Terms Used In Indiana Code > Title 4 > Article 32.3 > Chapter 5 - Conduct of Allowable Activities

• accredited state: means a state in which the insurance department or regulatory agency has qualified as meeting the minimum financial regulatory standards promulgated and established by the NAIC. See Indiana Code 27-1-35-2
• actuary: means a person who is a member in good standing of the American Academy of Actuaries. See Indiana Code 27-1-33-1
• adjusted RBC report: means an RBC report that has been adjusted by the commissioner under section 28 of this chapter. See Indiana Code 27-1-36-2
• Administrator: means a person who directly or indirectly and on behalf of an insurer underwrites, collects charges or premiums from, or adjusts or settles claims on residents of Indiana in connection with life, annuity, or health coverage offered or provided by an insurer. See Indiana Code 27-1-25-1
• affiliate: means any person who, directly or indirectly through one (1) or more intermediaries, controls, is controlled by, or is under common control with, the person to whom affiliation is attributed. See Indiana Code 27-1-37-0.2
• affiliate: has the meaning set forth in IC 27-1-25-1. See Indiana Code 27-1-37.3-2
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
• 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.
• Appraisal: A determination of property value.
• arrangement: refers to a multiple employer welfare arrangement. See Indiana Code 27-1-34-1
• articles of incorporation: includes both the original articles of incorporation and any and all amendments thereto, except where the original articles of incorporation only are expressly referred to, and includes articles of merger, consolidation and reinsurance, and in case of corporations, heretofore organized, articles of reorganization filed in the office of the secretary of state, and all amendments thereto. See Indiana Code 27-1-2-3
• 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
• Attorney-in-fact: A person who, acting as an agent, is given written authorization by another person to transact business for him (her) out of court.
• authorized control level event: has the meaning set forth in section 39 of this chapter. See Indiana Code 27-1-36-3
• authorized control level RBC: means , with respect to an insurer, the number determined under the risk-based capital formula in accordance with the RBC Instructions. See Indiana Code 27-1-36-4
• automated claims adjudication system: means a preprogrammed computer system that:

  Indiana Code 27-1-28-3

• capital: means the aggregate amount paid in on the shares of capital stock of a corporation issued and outstanding. See Indiana Code 27-1-2-3
• casualty and liability insurance: means the types of insurance described in IC 27-1-5-1, Class 2(h) and 2(l). See Indiana Code 27-1-30-2
• casualty insurance company: has the meaning set forth in IC 27-1-2-3(t). See Indiana Code 27-1-30-3
• catastrophe: means an event that is the subject of a declaration by the commissioner and that:

  Indiana Code 27-1-28-4

• certificate of authority: means an instrument in writing issued by the department to an insurer, which sets out the authority of such insurer to engage in the business of insurance or activities connected therewith. See Indiana Code 27-1-2-3
• 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.
• Church plan: has the meaning set forth in IC 27-8-10-1. See Indiana Code 27-1-25-1
• commission: refers to the Indiana political subdivision risk management commission established by this chapter. See Indiana Code 27-1-29-1
• commission: refers to the Indiana political subdivision risk management commission established by IC 27-1-29-5. See Indiana Code 27-1-29.1-1
• Commissioner: refers to the insurance commissioner appointed under IC 27-1-1-2. See Indiana Code 27-1-25-1
• Commissioner: refers to the insurance commissioner. See Indiana Code 27-1-26-1
• commissioner: refers to the insurance commissioner appointed under IC 27-1-1-2. See Indiana Code 27-1-33-2
• Commissioner: means the "insurance commissioner" of this state. See Indiana Code 27-1-2-3
• company action level event: has the meaning set forth in section 29 of this chapter. See Indiana Code 27-1-36-5
• company action level RBC: means , with respect to an insurer, the product of two (2) multiplied by the insurer's authorized control level RBC. See Indiana Code 27-1-36-6
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Continuance: Putting off of a hearing ot trial until a later time.
• Contract: A legal written agreement that becomes binding when signed.
• contract holder: means :

  Indiana Code 27-1-24.5-0.7

• contractor: refers to a person with a primary business purpose of entering into health care contracts with providers. See Indiana Code 27-1-37.3-3
• Control: means the direct or indirect possession of the power to direct or cause the direction of the management and policies of a person, whether:

  Indiana Code 27-1-25-1

• controlled: has the meaning set forth in IC 27-1-23-1. See Indiana Code 27-1-35-4
• controlled insurer: means a licensed insurer that is controlled, directly or indirectly, by a producer. See Indiana Code 27-1-35-5
• controlling producer: means a producer that, directly or indirectly, controls an insurer. See Indiana Code 27-1-35-6
• Conviction: A judgement of guilt against a criminal defendant.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• corporation: means an insurance company and includes all persons, partnerships, corporations, associations, orders or societies engaged in or proposing to engage in making any kind of insurance authorized by the laws of this state. See Indiana Code 27-1-2-3
• corrective order: means an order issued by the commissioner that specifies the corrective actions that the commissioner determines are required. See Indiana Code 27-1-36-7
• covered individual: means an individual who is entitled to coverage under a health plan. See Indiana Code 27-1-24.5-1
• Covered individual: means an individual who is covered under a benefit program provided by an insurer. See Indiana Code 27-1-25-1
• covered individual: means an individual who is entitled to coverage under a health plan. See Indiana Code 27-1-37.3-4
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Department: refers to the insurance department. See Indiana Code 27-1-26-1
• Department: means "the department of insurance" of this state. See Indiana Code 27-1-2-3
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• domestic insurer: means any:

  Indiana Code 27-1-36-8

• effective rate of reimbursement: includes the following:

  Indiana Code 27-1-24.5-2

• Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) ^{Source: OCC}
• emergency: 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 27-1-37-1

• equal access and incentives: means that a pharmacy benefit manager allows any willing pharmacy provider to participate as part of any of the pharmacy benefit manager's networks as long as the pharmacy provider agrees to the terms and conditions of the relevant contract applicable to any other pharmacy provider within that network. See Indiana Code 27-1-24.5-3
• 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.
• Federal Reserve System: The central bank of the United States. The Fed, as it is commonly called, regulates the U.S. monetary and financial system. The Federal Reserve System is composed of a central governmental agency in Washington, D.C. (the Board of Governors) and twelve regional Federal Reserve Banks in major cities throughout the United States. ^{Source: OCC}
• Fiduciary: A trustee, executor, or administrator.
• Financial institution: means a bank, savings association, credit union, or any other institution regulated under IC 28 or federal law. See Indiana Code 27-1-25-1
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Fixed Rate: Having a "fixed" rate means that the APR doesn't change based on fluctuations of some external rate (such as the "Prime Rate"). In other words, a fixed rate is a rate that is not a variable rate. A fixed APR can change over time, in several circumstances:
  • You are late making a payment or commit some other default, triggering an increase to a penalty rate
  • The bank changes the terms of your account and you do not reject the change.
  • The rate expires (if the rate was fixed for only a certain period of time).
• foreign insurer: means the following:

  Indiana Code 27-1-36-9

• fraternal benefit society: refers to a society (as defined in IC 27-11-1-11) that holds a certificate of authority issued under IC 27-11-4 or IC 27-11-8-5. See Indiana Code 27-1-36-9.2
• Fraud: Intentional deception resulting in injury to another.
• fund: refers to the political subdivision risk management fund established by this chapter. See Indiana Code 27-1-29-2
• fund: refers to the political subdivision catastrophic liability fund established by this chapter. See Indiana Code 27-1-29.1-2
• GAAP: refers to consistently applied United States generally accepted accounting principles. See Indiana Code 27-1-25-1
• generic drug: means a drug product that is identified by the drug's chemical name and that is:

  Indiana Code 27-1-24.5-4

• Governmental plan: has the meaning set forth in IC 27-8-10-1. See Indiana Code 27-1-25-1
• health benefit plan: means coverage for health care services provided under:

  Indiana Code 27-1-37.2-1

• health care contract: means a contract between a person and a provider specifying the rights and responsibilities of the:

  Indiana Code 27-1-37.3-6

• health carrier: means an entity:

  Indiana Code 27-1-37-1.5

• health insurance educator: refers to the health insurance educator appointed under section 6 of this chapter. See Indiana Code 27-1-37.2-3
• health insurer: means the following:

  Indiana Code 27-1-36-9.3

• health maintenance organization: has the meaning set forth in IC 27-13-1-19. See Indiana Code 27-1-36-9.4
• 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. See Indiana Code 27-1-37-2
• 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. See Indiana Code 27-1-37.1-1
• health plan: means the following:

  Indiana Code 27-1-24.5-5

• health plan: means a plan through which coverage is provided for health care services through insurance, prepayment, reimbursement, or otherwise. See Indiana Code 27-1-37.3-5
• health provider contract: means an agreement with a provider or a health provider facility relating to terms and conditions of reimbursement for health care services provided to an individual under:

  Indiana Code 27-1-37-3

• 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:

  Indiana Code 27-1-37.1-2

• health provider facility: means any of the following:

  Indiana Code 27-1-37-3.2

• Home state: means the District of Columbia or any state or territory of the United States in which an administrator is incorporated or maintains the administrator's principal place of business. See Indiana Code 27-1-25-1
• home state: means :

  Indiana Code 27-1-28-5

• hospital system: means :

  Indiana Code 27-1-37-3.5

• 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}
• independent adjuster: means a person, or an independent contractor or employee of a person, that:

  Indiana Code 27-1-28-6

• independent pharmacies: means pharmacies that are not a pharmacy benefit manager affiliate. See Indiana Code 27-1-24.5-6
• Insurance: means a contract of insurance or an agreement by which one (1) party, for a consideration, promises to pay money or its equivalent or to do an act valuable to the insured upon the destruction, loss or injury of something in which the other party has a pecuniary interest, or in consideration of a price paid, adequate to the risk, becomes security to the other against loss by certain specified risks; to grant indemnity or security against loss for a consideration. See Indiana Code 27-1-2-3
• Insurance producer: has the meaning set forth in Indiana Code 27-1-25-1
• Insurer: means :

  Indiana Code 27-1-25-1

• insurer: has the meaning set forth in IC 27-1-25-1(l). See Indiana Code 27-1-25.1-2
• insurer: means a life or health insurance company, fraternal benefit society, prepaid health plan, dental care plan, vision care plan, pharmaceutical plan, health maintenance organization, and all similar type organizations. See Indiana Code 27-1-26-1
• insurer: means any person, firm, association, or corporation duly authorized to act in Indiana as an insurance company pursuant to IC 27-1. See Indiana Code 27-1-33-3
• insurer: means any person, firm, association, or corporation licensed to transact a property/casualty insurance business in Indiana. See Indiana Code 27-1-35-7
• insurer: includes :

  Indiana Code 27-1-36-9.6

• insurer: means a company, firm, partnership, association, order, society or system making any kind or kinds of insurance and shall include associations operating as Lloyds, reciprocal or inter-insurers, or individual underwriters. See Indiana Code 27-1-2-3
• 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
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• 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.
• liability: means an obligation arising from a claim for the payment of money in an amount established under IC 34-13-3 (or Indiana Code 27-1-29-3
• liability: means an obligation arising from:

  Indiana Code 27-1-29.1-3

• life insurer: means an insurer that makes one (1) or more of the types of insurance described in Class 1 of IC 27-1-5-1. See Indiana Code 27-1-36-10
• limited service health maintenance organization: has the meaning set forth in IC 27-13-34-4. See Indiana Code 27-1-36-9.8
• mandatory control level event: has the meaning set forth in section 41 of this chapter. See Indiana Code 27-1-36-11
• mandatory control level RBC: means , with respect to an insurer, the product of seven-tenths (. See Indiana Code 27-1-36-12
• maximum allowable cost: means the maximum amount that a pharmacy benefit manager will reimburse a pharmacy for the cost of a generic drug. See Indiana Code 27-1-24.5-7
• maximum allowable cost list: means a list of drugs that is used:

  Indiana Code 27-1-24.5-8

• member: refers to any political subdivision that has a membership in the fund, as provided in section 9 of this chapter. See Indiana Code 27-1-29.1-4
• member: means one who holds a contract of insurance or is insured in an insurance company other than a stock corporation. See Indiana Code 27-1-2-3
• MGA: means any person, firm, association, or corporation:

  Indiana Code 27-1-33-4

• Month: means a calendar month, unless otherwise expressed. See Indiana Code 1-1-4-5
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• multiple employer welfare arrangement: means an entity other than a duly admitted insurer that establishes an employee benefit plan for the purpose of offering or providing accident and sickness or death benefits to the employees of at least two (2) employers, including self-employed individuals and their dependents. See Indiana Code 27-1-34-1
• NAIC: refers to the National Association of Insurance Commissioners. See Indiana Code 27-1-28-7
• NAIC: refers to the National Association of Insurance Commissioners. See Indiana Code 27-1-36-13
• negative trend: means , with respect to an insurer, a negative trend over a period of time, as determined in accordance with the trend test calculation included in the RBC instructions. See Indiana Code 27-1-36-14
• Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose.
• Nonresident administrator: means a person that applies for or holds a license under section 12. See Indiana Code 27-1-25-1
• 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.
• ORSA summary report: means a confidential, high level summary of an insurer or insurance group's ORSA. See Indiana Code 27-1-23.5-7
• 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.
• permitted group: means a group of ten (10) or more commercial, business, or not-for-profit entities that have a preexisting relationship to one another through:

  Indiana Code 27-1-30.4-1

• Person: has the meaning set forth in Indiana Code 27-1-25-1
• person: refers to a person described in IC 27-1-25-1(a)(15). See Indiana Code 27-1-25.1-3
• person: means an individual, an agency, a political subdivision, a partnership, a corporation, an association, or any other entity. See Indiana Code 27-1-37-4
• person: means an individual, an agency, a political subdivision, a partnership, a corporation, an association, or any other entity that enters into a health provider contract with a provider. See Indiana Code 27-1-37.1-3
• person: includes individuals, corporations, associations, and partnerships; personal pronoun includes all genders; the singular includes the plural and the plural includes the singular. See Indiana Code 27-1-2-3
• pharmacist: means an individual licensed as a pharmacist under IC 25-26. See Indiana Code 27-1-24.5-9
• pharmacist services: means products, goods, and services provided as part of the practice of pharmacy. See Indiana Code 27-1-24.5-10
• pharmacy: means the physical location:

  Indiana Code 27-1-24.5-11

• pharmacy benefit manager: means an entity that, on behalf of a health plan, state agency, insurer, managed care organization, or other third party payor:

  Indiana Code 27-1-24.5-12

• pharmacy benefit manager affiliate: means a pharmacy or pharmacist that directly or indirectly, through one (1) or more intermediaries:

  Indiana Code 27-1-24.5-13

• pharmacy services administrative organization: means an organization that assists independent pharmacies and pharmacy benefit managers or health plans to achieve administrative efficiencies, including contracting and payment efficiencies. See Indiana Code 27-1-24.5-15
• Plea: In a criminal case, the defendant's statement pleading "guilty" or "not guilty" in answer to the charges, a declaration made in open court.
• policy form: means :

  Indiana Code 27-1-26-1

• policyholder: means one who is a holder of a contract of insurance in an insurance company. See Indiana Code 27-1-2-3
• political subdivision: has the meaning set forth in IC 34-6-2-110. See Indiana Code 27-1-29-4
• political subdivision: has the meaning set forth in IC 34-6-2-110. See Indiana Code 27-1-29.1-5
• position: means the position of health insurance educator established under section 5 of this chapter. See Indiana Code 27-1-37.2-4
• 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}
• premium: means money or any other thing of value paid or given in consideration to an insurer, insurance producer, or solicitor on account of or in connection with a contract of insurance and shall include as a part but not in limitation of the above, policy fees, admission fees, membership fees and regular or special assessments and payments made on account of annuities. See Indiana Code 27-1-2-3
• Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed.
• producer: means an insurance broker or brokers or any other person, firm, association, or corporation, when, for any compensation, commission, or other thing of value, the person, firm, association, or corporation acts or aids in any manner in soliciting, negotiating, or procuring the making of any insurance contract on behalf of an insured other than the person, firm, association, or corporation. See Indiana Code 27-1-35-8
• Property: includes personal and real property. See Indiana Code 1-1-4-5
• property and casualty insurance: means one (1) or more of the types of insurance described in IC 27-1-5-1, Class 2 and Class 3. See Indiana Code 27-1-30.4-2
• property and casualty insurer: means an insurer that is authorized to make one (1) or more of the types of insurance described in Class 2 and Class 3 of IC 27-1-5-1. See Indiana Code 27-1-36-15
• provider: means an individual or entity licensed or legally authorized to provide health care services. See Indiana Code 27-1-37-5
• provider: means :

  Indiana Code 27-1-37.1-4

• RBC: refers to risk based capital. See Indiana Code 27-1-36-16
• RBC level: means an insurer's:

  Indiana Code 27-1-36-18

• RBC plan: means a comprehensive financial plan containing the elements specified in section 30 of this chapter. See Indiana Code 27-1-36-19
• RBC report: means the report required by section 25 of this chapter. See Indiana Code 27-1-36-20
• rebate: means a discount or other price concession that is:

  Indiana Code 27-1-24.5-16

• regulatory action level event: has the meaning set forth in section 35 of this chapter. See Indiana Code 27-1-36-21
• regulatory action level RBC: means , with respect to an insurer, the product of one and five-tenths (1. See Indiana Code 27-1-36-22
• Reinsurer: means an insurer that:

  Indiana Code 27-1-2-3

• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• revised RBC plan: means the revised RBC plan that an insurer must prepare, with or without the commissioner's recommendation, if the commissioner rejects the insurer's previous RBC plan. See Indiana Code 27-1-36-23
• Service of process: The service of writs or summonses to the appropriate party.
• 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.
• shareholder: means one who is a holder of record of shares of stock in a corporation, unless the context otherwise requires. See Indiana Code 27-1-2-3
• Statute: A law passed by a legislature.
• Subpoena: A command to a witness to appear and give testimony.
• Testify: Answer questions in court.
• Text: means all printed matter except the following:

  Indiana Code 27-1-26-1

• third party: means a person other than a:

  Indiana Code 27-1-24.5-17

• Tort: A civil wrong or breach of a duty to another person, as outlined by law. A very common tort is negligent operation of a motor vehicle that results in property damage and personal injury in an automobile accident.
• total adjusted capital: means the sum of:

  Indiana Code 27-1-36-24

• Transcript: A written, word-for-word record of what was said, either in a proceeding such as a trial or during some other conversation, as in a transcript of a hearing or oral deposition.
• Trustee: A person or institution holding and administering property in trust.
• underlying coverage: refers to any liability insurance policy that names a member of the fund or its officials or employees as a named insured, an additional named insured, an insured, or an additional insured. See Indiana Code 27-1-29.1-6
• United States: includes the District of Columbia and the commonwealths, possessions, states in free association with the United States, and the territories. See Indiana Code 1-1-4-5
• Variable Rate: Having a "variable" rate means that the APR changes from time to time based on fluctuations in an external rate, normally the Prime Rate. This external rate is known as the "index." If the index changes, the variable rate normally changes. Also see Fixed Rate.
• Verified: when applied to pleadings, means supported by oath or affirmation in writing. See Indiana Code 1-1-4-5
• Year: means a calendar year, unless otherwise expressed. See Indiana Code 1-1-4-5