Indiana Health Study Guide

Indiana’s health material rewards a particular habit: noticing when the state has split a rule that most states leave whole. Indiana sets two clean-claim deadlines where others set one. It runs continuation for a band of employers that overlaps federal COBRA rather than sitting beside it. And it built its Medicaid expansion through a waiver rather than taking the standard route. Each of those splits is a question waiting to be written.

Prompt pay — two deadlines, keyed to the medium

IC 27-8-5.7-6 requires an insurer to pay or deny a clean claim within 30 days if the claim was filed electronically and 45 days if it was filed on paper.

Most states publish a single number. Indiana keys the deadline to how the claim arrived, which means a candidate carrying one memorised figure gets roughly half these items wrong by construction. Learn them as a pair: 30 electronic, 45 paper.

The consequence of missing the deadline is the second half of the question, and it is not a flat fine. Interest accrues — from day 31 on an electronic claim, day 46 on a paper one — and Indiana does not print a percentage in the prompt-pay statute at all. It cross-references the Medicaid interest provision at IC 12-15-21-3 instead. So an item offering you “a 10% penalty” is offering a number Indiana never wrote down.

Continuation — a band, not a threshold

Federal COBRA applies to employers with 20 or more employees. Indiana’s own continuation statute, IC 27-8-15-31.1, applies to small-employer group plans of 1 to 50 employees.

Notice that those two do not sit end to end — they overlap across the twenty-to-fifty band. That is the design, and it is what an exam item exploits when it hands you an employer with thirty-five employees and asks which rule governs. Indiana’s continuation runs for up to 12 months, at a premium of up to 102% of the group rate.

The distractor that appears alongside it is 135%, which is a real Indiana number attached to a different thing: it caps a conversion policy, not continuation. One-oh-two to continue, one thirty-five to convert.

External review is binding — and that word matters

Indiana runs external review through a certified Independent Review Organization, and under IC 27-8-29-16 the IRO’s determination binds the insurer. It is not advisory, not a recommendation, not a step the plan may consider and decline.

Exam items in this area are usually built around the word rather than the process, offering “advisory,” “non-binding,” or “subject to the plan’s final determination” as plausible alternatives. In Indiana the IRO decides.

The public programs have Indiana names

Three facts that recur, and all three are Indiana-specific labels rather than general principles:

Indiana did expand Medicaid, but through a Section 1115 waiver — the Healthy Indiana Plan (HIP 2.0), effective February 2015. It is administered by the Family and Social Services Administration (FSSA), not by a department of health. Children and pregnant women are covered through Hoosier Healthwise, Indiana’s CHIP program.

And Indiana runs no state-based exchange. Individual buyers use HealthCare.gov, the federally-facilitated marketplace. A question that puts an Indiana consumer on a state exchange is describing something that does not exist.

Long-term care carries a training ladder, and one rung is classroom-only

This is the requirement most likely to affect your working life, and it is a gate on selling rather than a continuing education credit.

Before marketing, selling or soliciting any long-term care product in Indiana you must complete an 8-hour basic LTC course specifically approved for LTC. After that, you complete a minimum of 5 hours of LTC coursework every two years, and those five may be taken at any point within the period.

Marketing Indiana Long Term Care Partnership (ILTCP) policies raises it again: 15 hours initially — the 8 basic hours plus 7 hours in Partnership. The 7-hour Partnership course is a one-time requirement and is classroom only, with no self-study option. That is a scheduling constraint as much as an educational one, and it is worth putting on a calendar early.

LTC hours, like ethics hours, never carry over into the next continuing education period.