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 »

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 »

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 »

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 »

On Oct. 17, 2018, Insurance Commissioner Robertson issued Bulletin 245. The bulletin discusses the state and federal regulation of association health plans (AHPs), after the DOL’s final rules on AHPs were issued this summer. As background, AHPs are MEWAs and can fall under the jurisdiction of both federal and state law. The bulletin identifies the different types of AHPs and how Indiana law applies to them.

The bulletin essentially confirms that IN still has the same regulatory authority over MEWAs and AHPs as it did before the DOL published its final rule. Specifically, IN still requires self-insured AHPs to be licensed under state law.

While this bulletin doesn’t necessarily provide any new information, it’s a reminder to entities that might want to establish an AHP for IN employers that they must comply with state law.

Bulletin 245 »

On April 18, 2018, Indiana Insurance Commissioner Robertson released Bulletin 243, related to the extension of non-ACA-compliant small group and individual policies and plans. As background, on April 9, 2018, the federal government announced an additional transition policy that allows insurers (if allowed by the state) to renew non-grandfathered non-ACA-compliant plans (this transitional relief has been extended several times before). Such policies aren’t 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.

The bulletin states that Indiana will allow insurers to renew policies in the individual market and the small group market as long as the policy ends by Dec. 31, 2019, according to the extended transitional policy. Employers with non-ACA-compliant plans should work with their insurer and advisor on any policy extension.

Bulletin 243 »

On April 13, 2017, Gov. Holcomb signed SB 73, creating Public Law 45-2017, which requires a health insurance policy and a health maintenance organization contract to accept and respond to electronic prior authorization requests according to a particular electronic transaction standard.

As background, electronic prior authorization is the transmission of information between the prescriber and payer to determine whether or not the prior authorization is granted. This process improves the covered individual’s ability to obtain needed medications and provides an effective line of communication between prescribing health care providers, dispensing pharmacist and health plans.

Although this new law is aimed at insurers, it is important for employers to be aware of what insurers may be doing and what they are now required to do when issuing policies.

This law is effective Jan. 1, 2018.

Public Law 45-2017 »

On April 26, 2017, Gov. Holcomb signed HB 1540, creating Public Law 202-2017, which provides that a health insurance policy and a health maintenance organization contract that provide coverage for prescription medications must provide for synchronized refill schedule coordination for prescription medications for chronic conditions.

“Synchronize" means to use a single pharmacy dispensing process as a means of coordinating the covered individual's medications at the same time when:

1. A particular medication:
   1. is of a formulation that can be effectively split, and
   2. does not have quantity limits or dose optimization criteria as specified in the policy’s formulary and prior authorization requirements;
2. The covered individual is on a stabilized treatment plan for a chronic condition and the synchronization is for those drugs treating a chronic condition; and
3. The medication is not:
   1. an opioid, stimulant, sedative or hypnotic medication, or
   2. another medication that is addictive and subject to abuse

Although this new law is aimed at insurers, it is important for employers to be aware of what insurers may be doing and what they are now required to do when issuing policies.

This law is effective July 1, 2017.

Public Law 202-2017 »

On March 16, 2017, Indiana Insurance Commissioner Robertson released Bulletin 237 related to the extension of non-PPACA-compliant small group and individual policies and plans. As background, on Feb. 23, 2017, the federal government announced an additional transition policy that allows insurers (if allowed by the state) to renew non-grandfathered non-PPACA-compliant plans (this transitional relief has been extended twice before). Such policies are not required to be in compliance with certain PPACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit.

The bulletin states that Indiana will allow insurers to renew policies in the individual market and the small group market according to the extended transitional policy.

Bulletin 237 »

On Nov. 30, 2015, Insurance Commissioner Robertson issued Bulletin 221 regarding the definition of small group for purposes of providing employer health coverage. Indiana will continue to consider a small employer to be one who employs no more than 50 employees. There has been some confusion on how to count employees, so the department will issue an emergency rule to conform Indiana’s definition of “employee” for determining group size to the federal definition.

The department will define an employee as individual employed by an employer but not an individual owner or partner. Part-time and seasonal employees should be counted. The new rule will apply to non-grandfathered, PPACA-compliant plans with an effective date on or after Jan. 1, 2016.

Further, Bulletin 221 explains that because of the Protecting Affordable Coverage for Employees (PACE) Act, Bulletin 215 is withdrawn. Bulletin 2015 was issued June 4, 2015 (addressed in the June 30, 2015 edition of Compliance Corner), and allowed for transitional policies for employers with 51-100 employees to continue through renewal no later than Oct. 1, 2016. Those policies will not be considered transitional and will continue to be large group policies that may be renewed until Oct. 1, 2016. After that period, they must transition to a fully compliant policy.

Finally, another calculation affected by group size is MLR. The department considers groups of one to 100 employees to be a small group for purposes of calculating MLR. This policy will not change through the end of 2015. For plan years beginning before Jan. 1, 2016, premium rebate requirements of the ACA continue to apply in the small group market in Indiana only if the MLR is less than 80 percent. For plan years beginning on or after Jan. 1, 2016, groups of 51 or more employees will be considered large groups for purposes of calculating MLR.

Additional questions and examples are available within a small group FAQ found on the department’s website.

Bulletin 221 - Small Employer Definition »
FAQs »