Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 10 - HEALTHY INDIANA PLAN
Rule 8 - Managed Care Organizations and Administrators
Section 8-1 - Unauthorized cost sharing

Universal Citation: 405 IN Admin Code 8-1

Current through September 18, 2024

Authority: IC 12-15-44.5-9

Affected: IC 12-15-44.5

Sec. 1.

(a) Managed care organizations and providers shall not charge, collect, or impose cost sharing, including premiums, copayments, or coinsurance, to plan members for covered services, except in the following circumstances:

(1) Deductible amounts paid for with funds out of a member's POWER account.

(2) Emergency room copayments, as set forth in 405 IAC 10-7-9.

(3) Copayments, as set forth in 405 IAC 10-10-3(c).

(b) In those instances where the managed care organization pays for a service at the Medicare rate, any cost sharing that would typically be applicable in the Medicare program:

(1) shall not be applicable; and

(2) shall be included in the rate paid by the managed care organization.

(c) Notwithstanding subsection (a), managed care organizations and providers shall not charge, collect, or impose cost sharing, including premiums, copayments, or coinsurance, for any covered service to a member who is:

(1) pregnant; or

(2) an American Indian/Alaskan Native.

Disclaimer: These regulations may not be the most recent version. Indiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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