Indiana Health Insurance (IN)

Indiana (IN)
Individual Health Insurance Regulations

Learn more about Indiana Individual Health Insurance

Individual medical insurance plans in Indiana are not guarantee issue. All individual health insurance plans, under Indiana law, are medically underwritten. The underwriting process allows the health insurance company an opportunity to review your past and current health history. Based upon information provided to the insurance carrier during the application process, the insurance company may opt to deny coverage based on medical history, approve coverage, providing for an exclusionary period of up to 24 months or approve the application and offer full coverage. Indiana insurance laws provide the insurance carrier with a 12 month look back period and 24 month exclusionary period limit for pre-existing conditions. Credit for prior coverage is not required for individual health insurance policies. Indiana is one of few "non-rider" states, meaning that an insurance company may not place elimination riders on newly issued individual health plans.

Indiana (IN)
Small Group Health Insurance Regulations

Defined as any company with 2-50 employees, small employer group health insurance coverage in Indiana is guarantee-issue. This guarantee assures that small group employers may not be declined coverage based on past or current medical history of the group members. Health insurance carriers may impose a 9 month exclusionary period for pre-existing conditions on all applicants who do not have prior creditable coverage. The look-back period is limited to 6 months. For prior creditable coverage to be accepted there may not be a break in coverage of more than 63 days. Once eligible to join the group health plan, an employer may impose a waiting period upon the employee. Insurance carriers in Indiana that offer small group health insurance are permitted to medically underwrite group policies. This means that they can ask health questions to determine the rates that they want to charge the group as a whole. The rate adjustment factor is 35 percent of the indexed rate, meaning that the highest premium that can be charged to a group, regardless of health status, must not be 35% more than the standard rate. Additional factors used to determine rates are age, sex, geographical location, group size and industry rating.

Indiana COBRA and Continuation Coverage

Indiana does not have a state mini-COBRA regulation. Continuation of health insurance coverage or COBRA is regulated under federal COBRA laws. Under COBRA law, you may remain on your previous employers' group health plan and receive the same level of covered benefits for a period of 18 months. You will be responsible for paying the entire premium amount, plus a 2% administration fee. If the insurance company raises the premium on your employer's group health plan, you will also be subject to those higher rates. Once you have exhausted your COBRA benefits, and if you are found to be ineligible for individual health insurance, you may apply for HIPAA coverage under the state risk pool. Conversion plans are available through some insurance carriers.

Additional Indiana Resources

• Indiana Comprehensive Health Insurance Association
  Indiana state-sponsored health insurance program that provides health insurance coverage to individuals unable to obtain health care due to their high risk health conditions.
• Indiana Hoosier Healthwise
  Indiana state-sponsored health insurance program developed to provide health insurance coverage to children of low-income families.
• Indiana Health Coverage Programs
  Managed by the Office of Medicaid Policy and Planning, IHCP provides medical insurance coverage to low-income families in the state of Indiana.
• Senior Health Insurance Information Program
  Sponsored by the Centers for Medicare and Medicaid Services, this agency provides unbiased assistance to seniors in helping them understand their Medicare rights.

IN Medical Insurance Statistics

Total Population: 6,141,000
With Health Insurance: 5,270,000 / 85.8%
Without Health Insurance: 871,000 / 14.2%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of Indiana residents without health insurance has remained consistent since 2004.

Indiana Department of Insurance
Phone: 317-232-2395
Regulates the insurance industry in the State of Indiana and provides consumer protection by monitoring and regulating the financial and market conduct of insurance carriers and agents.

* Please refer to our legal terms and conditions for disclaimers pertaining to the content on this page.