Section 27-13-4-1 - General powers(a) Subject to section 3 of this chapter, the powers of a health maintenance organization include the following:(1) The purchase, lease, construction, renovation, operation, or maintenance of: (A) hospitals and medical facilities;(B) equipment for hospitals and medical facilities; and(C) other property reasonably required for the principal office of the health maintenance organization or for purposes necessary in the transaction of the business of the organization.(2) Engaging in transactions between affiliated entities, including loans and the transfer of responsibility under any or all contracts:(A) between affiliates; or(B) between the health maintenance organization and the parent organization of the health maintenance organization.(3) The furnishing of health care services through:(B) provider associations; and(C) agents for providers; who are under contract with or are employed by the health maintenance organization. The contracts with providers, provider associations, or agents of providers may include fee for service, cost plus, capitation, or other payment or risk-sharing arrangements.
(4) Contracting with any person for the performance on behalf of the health maintenance organization of certain functions, including:(5) Contracting with: (A) an insurance company licensed in Indiana;(B) an authorized reinsurer; or(C) a hospital authorized to conduct business in Indiana; for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization.
(6) The offering of point-of-service products.(7) The joint marketing of products with: (A) an insurance company that is licensed in Indiana; or(B) a hospital that is authorized to conduct business in Indiana; if the company that is offering each product is clearly identified.
(8) Administration of the provision of health care services at the expense of a self-funded plan.(b) A health maintenance organization may offer any of the following: (1) Plans that include only basic health care services.(2) Plans that include basic health care services and other health care services.(3) Plans that include health care services other than basic health care services so long as at least one (1) of the plans offered by the health maintenance organization includes basic health care services.(c) Notwithstanding subsection (a)(5), a health maintenance organization may not take credit for reinsurance unless the risk is ceded to a reinsurer qualified under IC 27-6-10.1.Amended by P.L. 130-2020,SEC. 15, eff. 7/1/2020.As added by P.L. 26-1994, SEC.25. Amended by P.L. 2-1995, SEC.111; P.L. 203-2001, SEC.18.