Authority: IC 12-15-44.5-9

Affected: IC 12-15-44.5

Sec. 1. (a) Managed care organizations and providers shall not charge, collect, or impose cost sharing, including premiums, copayments, or coinsurance, to plan members for covered services, except in the following circumstances:

1. (1) Deductible amounts paid for with funds out of a member's POWER account.
2. (2) Emergency room copayments, as set forth in 405 IAC 10-7-9.
3. (3) Copayments, as set forth in 405 IAC 10-10-3(c).

(b) In those instances where the managed care organization pays for a service at the Medicare rate, any cost sharing that would typically be applicable in the Medicare program:

1. (1) shall not be applicable; and
2. (2) shall be included in the rate paid by the managed care organization.

(c) Notwithstanding subsection (a), managed care organizations and providers shall not charge, collect, or impose cost sharing, including premiums, copayments, or coinsurance, for any covered service to a member who is:

1. (1) pregnant; or
2. (2) an American Indian/Alaskan Native.

(Office of the Secretary of Family and Social Services; 405 IAC 10-8-1; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA; filed Jan 19, 2018, 8:42 a.m.: 20180214-IR-405170484FRA; errata filed Feb 22, 2018, 9:36 a.m.: 20180307-IR-405180114ACA; readopted filed Oct 16, 2024, 11:20 a.m.: 20241113-IR-405230817RFA)