CHAPTER 8. GROUP INSURANCE FOR PUBLIC EMPLOYEES

IC 5-10-8
     Chapter 8. Group Insurance for Public Employees

IC 5-10-8-1
Definitions
    
Sec. 1. The following definitions apply in this chapter:
        (1) "Employee" means:
            (A) an elected or appointed officer or official, or a full-time employee;
            (B) if the individual is employed by a school corporation, a full-time or part-time employee;
            (C) for a local unit public employer, a full-time or part-time employee or a person who provides personal services to the unit under contract during the contract period; or
            (D) a senior judge appointed under IC 33-24-3-7;
        whose services have continued without interruption at least thirty (30) days.
        (2) "Group insurance" means any of the kinds of insurance fulfilling the definitions and requirements of group insurance contained in IC 27-1.
        (3) "Insurance" means insurance upon or in relation to human life in all its forms, including life insurance, health insurance, disability insurance, accident insurance, hospitalization insurance, surgery insurance, medical insurance, and supplemental medical insurance.
        (4) "Local unit" includes a city, town, county, township, public library, municipal corporation (as defined in IC 5-10-9-1), or school corporation.
        (5) "New traditional plan" means a self-insurance program established under section 7(b) of this chapter to provide health care coverage.
        (6) "Public employer" means the state or a local unit, including any board, commission, department, division, authority, institution, establishment, facility, or governmental unit under the supervision of either, having a payroll in relation to persons it immediately employs, even if it is not a separate taxing unit. With respect to the legislative branch of government, "public employer" or "employer" refers to the following:
            (A) The president pro tempore of the senate, with respect to former members or employees of the senate.
            (B) The speaker of the house, with respect to former members or employees of the house of representatives.
            (C) The legislative council, with respect to former employees of the legislative services agency.
        (7) "Public employer" does not include a state educational institution.
        (8) "Retired employee" means:
            (A) in the case of a public employer that participates in the public employees' retirement fund, a former employee who qualifies for a benefit under IC 5-10.3-8 or IC 5-10.2-4;             (B) in the case of a public employer that participates in the teachers' retirement fund under IC 5-10.4, a former employee who qualifies for a benefit under IC 5-10.4-5; and
            (C) in the case of any other public employer, a former employee who meets the requirements established by the public employer for participation in a group insurance plan for retired employees.
        (9) "Retirement date" means the date that the employee has chosen to receive retirement benefits from the employees' retirement fund.
As added by Acts 1980, P.L.8, SEC.41. Amended by P.L.39-1986, SEC.1; P.L.56-1989, SEC.1; P.L.39-1990, SEC.1; P.L.40-1990, SEC.1; P.L.233-1999, SEC.1; P.L.50-2000, SEC.1; P.L.13-2001, SEC.7; P.L.98-2004, SEC.65; P.L.2-2006, SEC.14; P.L.2-2007, SEC.81; P.L.194-2007, SEC.1.

IC 5-10-8-2
Repealed
    
(Repealed by P.L.24-1985, SEC.25(c).)

IC 5-10-8-2.1
Repealed
    
(Repealed by P.L.1-1991, SEC.32.)

IC 5-10-8-2.2
Public safety employees; surviving spouses; dependents
    
Sec. 2.2. (a) As used in this section, "dependent" means a natural child, stepchild, or adopted child of a public safety employee who:
        (1) is less than eighteen (18) years of age;
        (2) is at least eighteen (18) years of age and has a physical or mental disability (using disability guidelines established by the Social Security Administration); or
        (3) is at least eighteen (18) and less than twenty-three (23) years of age and is enrolled in and regularly attending a secondary school or is a full-time student at an accredited college or university.
    (b) As used in this section, "public safety employee" means a full-time firefighter, police officer, county police officer, or sheriff.
    (c) This section applies only to local unit public employers and their public safety employees.
    (d) A local unit public employer may provide programs of group health insurance for its active and retired public safety employees through one (1) of the following methods:
        (1) By purchasing policies of group insurance.
        (2) By establishing self-insurance programs.
        (3) By electing to participate in the local unit group of local units that offer the state employee health plan under section 6.6 of this chapter.
        (4) If the local unit public employer is a school corporation, by electing to provide the coverage through a state employee health

plan under section 6.7 of this chapter.
A local unit public employer may provide programs of group insurance other than group health insurance for the local unit public employer's active and retired public safety employees by purchasing policies of group insurance and by establishing self-insurance programs. However, the establishment of a self-insurance program is subject to the approval of the unit's fiscal body.
    (e) A local unit public employer may pay a part of the cost of group insurance for its active and retired public safety employees. However, a local unit public employer that provides group life insurance for its active and retired public safety employees shall pay a part of the cost of that insurance.
    (f) A local unit public employer may not cancel an insurance contract under this section during the policy term of the contract.
    (g) After June 30, 1989, a local unit public employer that provides a group health insurance program for its active public safety employees shall also provide a group health insurance program to the following persons:
        (1) Retired public safety employees.
        (2) Public safety employees who are receiving disability benefits under IC 36-8-6, IC 36-8-7, IC 36-8-7.5, IC 36-8-8, or IC 36-8-10.
        (3) Surviving spouses and dependents of public safety employees who die while in active service or after retirement.
    (h) A public safety employee who is retired or has a disability and is eligible for group health insurance coverage under subsection (g)(1) or (g)(2):
        (1) may elect to have the person's spouse, dependents, or spouse and dependents covered under the group health insurance program at the time the person retires or becomes disabled;
        (2) must file a written request for insurance coverage with the employer within ninety (90) days after the person retires or begins receiving disability benefits; and
        (3) must pay an amount equal to the total of the employer's and the employee's premiums for the group health insurance for an active public safety employee (however, the employer may elect to pay any part of the person's premiums).
    (i) Except as provided in IC 36-8-6-9.7(f), IC 36-8-6-10.1(h), IC 36-8-7-12.3(g), IC 36-8-7-12.4(j), IC 36-8-7.5-13.7(h), IC 36-8-7.5-14.1(i), IC 36-8-8-13.9(d), IC 36-8-8-14.1(h), and IC 36-8-10-16.5 for a surviving spouse or dependent of a public safety employee who dies in the line of duty, a surviving spouse or dependent who is eligible for group health insurance under subsection (g)(3):
        (1) may elect to continue coverage under the group health insurance program after the death of the public safety employee;
        (2) must file a written request for insurance coverage with the employer within ninety (90) days after the death of the public safety employee; and         (3) must pay the amount that the public safety employee would have been required to pay under this section for coverage selected by the surviving spouse or dependent (however, the employer may elect to pay any part of the surviving spouse's or dependents' premiums).
    (j) The eligibility for group health insurance under this section for a public safety employee who is retired or has a disability ends on the earlier of the following:
        (1) When the public safety employee becomes eligible for Medicare coverage as prescribed by 42 U.S.C. 1395 et seq.
        (2) When the employer terminates the health insurance program for active public safety employees.
    (k) A surviving spouse's eligibility for group health insurance under this section ends on the earliest of the following:
        (1) When the surviving spouse becomes eligible for Medicare coverage as prescribed by 42 U.S.C. 1395 et seq.
        (2) When the unit providing the insurance terminates the health insurance program for active public safety employees.
        (3) The date of the surviving spouse's remarriage.
        (4) When health insurance becomes available to the surviving spouse through employment.
    (l) A dependent's eligibility for group health insurance under this section ends on the earliest of the following:
        (1) When the dependent becomes eligible for Medicare coverage as prescribed by 42 U.S.C. 1395 et seq.
        (2) When the unit providing the insurance terminates the health insurance program for active public safety employees.
        (3) When the dependent no longer meets the criteria set forth in subsection (a).
        (4) When health insurance becomes available to the dependent through employment.
    (m) A public safety employee who is on leave without pay is entitled to participate for ninety (90) days in any group health insurance program maintained by the local unit public employer for active public safety employees if the public safety employee pays an amount equal to the total of the employer's and the employee's premiums for the insurance. However, the employer may pay all or part of the employer's premium for the insurance.
    (n) A local unit public employer may provide group health insurance for retired public safety employees or their spouses not covered by subsections (g) through (l) and may provide group health insurance that contains provisions more favorable to retired public safety employees and their spouses than required by subsections (g) through (l). A local unit public employer may provide group health insurance to a public safety employee who is on leave without pay for a longer period than required by subsection (m), and may continue to pay all or a part of the employer's premium for the insurance while the employee is on leave without pay.
As added by P.L.58-1989, SEC.2. Amended by P.L.41-1990, SEC.2; P.L.286-2001, SEC.1; P.L.86-2003, SEC.1; P.L.2-2005, SEC.15;

P.L.99-2007, SEC.13; P.L.3-2008, SEC.24; P.L.182-2009(ss), SEC.65.

IC 5-10-8-2.5
Repealed
    
(Repealed by P.L.14-1986, SEC.19.)

IC 5-10-8-2.6
Local unit public employers and employees; programs; self-insurance; payment of part of cost; noncancelability; retired employees
    
Sec. 2.6. (a) This section applies only to local unit public employers and their employees. This section does not apply to public safety employees, surviving spouses, and dependents covered by section 2.2 of this chapter.
    (b) A public employer may provide programs of group insurance for its employees and retired employees. The public employer may, however, exclude part-time employees and persons who provide services to the unit under contract from any group insurance coverage that the public employer provides to the employer's full-time employees. A public employer may provide programs of group health insurance under this section through one (1) of the following methods:
        (1) By purchasing policies of group insurance.
        (2) By establishing self-insurance programs.
        (3) By electing to participate in the local unit group of local units that offer the state employee health plan under section 6.6 of this chapter.
        (4) If the local unit public employer is a school corporation, by electing to provide the coverage through a state employee health plan under section 6.7 of this chapter.
A public employer may provide programs of group insurance other than group health insurance under this section by purchasing policies of group insurance and by establishing self-insurance programs. However, the establishment of a self-insurance program is subject to the approval of the unit's fiscal body.
    (c) A public employer may pay a part of the cost of group insurance, but shall pay a part of the cost of group life insurance for local employees. A public employer may pay, as supplemental wages, an amount equal to the deductible portion of group health insurance as long as payment of the supplemental wages will not result in the payment of the total cost of the insurance by the public employer.
    (d) An insurance contract for local employees under this section may not be canceled by the public employer during the policy term of the contract.
    (e) After June 30, 1986, a public employer shall provide a group health insurance program under subsection (g) to each retired employee:
        (1) whose retirement date is:             (A) after May 31, 1986, for a retired employee who was a teacher (as defined in IC 20-18-2-22) for a school corporation; or
            (B) after June 30, 1986, for a retired employee not covered by clause (A);
        (2) who will have reached fifty-five (55) years of age on or before the employee's retirement date but who will not be eligible on that date for Medicare coverage as prescribed by 42 U.S.C. 1395 et seq.;
        (3) who will have completed twenty (20) years of creditable employment with a public employer on or before the employee's retirement date, ten (10) years of which must have been completed immediately preceding the retirement date; and
        (4) who will have completed at least fifteen (15) years of participation in the retirement plan of which the employee is a member on or before the employee's retirement date.
    (f) A group health insurance program required by subsection (e) must be equal in coverage to that offered active employees and must permit the retired employee to participate if the retired employee pays an amount equal to the total of the employer's and the employee's premiums for the group health insurance for an active employee and if the employee, within ninety (90) days after the employee's retirement date, files a written request with the employer for insurance coverage. However, the employer may elect to pay any part of the retired employee's premiums.
    (g) A retired employee's eligibility to continue insurance under subsection (e) ends when the employee becomes eligible for Medicare coverage as prescribed by 42 U.S.C. 1395 et seq., or when the employer terminates the health insurance program. A retired employee who is eligible for insurance coverage under subsection (e) may elect to have the employee's spouse covered under the health insurance program at the time the employee retires. If a retired employee's spouse pays the amount the retired employee would have been required to pay for coverage selected by the spouse, the spouse's subsequent eligibility to continue insurance under this section is not affected by the death of the retired employee. The surviving spouse's eligibility ends on the earliest of the following:
        (1) When the spouse becomes eligible for Medicare coverage as prescribed by 42 U.S.C. 1395 et seq.
        (2) When the employer terminates the health insurance program.
        (3) Two (2) years after the date of the employee's death.
        (4) The date of the spouse's remarriage.
    (h) This subsection does not apply to an employee who is entitled to group insurance coverage under IC 20-28-10-2(b). An employee who is on leave without pay is entitled to participate for ninety (90) days in any group health insurance program maintained by the public employer for active employees if the employee pays an amount equal to the total of the employer's and the employee's premiums for the insurance. However, the employer may pay all or part of the

employer's premium for the insurance.
    (i) A public employer may provide group health insurance for retired employees or their spouses not covered by subsections (e) through (g) and may provide group health insurance that contains provisions more favorable to retired employees and their spouses than required by subsections (e) through (g). A public employer may provide group health insurance to an employee who is on leave without pay for a longer period than required by subsection (h), and may continue to pay all or a part of the employer's premium for the insurance while the employee is on leave without pay.
As added by P.L.1-1991, SEC.33. Amended by P.L.286-2001, SEC.2; P.L.1-2005, SEC.76; P.L.182-2009(ss), SEC.66.

IC 5-10-8-2.7
Insurance of rostered volunteers
    
Sec. 2.7. (a) As used in this section, "rostered volunteer" means a volunteer:
        (1) whose name has been entered on a roster of volunteers for a volunteer program operated by a local unit; and
        (2) who has been approved by the proper authorities of the local unit.
The term does not include a volunteer firefighter (as defined in IC 36-8-12-2) or an inmate assigned to a correctional facility operated by the state or a local unit.
    (b) As used in this section, "local unit" does not include a school corporation.
    (c) The fiscal body of a local unit may elect to provide insurance for rostered volunteers for life, accident, or sickness coverage.
As added by P.L.51-1993, SEC.1.

IC 5-10-8-3
Repealed
    
(Repealed by P.L.24-1985, SEC.25(c).)

IC 5-10-8-3.1
Employees withholding from salaries or wages; retired employees; assignment of part of retirement benefit
    
Sec. 3.1. (a) A public employer that contracts for a group insurance plan or establishes a self-insurance plan for its employees may withhold or cause to be withheld from participating employees' salaries or wages whatever part of the cost of the plan the employees are required to pay. The chief fiscal officer responsible for issuing paychecks or warrants to the employees shall make deductions from the individual employees' paychecks or warrants to pay the premiums for the insurance. Except as provided by section 7(d) of this chapter, the fiscal officer shall require written authorization from state employees, and may require written authorization from local employees, to make the deductions. One (1) authorization signed by an employee is sufficient authorization for the fiscal officer to continue to make deductions for this purpose until revoked in writing

by the employee.
    (b) A public employer that contracts for a group insurance plan or establishes a self-insurance plan for its retired employees may require that the retired employees pay any part of the cost of the plan that is not paid by the public employer. A retired employee may assign part or all of the retired employee's benefit payable under IC 5-10.3-8, IC 5-10.4-5, or any other retirement program for this required payment.
As added by P.L.24-1985, SEC.10. Amended by P.L.27-1988, SEC.3; P.L.2-2006, SEC.15.

IC 5-10-8-4
Discrimination as to form of insurance between certain employees; exception
    
Sec. 4. Self-insurance plans for state employees involving income disability insurance, principal amount accident insurance, or both, must not, as to the form or forms of the insurance, discriminate between the employees of any department, commission, board, division, facility, institution, authority, or other establishment, except that the contributions for the insurance and benefits from the insurance may be equitably graduated in relation to:
        (1) the employment compensation schedule; and
        (2) if actuarially justified, the employee's age.
As added by Acts 1980, P.L.8, SEC.41. Amended by P.L.24-1985, SEC.11; P.L.27-1988, SEC.4.

IC 5-10-8-5
Establishment of common and unified plan of group insurance
    
Sec. 5. Two (2) or more local public employers may establish a common and unified plan of group insurance for their employees, including retired local employees. The plan shall be effected through a trust, agency, or any other legal arrangement with careful accounting and fiscal responsibility.
As added by Acts 1980, P.L.8, SEC.41. Amended by P.L.24-1985, SEC.12.

IC 5-10-8-6
Establishment of common and unified plans by state law enforcement agencies
    
Sec. 6. (a) The state police department, conservation officers of the department of natural resources, gaming agents of the Indiana gaming commission, gaming control officers of the Indiana gaming commission, and the state excise police may establish common and unified plans of self-insurance for their employees, including retired employees, as separate entities of state government. These plans may be administered by a private agency, business firm, limited liability company, or corporation.
    (b) Except as provided in IC 5-10-14, the state agencies listed in subsection (a) may not pay as the employer part of benefits for any employee or retiree an amount greater than that paid for other state

employees for group insurance.
As added by Acts 1980, P.L.8, SEC.41. Amended by Acts 1982, P.L.36, SEC.1; P.L.24-1985, SEC.13; P.L.14-1986, SEC.11; P.L.8-1993, SEC.53; P.L.24-2005, SEC.1; P.L.170-2005, SEC.15; P.L.1-2006, SEC.95; P.L.227-2007, SEC.55.

IC 5-10-8-6.5
General assembly members and former members
    
Sec. 6.5. (a) A member of the general assembly may elect to participate in either:
        (1) the plan of self-insurance established by the state police department under section 6 of this chapter;
        (2) the plan of self-insurance established by the state personnel department under section 7 of this chapter; or
        (3) a prepaid health care delivery plan established under section 7 of this chapter.
    (b) A former member of the general assembly who meets the criteria for participation in a group health insurance program provided under section 8(e) or 8.1 of this chapter may elect to participate in either:
        (1) the plan of self-insurance established by the state police department under section 6 of this chapter; or
        (2) a group health insurance program provided under section 8(e) or 8.1 of this chapter.
    (c) A member of the general assembly or former member of the general assembly who chooses a plan described in subsection (a)(1) or (b)(1) shall pay any amount of both the employer and the employee share of the cost of the coverage that exceeds the cost of the coverage under the new traditional plan.
As added by P.L.233-1999, SEC.2.

IC 5-10-8-6.6
Local unit groups
    
Sec. 6.6. (a) As used in this section, "local unit group" means all of the local units that elect to provide coverage for health care services for active and retired:
        (1) elected or appointed officers and officials;
        (2) full-time employees; and
        (3) part-time employees;
of the local unit under this section.
    (b) As used in this section, "state employee health plan" means:
        (1) an accident and sickness insurance policy (as defined in IC 27-8-5.6-1) purchased through the state personnel department under section 7(a) of this chapter; or
        (2) a contract with a prepaid health care delivery plan entered into by the state personnel department under section 7(c) of this chapter.
    (c) The state personnel department shall allow a local unit to participate in the local unit group by electing to provide coverage of health care services for active and retired:         (1) elected or appointed officers and officials;
        (2) full-time employees; and
        (3) part-time employees;
of the local unit under a state employee health plan.
    (d) If a local unit elects to provide coverage under subsection (c):
        (1) the local unit group must be treated as a single group that is separate from the group of state employees that is covered under a state employee health plan;
        (2) the state personnel department shall:
            (A) establish:
                (i) the premium costs, as determined by an accident and sickness insurer or a prepaid health care delivery plan under which coverage is provided under this section;
                (ii) the administrative costs; and
                (iii) any other costs;
            of the coverage provided under this section, including the cost of obtaining insurance or reinsurance, for the local unit group as a whole; and
            (B) establish a uniform premium schedule for each accident and sickness insurance policy or prepaid health care delivery plan under which coverage is provided under this section for the local unit group; and
        (3) the local unit shall provide for payment of the cost of the coverage as provided in sections 2.2 and 2.6 of this chapter.
The premium determined under subdivision (2) and paid by an individual local unit shall not be determined based on claims made by the local unit.
    (e) The state personnel department shall provide an annual opportunity for local units to elect to provide or terminate coverage under subsection (c).
    (f) The state personnel department may adopt rules under IC 4-22-2 to establish minimum participation and contribution requirements for participation in a state employee health plan under this section.
As added by P.L.286-2001, SEC.3.

IC 5-10-8-6.7
Election of state employee health care program by school corporation
    
Sec. 6.7. (a) As used in this section, "state employee health plan" means a:
        (1) self-insurance program established under section 7(b) of this chapter; or
        (2) contract with a prepaid health care delivery plan entered into under section 7(c) of this chapter;
to provide group health coverage for state employees.
    (b) The state personnel department shall allow a school corporation to elect to provide coverage of health care services for active and retired employees of the school corporation under any state employee health plan. If a school corporation elects to provide

coverage of health care services for active and retired employees of the school corporation under a state employee health plan, it must provide coverage for all active and retired employees of the school corporation under the state employee health plan (other than any employees covered by an Indiana comprehensive health insurance association policy or individuals who retire from the school corporation before July 1, 2010) if coverage was provided for these employees under the prior policies.
    (c) The following apply if a school corporation elects to provide coverage for active and retired employees of the school corporation under subsection (b):
        (1) The state shall not pay any part of the cost of the coverage.
        (2) The coverage provided to an active or retired school corporation employee under this section must be the same as the coverage provided to an active or retired state employee under the state employee health plan.
        (3) Notwithstanding sections 2.2 and 2.6 of this chapter:
            (A) the school corporation shall pay for the coverage provided to an active or retired school corporation employee under this section an amount not more than the amount paid by the state for coverage provided to an active or retired state employee under the state employee health plan; and
            (B) an active or retired school corporation employee shall pay for the coverage provided to the active or retired school corporation employee under this section an amount that is at least equal to the amount paid by an active or retired state employee for coverage provided to the active or retired state employee under the state employee health plan.
        However, this subdivision does not apply to contractual commitments made by a school corporation to individuals who retire before July 1, 2010.
        (4) The school corporation shall pay any administrative costs of the school corporation's participation in the state employee health plan.
        (5) The school corporation shall provide the coverage elected under subsection (b) for a period of at least three (3) years beginning on the date the coverage of the school corporation employees under the state employee health plan begins.
    (d) The state personnel department shall provide an enrollment period at least every thirty (30) days for a school corporation that elects to provide coverage under subsection (b).
    (e) The state personnel department may adopt rules under IC 4-22-2 to implement this section.
    (f) Neither this section nor a school corporation's election to participate in a state employee health plan as provided in this section impairs the rights of an exclusive representative of the certificated or noncertificated employees of the school corporation to collectively bargain all matters related to school employee health insurance programs and benefits.
As added by P.L.182-2009(ss), SEC.67. Amended by

P.L.182-2009(ss), SEC.515; P.L.109-2010, SEC.1.

IC 5-10-8-7
Group insurance; self-insurance; health services; disability plans
    
Sec. 7. (a) The state, excluding state educational institutions, may not purchase or maintain a policy of group insurance, except:
        (1) life insurance for the state's employees;
        (2) long term care insurance under a long term care insurance policy (as defined in IC 27-8-12-5), for the state's employees;
        (3) an accident and sickness insurance policy (as defined in IC 27-8-5.6-1) that covers individuals to whom coverage is provided by a local unit under section 6.6 of this chapter; or
        (4) an insurance policy that provides coverage that supplements coverage provided under a United States military health care plan.
    (b) With the consent of the governor, the state personnel department may establish self-insurance programs to provide group insurance other than life or long term care insurance for state employees and retired state employees. The state personnel department may contract with a private agency, business firm, limited liability company, or corporation for administrative services. A commission may not be paid for the placement of the contract. The department may require, as part of a contract for administrative services, that the provider of the administrative services offer to an employee terminating state employment the option to purchase, without evidence of insurability, an individual policy of insurance.
    (c) Notwithstanding subsection (a), with the consent of the governor, the state personnel department may contract for health services for state employees and individuals to whom coverage is provided by a local unit under section 6.6 of this chapter through one (1) or more prepaid health care delivery plans.
    (d) The state personnel department shall adopt rules under IC 4-22-2 to establish long term and short term disability plans for state employees (except employees who hold elected offices (as defined by IC 3-5-2-17)). The plans adopted under this subsection may include any provisions the department considers necessary and proper and must:
        (1) require participation in the plan by employees with six (6) months of continuous, full-time service;
        (2) require an employee to make a contribution to the plan in the form of a payroll deduction;
        (3) require that an employee's benefits under the short term disability plan be subject to a thirty (30) day elimination period and that benefits under the long term plan be subject to a six (6) month elimination period;
        (4) prohibit the termination of an employee who is eligible for benefits under the plan;
        (5) provide, after a seven (7) day elimination period, eighty percent (80%) of base biweekly wages for an employee disabled by injuries resulting from tortious acts, as distinguished from

passive negligence, that occur within the employee's scope of state employment;
        (6) provide that an employee's benefits under the plan may be reduced, dollar for dollar, if the employee derives income from:
            (A) Social Security;
            (B) the public employees' retirement fund;
            (C) the Indiana state teachers' retirement fund;
            (D) pension disability;
            (E) worker's compensation;
            (F) benefits provided from another employer's group plan; or
            (G) remuneration for employment entered into after the disability was incurred.
        (The department of state revenue and the department of workforce development shall cooperate with the state personnel department to confirm that an employee has disclosed complete and accurate information necessary to administer subdivision (6).)
        (7) provide that an employee will not receive benefits under the plan for a disability resulting from causes specified in the rules; and
        (8) provide that, if an employee refuses to:
            (A) accept work assignments appropriate to the employee's medical condition;
            (B) submit information necessary for claim administration; or
            (C) submit to examinations by designated physicians;
        the employee forfeits benefits under the plan.
    (e) This section does not affect insurance for retirees under IC 5-10.3 or IC 5-10.4.
    (f) The state may pay part of the cost of self-insurance or prepaid health care delivery plans for its employees.
    (g) A state agency may not provide any insurance benefits to its employees that are not generally available to other state employees, unless specifically authorized by law.
    (h) The state may pay a part of the cost of group medical and life coverage for its employees.
As added by P.L.28-1983, SEC.50. Amended by P.L.24-1985, SEC.14; P.L.39-1986, SEC.4; P.L.14-1986, SEC.12; P.L.27-1988, SEC.5; P.L.8-1993, SEC.54; P.L.21-1995, SEC.10; P.L.14-1996, SEC.5; P.L.41-1997, SEC.1; P.L.286-2001, SEC.4; P.L.2-2006, SEC.16; P.L.158-2006, SEC.2; P.L.2-2007, SEC.82.

IC 5-10-8-7.1
Coverage for pervasive developmental disorder
    
Sec. 7.1. (a) As used in this section, "covered individual" means an individual who is:
        (1) covered under a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) entitled to health services under a contract with a prepaid health care delivery plan that is entered into or renewed under

section 7(c) of this chapter.
    (b) As used in this section, "pervasive developmental disorder" means a neurological condition, including Asperger's syndrome and autism, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.
    (c) A self-insurance program established under section 7(b) of this chapter to provide health care coverage must provide a covered individual with coverage for the treatment of a pervasive developmental disorder. Coverage provided under this section is limited to treatment that is prescribed by the covered individual's treating physician in accordance with a treatment plan. A self-insurance program may not deny or refuse to issue coverage on, refuse to contract with, or refuse to renew, refuse to reissue, or otherwise terminate or restrict coverage on, an individual under an insurance policy or health plan solely because the individual is diagnosed with a pervasive developmental disorder.
    (d) A contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter must provide a covered individual with services for the treatment of a pervasive developmental disorder. Services provided under this section are limited to treatment that is prescribed by the covered individual's treating physician in accordance with a treatment plan. A prepaid health care delivery plan may not deny or refuse to provide services to, or refuse to renew, refuse to reissue, or otherwise terminate or restrict services to, an individual solely because the individual is diagnosed with a pervasive developmental disorder.
    (e) The coverage required by subsection (c) and services required by subsection (d) may not be subject to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable to a covered individual than the dollar limits, deductibles, copayments, or coinsurance provisions that apply to physical illness generally under the self-insurance program or contract with a prepaid health care delivery plan.
As added by P.L.148-2001, SEC.1.

IC 5-10-8-7.2
Breast cancer; definitions; self-insurance programs; health maintenance organizations; diagnostic services
    
Sec. 7.2. (a) As used in this section, "breast cancer diagnostic service" means a procedure intended to aid in the diagnosis of breast cancer. The term includes procedures performed on an inpatient basis and procedures performed on an outpatient basis, including the following:
        (1) Breast cancer screening mammography.
        (2) Surgical breast biopsy.
        (3) Pathologic examination and interpretation.
    (b) As used in this section, "breast cancer outpatient treatment services" means procedures that are intended to treat cancer of the human breast and that are delivered on an outpatient basis. The term

includes the following:
        (1) Chemotherapy.
        (2) Hormonal therapy.
        (3) Radiation therapy.
        (4) Surgery.
        (5) Other outpatient cancer treatment services prescribed by a physician.
        (6) Medical follow-up services related to the procedures set forth in subdivisions (1) through (5).
    (c) As used in this section, "breast cancer rehabilitative services" means procedures that are intended to improve the results of or to ameliorate the debilitating consequences of the treatment of breast cancer and that are delivered on an inpatient or outpatient basis. The term includes the following:
        (1) Physical therapy.
        (2) Psychological and social support services.
        (3) Reconstructive plastic surgery.
    (d) As used in this section, "breast cancer screening mammography" means a standard, two (2) view per breast, low-dose radiographic examination of the breasts that is:
        (1) furnished to an asymptomatic woman; and
        (2) performed by a mammography services provider using equipment designed by the manufacturer for and dedicated specifically to mammography in order to detect unsuspected breast cancer.
The term includes the interpretation of the results of a breast cancer screening mammography by a physician.
    (e) As used in this section, "covered individual" means a female individual who is:
        (1) covered under a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) entitled to services under a contract with a health maintenance organization (as defined in IC 27-13-1-19) that is entered into or renewed under section 7(c) of this chapter.
    (f) As used in this section, "mammography services provider" means an individual or facility that:
        (1) has been accredited by the American College of Radiology;
        (2) meets equivalent guidelines established by the state department of health; or
        (3) is certified by the federal Department of Health and Human Services for participation in the Medicare program (42 U.S.C. 1395 et seq.).
    (g) As used in this section, "woman at risk" means a woman who meets at least one (1) of the following descriptions:
        (1) A woman who has a personal history of breast cancer.
        (2) A woman who has a personal history of breast disease that was proven benign by biopsy.
        (3) A woman whose mother, sister, or daughter has had breast cancer.
        (4) A woman who is at least thirty (30) years of age and has not

given birth.
    (h) A self-insurance program established under section 7(b) of this chapter to provide health care coverage must provide covered individuals with coverage for breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services. The coverage must provide reimbursement for breast cancer screening mammography at a level at least as high as:
        (1) the limitation on payment for screening mammography services established in 42 CFR 405.534(b)(3) according to the Medicare Economic Index at the time the breast cancer screening mammography is performed; or
        (2) the rate negotiated by a contract provider according to the provisions of the insurance policy;
whichever is lower. The costs of the coverage required by this subsection may be paid by the state or by the employee or by a combination of the state and the employee.
    (i) A contract with a health maintenance organization that is entered into or renewed under section 7(c) of this chapter must provide covered individuals with breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services.
    (j) The coverage required by subsection (h) and services required by subsection (i) may not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to covered individuals than the dollar limits, deductibles, or coinsurance provisions applying to physical illness generally under the self-insurance program or contract with a health maintenance organization.
    (k) The coverage for breast cancer diagnostic services required by subsection (h) and the breast cancer diagnostic services required by subsection (i) must include the following:
        (1) In the case of a covered individual who is at least thirty-five (35) years of age but less than forty (40) years of age, at least one (1) baseline breast cancer screening mammography performed upon the individual before she becomes forty (40) years of age.
        (2) In the case of a covered individual who is:
            (A) less than forty (40) years of age; and
            (B) a woman at risk;
        at least one (1) breast cancer screening mammography performed upon the covered individual every year.
        (3) In the case of a covered individual who is at least forty (40) years of age, at least one (1) breast cancer screening mammography performed upon the individual every year.
        (4) Any additional mammography views that are required for proper evaluation.
        (5) Ultrasound services, if determined medically necessary by the physician treating the covered individual.
    (l) The coverage for breast cancer diagnostic services required by subsection (h) and the breast cancer diagnostic services required by subsection (i) shall be provided in addition to any benefits

specifically provided for x-rays, laboratory testing, or wellness examinations.
As added by P.L.35-1992, SEC.1. Amended by P.L.26-1994, SEC.1; P.L.170-1999, SEC.1.

IC 5-10-8-7.3
Early intervention services for first steps children
    
Sec. 7.3. (a) As used in this section, "covered individual" means an individual who is:
        (1) covered under a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) entitled to services under a contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter.
    (b) As used in this section, "early intervention services" means services provided to a first steps child under IC 12-12.7-2 and 20 U.S.C. 1432(4).
    (c) As used in this section, "first steps child" means an infant or toddler from birth through two (2) years of age who is enrolled in the Indiana first steps program and is a covered individual.
    (d) As used in this section, "first steps program" refers to the program established under IC 12-12.7-2 and 20 U.S.C. 1431 et seq. to meet the needs of:
        (1) children who are eligible for early intervention services; and
        (2) their families.
The term includes the coordination of all available federal, state, local, and private resources available to provide early intervention services within Indiana.
    (e) As used in this section, "health benefits plan" means a:
        (1) self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter.
    (f) A health benefits plan that provides coverage for early intervention services shall reimburse the first steps program for payments made by the program for early intervention services that are covered under the health benefits plan.
    (g) The reimbursement required under subsection (f) may not be applied to any annual or aggregate lifetime limit on the first steps child's coverage under the health benefits plan.
    (h) The first steps program may pay required deductibles, copayments, or other out-of-pocket expenses for a first steps child directly to a provider. A health benefits plan shall apply any payments made by the first steps program to the health benefits plan's deductibles, copayments, or other out-of-pocket expenses according to the terms and conditions of the health benefits plan.
As added by P.L.121-1999, SEC.1. Amended by P.L.246-2005, SEC.47; P.L.93-2006, SEC.2.
IC 5-10-8-7.5
Prostate specific antigen test
    
Sec. 7.5. (a) As used in this section, "covered individual" means a male individual who is:
        (1) covered under a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) entitled to services under a contract with a health maintenance organization (as defined in IC 27-13-1-19) that is entered into or renewed under section 7(c) of this chapter.
    (b) As used in this section, "prostate specific antigen test" means a standard blood test performed to determine the level of prostate specific antigen in the blood.
    (c) A self-insurance program established under section 7(b) of this chapter to provide health care coverage must provide covered individuals with coverage for prostate specific antigen testing.
    (d) A contract with a health maintenance organization that is entered into or renewed under section 7(c) of this chapter must provide covered individuals with prostate specific antigen screening.
    (e) The coverage required under subsections (c) and (d) must include the following:
        (1) At least one (1) prostate specific antigen test annually for a covered individual who is at least fifty (50) years of age.
        (2) At least one (1) prostate specific antigen test annually for a covered individual who is less than fifty (50) years of age and who is at high risk for prostate cancer according to the most recent published guidelines of the American Cancer Society.
    (f) The coverage required under this section may not be subject to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable to covered individuals than the dollar limits, deductibles, copayments, or coinsurance provisions applying to physical illness generally under the self-insurance program or contract with a health maintenance organization.
    (g) The coverage for prostate specific antigen screening shall be provided in addition to benefits specifically provided for x-rays, laboratory testing, or wellness examinations.
As added by P.L.170-1999, SEC.2.

IC 5-10-8-7.7
Surgical treatment for morbid obesity
    
Sec. 7.7. (a) As used in this section, "covered individual" means an individual who is covered under a health care plan.
    (b) As used in this section, "health care plan" means:
        (1) a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) a contract entered into under section 7(c) of this chapter to provide health services through a prepaid health care delivery plan.
    (c) As used in this section, "health care provider" means a:
        (1) physician licensed under IC 25-22.5; or
        (2) hospital licensed under IC 16-21; that provides health care services for surgical treatment of morbid obesity.
    (d) As used in this section, "morbid obesity" means:
        (1) a body mass index of at least thirty-five (35) kilograms per meter squared, with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; or
        (2) a body mass index of at least forty (40) kilograms per meter squared without comorbidity.
For purposes of this subsection, body mass index is equal to weight in kilograms divided by height in meters squared.
    (e) Except as provided in subsection (f), the state shall provide coverage for nonexperimental, surgical treatment by a health care provider of morbid obesity:
        (1) that has persisted for at least five (5) years; and
        (2) for which nonsurgical treatment that is supervised by a physician has been unsuccessful for at least six (6) consecutive months.
    (f) The state may not provide coverage for surgical treatment of morbid obesity for a covered individual who is less than twenty-one (21) years of age unless two (2) physicians licensed under IC 25-22.5 determine that the surgery is necessary to:
        (1) save the life of the covered individual; or
        (2) restore the covered individual's ability to maintain a major life activity (as defined in IC 4-23-29-6);
and each physician documents in the covered individual's medical record the reason for the physician's determination.
As added by P.L.78-2000, SEC.1. Amended by P.L.196-2005, SEC.1; P.L.102-2006, SEC.1.

IC 5-10-8-7.8
Colorectal cancer testing coverage
    
Sec. 7.8. (a) As used in this section, "covered individual" means an individual who is:
        (1) covered under a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) entitled to services under a contract with a health maintenance organization (as defined in IC 27-13-1-19) that is entered into or renewed under section 7(c) of this chapter.
    (b) A:
        (1) self-insurance program established under section 7(b) of this chapter to provide health care coverage; or
        (2) contract with a health maintenance organization that is entered into or renewed under section 7(c) of this chapter;
must provide coverage for colorectal cancer examinations and laboratory tests for cancer for any nonsymptomatic covered individual, in accordance with the current American Cancer Society guidelines.
    (c) For a covered individual who is:
        (1) at least fifty (50) years of age; or         (2) less than fifty (50) years of age and at high risk for colorectal cancer according to the most recent published guidelines of the American Cancer Society;
the coverage required under this section must meet the requirements set forth in subsection (d).
    (d) A covered individual may not be required to pay an additional deductible or coinsurance for the colorectal cancer examination and laboratory testing benefit that is greater than an annual deductible or coinsurance established for similar benefits under a self-insurance program or contract with a health maintenance organization. If the program or contract does not cover a similar benefit, a deductible or coinsurance may not be set at a level that materially diminishes the value of the colorectal cancer examination and laboratory testing benefit required under this section.
As added by P.L.54-2000, SEC.1.

IC 5-10-8-8
Retired employees; ability of employer to pay premiums
    
Sec. 8. (a) This section applies only to the state and employees who are not covered by a plan established under section 6 of this chapter.
    (b) After June 30, 1986, the state shall provide a group health insurance plan to each retired employee:
        (1) whose retirement date is:
            (A) after June 29, 1986, for a retired employee who was a member of the field examiners' retirement fund;
            (B) after May 31, 1986, for a retired employee who was a member of the Indiana state teachers' retirement fun