As used in this chapter, "grievance" means any dissatisfaction expressed by or on behalf of a covered individual regarding:

1. (1) a determination that a service or proposed service is not appropriate or medically necessary;
2. (2) a determination that a service or proposed service is experimental or investigational;
3. (3) the availability of participating providers;
4. (4) the handling or payment of claims for health care services;

5. (5) matters pertaining to the contractual relationship between:

   1. (A) a covered individual and an insurer; or
   2. (B) a group policyholder and an insurer;
6. (6) an insurer's decision to rescind an accident and sickness insurance policy; or

7. (7) a determination concerning a prior authorization request under IC 27-1-37.5 ;

   and for which the covered individual has a reasonable expectation that action will be taken to resolve or reconsider the matter that is the subject of dissatisfaction.

As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.1-2002, SEC.114; P.L.160-2011, SEC.22; P.L.77-2018, SEC.3.