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Compliance Corner

State Updates

Telehealth Coverage Expanded

May 11, 2021

On April 20, 2021, Gov. Holcomb signed Indiana Senate Bill 3 into law, expanding the use of telehealth services, and making several other changes related to telehealth.

Among other items, the law provides for additional flexibility and technology platforms in receiving telehealth services. Of note, the new law now permits telehealth services delivered via email, instant message, facsimile, and internet questionnaire when the practitioner has an established relationship with the patient. Further, the requirements for a prescriber issuing a prescription to a patient via telehealth services are also amended to allow prescribers to issue prescriptions even if the patient has not been examined previously by the prescriber when certain conditions are met. In addition, the law states that telehealth services are prohibited to provide any abortion, including prescription for any purpose intending to result in an abortion.

The new law is effective as of April 20, 2021, although nothing in the new law requires an individual to provide or use telehealth services.

Employers should be aware of these developments.

S.B. 3 »

Extended Relief for Non-ACA-Compliant Small Group and Individual Policies and Plans

April 13, 2021

On March 31, 2021, Insurance Commissioner Robertson released Bulletin 258, extending the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans that renew for a policy year starting on or before October 1, 2022, as long as the transitional policy ends by December 31, 2022.

As background, on January 19, 2021, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, if the state allows for such an extension. Such transition policies are not required to comply with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to Indiana and allows the issuer to renew these non-ACA compliant plans.

Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.

Bulletin 258 »

Health Benefit Mandate: Coverage for Treatment of Certain Pediatric Conditions

June 23, 2020

Effective July 1, 2020, health plans are required to provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome, including treatment with intravenous immunoglobulin therapy. Further, this coverage may not be subject to annual or lifetime limitation, deductible, copayment or coinsurance provisions that are more restrictive than those that apply generally under the contract or policy.

As background, Indiana law requires health insurance issuers to include coverage for certain benefits and services in health plans that employers can purchase from issuers. These Indiana health benefit mandates apply to group health insurance plans that cover two or more employees who live or work in Indiana. Indiana health benefit mandates do not apply to self-insured group health plans.

Employers who sponsor fully insured group health plans issued in Indiana should be aware of this new mandate and confirm that their insurers are in compliance effective July 1, 2020.

H.B. 1372 »

Mastectomy Mandate Changes

May 12, 2020

Effective July 1, 2020, health plans that cover mastectomies are required to provide coverage for custom fabricated breast prostheses, along with one additional breast prosthesis per breast affect by the mastectomy. As background, Indiana’s current benefit mandates require plans that provide coverage for a mastectomy to also provide coverage for prosthetic devices, reconstructive surgery of the affected breast and reconstructive surgery of the other breast as appropriate. On March 18, 2020, S.B. 239 was signed by Governor Holcomb and became Public Law 67, which now requires this new health benefit mandate effective July 1, 2020.  

Employers who sponsor fully insured group health plans issued in Indiana should be aware of this new health benefits mandate and confirm that their insurers are in compliance effective July 1, 2020.

S.B. 239 »

Extension of the Moratorium on Policy Cancellation and Nonrenewals

May 12, 2020

On May 7, 2020, Indiana DOI (IDOI) issued Bulletin 254, extending the current moratorium on policy cancellations and nonrenewals until May 31, 2020. The IDOI confirms that this moratorium is not a waiver; rather, it is an extension of the period in which to pay the premium.

As background, Bulletin 252 implemented a 60-day moratorium (applicable March 19, 2020, through May 18, 2020) on policy cancellations for nonpayment of premiums applicable to all lines of business (as mentioned in the March 31, 2020, Compliance Corner article “COVID-19 and Health Insurance Coverage”). Subsequently, Executive Order 20-25 was issued on May 1, 2020, renewing the public health emergency declaration for the COVID-19 outbreak and requesting the current moratorium on policy cancellations and nonrenewals continue until May 31, 2020.

Employers should be aware of these developments.

Bulletin 254 »
Executive Order 20-25 »
Bulletin 252 »

Coverage Reminders for COVID-19 Testing, Telemedicine and Other Services

April 28, 2020

On April 21, 2020, the Indiana Department of Insurance issued Bulletin 253, providing further guidance during the public health emergency that supplements Executive Order 20-13 and Bulletin 252. (See the April 14, 2020, and March 31, 2020, Compliance Corner articles for more information on Order 2020-13 and Bulletin 252).

As an overview, Bulletin 253 provides guidance and reminders regarding COVID-19 testing and treatment (consistent with federal laws FFCRA and CARES Act) and specifically reminds insurers to:

  • Waive cost sharing for telemedicine services related to testing and screening of COVID-19 (and encourages telemedicine to be used in any applicable instances in connection with testing, screening and treatment of COVID-19)
  • Promote and support use of telemedicine and not to limit telemedicine care to COVID-19-related services
  • Allow for telemedicine coverage without impacting HSA eligibility
  • Permit audio-only telemedicine services for Medicare beneficiaries
  • Allow for early prescription drug refills when appropriate and encourages insurers to permit use of out-of-network pharmacies (at in-network benefit level of coverage) if there is a shortage of medications at network pharmacies

While the above guidance largely impacts insurers, employers should be aware of these reminders.

Bulletin 253 »

Telemedicine Access Expanded

April 14, 2020

On March 30, 2020, Gov. Holcomb issued Executive Order 20-13, which provides additional directives to help manage Indiana’s health care response during the public health emergency. The executive order expands access to telehealth by suspending the prohibition against audio-only telemedicine; permitting physical therapists, occupational therapists and speech therapists to practice via telemedicine (but not audio-only); and requiring health insurers to provide coverage for expanded telemedicine per the executive order and any other executive order issued in response to the public health emergency (among other items addressed).

In addition, on April 7, 2020, Executive Order 20-19 was issued which allows health care providers without an active license to obtain temporary authorizations to provide health care services as outlined in the executive order in response to the global COVID-19 public health emergency.

Employers should be aware of these developments.

Executive Order 20-13 »
Executive Order 20-19 »

COVID-19 and Health Insurance Coverage

March 31, 2020

On March 19, 2020, Gov. Holcomb issued Executive Order 20-05 providing guidance in response to the COVID-19 public health emergency. Further, Bulletin 252 was issued on March 26, 2020, to assist those regulated by the Indiana Department of Insurance regarding said executive order. Among other topics for various state agencies, the executive order requests insurers to:

  • Implement a 60-day moratorium (March 19, 2020, through May 18, 2020) on policy cancellations for nonpayment of premiums applicable to all lines of business
  • Cover COVID-19 testing without requiring prior authorization
  • Not increase prices or coverage costs involving COVID-19 medical care

Further, the executive order states that mental health professionals are permitted to practice via telemedicine, and that premium payments required for the Healthy Indiana Plan (HIP) and Children’s Health Insurance Program (CHIP) are waived. It also expands telehealth services (by suspending restrictions and requirements for face-to-face encounters for certain health services).

Employers should be aware of these developments.

Executive Order 20-05 »
Bulletin 252 »

Extended Relief for Non-ACA-compliant Small Group and Individual Policies and Plans

June 11, 2019

On May 24, 2019, Ins. Commissioner Robertson released Bulletin 250, extending the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans that renew for a policy year starting on or before October 1, 2020, as long as the transitional policy ends by December 31, 2020.

As background, on March 25, 2019, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows for such an extension. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to Indiana and allows the issuer to renew these non-ACA compliant plans.

Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.

Bulletin 250 »

Guidance for Short-Term Health Insurance

December 11, 2018

On Sept. 4, 2018, Insurance Commissioner Robertson released Bulletin 244 to remind carriers and producers who issue policies in Indiana of the state insurance requirements for short-term health insurance. This bulletin is intended to remind carriers doing business in the state that state law isn’t preempted regarding short-term health insurance and, thus, carriers doing business in Indiana must continue to comply with state law.

As background, the federal government issued a rule in August 2018 that extended the initial contract term of short-term policies issued on or after Oct. 2, 2018, to be no more than 12 months while limiting renewals or extension of such policies to no more than 36 months. Unlike the federal rule, Indiana law limits a short-term policy to a term that is less than 6 months. Moreover, short-term policies in Indiana are nonrenewable.

This bulletin was for informational purposes only and employers need not take any action at this time. The intent was to remind carriers that Indiana insurance law continues to apply to short-term health insurance, and carriers must factor in Indiana policies before issuing a product in response to the federal guidelines.

Bulletin 244 »


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