§ 27-8-11-1 — Definitions

Indiana § 27-8-11-1

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 11: Accident and Sickness Insurance─Reimbursement

Text

(a) The definitions in this section apply
throughout this chapter.
(b) "Credentialing" means a process through which an insurer
makes a determination:
(1) based on criteria established by the insurer; and
(2) concerning whether a provider is eligible to:
(A) provide health care services to an insured; and
(B) receive reimbursement for the health care services;
under an agreement entered into between the provider and the
insurer under section 3 of this chapter.
(c) "Health care services":
(1) means health care related services or products rendered or
sold by a provider within the scope of the provider's license or
legal authorization; and
(2) includes hospital, medical, surgical, dental, vision, and
pharmaceutical services or products.
(d) "Insured" means an individual entitled to reimbursement for
expenses of health care services under a policy issued or administered
by an insurer.
(e) "Insurer" means an insurance company authorized in this state
to issue policies that provide reimbursement for expenses of health care
services.
(f) "Person" means an individual, an agency, a political subdivision,
a partnership, a corporation, an association, or any other entity.
(g) "Preferred provider plan" means an undertaking to enter into
agreements with providers relating to terms and conditions of
reimbursements for the health care services of insureds, members, or
enrollees relating to the amounts to be charged to insureds, members,
or enrollees for health care services.
(h) "Provider" means an individual or entity duly licensed or legally
authorized to provide health care services.

Legislative History

As added by P.L.140-1984, SEC.1. Amended by P.L.31-1988, SEC.22; P.L.26-2005, SEC.1.