CHAPTER 1. DEFINITIONS
IC 27-17
ARTICLE 17. DISCOUNT MEDICAL CARD
PROGRAM ORGANIZATIONS
IC 27-17-1
Chapter 1. Definitions
IC 27-17-1-1
Application of definitions
Sec. 1. The definitions in this chapter apply throughout this
article.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-2
"Cardholder"
Sec. 2. "Cardholder" means a person that pays consideration for
the right to participate in a discount medical card program.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-3
"Commissioner"
Sec. 3. "Commissioner" refers to the insurance commissioner
appointed under IC 27-1-1-2.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-4
"Department"
Sec. 4. "Department" refers to the department of insurance created
by IC 27-1-1-1.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-5
"Discount medical card program"
Sec. 5. "Discount medical card program" means a program
through which a discount medical card program organization
provides, in exchange for consideration, a cardholder with access to
medical services provided by a program provider under a provider
agreement. The term does not include:
(1) a policy or contract regulated under this title; or
(2) self-funded coverage regulated under the federal Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1001 et
seq.).
As added by P.L.73-2006, SEC.3.
IC 27-17-1-6
"Discount medical card program organization"
Sec. 6. (a) "Discount medical card program organization" means
a person that:
(1) negotiates and enters into provider agreements;
(2) in exchange for consideration, provides cardholders with a
right of access to the discounted prices available under the
provider agreements entered into under subdivision (1); and
(3) determines the charge to cardholders for the discount prices.
(b) The term does not include the following:
(1) An insurance company, or an affiliate (as defined in
IC 27-1-12-2) of an insurance company, that is regulated under
this title.
(2) A health maintenance organization, or an affiliate (as
defined in IC 27-1-12-2) of a health maintenance organization,
that is regulated under this title.
(3) A limited service health maintenance organization, or an
affiliate (as defined in IC 27-1-12-2) of a limited service health
maintenance organization, that is regulated under this title.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-7
"Marketer"
Sec. 7. "Marketer" means a person that markets, promotes, sells,
or distributes a discount medical card program. The term includes a
person that markets or distributes a discount medical card program
under the person's own name, but does not operate a discount
medical card program.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-8
"Medical service"
Sec. 8. (a) "Medical service" means care, service, or treatment
related to:
(1) an illness or a dysfunction of; or
(2) injury to;
the human body.
(b) The term includes physician care, inpatient care, hospital
services, surgical services, emergency services, ambulance services,
dental care services, vision care services, mental health services,
substance abuse services, chiropractic services, podiatric care
services, laboratory services, radiology services, and medical
equipment and supplies.
(c) The term does not include pharmaceutical supplies or
prescriptions.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-9
"Person"
Sec. 9. "Person" means an individual or a business entity.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-10
"Program provider"
Sec. 10. "Program provider" means a provider that has,
individually or through a provider network, entered into a provider
agreement with a discount medical card program organization.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-11
"Provider"
Sec. 11. "Provider" means a person that is licensed under Indiana
law to provide medical services.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-12
"Provider agreement"
Sec. 12. "Provider agreement" means a written agreement between
a discount medical card program organization and a:
(1) provider; or
(2) provider network;
for the provider or providers that belong to the provider network to
render medical services to cardholders at discounted rates.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-13
"Provider network"
Sec. 13. "Provider network" means a group of two (2) or more
providers that is represented by a person for purposes of negotiations
with third parties.
As added by P.L.73-2006, SEC.3.
IC 27-17-1-14
"Service area"
Sec. 14. "Service area" means a geographic area within a radius
of sixty (60) miles from the home or place of business of a
cardholder.
As added by P.L.73-2006, SEC.3.