Applicability; disclosure to policyholder or subscriber; acknowledgment; submission to all payer claims data base; examination

Sec. 13.5. (a) This section applies only to the following: (1) An individual, group, franchise, or blanket policy of accident and sickness insurance, as defined in IC 27-8-5-1. However, this section does not apply to the types of insurance and coverage described in IC 27-8-5-2.5(a). (2) An individual or group health maintenance organization contract entered into under IC 27-13. (b) As used in this section, "third party administrator" means a person who: (1) is licensed under IC 27-1-25; and (2) administers a policy of accident and sickness insurance described in subsection (a)(1) or a health maintenance organization contract described in subsection (a)(2). (c) Except as provided in subsection (f), an insurer that issues an insurance policy, a health maintenance organization that enters into a health maintenance organization contract, or a third party administrator shall disclose to the policyholder or subscriber in a separate written notification: (1) any commission, service fee, or brokerage fee that has been or will be paid to an insurance producer for selling, soliciting, or negotiating the policy or contract; and (2) whether the amount disclosed under subdivision (1) is based on a percentage of total plan premiums or a flat per member fee. (d) An insurer, a health maintenance organization, or a third party administrator shall provide a copy of the written notification described in subsection (c) to the policyholder or subscriber: (1) when the insurance policy is issued or the contract is entered into; and (2) each time the insurance policy or contract is renewed. (e) Each copy of a written notification described in subsection (c) must include a signature line on which the policyholder may sign to acknowledge receiving the written notification. (f) This section does not require the disclosure to the policyholder of a commission, service fee, or brokerage fee in connection with the issuance of an insurance policy if a federal law or regulation requires disclosure of the commission, service fee, or brokerage fee to the policyholder. (g) An insurer, a health maintenance organization, and a third party administrator shall submit the information described in subsection (c) to the executive director of the all payer claims data base established under IC 27-1-44.5 for inclusion in the data base. (h) The department shall perform an examination under IC 27-1-3.1 for any alleged violation of this section.