Section 27-8-5-2.5 - Coverage under individual, and certain association group, policies of accident and sickness insurance; waivers(a) As used in this section, the term "policy of accident and sickness insurance" does not include the following:(1) Accident only, credit, dental, vision, Medicare supplement, long term care, or disability income insurance.(2) Coverage issued as a supplement to liability insurance.(3) Automobile medical payment insurance.(4) A specified disease policy.(5) A short term insurance plan that:(A) may be renewed for the greater of:(i) thirty-six (36) months; or(ii) the maximum period permitted under federal law;(B) has a term of not more than three hundred sixty-four (364) days; and(C) has an annual limit of at least two million dollars ($2,000,000).(6) A policy that provides indemnity benefits not based on any expense incurred requirement, including a plan that provides coverage for:(A) hospital confinement, critical illness, or intensive care; or(B) gaps for deductibles or copayments.(7) Worker's compensation or similar insurance.(8) A student health plan.(9) A supplemental plan that always pays in addition to other coverage.(10) An employer sponsored health benefit plan that is: (A) provided to individuals who are eligible for Medicare; and(B) not marketed as, or held out to be, a Medicare supplement policy.(b) The benefits provided by: (1) an individual policy of accident and sickness insurance; or(2) a certificate of coverage that is issued under a nonemployer based association group policy of accident and sickness insurance to an individual who is a resident of Indiana; may not be excluded, limited, or denied for more than twelve (12) months after the effective date of the coverage because of a preexisting condition of the individual.
(c) An individual policy of accident and sickness insurance or a certificate of coverage described in subsection (b) may not define a preexisting condition, a rider, or an endorsement more restrictively than as:(1) a condition that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment during the twelve (12) months immediately preceding the effective date of the plan;(2) a condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve (12) months immediately preceding the effective date of the plan; or(3) a pregnancy existing on the effective date of the plan.(d) An insurer shall reduce the period allowed for a preexisting condition exclusion described in subsection (b) by the amount of time the individual has continuously served under a preexisting condition clause for a policy of accident and sickness insurance issued under IC 27-8-15 if the individual applies for a policy under this chapter not more than thirty (30) days after coverage under a policy of accident and sickness insurance issued under IC 27-8-15 expires.Amended by P.L. 288-2019,SEC. 2, eff. 7/1/2019.As added by P.L. 93-1995, SEC.6. Amended by P.L. 190-1996, SEC.1; P.L. 211-2003, SEC.2; P.L. 127-2006, SEC.1; P.L. 173-2007, SEC.23; P.L. 3-2008, SEC.212.