Terms Used In Indiana Code > Title 25 > Article 1 > Chapter 9.1 - Out of Network Provider Referrals

• affiliated: refers to a provider that is a member of the same provider group as another provider. See Indiana Code 25-1-9.1-2
• Contract: A legal written agreement that becomes binding when signed.
• covered individual: means an individual who is entitled to coverage under a health plan. See Indiana Code 25-1-9.1-3
• emergency medical condition: means a medical condition that arises suddenly and unexpectedly and manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent lay person who possesses an average knowledge of health and medicine to:

  Indiana Code 25-1-9.1-4

• health plan: means :

  Indiana Code 25-1-9.1-5

• Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. ^{Source: FDIC}
• network: means a group of two (2) or more providers that have entered into:

  Indiana Code 25-1-9.1-6

• network provider: means a provider described in section 6 of this chapter. See Indiana Code 25-1-9.1-7
• out of network provider: means a provider that is not described in section 6 of this chapter. See Indiana Code 25-1-9.1-8
• provider: means a practitioner described in IC 25-1-9-2(a)(1). See Indiana Code 25-1-9.1-9
• provider group: means a legal entity:

  Indiana Code 25-1-9.1-10

• referral: means a recommendation or direction made by a provider to a covered individual that the covered individual receive a health care item or service rendered by another provider that is not affiliated with the first provider. See Indiana Code 25-1-9.1-11