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IC 27-1-37-2
"Health maintenance organization" defined
Sec. 2. As used in this chapter, "health maintenance organization"
means a person that undertakes to provide or arrange for the delivery
of health care services to individuals on a prepaid basis, except for
the individual's responsibility for copayments or deductibles. The
term includes a limited service health maintenance organization. The
term does not include a staff-model health maintenance organization
that employs a group of providers and that requires the providers to
provide health care services solely to individuals who are entitled to
coverage under a contract with the staff-model health maintenance
organization or an affiliate of the staff-model health maintenance
organization.
As added by P.L.197-2001, SEC.1.
IC 27-1-37-3
"Health provider contract" defined
Sec. 3. As used in this chapter, "health provider contract" means
an agreement with a provider relating to terms and conditions of
reimbursement for health care services provided to an individual
under:
(1) an employee welfare benefit plan (as defined in 29 U.S.C.
1002 et seq.);
(2) a policy of accident and sickness insurance (as defined in
IC 27-8-5-1);
(3) a contract with a health maintenance organization;
(4) a self-insurance program established under IC 5-10-8-7(b);
or
(5) a prepaid health care delivery plan entered into under
IC 5-10-8-7(c).
As added by P.L.197-2001, SEC.1.
IC 27-1-37-5
"Provider" defined
Sec. 5. As used in this chapter, "provider" means an individual or
entity licensed or legally authorized to provide health care services.
As added by P.L.197-2001, SEC.1.
IC 27-1-37-6
Requiring provider to provide health care services
Sec. 6. (a) Except as provided in subsection (b), a person may not
require a provider, as a condition of entering into a health provider
contract for the provision of health care services other than health
care services to enrollees of a health maintenance organization, to
provide health care services to enrollees of a health maintenance
organization.
(b) A person may require a provider, as a condition of entering
into a health provider contract for the provision of health care
services other than health care services to enrollees of a health
maintenance organization, to provide health care services to enrollees
of a health maintenance organization:
(1) in an emergency; or
(2) upon referral.
(c) If a person requires a provider to provide health care services
to enrollees of a health maintenance organization under subsection
(b), the person:
(1) shall reimburse the provider at rates established under the
health provider contract; and
(2) may not require the provider to comply with the terms and
conditions of the health maintenance organization.
As added by P.L.197-2001, SEC.1.