{"data":{"id":"us-in/ic-27-1-46.5-10","jurisdiction":"us-in","citation":"IC 27-1-46.5-10","heading":"Offer of a direct to employer health care arrangement by a hospital; benchmark; requirements; audit; assessment","body":"Sec. 10. (a) Beginning September 1, 2026, a hospital that is not a part of an Indiana nonprofit hospital system shall offer a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare.\n(b) The benchmark described in subsection (a) shall be calculated by taking the sum of:\n(1) hospital inpatient facility prices;\n(2) hospital outpatient facility prices; and\n(3) professional fee for services provided to a patient by an employed qualified practitioner;\nexpressed as a percentage of full Medicare.\n(c) A hospital meets the requirements of subsection (a) by doing any of the following:\n(1) Offering a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare as an individual hospital.\n(2) Offering a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare as a hospital system.\n(3) Participating in a narrow network of hospitals to offer a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare.\n(d) Beginning October 1, 2026, and before every October 1 thereafter, a hospital shall cooperate with an audit by the Indiana department of health to determine compliance with this section.\n(e) The Indiana department of health shall assess a hospital that the Indiana department of health determines through an audit has violated this section with a civil penalty of ten thousand dollars ($10,000) per day per hospital that is unable to demonstrate compliance with this section. A fine collected under this subsection shall be deposited into the payer affordability penalty fund established by IC 12-15-1-18.5.","path":["TITLE 27. INSURANCE","ARTICLE 1. DEPARTMENT OF INSURANCE","Chapter 46.5. Direct to Employer Health Care Arrangements"],"source_url":"https://iga.in.gov/ic/2026/Title_27.html#27-1-46.5-10","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-25T05:39:04Z","sha256":"d8588b591b66b7d7411171b8492fab8abdd780df96471a40bd7f1d9fdd2b907c","source_id":"us-in","stale":false,"prev":"us-in/ic-27-1-46.5-9","next":"us-in/ic-27-1-46.5-11"},"notice":"GroundRules: Original legal text. Not legal advice."}