provide benefits to any covered person not only for the specified disease or diseases but also for any other condition or conditions or disease or diseases, directly caused or aggravated by the specified disease or diseases or the treatment of the specified disease or diseases;
      4. (D) Policies containing specified disease coverage shall be at least guaranteed renewable;
      5. (E) No policy issued pursuant to this section shall contain a waiting or probationary period greater than thirty (30) days;
      6. (F)

3. (i) Any application for specified disease coverage shall contain a statement above the signature of the applicant that no person to be covered for specified disease is also covered by any Title XIX program (Medicaid or any similar name).

   1. (ii) Such statement may be combined with any other statement for which the insurer may require the applicant's signature;

      1. (G) Payments may be conditioned upon a covered person's receiving medically necessary care, given in a medically appropriate location, under a medically accepted course of diagnosis or treatment;
      2. (H) Except for the uniform provision regarding other insurance with this insurer, benefits for specified disease coverage shall be paid regardless of other coverage available through individual health insurance; and

      3. (I)

         1. (i) After the effective date of the coverage (or applicable waiting period, if any) benefits shall begin with the first day of care or confinement if such care or confinement is for a covered disease even though the diagnosis is made at some later date.
         2. (ii) The retroactive application of such coverage may not be less than ninety (90) days prior to such diagnosis.
         3. (c) The following minimum benefit standards apply to noncancer coverages, and one (1) of the following standards must be met:

   2. (1) A policy that provides coverage for each person insured under the policy for a specifically named disease or diseases with a deductible amount not in excess of two hundred fifty dollars ($250), an overall aggregate benefit limit of no less than ten thousand dollars ($10,000), and a benefit period of not less than three (3) years for at least the following incurred expenses:

      1. (A) Hospital room and board and any other hospital furnished medical services or supplies;
      2. (B) Treatment by a legally qualified physician or surgeon;
      3. (C) Private duty services of a registered nurse (RN);
      4. (D) X-ray, radium, and other therapy procedures used in diagnosis and treatment;
      5. (E) Professional ambulance for local service to or from a local hospital;
      6. (F) Blood transfusions, including expense incurred for blood donors;
      7. (G) Drugs and medicines prescribed by a physician;
      8. (H) The rental of an iron lung or similar mechanical apparatus;
      9. (I) Braces, crutches, and wheelchairs as are deemed necessary by the attending physician for the treatment of the disease;
      10. (J) Emergency transportation if, in the opinion of the attending physician, it is necessary to transport the insured to another locality for treatment of the disease; and
      11. (K) May include coverage of any other expenses necessarily incurred in the treatment of the disease; or

   3. (2) A policy that provides coverage for each person insured under the policy for a specifically named disease or diseases with:

      1. (A) No deductible amount;
      2. (B) An overall aggregate benefit limit of not less than fifty thousand dollars ($50,000) payable at the rate of not less than one hundred dollars ($100) a day while confined in a hospital; and

      3. (C) A benefit period of not less than five hundred (500) days.

         1. (d) A policy that provides coverage for each person insured under the policy for cancer-only coverage or in combination with one (1) or more other specified diseases on an expense-incurred basis for services, supplies, care, and treatment that are ordered or prescribed by a physician as necessary for the treatment of cancer, in amounts not in excess of the usual and customary charges, with a deductible amount not in excess of two hundred fifty dollars ($250), an overall aggregate benefit limit of not less than ten thousand dollars ($10,000), and a benefit period of not less than three (3) years for at least the following:
   4. (1) Treatment by, or under the direction of, a legally qualified physician or surgeon;
   5. (2) X-ray, radium, chemotherapy, and other therapy procedures used in diagnosis and treatment;
   6. (3) Hospital room and board and any other hospital furnished medical services or supplies;
   7. (4) Blood transfusions and the administration thereof, including expense incurred for blood donors;
   8. (5) Drugs and medicines prescribed by a physician;
   9. (6) Professional ambulance for local service to or from a local hospital;
   10. (7) Private duty services of a registered nurse (RN) provided in a hospital;

   11. (8)

       1. (A) May include coverage of any other expenses necessarily incurred in the treatment of the disease.

       2. (B) Provided, however, if such other expenses are covered, that the items listed in subdivisions (d)(1), (2), (4), (5), and (7) of this section plus at least the following shall be included, but may be subject to copayment by the covered person not to exceed twenty percent (20%) of covered charges, when rendered on an outpatient basis:

          1. (i) Braces, crutches, and wheelchairs as are deemed necessary by the attending physician for the treatment of the disease;
          2. (ii) Emergency transportation if, in the opinion of the attending physician, it is necessary to transport the insured to another locality for treatment of the disease;
          3. (iii)
4. (a) (a) Home health care that is necessary care and treatment provided at the covered person's residence by a home healthcare agency or by others under arrangements made with a home healthcare agency.

5. (b) (b) The program of treatment must be prescribed in writing by the covered person's attending physician, who must approve the program prior to its start.

   1. (c) (c) The physician must certify that hospital confinement would be otherwise required.

      1. (d) (d) For definition of “home healthcare agency”, see subsection (f) of this section;

         1. (iv) Physical, speech, hearing, and occupational therapy;
         2. (v) Special equipment, including:
6. (a) (a) Hospital bed toilette;

7. (b) (b) Pulleys;

   1. (c) (c) Wheelchairs;

      1. (d) (d) Aspirator;
8. (e) (e) Chux;
9. (f) (f) Oxygen;
10. (g) (g) Surgical dressings;

11. (h) (h) Rubber shields; and

    1. (i) (i) Colostomy and ileostomy appliances;

       1. (vi) Prosthetic devices, including wigs and artificial breasts; and

          1. (vii) Nursing home care for noncustodial services; and
    2. (9) May include coverage of any other expenses necessarily incurred in the treatment of the disease.

12. (e)

    1. (1) The following minimum benefit standards apply to cancer coverages written on a per diem indemnity basis, which must offer covered persons:

       1. (A) A fixed-sum payment of at least one hundred fifty dollars ($150) for each day of hospital confinement for at least three hundred sixty-five (365) days; and
       2. (B) A fixed-sum payment equal to one-half (1/2) the hospital inpatient benefit for each day of hospital or nonhospital outpatient surgery, chemotherapy, and radiation therapy, for at least three hundred sixty-five (365) days of treatment.

    2. (2)

       1. (A) Benefits tied to confinement in a skilled nursing home or to receipt of home health care are optional.

       2. (B) If a policy offers these benefits, they must equal the following:

          1. (i) A fixed-sum payment equal to one-fourth (1/4) of the hospital inpatient benefit for each day of skilled nursing home confinement for at least one hundred (100) days;
          2. (ii) A fixed-sum payment equal to one-fourth (1/4) of the hospital inpatient benefit for each day of home health care for at least one hundred (100) days; and
          3. (iii) Notwithstanding any other provision of this part, any restriction or limitation applied to the benefits in subdivisions (e)(2)(B)(i) and (e)(2)(B)(ii) of this section, whether by definition or otherwise, shall be no more restrictive than those under Medicare.

13. (f) Home healthcare agency.

    1. (1) A home healthcare agency is one that:

       1. (A) Is an agency approved under Title XVIII of the Social Security Act (Medicare);
       2. (B) Is licensed to provide home health care under applicable state law; or

       3. (C) Meets all of the following requirements:

          1. (i) It is primarily engaged in providing home healthcare services;
          2. (ii) Its policies are established by a group of professional personnel, including at least:
14. (a) (a) One (1) physician; and

15. (b) (b) One (1) registered nurse (RN);

    1. (iii) Supervision of home healthcare services is provided by a physician or a registered nurse (RN);

       1. (iv) It maintains clinical records on all patients; and

          1. (v) It has a full-time administrator.

    2. (2) Home health care includes, but is not limited to:

       1. (A) Part-time or intermittent skilled nursing services provided by a registered nurse (RN) or a licensed practical nurse (LPN);

       2. (B) Part-time or intermittent home health aide services that provide supportive services in the home under the supervision of a:

          1. (i) Registered nurse; or
          2. (ii) Physical, speech, or hearing occupational therapist;
       3. (C) Physical, occupational, or speech and hearing therapy; and
       4. (D) Medical supplies, drugs, and medicines prescribed by a physician and related pharmaceutical services, and laboratory services to the extent such charges or costs would have been covered under the policy if the insured person had remained in the hospital.

Codification Notes: Title XVIII of the Social Security Act (Medicare) is codified at 42 U.S.C. § 1001 et seq.