Whether you have five employees or 5,000, every employer has felt the pressure of rising Indiana Group Health Insurance costs. But now you have a new advantage with House Enrolled Act 1004, a state law that empowers you to demand transparency, control costs, and renegotiate what you’re paying for healthcare.
At Nefouse & Associates, we believe this law gives every Indiana employer—large or small—a seat at the table. Here’s what it means and how you can act on it.
New Employer Advantages in Indiana Group Health Insurance
1. Access Fairer Hospital Pricing
As of September 1, 2025, Indiana’s largest nonprofit hospital systems (like IU Health and Ascension) must offer employers direct-to-contract health plans priced at or below 260% of Medicare.
- Applies to all employer groups, fully insured or self-funded
- You can access compliant pricing through narrow networks or direct contracting.
- This requirement will be enforced with loss of nonprofit status if systems don’t comply.
This matters because Indiana employers often pay 350% of Medicare pricing and his law gives you the legal right to ask for something lower. You may experience potential savings of 15–25% on hospital claims.
2. Get Transparency Drug Rebates
Starting in 2026, you’ll receive the following disclosures:
- TPA compensation disclosures
- Annual summaries of drug rebates (from insurers or PBMs)
- Cost transparency for generics, based on NADAC (national average acquisition cost)
You also gain the right to audit your PBM once per year, a tool that was out of reach for most employers before.
These disclosures help you see the total cost picture and eliminate unnecessary markups or hidden fees, major wins for any company managing a benefits budget.
3. Push Back on Legacy Networks and Overpriced Plans
HEA 1004 levels the playing field. You no longer have to guess if your hospital network is inflating your costs.
- Ask your broker or carrier how your network compares to the 260% Medicare benchmark.
- Consider compliant narrow networks to reduce claims volatility.
- Restructure your plan design around real cost data and not carrier averages.
At Nefouse & Associates, we help Indiana employers at every size leverage this new law to optimize networks, explore level-funded or self-funded models, and negotiate better pharmacy terms.
This Law Was Made for Indiana Group Health Insurance Employers
HEA 1004 (2025) sends a clear message: Indiana’s health system must answer to employers. If you’re ready to take control of your Indiana Group Health Insurance plan—and your spend—we’re here to help you get there. Contact Nefouse & Associates today to schedule a no-obligation healthcare strategy review.
