Federal & State Regulations | Health plans - Indiana | J. J. Keller® Compliance Network

State Info

Summary of differences between federal and state regulations

Employee health plans are generally covered under the federal jurisdiction of the Employee Retirement Income Security Act (ERISA).

Federal ERISA plans generally do not have to comply with state laws. ERISA rules preempt or block state laws that relate to ERISA plans. State insurance laws, however, do apply.

If the plan covers inpatient services for the treatment of mental illness, substance abuse, or both, it must cover inpatient services provided by a community mental health center or by any psychiatric hospital licensed to offer those services. §27-8-5-15.5
Plans may not permit treatment limitations or financial requirements on the coverage of services for a mental illness if similar limitations or requirements are not imposed on the coverage of services for other medical or surgical conditions. §27-8-5-15.6
There is a 31-day grace period. §27-8-5-19
Plans must cover newly adopted children as for other dependents. §27-8-5-21
Plans must include coverage for anesthesia and hospital charges for dental care if the condition of the insured requires dental treatment to be rendered in a hospital or an ambulatory outpatient surgical center. §27-8-5-27
Newborns are covered from moment of birth. §27-8-5.6-2
Optional coverage for morbid obesity. §27-8-14.1
Coverage for pervasive developmental disorders. §27-8-14.2
Coverage for diabetes management, including treatment, supplies, and equipment. §27-8-14.5
Coverage for prostate specific antigen testing. §27-8-14.7
Coverage for colorectal cancer screening for those who are at least 50 years old or at high risk. §27-8-14.8
Reimbursement for off label drug cancer treatment. §27-8-20
Coverage for victims of abuse. §27-8-24.3
Questions regarding genetic screening or testing results are prohibited. §27-8-26
Effective July 1, 2005, explanation of benefits or claims summary statements may be in electronic or paper form. Paper copies are to be sent upon request. §27-8-5.5-2
Effective July 1, 2007, accident and sickness policies must cover children until they become 24 years old. §27-8-5-28

Indiana also provides for “Small Employer Group Health Insurance.” §27-8-15