Chapter 1 Definitions
Chapter 2 Establishment of Health Maintenance Organizations
Chapter 3 Issuance of Certificates of Authority
Chapter 4 Powers of Health Maintenance Organizations
Chapter 5 Fiduciary Responsibilities
Chapter 6 Quality Management Programs
Chapter 7 Requirements for Group Contracts, Individual Contracts, and Evidence of Coverage
Chapter 8 Annual Report
Chapter 9 Information to Enrollees or Subscribers
Chapter 10 Grievance Procedures
Chapter 10.1 External Review of Grievances
Chapter 11 Investments
Chapter 12 Protection Against Insolvency; Net Worth Requirements
Chapter 13 Protection Against Insolvency; Deposit Requirements
Chapter 14 Protection Against Insolvency; Liabilities
Chapter 15 Participating Providers; Contracts and Legal Actions
Chapter 17 Protection Against Insolvency; Notice of Termination
Chapter 19 Replacement Coverage in Event of Receivership
Chapter 20 Filing Requirements
Chapter 21 Insurance Producers of Health Maintenance Organizations and Limited Service Health Maintenance Organizations
Chapter 22 Powers of Insurers and Hospital Corporations
Chapter 23 Examinations
Chapter 24 Suspension, Revocation, or Denial of Certificate of Authority
Chapter 25 Rehabilitation or Liquidation of Health Maintenance Organizations
Chapter 26 Summary of Orders and Supervision
Chapter 27 Fees
Chapter 28 Penalties and Enforcement
Chapter 29 Statutory Construction and Relationship to Other Laws
Chapter 30 Filings and Reports as Public Documents
Chapter 31 Confidentiality of Medical Information and Limitation of Liability
Chapter 32 Transfers of Ownership
Chapter 32.5 Voluntary Dissolution
Chapter 33 Coordination of Benefits
Chapter 34 Limited Service Health Maintenance Organizations
Chapter 35 General Rulemaking Authority
Chapter 36 Patient Protection; Clinical Decision Making; Access to Personnel and Facilities
Chapter 36.2 Provider Payment
Chapter 37 Patient Protection; Choice of Health Care Professional
Chapter 37.5 Mail Order and Internet Pharmacy Designation
Chapter 38 Patient Protection; Drugs and Devices; Drug Utilization Review Program
Chapter 39 Patient Protection; Experimental Treatments
Chapter 40 Patient Protection; Health Maintenance Organization Comparison Sheets
Chapter 41 Claims
Chapter 42 Specific Reporting Requirements
Chapter 43 Credentialing

Terms Used In Indiana Code > Title 27 > Article 13 - Health Maintenance Organizations

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Attorney: includes a counselor or other person authorized to appear and represent a party in an action or special proceeding. See Indiana Code 1-1-4-5
  • Autism: means a neurological condition as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. See Indiana Code 1-1-4-5
  • Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
  • Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
  • Caucus: From the Algonquian Indian language, a caucus meant "to meet together." An informal organization of members of the legislature that exists to discuss issues of mutual concern and possibly to perform legislative research and policy planning for its members. There are regional, political or ideological, ethnic, and economic-based caucuses.
  • Charity: An agency, institution, or organization in existence and operating for the benefit of an indefinite number of persons and conducted for educational, religious, scientific, medical, or other beneficent purposes.
  • clean claim: means a claim submitted by a provider for payment for health care services provided to an enrollee that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. See Indiana Code 27-13-36.2-1
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Dependent: A person dependent for support upon another.
  • discontinuance: means the termination of the contract between a group contract holder and a health maintenance organization due to the receivership of the health maintenance organization. See Indiana Code 27-13-19-1
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • enrollee: means an individual who is entitled to limited health services under a contract with an entity authorized to provide or arrange for limited health services under this chapter. See Indiana Code 27-13-34-1
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • evidence of coverage: means the certificate, agreement, or contract issued under section 13 of this chapter setting forth the coverage to which an enrollee is entitled. See Indiana Code 27-13-34-2
  • Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
  • Felony: A crime carrying a penalty of more than a year in prison.
  • Fiduciary: A trustee, executor, or administrator.
  • Fraud: Intentional deception resulting in injury to another.
  • Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
  • Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
  • health maintenance organization: includes :

    Indiana Code 27-13-36.2-2

  • in writing: include printing, lithographing, or other mode of representing words and letters. See Indiana Code 1-1-4-5
  • 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
  • Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. Source: OCC
  • Judgment: means all final orders, decrees, and determinations in an action and all orders upon which executions may issue. See Indiana Code 1-1-4-5
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • limited health services: refers to :

    Indiana Code 27-13-34-3

  • limited service health maintenance organization: means a corporation, partnership, limited liability company, or other entity that undertakes to provide or arrange a limited health service on a prepayment basis or other basis. See Indiana Code 27-13-34-4
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • medical record: means written or printed information possessed by a provider (as defined in IC 16-18-2-295) concerning any diagnosis, treatment, or prognosis of the patient, unless otherwise defined. See Indiana Code 1-1-4-5
  • Month: means a calendar month, unless otherwise expressed. See Indiana Code 1-1-4-5
  • National Bank: A bank that is subject to the supervision of the Comptroller of the Currency. The Office of the Comptroller of the Currency is a bureau of the U.S. Treasury Department. A national bank can be recognized because it must have "national" or "national association" in its name. Source: OCC
  • net worth: means the excess of total assets over total liabilities, excluding liabilities that have been subordinated in a manner acceptable to the commissioner. See Indiana Code 27-13-12-1
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Oversight: Committee review of the activities of a Federal agency or program.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Population: has the meaning set forth in IC 1-1-3. See Indiana Code 1-1-4-5
  • Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
  • Property: includes personal and real property. See Indiana Code 1-1-4-5
  • provider: means a physician, a dentist, an optometrist, a health facility, or other person or institution that is licensed or otherwise authorized to deliver or furnish limited health service. See Indiana Code 27-13-34-5
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • Statute: A law passed by a legislature.
  • Subpoena: A command to a witness to appear and give testimony.
  • subscriber: means a person whose employment status or other status, except for family dependency, is the basis for eligibility for limited health services under a contract with an entity authorized to provide or arrange for limited health services under this chapter. See Indiana Code 27-13-34-6
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • Trustee: A person or institution holding and administering property in trust.
  • Uphold: The decision of an appellate court not to reverse a lower court decision.
  • Year: means a calendar year, unless otherwise expressed. See Indiana Code 1-1-4-5