Indiana § 27-8-11-1 - Definitions

§ 27-8-11-1. Definitions

Sec. 1. (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.

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