Section 760 IAC 2-20-41 - Plan of actionAuthority: IC 27-8-12-7.1
Affected: IC 12-15-2; IC 12-15-39.6
Sec. 41.
(a) Each issuer shall, prior to qualification by the department of insurance, submit to OMPP a plan for complying with the information maintenance and documentation requirements set forth in sections 37.1 and 38 of this rule. No policy or certificate shall be qualified until OMPP has approved the issuer's documentation plan for the policy or certificate. The documentation plan will include the following:(1) The location where records will be kept. Records required for purposes of the Indiana long term care program must be available at no more than three (3) locations, each of which shall be easily accessible to OMPP serving as representative of the department of insurance.(2) The issuer shall agree to give OMPP access to all information described in section 38 of this rule on an aggregate basis for all policyholders or certificateholders and on an individual basis for all policyholders or certificateholders who have ever received any benefits. Access to information on persons who have not applied for Medicaid is required in order to determine if an issuer's system for documenting asset protection is functioning correctly. The OMPP shall have the final decision concerning the frequency of access to the data and the size of samples for auditing or other purposes.(3) The name, job title, address, and telephone number of the person primarily responsible for the maintenance of the information required and for acting as liaison with OMPP and the department of insurance concerning the information.(4) Methods for determining when insurance benefits or prepaid benefits qualify for asset protection, including the following:(A) Documentation of the insured event.(B) Description of services.(C) Documentation of charges and benefits paid.(D) Documentation of plans of care, when required.(5) Description of electronic and manual systems which will be used in maintaining the required information.(6) Information that will be retained which is needed to comply with this rule.(7) Copies of forms and descriptions of standard procedures for maintaining and reporting the information required, including the specific electronic medium that will be used to report required information and a description of the relevant files.(b) After OMPP reviews a plan of action, OMPP shall advise the department of insurance and the issuer in writing whether OMPP approves the plan of action. If OMPP disapproves a plan of action, OMPP shall advise the department of insurance and the issuer of the shortcomings in the plan of action and shall instruct the issuer of the methods necessary to resolve them.
Department of Insurance; 760 IAC 2-20-41; filed Nov 20, 1992, 9:00 a.m.: 16 IR 1156; filed Feb 9, 1999, 5:02 p.m.: 22 IR 1999; readopted filed Sep 14, 2001, 12:22 p.m.: 25 IR 531; readopted filed Nov 27, 2007, 4:01 p.m.: 20071226-IR-760070717RFA; readopted filed November 26, 2013, 3:43 p.m.: 20131225-IR-760130479RFAReadopted filed 11/19/2019, 9:18 a.m.: 20191218-IR-760190497RFAReadopted filed 11/30/2022, 11:39 a.m.: 20221228-IR-760220302RFA