BCBSTX member instructions
Agree on a price, submit the form with an itemized receipt and payment proof, then the carrier checks its plan rate.
Does Indiana's law apply to your plan?
This is the first question - before prices, before paperwork. Indiana's deductible-credit law applies to state-regulated health plans entered into or renewed after June 30, 2025.
Question one
Who takes the risk for your plan?
Choose the closest answer. This is a routing check, not an eligibility determination.
Your plan's duties
Indiana law requires a process.
The question is not whether there is a process. The law says there must be one. The question is where your plan publishes it and what it requires.
- Have a procedure for crediting direct payments and identify the required documentation.
- Either publish its average discounted rates or point members to Indiana Health Prices, the state's official price database.
- Display the procedure and documentation information on its website, with a link to the database.
What a carrier process looks like
This process already exists in carrier paperwork.
Blue Cross Blue Shield of Texas publishes step-by-step instructions and a standard medical claim form with a checkbox for cash-payment credit. Indiana plans use their own procedures, so ask your plan through the member portal and keep the written answer.
BCBSTX medical claim form
The ordinary member form includes a dedicated checkbox for in-network credit for a cash payment to a provider.
Indiana-regulated plans
This includes a plan you bought yourself on HealthCare.gov or directly from an insurer; a fully insured employer plan, where the insurer takes the claims risk; and the State of Indiana employee plan, which the law names specifically. Your plan still decides whether a particular payment qualifies.
Most large-employer plans
A large company may offer a plan administered by Anthem or UnitedHealthcare while paying the medical claims itself. That is a private self-funded (ERISA) employer plan governed mainly by federal law and generally outside this Indiana mandate. The State of Indiana employee plan is different: the statute names it specifically. The logo on an ID card identifies the administrator, not necessarily who takes the risk.
About two-thirds of covered workers nationwide are in self-funded plans. IU Fairbanks reports a similarly high self-funded share among Indiana's private-sector workforce.
KFF 2025 Employer Health Benefits Survey · IU Fairbanks Indiana analysis
Level-funded employer plans
Many smaller employers use level-funded plans. They can feel like conventional insurance - fixed monthly payments and a large carrier name - but are technically self-funded and generally outside state insurance mandates. KFF reports level funding in 37% of covered workers at firms with 10 to 199 workers. If your employer has fewer than 200 employees, ask rather than assume.
Federal and limited-benefit coverage
Medicare, Medicare Advantage, Medicaid, TRICARE, health-sharing ministries, short-term coverage, and fixed-indemnity plans are outside this Indiana mandate.
Get the funding answer in writing.
- Ask HR: "Is our health plan fully insured, self-funded, or level-funded?"
- Check plan documents: "insured by" or "underwritten by" points to fully insured. "Self-funded," "self-insured," or "administered by" points to self-funded.
- Ask through the member portal: "Is my plan subject to Indiana Code 27-1-48.5, the out-of-pocket expense credit?" Keep the written answer.
If the plan is privately self-funded
The mandate may not reach it. The cash price can still matter.
Paying a lower cash price may still cost less when you do not expect to reach your deductible. An employer may also choose to credit documented payments voluntarily. Ask HR whether the plan will do so before you pay.
When in doubt, ask in writing before paying cash. Nothing here is legal or insurance advice - your plan decides what qualifies under the law. Official Indiana Code · Open the qualification tool · Open the document kit