Section 407 IAC 1-2-7 - Insurance information; releaseAuthority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 7.
(a) As used in this section, "insurer" means any insurance company, health maintenance organization, prepaid health care delivery plan, self-funded employee benefit plan, pension fund, retirement system, group coverage plan, blanket coverage plan, franchise insurance coverage plan, individual coverage plan, family-type insurance coverage plan, Blue Cross/Blue Shield plan, group practice plan, individual practice plan, labor-management trusteed plan, union welfare plan, employer organization plan, employee benefit organization plan, governmental program plan, fraternal benefits society, Indiana Comprehensive Health Insurance Association plan, any plan or coverage required or provided by any statute, or similar entity that is:(1) doing business in this state; and(2) under an obligation to make payments for medical services as a result of an injury, illness, or disease suffered by a CHIP member.(b) A CHIP applicant or member or one legally authorized to seek CHIP benefits on behalf of the applicant or member shall be considered to have authorized all insurers to release to the office all available information needed by the office to secure or enforce its rights pertaining to third party liability collection.(c) Every insurer shall provide to the office, upon written request, information pertaining to coverage and benefits paid or available to an individual under an individual, group, or blanket policy or certificate of coverage when the office certifies that such individual is an applicant for or a member of CHIP. Information, to the extent available, regarding the insured may include, but need not be limited to, the following:(1) Name, address, and Social Security number of the insured.(2) Policy numbers, the terms of the policy, and the benefit code.(3) Names of covered dependents whom the state certifies are applicants or members.(4) Name and address of employer, other person, or organization that holds the group policy.(5) Name and address of employer, other person, or organization through which the coverage was obtained.(6) Benefits remaining available under the policy, including, but not limited to, coverage periods, lifetime days, and lifetime funds.(7) The deductible and the amount of deductible outstanding for each benefit at the time of the request.(8) Any additional coinsurance information that may be on file.(9) Copies of claims when requested for legal proceedings.(10) Copies of checks and their endorsements when these documents are needed as part of an investigation of a member and provider.(11) Other policy information that the office certifies in writing is necessary to secure and enforce its rights pertaining to third party liability collection.(12) Carrier information, including the following:(A) Name and address of carrier.(B) Adjuster's name and address.(C) Policy number and claim number.(13) Claims information, including the following: (A) Identity of the individual to whom the service was rendered.(B) Identity of the provider rendering services.(C) Identity and position of provider's employee rendering the services, if necessary for claims processing.(D) Date on which services were rendered.(E) A detailed explanation of charges and benefits.Office of the Children's Health Insurance Program; 407 IAC 1-2-7; filed May 3, 2000, 2:02 p.m.: 23 IR 2229; readopted filed May 22, 2006, 3:22 p.m.: 29 IR 3424; readopted filed Jun 18, 2012, 11:23 a.m.: 20120718-IR-407120202RFA