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

Terms Used In Indiana Code 27-1-46-12

  • covered individual: means an individual who is entitled to be provided health care services according to a health carrier's network plan. See Indiana Code 27-1-46-1
  • 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:

    Indiana Code 27-1-46-2

  • 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. See Indiana Code 27-1-46-4
  • network: means a group of provider facilities and practitioners that:

    Indiana Code 27-1-46-5

  • network plan: means a plan of a health carrier that:

    Indiana Code 27-1-46-6

  • price: means the negotiated rate between the:

    Indiana Code 27-1-46-8.5

  • provider: means :

    Indiana Code 27-1-46-9

  • provider facility: means any of the following:

    Indiana Code 27-1-46-10

  • Verified: when applied to pleadings, means supported by oath or affirmation in writing. See Indiana Code 1-1-4-5
(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.

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