Indiana Health Insurance Guide
Indiana Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
If you live in Indiana, you can choose from a variety of private health insurance plans that include plans for individuals and group plans provided by an employer, as well as Indiana State-funded affordable health insurance for eligible individuals and families, and federal programs such as Medicaid and COBRA.
Indiana is not a guarantee issue state. That means private insurance companies are not required to sell you an individual health insurance policy if do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health. If you are accepted, the insurer has the right to impose an exclusionary period up to 24 months for any pre-existing conditions. Indiana also allows insurance companies to a 12-month look-back period. Credit for prior coverage is not a requirement for individual insurance coverage in Indiana. In addition, Indiana is a non-rider state; your insurance company cannot place elimination riders on newly issued individual plans.
Indiana does not cap what a private insurance company can charge you for an individual plan. Your premiums can be based on the type of plan you apply for, your health, age, sex and lifestyle habits including tobacco use. If you represent a higher risk, you may be offered a policy with a correspondingly higher premium.
Indiana is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status.
Indiana is a guarantee issue state for group health plans issued to small businesses. If your Indiana health insurance is provided through your employer, your coverage cannot be denied because of your past or current health health. However, a 9-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of creditable coverage. Furthermore, an employer can specify a waiting period before new hires become eligible for group coverage, although it must be applied equally. Indiana allows group health insurance issuers to medically underwrite policies to determine the premium they will charge the entire group, although the highest premium cannot be 35% more than the standard rate. In addition to health, insurers can use age, sex, geographical location, industry rating and group size to assign a group rate.
Indiana Mandated Health Benefits
Indiana laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism
- Autism
- Breast Reconstruction
- Cervical Cancer and HPV Screening
- Cleft Palate
- Colorectal Cancer Screening
- Drug Abuse Treatment
- Dental Anesthesia
- Diabetes Supplies and Self Management
- Emergency Services
- Coverage for newborn and adopted children under parent's policy
- Coverage for students and handicapped dependents under their parent’s policy
- Coverage for continuation/employees and conversion to non-groups.
Types Health Insurance Plans Available in Indiana
The following major medical health insurance plans are generally available in Indiana. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Indiana
Indiana has a high risk pool, Indiana Comprehensive Health Insurance Association (ICHIA)to provide health insurance coverage to individuals who are unable to purchase it because of a pre-existing health condition. You are eligible if you have been an Indiana resident for at least 12 months, if you have applied for individual coverage and been rejected by at least one company, are not eligible for HIPPA coverage, Medicaid or Medicare, and have exhausted all COBRA coverage. Under ICHIA, you can choose from four comprehensive PPO plans, each with its own deductible, coinsurance and out-of-pocket maximum.
Indiana Hoosier Healthwise
This is Indiana’s health care program for eligible resident children 18 or younger, pregnant women and low-income working families. Eligibility includes meeting income requirements. Different packages are available for different recipients. Depending on plan, there may be no premiums or low-cost coverage. Covered services and benefits include check-ups and doctor visits, well-child visits, hospitalization, clinical services, prescription drugs, lab and x-rays, mental health care, substance abuse treatment, dental and vision care, home health care, hospice care, family planning, and nursing facility services. Coverage is provided for 12 months. Renewal requires completing an eligibility review application.
Regulating Agency
The Indiana Department of Insurance is responsible for regulating Indiana’s health insurance industry.
Get access to Indiana health insurance quotes from http://www.einsurance.com/health-insurance/.
Indiana Department of Insurance (IDOI)
311 West Washington Street, Suite 300
Indianapolis, IN 46204
(317) 232-2385
http://www.in.gov/idoi/
Indiana Comprehensive Health Insurance Association (ICHIA)
PO Box 33730
Indianapolis, IN 46203-0730
(317) 614-2133, (800) 552-7921
http://www.ichia.org/
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/