760 IAC 4-2-1 - Definitions
Authority: IC 27-19-1-4; IC 27-19-4-1
Affected: IC 12-8-1.5-2; IC 12-10; IC 12-15-44.5; IC 12-17.6; IC 16-28; IC 27-1-1; IC 27-19-2; IC 27-19-4-1
Sec. 1.
The definitions set forth in IC 27-19-2 and the following definitions apply throughout this article:
(1) "Application organization " means a
navigator described in Section 1311(i) of PPACA (42 U.S.C.
18031(i)) , a certified
application counselor organization described in
45 CFR
155.225 issued pursuant to PPACA , or any
other federal assistance program under PPACA, or an entity that employs
personnel to assist individuals with application for and enrollment in a QHP
through a health benefit exchange or in a public health insurance program. An
application organization does not include:
(A) An entity that makes presumptive
eligibility determinations concerning an individual's eligibility for
enrollment in a public health insurance program unless such entity also assists
individuals with the full application for and enrollment in a public health
insurance program or QHP through a health benefit exchange.
(B) A state agency, division, or subdivision
thereof.
(C) An entity that only
performs one (1) or both of the following two (2) functions:
(i) Provides assistance with application for
and enrollment in a public health insurance program to individuals who may be
eligible for Medicaid nursing home care.
(ii) Provides individuals with general
information concerning the application process for enrollment in a QHP through
a health benefit exchange or in a public health insurance program but does not
assist individuals with application for or enrollment in a QHP through a health
benefit exchange or in a public health insurance program.
(2) "Assist " or "assistance" means
to help an individual with the completion of an application for a QHP through a
health benefit exchange or an application for a public health insurance
program.
(3) "CHIP " refers to the
children's health insurance program under Title XXI of the Social Security Act
and IC 12-17.6.
(4) "Commissioner "
refers to the insurance commissioner appointed under IC 27-1-1-2.
(5) "Department " refers to the department of
insurance created under IC 27-1-1-1.
(6) "Entity " means any type of corporation,
company, partnership, association, institution, or any other organization, as
distinguished from an individual.
(7) "Group health plan " has the meaning set
forth in Section 2791 of the federal Public Health Service Act (42 U.S.C.
300gg-91) .
(8) "Health benefit exchange " means an
American health benefit exchange or marketplace operating in Indiana pursuant
to PPACA.
(9) "Health insurance
coverage " has the meaning set forth in Section 2791 of the federal Public
Health Service Act (42
U.S.C. 300gg-91) .
(10) "Health plan " means a policy or contract
that provides health insurance coverage . The term includes a group health plan ,
QHP, or public health insurance program.
(11) "Healthy Indiana Plan 2.0 " or "HIP 2.0"
refers to the 1115 waiver program established by IC 12-15-44.5.
(13) "Medicaid home and community-based
waiver services" means those services provided in accordance with IC 12-10 and
455 IAC 2-4.
(14) "Navigator " means a navigator described
in Section 1311(i) of PPACA (42 U.S.C.
18031(i)) , a certified
application counselor described in
45 CFR
155.225 issued pursuant to PPACA , or any
other federal assistance personnel as provided by PPACA, or a person who
assists individuals with application for and enrollment in a QHP through a
health benefit exchange or in a public health insurance program. A navigator
does not include:
(A) A person who makes
presumptive eligibility determinations concerning an individual's eligibility
for enrollment in a public health insurance program unless such person also
assists individuals with the full application for and enrollment in a public
health insurance program or a QHP through a health benefit exchange .
(B) An employee or contractor of a state
agency, division, or subdivision thereof who is performing their job function
for such state agency, division, or subdivision.
(C) A person who is the authorized
representative on behalf of an individual applying for a public health
insurance program unless such person also assists an individual with
application for and enrollment in a public health insurance program or a QHP
through a health benefit exchange not as the individual's authorized
representative.
(D) A person who
only performs one (1) or both of the following two (2) functions:
(i) Provides assistance with application for
and enrollment in a public health insurance program to individuals who may be
eligible for Medicaid nursing home care.
(ii) Provides individuals with general
information concerning the application process for enrollment in a QHP through
a health benefit exchange or in a public health insurance program but does not
assist individuals with application completion or enrollment in a QHP through a
health benefit exchange or in a public health insurance program.
(15) "Nonresident " means
an individual with a permanent home address outside of Indiana or an entity
with a physical address outside of Indiana.
(16) "Nursing home care " means in-patient
care and services provided by nursing homes, also identified as long term care
facilities, licensed under IC 16-28 and meeting Medicaid standards described in
405 IAC 1-3.
(17) "Person" means an individual or
entity .
(18) "Personal information "
means any nonpublic information that is provided to a navigator or application
organization by an individual for purposes of assisting with application for
and enrollment of such individual in a QHP through a health benefit exchange or
in a public health insurance program, including, but not limited to:
(A) Social Security number;
(B) first and last name;
(C) driver's license number;
(D) bank account number;
(E) credit card number;
(F) street address;
(G) medical or health information;
(H) state identification card number;
or
(I) financial account number or
debit card number.
(19)
"PPACA " refers to the federal Patient Protection and Affordable Care Act (
P.L.
111-148 ), as amended by the federal Health Care
and Education Reconciliation Act (
P.L.
111-152 ).
(20) "Program " means an insurance trade
association, accredited college or university, educational organization, or
application organization that offers navigator precertification education that
is approved by the commissioner in compliance with
760 IAC 4-8.
(21) "Provider " means an individual,
insurance trade association, accredited college or university, educational
organization, or application organization that offers a navigator continuing
education course that is approved by the commissioner in compliance with
760 IAC 4-9.
(22) "Public health insurance program " refers
to health coverage provided under a state or federal government program ,
including Medicaid , CHIP , and HIP 2.0.
(23) "QHP " refers to a qualified health plan
that has been certified under Section 1301 of PPACA (42 U.S.C.
18021(a)) to meet the
criteria for availability through a health benefit exchange operating in
Indiana.
(24) "Resident " means an
individual with a permanent home address in Indiana or an entity with a
physical address in Indiana.
(25)
"Secretary " refers to the secretary of the office of the secretary of family
and social services appointed under IC 12-8 1.5-2.
(26) "Security breach " means an unauthorized
acquisition of or disclosure of personal information that compromises the
security, confidentiality, or integrity of such personal information .
Notes
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