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Rights – Laws

Health insurance regulations in Indiana are in health reform limbo, as with the remainder of the country: some laws are already in effect, and others to come. At the moment, there are still laws that can easily prevent individuals with pre-existing conditions from obtaining coverage, and others may experience rate increases due to something as simple as their gender or age. However, there are laws benefiting the Indiana policyholder, which offer protection from losing coverage and help keep you insured. Knowing what you are entitled so as the purchaser of a health plan is very important, especially as laws continue to evolve.


Guaranteed Renewal

The state of Indiana permits guaranteed renewal of health plans, which means while your insurer retains the ability to increase rates based on your health, age, and other factors, they are unable to terminate your plan once approved. This is of course assuming you pay your premiums, and do not commit fraud against your insurance company. Even if you acquire an illness or condition during the course of your health plan’s term, you cannot lose your benefits. In addition, the insurer must offer to renew your plan at the end of a term in order to maintain continuous coverage in the following year.


Pre-Existing Conditions

While the Affordable Care Act did eliminate the possibility of children getting rejected for a health plan due to their conditions, adults in Indiana are still subject to state laws and the underwriting process. Indiana has a look-back period of 12 months for pre-existing conditions, and insurance companies can fully decline an applicant based on their condition, or accept them for an increased premium. Insurers are also permitted to issue an exclusion period of up to 12 months to any health plan, omitting coverage related to that member’s condition for however long they decide.

These conditions are judged not only by concrete medical records, but also by any conditions for which a person has shown symptoms though not formally diagnosed or treated. Despite the judgment for conditions, the exclusion period is the longest an insurer can withhold coverage, as elimination riders are not permitted. However, for individuals with pre-existing conditions without proof of prior creditable coverage, an exclusion period of up to 10 years can be issued. As mentioned, children under age 19 with pre-existing conditions must be accepted by Indiana insurance companies, though they can be rated up based on their condition.

The state of Indiana places no limit on how much an insurer can increase a person’s rates due to their condition. Varying between each company, an applicant can be declined or rated up to the percentage dictated by the company’s underwriting guidelines. Indiana residents with pre-existing conditions who are denied coverage have several options as an alternative. The state has its own high-risk pool, the Indiana Comprehensive Health Insurance Association (ICHIA), though it is now mandatory to apply for coverage through the Pre-Existing Condition Insurance Plan (PCIP) before attempting to enroll in ICHIA.


Mandatory Benefits

Indiana offers numerous health benefits required by state law for coverage by each private insurer. Therefore, if you purchase a plan on the individual and family market, these services must be available through any such health insurance policy. In the group market, these benefits should also be cleared for coverage. The state’s laws currently exceed the criteria set by the Affordable Care Act for Essential Health Benefits, which gives Indiana policyholders an advantage when it comes to certain types of care. Indiana state laws presently include the following benefits for each health plan:

  • Alcoholism
  • Autism
  • Cervical cancer and HPV screening
  • Cleft palate
  • Colorectal cancer screening
  • Dental anesthesia
  • Diabetes supplies and self management
  • Emergency care
  • Employee continuous coverage and conversion to non-groups
  • Newborn and adopted children coverage through parents’ plan
  • Reconstructive breast surgery
  • Student and disabled dependent coverage through parents’ plan
  • Substance abuse treatment