Indiana Code 27-8-15-28. Waiver of exclusion and limitation period
(1) A hospital or medical expense incurred policy or certificate.
Terms Used In Indiana Code 27-8-15-28
- Contract: A legal written agreement that becomes binding when signed.
- Dependent: A person dependent for support upon another.
- eligible employee: means an employee:
Indiana Code 27-8-15-8.5
- insurer: means any person who provides health insurance in Indiana. See Indiana Code 27-8-15-10
- plan: means any:
Indiana Code 27-8-15-9
- small employer: means any person, firm, corporation, limited liability company, partnership, or association actively engaged in business who, on at least fifty percent (50%) of the working days of the employer during the preceding calendar year, employed at least two (2) but not more than fifty (50) eligible employees, the majority of whom work in Indiana. See Indiana Code 27-8-15-14
- small employer insurer: means any insurer that offers a health insurance plan covering the employees of a small employer. See Indiana Code 27-8-15-15
(3) A health maintenance organization subscriber contract.
(4) Medicare or Medicaid.
(5) An employer based health insurance arrangement.
(6) An individual health insurance policy.
(7) A policy issued by the Indiana comprehensive health insurance association under IC 27-8-10.
(8) An employee welfare benefit plan (as defined in 29 U.S.C. § 1002) that is self-funded.
(9) A conversion policy issued under section 31 or 31.1 of this chapter.
(b) Except as provided in section 29 of this chapter, a small employer insurer shall waive the exclusion period described in section 27 of this chapter applicable to a preexisting condition or the limitation period with respect to a particular service in a health insurance plan for the time an eligible employee or a dependent of an eligible employee was previously covered by a health insurance plan if the following conditions are met:
(1) The eligible employee or a dependent of the eligible employee was previously covered by a health insurance plan that provided benefits with respect to the particular service.
(2) Coverage under the health insurance plan was continuous to a date not more than sixty-three (63) days before the effective date of enrollment by:
(A) the eligible employee; or
(B) a dependent of the eligible employee.
(c) In determining whether an eligible employee or a dependent of the eligible employee meets the requirements of subsection (b)(2), a waiting period imposed by a small employer insurer or small employer before new coverage may become effective must be excluded from the calculation.
(d) This section does not preclude the application of any waiting period applicable to all new enrollees under a plan.
As added by P.L.93-1995, SEC.16. Amended by P.L.190-1996, SEC.6; P.L.91-1998, SEC.19.