Sec. 13. (a) Every subscriber of a limited service health maintenance organization shall be issued an evidence of coverage in electronic or paper form, which must contain a clear and complete statement of the following:

(1) The limited health services to which each enrollee is entitled.

Terms Used In Indiana Code 27-13-34-13

  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • enrollee: means an individual who is entitled to limited health services under a contract with an entity authorized to provide or arrange for limited health services under this chapter. See Indiana Code 27-13-34-1
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • evidence of coverage: means the certificate, agreement, or contract issued under section 13 of this chapter setting forth the coverage to which an enrollee is entitled. See Indiana Code 27-13-34-2
  • limited health services: refers to :

    Indiana Code 27-13-34-3

  • limited service health maintenance organization: means a corporation, partnership, limited liability company, or other entity that undertakes to provide or arrange a limited health service on a prepayment basis or other basis. See Indiana Code 27-13-34-4
  • subscriber: means a person whose employment status or other status, except for family dependency, is the basis for eligibility for limited health services under a contract with an entity authorized to provide or arrange for limited health services under this chapter. See Indiana Code 27-13-34-6
(2) Any limitation of the services, kinds of services, or benefits to be provided.

(3) Any exclusions, including any copayment or other charges.

(4) Where and in what manner information is available as to where and how services may be obtained.

(5) The method for resolving complaints.

     (b) Any amendment to the evidence of coverage may be provided to the subscriber in a separate document in electronic or paper form.

     (c) A limited service health maintenance organization shall issue the evidence of coverage described in subsection (a) and an amendment described in subsection (b) in paper form upon the request of the subscriber.

     (d) A limited service health maintenance organization shall include in the limited service health maintenance organization’s enrollment materials information concerning the manner in which a subscriber may:

(1) obtain an evidence of coverage; and

(2) request the evidence of coverage in paper form.

As added by P.L.26-1994, SEC.25. Amended by P.L.125-2005, SEC.8.

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