Authority: IC 27-16-4-7; IC 27-16-5-4; IC 27-16-5-6; IC 27-16-8-4
Affected: IC 27-16
Sec. 1. The definitions set forth in IC 27-16 and the following definitions apply throughout this rule:
- (1) "Fully insured" means a health benefit plan for which one hundred percent (100%) of the liability has been assumed by an insurance company or health maintenance organization authorized to conduct business in Indiana. The health benefit plan may include a layer of financial responsibility for claims assumed by the PEO as long as the insurance company or health maintenance organization is responsible for 100% of the PEO's liability in the event of nonpayment by the PEO. The covered individual must be entitled to make a claim for payment directly to the insurance company or health maintenance organization. A fully insured plan may have copay or deductible requirements as permitted by law.
(2) "Health benefit plan" means a plan that provides benefits for health care services. The term does not include the following:
- (A) Accident only or disability income insurance or a combination thereof.
- (B) Credit only insurance.
- (C) Disability insurance.
- (D) Coverage for a specified disease or illness.
- (E) Medicare supplement policies.
- (F) Long term care coverage.
- (G) Workers' compensation insurance.
- (H) Hospital indemnity of fixed indemnity insurance.
- (I) Reinsurance contract issued on a stop loss, quota share, or similar basis.
- (J) Short term major medical contracts.
- (K) Liability insurance.
- (L) Limited benefit coverage such as dental or vision only.
- (3) "Qualified actuary" means an actuary that is a member of the American Academy of Actuaries and a Fellow in the Society of Actuaries.
(Department of Insurance; 760 IAC 1-73-1; filed May 24, 2007, 4:15 p.m.: 20070620-IR-760060069FRA; readopted filed Nov 26, 2013, 3:43 p.m.: 20131225-IR-760130479RFA; readopted filed Nov 19, 2019, 9:18 a.m.: 20191218-IR-760190497RFA; readopted filed Oct 22, 2025, 3:17 p.m.: 20251119-IR-760240637RFA)