Indiana writes benefits into a group health policy by statute, and the statutes come in three shapes. Some require the coverage outright. Some require a plan that already covers a subject to cover it a particular way. Some require only that the coverage be offered. Which shape a statute has decides whether the benefit is in your policy.
Three shapes an Indiana coverage statute comes in
A free-standing mandate says the insurer must provide coverage for something. If your policy is within its reach, the benefit is in the contract whether or not anyone negotiated for it.
A contingent mandate says that a policy covering a subject must cover it in a certain way. It shapes a benefit that is already there. It does not put a benefit into a plan that lacks one.
An offer mandate says the insurer shall offer the coverage. That is a duty to put something on the table. It does not put anything in the policy at all, and an offer that was not accepted leaves the contract exactly as it was.
Nearly every mistake employers make reading Indiana benefit law is a mix-up between those three. The chapter headings do not distinguish them, and a heading that reads like a requirement can sit over a subsection that is nothing of the kind.
Screening mammography, written into a group policy
IC 27-8-14-6 requires that an insurer provide coverage for breast cancer screening mammography in an accident and sickness insurance policy it issues in Indiana. The coverage reaches more than the scan itself: the section includes any additional mammography views required for proper evaluation, and ultrasound services where the treating physician determines them medically necessary. Cost sharing for it may not be less favorable to the insured than the cost sharing applied to physical illness generally (IC 27-8-14).
Its reach into the group market is the clearest of any mandate discussed here, because the chapter says so on its face — IC 27-8-14-1(a) limits the chapter’s accident and sickness insurance policy to one that is issued on a group basis.
Two narrowings belong with it. The chapter defines “woman at risk” by a multi-branch test that is worth reading in the statute rather than in anyone’s summary. And subsection (f) changes the duty for policies that are not employer based: for those, the insurer must offer the coverage rather than provide it. The employer-based policy gets the stronger version.
Treatment for an autism spectrum disorder
IC 27-8-14.2-4 provides that an accident and sickness insurance policy issued on a group basis must provide coverage for the treatment of an autism spectrum disorder of an insured. The section also bars an insurer from denying or refusing to issue coverage on an individual solely because that individual is diagnosed with an autism spectrum disorder.
The chapter splits the duty deliberately — section 4 is the group requirement and section 5 is the individual one — so the precise citation for an employer plan is section 4, not the chapter at large.
The second sentence of section 4 is a real limit and is often dropped in summaries: coverage under the section is limited to treatment prescribed by the insured’s treating physician in accordance with a treatment plan. The mandate is not open-ended, and the treatment plan is the mechanism it runs through.
Medically necessary treatment for diabetes
IC 27-8-14.5-4 requires a health insurance plan issued by an insurer to provide coverage for the medically necessary treatment of diabetes, including medically necessary supplies and equipment ordered in writing by a physician or a podiatrist. The chapter reaches a group plan because it defines a health insurance plan to include a hospital or medical expense incurred policy or certificate, and the certificate is the group form.
The closing words of that section are doing work and should not be dropped: the coverage is subject to the general provisions of the health insurance plan. That is a genuine qualifier, not throat-clearing.
The mandate is also not one section. The same chapter carries a second duty around self-management training at IC 27-8-14.5-6 and a cost-sharing rule at IC 27-8-14.5-5. An employer reading only the headline section has not read the whole requirement.
Real-World Scenario: An Indianapolis employer forwarded us a list of Indiana mandates she had found and asked why three of the items on it were nowhere in her policy. Reading the statutes underneath the list, one was contingent on a benefit her plan did not carry, one required only that the coverage be offered, and one came from a chapter defining its terms for an entirely different purpose. The list was not dishonest. It had simply flattened three kinds of statute into one column headed “required”, which is the flattening that makes a benefit list unusable.
Biomarker testing, and the line the statute draws around it
The newest of the mandates described here is IC 27-8-14.3-10, added in 2024 and applying to policies issued, renewed or entered into after June 30 of that year. It requires a health plan to provide coverage for biomarker testing for the purposes of diagnosis, treatment, appropriate management or ongoing monitoring of an enrollee’s disease or condition, where the testing is supported by medical and scientific evidence from the sources the section names (IC 27-8-14.3).
It also builds in patient-side machinery that is unusual in a benefit mandate. Subsection (b) requires the coverage to be provided in a manner that limits disruptions in care, including the need for multiple biopsies or biospecimen samples. Subsection (d) sets turnaround deadlines where prior authorization is required — not more than five (5) business days for a nonurgent request and not more than forty-eight (48) hours for an urgent one. Subsection (e) requires an accessible exception process, published on the plan’s website.
And subsection (c) draws the line: nothing in the section shall be construed to require coverage of biomarker testing for screening purposes. Anyone telling you Indiana requires plans to cover biomarker screening is contradicting the statute directly.
Wearable cardioverter defibrillators
IC 27-8-39-3 requires a policy of accident and sickness insurance to provide coverage for wearable cardioverter defibrillators, including the cost of the device, any necessary accessory, and ongoing monitoring services (IC 27-8-39). IC 27-8-39-4 adds that the coverage may not be subject to an annual or lifetime limitation.
Two qualifications. The chapter defines the device itself by a three-part test — worn externally, continually monitoring and analyzing heart rhythm, and delivering a shock when an abnormal rhythm is detected — and that definition is what the mandate attaches to. And subsection 3(b) requires the coverage to be in accordance with a local or national coverage determination as those are defined for Medicare purposes. The coverage is real and it is not open-ended.
A maternity chapter that only reaches a plan already covering maternity
IC 27-8-24 is the clearest contingent mandate in this group and the one most often reported as something it is not. IC 27-8-24-1 reaches policies written on an individual basis, a group basis, a franchise basis or a blanket basis — and only those that provide maternity benefits (IC 27-8-24). Where a plan does provide them, IC 27-8-24-4 requires minimum benefits to a mother and her newborn covering a minimum length of postpartum stay, the examinations required under IC 16-41-17-2, and the testing required under IC 16-41-6-4.
The stay is stated by cross-reference rather than by number: consistent with the minimum postpartum hospital stay recommended by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists in their Guidelines for Perinatal Care. There is no figure in the statute, and section 4 opens by excepting section 5, which sets out conditions warranting a shorter stay together with an at-home visit. Anyone quoting you a day count is quoting a summary.
Separately from all of that, federal rules require coverage in the small group market to include the essential health benefits package, and maternity and newborn care is one of the categories named in it (45 CFR 156.110). Those are two texts, and they are set out here as two texts.
An offer is not a benefit
IC 27-8-14.1-4(a) requires an insurer to offer coverage for morbid obesity surgery. That is the whole duty. The statute does not put the benefit in the policy, and a plan that does not cover it is not evidence of an insurer cutting a corner.
This matters more than it sounds like it should, because offer mandates and coverage mandates get printed in the same column on every summary list on the internet. The practical consequence is straightforward: a benefit that Indiana requires to be offered is something to raise at quote or at renewal as an addition to be priced, not something to point at as a violation.
Indiana’s list is longer than this page
Whatever else you take from this, take this: Indiana’s mandates include the ones above. They are not the set.
Others we read and confirmed reach the group market as well — screening for high breast density at IC 27-8-13.5-5, prostate specific antigen testing at IC 27-8-14.7-4, colorectal cancer screening at IC 27-8-14.8-3, orthotic and prosthetic devices at IC 27-8-24.2-5, medication synchronization at IC 27-8-31.4-6, telehealth at IC 27-8-34-6, chronic pain management at IC 27-8-35.5-5, and PANS and PANDAS at IC 27-8-37-2. Further chapters of the same article announce coverage requirements on subjects we have not read for this page, among them newborn coverage, off-label drug treatment, chemotherapy and emergency ambulance transport. And the article governing HMOs was not swept at all, so a group plan written as an HMO contract may answer to text described nowhere here.
Underneath every one of them sits the federal floor: coverage in the small group market must include the essential health benefits package, built from the categories set out at 45 CFR 156.110 and linked above. Indiana’s statutes sit on top of that floor rather than in place of it. The body that stands behind the state side is the Indiana Department of Insurance.
If you want your own policy read against this rather than a list read against your memory of it, send it over or get in touch. We place group health with dental and vision beside it, we work first plans as their own problem, the wider Indiana picture and the rest of our licensed footprint are both written down, and so is who is doing the reading.
The bottom line
Indiana’s mandates include coverage written straight into a group policy, coverage that attaches only to a plan already covering the subject, and coverage an insurer must merely offer — and the difference between those three decides whether the benefit is actually in your contract.
Frequently asked questions
Our policy does not mention obesity surgery. Did the insurer skip an Indiana requirement?
Probably not. IC 27-8-14.1-4(a) is an offer mandate — it requires an insurer to offer the coverage, which is a different act from including it. An offer that was made and not taken leaves nothing in the contract. If you want the benefit, the place to raise it is at quote or renewal, as something to be added, not as something to be enforced.
Does Indiana require our group plan to cover maternity?
The Indiana chapter is contingent rather than free-standing. IC 27-8-24 reaches a policy that provides maternity benefits and sets minimum benefits within it; it does not put maternity into a plan that lacks it. Separately, federal rules require small group market coverage to include the essential health benefits package, and maternity and newborn care is one of the named categories in that package.
How long does a policy have to cover a hospital stay after a birth in Indiana?
Indiana does not state a number. IC 27-8-24-4 requires a minimum length of postpartum stay consistent with the guidelines recommended by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, and it opens by excepting section 5 of the chapter, which sets out conditions warranting a shorter stay together with an at-home visit. Any day count you read elsewhere is somebody’s summary.
We read that Indiana covers biomarker testing. Does that include screening?
No, and the statute says so in its own words. IC 27-8-14.3-10 requires coverage for biomarker testing for diagnosis, treatment, appropriate management or ongoing monitoring where the testing is supported by the evidence sources the section names. Subsection (c) then provides that nothing in the section shall be construed to require coverage of biomarker testing for screening purposes. That carve-out is express.
Our plan is level-funded. Do these Indiana requirements still reach it?
Ask the issuer and ask counsel, because the chapters quoted here place their duty on an insurer issuing a policy or certificate. The federal Departments have described level-funded arrangements as self-funded, and have described small group market policies as ones that must cover state- and federally-mandated benefits — while noting employers moving out of that market may not realize which benefits stop traveling with them.
Is the list on this page the complete set of Indiana mandates?
No, and no page should tell you it is. Indiana’s mandates include the ones described here and a number of others we read and confirmed, and further chapters of the same article announce coverage requirements we did not read. Treat any enumeration, including this one, as a sample with citations attached rather than as the boundary of Indiana law.
About the author
Nate Jones, CPCU, is the founder of Wexford Insurance and Wexford Health Insurance, an independent agency placing small-business group benefits in 9 states. Nate reads Indiana benefit mandates at subsection level for employers, where the difference between a requirement to cover and a requirement to offer is the whole answer. Start with the Wexford Health Insurance quote form.