SB 189

           Second Regular Session of the 124th General Assembly (2026)
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between statutes enacted by the 2025 Regular Session of the General Assembly.
    SENATE ENROLLED ACT No. 189
    AN ACT to amend the Indiana Code concerning insurance.
    Be it enacted by the General Assembly of the State of Indiana:
   SECTION 1. IC 27-1-45.2 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]:
   Chapter 45.2. Independent Dispute Resolution
   Sec. 1. This chapter applies to any dispute subject to the federal
independent dispute resolution process established under Section
2799A-1 of the Public Health Service Act (42 U.S.C. 300gg-111)
and its implementing regulations.
   Sec. 2. (a) As used in this chapter, "claim specific payment
information" means billed charges, allowed amounts, payment
amounts, cost sharing amounts, and any other monetary amounts
associated with the adjudication of an identifiable health care
claim.
   (b) The term does not include aggregated or de-identified data
that cannot reasonably be used to identify a specific claim, patient,
or provider.
   Sec. 3. As used in this chapter, "facility" means a licensed health
care facility in which health care services are provided to
individuals.
   Sec. 4. (a) As used in this chapter, "health carrier" means an
entity:
     (1) that is subject to this title and the administrative rules
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      adopted under this title; and
      (2) that enters into a contract to:
          (A) provide health care services;
          (B) deliver health care services;
          (C) arrange for health care services; or
          (D) pay for or reimburse any of the cost of health care
          services.
    (b) The term includes the following:
      (1) An insurer (as defined in IC 27-1-2-3(x)) that issues a
      policy of accident and sickness insurance (as defined in
      IC 27-8-5-1(a)).
      (2) A health maintenance organization (as defined in
      IC 27-13-1-19).
      (3) An administrator (as defined in IC 27-1-25-1(a)) that is
      licensed under IC 27-1-25.
      (4) A state employee health plan offered under IC 5-10-8.
      (5) A short term insurance plan (as defined in IC 27-8-5.9-3).
      (6) Any other entity that provides a plan of health insurance,
      health benefits, or health care services.
    (c) The term does not include:
      (1) an insurer that issues a policy of accident and sickness
      insurance;
      (2) a limited service health maintenance organization (as
      defined in IC 27-13-34-4); or
      (3) an administrator;
that only provides coverage for, or processes claims for, dental or
vision care services.
    Sec. 5. As used in this chapter, "independent dispute resolution"
means the federal independent dispute resolution process
established under 42 U.S.C. 300gg-111 and 45 CFR Part 149,
Subpart F.
    Sec. 6. As used in this chapter, "initiating party" means a health
carrier or out of network provider that submits a request for
independent dispute resolution under federal law.
    Sec. 7. As used in this chapter, "out of network provider" means
a provider that is not contracted with a health carrier to provide
health care services to covered individuals at not more than a
preestablished rate or amount of compensation.
    Sec. 8. As used in this chapter, "provider" means an individual
licensed or legally authorized to provide health care services.
    Sec. 9. As used in this chapter, "qualified dispute" means a
distinct item or service that is included in a request for
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independent dispute resolution.
   Sec. 10. (a) An initiating party that submits a request for
independent dispute resolution shall provide written notice to the
facility not later than three (3) business days after submitting the
request.
   (b) The notice required under subsection (a) must, at a
minimum, include a copy of the form used by the initiating party
to request independent dispute resolution.
   (c) An initiating party that fails to provide notice as required
under this section is subject to enforcement as follows:
      (1) If the initiating party is an out of network provider, the
      appropriate board (as defined in IC 25-1-9-1) may take action
      against the provider:
         (A) under IC 25-1-9-9(a)(3) or IC 25-1-9-9(a)(4) for an
         initial or isolated violation of this section; or
         (B) under IC 25-1-9-9(a)(6) for repeated or persistent
         violations of this section.
      (2) If the initiating party is a health carrier, the department
      may enforce this section in accordance with IC 27-1-3-19.
      (3) A penalty under subdivision (1)(B) may not exceed five
      thousand dollars ($5,000) annually.
   (d) An enforcement action under subsection (c) does not relieve
any party of the obligation to participate in the conference and
good faith negotiation required by this chapter.
   Sec. 11. (a) If, during any ninety (90) day period, an initiating
party submits requests for independent dispute resolutions that, in
the aggregate, include twenty-five (25) or more qualified disputes,
the health carrier may:
      (1) provide written notice to the out of network provider and
      the facility that includes:
         (A) a description of the independent dispute resolution
         requests that are the basis for the notice, including
         applicable dates of service;
         (B) identification of the party involved, including the name
         and tax identification number, if known;
         (C) the name and contact information of a representative
         authorized to negotiate on behalf of the health carrier; and
         (D) the requirement to participate in a conference and
         good faith negotiation; and
      (2) deliver the notice to the out of network provider and the
      facility by:
         (A) electronic mail; and
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         (B) certified mail.
   (b) If a health carrier provides notice under subsection (a), the
health carrier, the out of network provider, and the facility shall
engage in good faith efforts to negotiate a resolution not later than
thirty (30) days after the notice is provided, including:
     (1) at least one (1) conference between authorized
     representatives; and
     (2) a reasonable exchange of information necessary to
     evaluate and address the conduct described in the notice.
   (c) A conference under subsection (b) may not:
     (1) adjudicate individual claims;
     (2) alter rights or obligations under federal or state law; or
     (3) occur more than once per calendar quarter.
   Sec. 12. (a) A conference under section 11(b) of this chapter
must result in a written memorandum of conference.
   (b) The memorandum must include the following information
for the disputes reviewed:
     (1) Identification of the disputes.
     (2) The initial paid claim amount made by the health carrier
     to the out of network provider.
     (3) The health carrier offer made during the applicable
     federal open negotiation period.
     (4) The out of network provider requested amount.
     (5) The qualifying payment amount, as determined under
     federal law.
   (c) The memorandum is informational only and does not:
     (1) impose penalties, fees, or financial disincentives;
     (2) mandate payment outcomes;
     (3) affect eligibility for independent dispute resolution; or
     (4) alter claim level rights or remedies under federal or state
     law.
   (d) The completed memorandum of conference shall be filed
with the department. Claim specific payment information
contained in the memorandum is confidential under IC 5-14-3-4
and is exempt from public access and disclosure under Indiana law.
   (e) The department may not publish a memorandum that is filed
under subsection (d). However, the department shall publish on the
department's website information concerning the aggregate
number of memorandums filed with the department.
   Sec. 13. (a) A health carrier may not assess a facility or a
provider an administrative fee or penalty related to the provision
of care to an individual that involves an out of network provider.
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   (b) If a health carrier assesses an administrative fee or penalty
under subsection (a), the health carrier commits an unfair and
deceptive act or practice in the business of insurance under
IC 27-4-1-4 and is subject to the penalties and procedures set forth
in IC 27-4-1.
   SECTION 2. IC 27-4-1-4, AS AMENDED BY P.L.158-2024,
SECTION 19, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 4. (a) The following are hereby defined as
unfair methods of competition and unfair and deceptive acts and
practices in the business of insurance:
     (1) Making, issuing, circulating, or causing to be made, issued, or
     circulated, any estimate, illustration, circular, or statement:
         (A) misrepresenting the terms of any policy issued or to be
         issued or the benefits or advantages promised thereby or the
         dividends or share of the surplus to be received thereon;
         (B) making any false or misleading statement as to the
         dividends or share of surplus previously paid on similar
         policies;
         (C) making any misleading representation or any
         misrepresentation as to the financial condition of any insurer,
         or as to the legal reserve system upon which any life insurer
         operates;
         (D) using any name or title of any policy or class of policies
         misrepresenting the true nature thereof; or
         (E) making any misrepresentation to any policyholder insured
         in any company for the purpose of inducing or tending to
         induce such policyholder to lapse, forfeit, or surrender the
         policyholder's insurance.
     (2) Making, publishing, disseminating, circulating, or placing
     before the public, or causing, directly or indirectly, to be made,
     published, disseminated, circulated, or placed before the public,
     in a newspaper, magazine, or other publication, or in the form of
     a notice, circular, pamphlet, letter, or poster, or over any radio or
     television station, or in any other way, an advertisement,
     announcement, or statement containing any assertion,
     representation, or statement with respect to any person in the
     conduct of the person's insurance business, which is untrue,
     deceptive, or misleading.
     (3) Making, publishing, disseminating, or circulating, directly or
     indirectly, or aiding, abetting, or encouraging the making,
     publishing, disseminating, or circulating of any oral or written
     statement or any pamphlet, circular, article, or literature which is
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   false, or maliciously critical of or derogatory to the financial
   condition of an insurer, and which is calculated to injure any
   person engaged in the business of insurance.
   (4) Entering into any agreement to commit, or individually or by
   a concerted action committing any act of boycott, coercion, or
   intimidation resulting or tending to result in unreasonable
   restraint of, or a monopoly in, the business of insurance.
   (5) Filing with any supervisory or other public official, or making,
   publishing, disseminating, circulating, or delivering to any person,
   or placing before the public, or causing directly or indirectly, to
   be made, published, disseminated, circulated, delivered to any
   person, or placed before the public, any false statement of
   financial condition of an insurer with intent to deceive. Making
   any false entry in any book, report, or statement of any insurer
   with intent to deceive any agent or examiner lawfully appointed
   to examine into its condition or into any of its affairs, or any
   public official to which such insurer is required by law to report,
   or which has authority by law to examine into its condition or into
   any of its affairs, or, with like intent, willfully omitting to make a
   true entry of any material fact pertaining to the business of such
   insurer in any book, report, or statement of such insurer.
   (6) Issuing or delivering or permitting agents, officers, or
   employees to issue or deliver, agency company stock or other
   capital stock, or benefit certificates or shares in any common law
   corporation, or securities or any special or advisory board
   contracts or other contracts of any kind promising returns and
   profits as an inducement to insurance.
   (7) Making or permitting any of the following:
       (A) Unfair discrimination between individuals of the same
       class and equal expectation of life in the rates or assessments
       charged for any contract of life insurance or of life annuity or
       in the dividends or other benefits payable thereon, or in any
       other of the terms and conditions of such contract. However,
       in determining the class, consideration may be given to the
       nature of the risk, plan of insurance, the actual or expected
       expense of conducting the business, or any other relevant
       factor.
       (B) Unfair discrimination between individuals of the same
       class involving essentially the same hazards in the amount of
       premium, policy fees, assessments, or rates charged or made
       for any policy or contract of accident or health insurance or in
       the benefits payable thereunder, or in any of the terms or
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       conditions of such contract, or in any other manner whatever.
       However, in determining the class, consideration may be given
       to the nature of the risk, the plan of insurance, the actual or
       expected expense of conducting the business, or any other
       relevant factor.
       (C) Excessive or inadequate charges for premiums, policy
       fees, assessments, or rates, or making or permitting any unfair
       discrimination between persons of the same class involving
       essentially the same hazards, in the amount of premiums,
       policy fees, assessments, or rates charged or made for:
         (i) policies or contracts of reinsurance or joint reinsurance,
         or abstract and title insurance;
         (ii) policies or contracts of insurance against loss or damage
         to aircraft, or against liability arising out of the ownership,
         maintenance, or use of any aircraft, or of vessels or craft,
         their cargoes, marine builders' risks, marine protection and
         indemnity, or other risks commonly insured under marine,
         as distinguished from inland marine, insurance; or
         (iii) policies or contracts of any other kind or kinds of
         insurance whatsoever.
   However, nothing contained in clause (C) shall be construed to
   apply to any of the kinds of insurance referred to in clauses (A)
   and (B) nor to reinsurance in relation to such kinds of insurance.
   Nothing in clause (A), (B), or (C) shall be construed as making or
   permitting any excessive, inadequate, or unfairly discriminatory
   charge or rate or any charge or rate determined by the department
   or commissioner to meet the requirements of any other insurance
   rate regulatory law of this state.
   (8) Except as otherwise expressly provided by IC 27-1-47 or
   another law, knowingly permitting or offering to make or making
   any contract or policy of insurance of any kind or kinds
   whatsoever, including but not in limitation, life annuities, or
   agreement as to such contract or policy other than as plainly
   expressed in such contract or policy issued thereon, or paying or
   allowing, or giving or offering to pay, allow, or give, directly or
   indirectly, as inducement to such insurance, or annuity, any rebate
   of premiums payable on the contract, or any special favor or
   advantage in the dividends, savings, or other benefits thereon, or
   any valuable consideration or inducement whatever not specified
   in the contract or policy; or giving, or selling, or purchasing or
   offering to give, sell, or purchase as inducement to such insurance
   or annuity or in connection therewith, any stocks, bonds, or other
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   securities of any insurance company or other corporation,
   association, limited liability company, or partnership, or any
   dividends, savings, or profits accrued thereon, or anything of
   value whatsoever not specified in the contract. Nothing in this
   subdivision and subdivision (7) shall be construed as including
   within the definition of discrimination or rebates any of the
   following practices:
       (A) Paying bonuses to policyholders or otherwise abating their
       premiums in whole or in part out of surplus accumulated from
       nonparticipating insurance, so long as any such bonuses or
       abatement of premiums are fair and equitable to policyholders
       and for the best interests of the company and its policyholders.
       (B) In the case of life insurance policies issued on the
       industrial debit plan, making allowance to policyholders who
       have continuously for a specified period made premium
       payments directly to an office of the insurer in an amount
       which fairly represents the saving in collection expense.
       (C) Readjustment of the rate of premium for a group insurance
       policy based on the loss or expense experience thereunder, at
       the end of the first year or of any subsequent year of insurance
       thereunder, which may be made retroactive only for such
       policy year.
       (D) Paying by an insurer or insurance producer thereof duly
       licensed as such under the laws of this state of money,
       commission, or brokerage, or giving or allowing by an insurer
       or such licensed insurance producer thereof anything of value,
       for or on account of the solicitation or negotiation of policies
       or other contracts of any kind or kinds, to a broker, an
       insurance producer, or a solicitor duly licensed under the laws
       of this state, but such broker, insurance producer, or solicitor
       receiving such consideration shall not pay, give, or allow
       credit for such consideration as received in whole or in part,
       directly or indirectly, to the insured by way of rebate.
   (9) Requiring, as a condition precedent to loaning money upon the
   security of a mortgage upon real property, that the owner of the
   property to whom the money is to be loaned negotiate any policy
   of insurance covering such real property through a particular
   insurance producer or broker or brokers. However, this
   subdivision shall not prevent the exercise by any lender of the
   lender's right to approve or disapprove of the insurance company
   selected by the borrower to underwrite the insurance.
   (10) Entering into any contract, combination in the form of a trust
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   or otherwise, or conspiracy in restraint of commerce in the
   business of insurance.
   (11) Monopolizing or attempting to monopolize or combining or
   conspiring with any other person or persons to monopolize any
   part of commerce in the business of insurance. However,
   participation as a member, director, or officer in the activities of
   any nonprofit organization of insurance producers or other
   workers in the insurance business shall not be interpreted, in
   itself, to constitute a combination in restraint of trade or as
   combining to create a monopoly as provided in this subdivision
   and subdivision (10). The enumeration in this chapter of specific
   unfair methods of competition and unfair or deceptive acts and
   practices in the business of insurance is not exclusive or
   restrictive or intended to limit the powers of the commissioner or
   department or of any court of review under section 8 of this
   chapter.
   (12) Requiring as a condition precedent to the sale of real or
   personal property under any contract of sale, conditional sales
   contract, or other similar instrument or upon the security of a
   chattel mortgage, that the buyer of such property negotiate any
   policy of insurance covering such property through a particular
   insurance company, insurance producer, or broker or brokers.
   However, this subdivision shall not prevent the exercise by any
   seller of such property or the one making a loan thereon of the
   right to approve or disapprove of the insurance company selected
   by the buyer to underwrite the insurance.
   (13) Issuing, offering, or participating in a plan to issue or offer,
   any policy or certificate of insurance of any kind or character as
   an inducement to the purchase of any property, real, personal, or
   mixed, or services of any kind, where a charge to the insured is
   not made for and on account of such policy or certificate of
   insurance. However, this subdivision shall not apply to any of the
   following:
       (A) Insurance issued to credit unions or members of credit
       unions in connection with the purchase of shares in such credit
       unions.
       (B) Insurance employed as a means of guaranteeing the
       performance of goods and designed to benefit the purchasers
       or users of such goods.
       (C) Title insurance.
       (D) Insurance written in connection with an indebtedness and
       intended as a means of repaying such indebtedness in the
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       event of the death or disability of the insured.
       (E) Insurance provided by or through motorists service clubs
       or associations.
       (F) Insurance that is provided to the purchaser or holder of an
       air transportation ticket and that:
         (i) insures against death or nonfatal injury that occurs during
         the flight to which the ticket relates;
         (ii) insures against personal injury or property damage that
         occurs during travel to or from the airport in a common
         carrier immediately before or after the flight;
         (iii) insures against baggage loss during the flight to which
         the ticket relates; or
         (iv) insures against a flight cancellation to which the ticket
         relates.
   (14) Refusing, because of the for-profit status of a hospital or
   medical facility, to make payments otherwise required to be made
   under a contract or policy of insurance for charges incurred by an
   insured in such a for-profit hospital or other for-profit medical
   facility licensed by the Indiana department of health.
   (15) Refusing to insure an individual, refusing to continue to issue
   insurance to an individual, limiting the amount, extent, or kind of
   coverage available to an individual, or charging an individual a
   different rate for the same coverage, solely because of that
   individual's blindness or partial blindness, except where the
   refusal, limitation, or rate differential is based on sound actuarial
   principles or is related to actual or reasonably anticipated
   experience.
   (16) Committing or performing, with such frequency as to
   indicate a general practice, unfair claim settlement practices (as
   defined in section 4.5 of this chapter).
   (17) Between policy renewal dates, unilaterally canceling an
   individual's coverage under an individual or group health
   insurance policy solely because of the individual's medical or
   physical condition.
   (18) Using a policy form or rider that would permit a cancellation
   of coverage as described in subdivision (17).
   (19) Violating IC 27-1-22-25, IC 27-1-22-26, or IC 27-1-22-26.1
   concerning motor vehicle insurance rates.
   (20) Violating IC 27-8-21-2 concerning advertisements referring
   to interest rate guarantees.
   (21) Violating IC 27-8-24.3 concerning insurance and health plan
   coverage for victims of abuse.
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   (22) Violating IC 27-8-26 concerning genetic screening or testing.
   (23) Violating IC 27-1-15.6-3(b) concerning licensure of
   insurance producers.
   (24) Violating IC 27-1-38 concerning depository institutions.
   (25) Violating IC 27-8-28-17(c) or IC 27-13-10-8(c) concerning
   the resolution of an appealed grievance decision.
   (26) Violating IC 27-8-5-2.5(e) through IC 27-8-5-2.5(j) (expired
   July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1,
   2007, and repealed).
   (27) Violating IC 27-2-21 concerning use of credit information.
   (28) Violating IC 27-4-9-3 concerning recommendations to
   consumers.
   (29) Engaging in dishonest or predatory insurance practices in
   marketing or sales of insurance to members of the United States
   Armed Forces as:
       (A) described in the federal Military Personnel Financial
       Services Protection Act, P.L.109-290; or
       (B) defined in rules adopted under subsection (b).
   (30) Violating IC 27-8-19.8-20.1 concerning stranger originated
   life insurance.
   (31) Violating IC 27-2-22 concerning retained asset accounts.
   (32) Violating IC 27-8-5-29 concerning health plans offered
   through a health benefit exchange (as defined in IC 27-19-2-8).
   (33) Violating a requirement of the federal Patient Protection and
   Affordable Care Act (P.L. 111-148), as amended by the federal
   Health Care and Education Reconciliation Act of 2010 (P.L.
   111-152), that is enforceable by the state.
   (34) After June 30, 2015, violating IC 27-2-23 concerning
   unclaimed life insurance, annuity, or retained asset account
   benefits.
   (35) Willfully violating IC 27-1-12-46 concerning a life insurance
   policy or certificate described in IC 27-1-12-46(a).
   (36) Violating IC 27-1-37-7 concerning prohibiting the disclosure
   of health care service claims data.
   (37) Violating IC 27-4-10-10 concerning virtual claims payments.
   (38) Violating IC 27-1-24.5 concerning pharmacy benefit
   managers.
   (39) Violating IC 27-7-17-16 or IC 27-7-17-17 concerning the
   marketing of travel insurance policies.
   (40) Violating IC 27-1-49 concerning individual prescription drug
   rebates.
   (41) Violating IC 27-1-50 concerning group prescription drug
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     rebates.
     (42) Violating IC 27-1-45.2-13 concerning an administrative
     fee or penalty imposed on a facility or a provider by a health
     carrier related to the provision of care to an individual that
     involves an out of network provider.
   (b) Except with respect to federal insurance programs under
Subchapter III of Chapter 19 of Title 38 of the United States Code, the
commissioner may, consistent with the federal Military Personnel
Financial Services Protection Act (10 U.S.C. 992 note), adopt rules
under IC 4-22-2 to:
     (1) define; and
     (2) while the members are on a United States military installation
     or elsewhere in Indiana, protect members of the United States
     Armed Forces from;
dishonest or predatory insurance practices.
   SECTION 3. An emergency is declared for this act.
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President of the Senate
President Pro Tempore
Speaker of the House of Representatives
Governor of the State of Indiana
Date:  Time:
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