HB 1279

                                                             Introduced Version
           HOUSE BILL No. 1279
                 _____
              DIGEST OF INTRODUCED BILL
Citations Affected: IC 27-1-53.
Synopsis: Collection of cost sharing. Provides that an insurer: (1) must
pay a health care provider the full amount due for health care services
under the health care provider's agreement with the insurer, including
any cost sharing; (2) has the sole responsibility for collecting cost
sharing from a covered individual; and (3) upon request of the covered
individual, must collect cost sharing throughout the policy year in
increments defined by the insurer. Prohibits an insurer from taking
certain actions regarding the collection of cost sharing. Requires each
insurer to certify to the insurance commissioner, before December 31
of each year, that the insurer has fully and completely complied with
the requirements during the previous calendar year.
Effective: January 1, 2027.
                               Barrett
   January 6, 2026, read first time and referred to Committee on Insurance.
2026  IN 1279—LS 6825/DI 141
                                                                                       Introduced
            Second Regular Session of the 124th General Assembly (2026)
 PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
 Constitution) is being amended, the text of the existing provision will appear in this style type,
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 a new provision to the Indiana Code or the Indiana Constitution.
  Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
 between statutes enacted by the 2025 Regular Session of the General Assembly.
                   HOUSE BILL No. 1279
    A BILL FOR AN ACT to amend the Indiana Code concerning
 insurance.
     Be it enacted by the General Assembly of the State of Indiana:
1     SECTION 1. IC 27-1-53 IS ADDED TO THE INDIANA CODE AS
2 A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
3 JANUARY 1, 2027]:
4     Chapter 53. Collection of Cost Sharing for Health Care Services
5     Sec. 1. As used in this chapter, "administrator" means a person
6 who, directly or indirectly and on behalf of an insurer:
7(1) underwrites; or
8(2) collects charges or premiums from or adjusts or settles
9claims on residents of Indiana;
10 in connection with health insurance coverage offered or provided
11 by an insurer.
12     Sec. 2. As used in this chapter, "cost sharing" means any
13 copayment, coinsurance, deductible, or other similar charge that
14 is:
15(1) required of a covered individual for a health care service
16covered by a policy of health insurance coverage, including a
17prescription drug; and
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1      (2) paid:
2(A) by; or
3(B) on behalf of;
4      the covered individual.
5    Sec. 3. As used in this chapter, "covered individual" means an
6 individual who is entitled to health insurance coverage under a
7 policy or contract.
8    Sec. 4. As used in this chapter, "health care provider" means an
9 individual or entity that is licensed, certified, or otherwise
10 authorized to administer health care services under Indiana law.
11    Sec. 5. As used in this chapter, "health care service" means a
12 service or good furnished for the purpose of preventing,
13 alleviating, curing, or healing:
14      (1) human illness;
15      (2) physical disability; or
16      (3) injury.
17    Sec. 6. As used in this chapter, "health insurance coverage"
18 means:
19      (1) an individual or group policy of accident and sickness
20      insurance (as defined in IC 27-8-5-1);
21      (2) an individual contract (as defined in IC 27-13-1-21) or a
22      group contract (as defined in IC 27-13-1-16) that provides
23      coverage for basic health care services (as defined in
24      IC 27-13-1-4);
25      (3) a self-funded health benefit plan that complies with the
26      federal Employee Retirement Income Security Act (ERISA)
27      of 1974 (29 U.S.C. 1001 et seq.); and
28      (4) the Medicaid risk based managed care program under
29      IC 12-15.
30    Sec. 7. As used in this chapter, "insurer" means an insurer that
31 provides health insurance coverage to a covered individual. The
32 term includes:
33      (1) an administrator; or
34      (2) a pharmacy benefit manager (as defined in
35      IC 27-1-24.5-12);
36 of a policy or contract of health insurance coverage.
37    Sec. 8. As used in this chapter, "person" means a natural
38 person, corporation, mutual company, unincorporated association,
39 partnership, joint venture, limited liability company, trust, estate,
40 foundation, not-for-profit corporation, unincorporated
41 organization, government, or governmental subdivision or agency.
42    Sec. 9. (a) An insurer shall:
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1      (1) pay a health care provider the full amount due for health
2      care services under the health care provider's agreement with
3      the insurer, including any cost sharing;
4      (2) have the sole responsibility for collecting cost sharing from
5      a covered individual; and
6      (3) upon request of the covered individual, collect cost sharing
7      throughout the policy year in increments defined by the
8      insurer.
9    (b) An insurer may not:
10      (1) withhold an amount for cost sharing from the payment to
11      a health care provider;
12      (2) require a health care provider to offer additional discounts
13      to a covered individual outside the terms of the health care
14      provider's agreement with the insurer;
15      (3) deny or delay payment to a health care provider for the
16      insurer's failure to collect the covered individual's cost
17      sharing; or
18      (4) require a person to collect the covered individual's cost
19      sharing on behalf of the insurer.
20    (c) An insurer may not cancel the health insurance coverage of
21 a covered individual solely for failure to collect cost sharing.
22    (d) An expense incurred by an insurer to implement or comply
23 with this chapter may not be used as justification to increase
24 premiums or decrease payments to a health care provider.
25    Sec. 10. Before December 31 of each year, each insurer shall
26 certify to the commissioner that the insurer has fully and
27 completely complied with the requirements of this chapter during
28 the previous calendar year. The certification must be signed by the
29 chief executive officer or chief financial officer of the insurer.
 2026  IN 1279—LS 6825/DI 141