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16-25A-41
Section 16-25A-41 Definitions. The following terms shall have the following meanings, unless
the context clearly indicates otherwise: (1) BOARD. The Public Education Flexible Employees
Benefit Board. (2) EMPLOYEE. Any person employed by a state or local board of education, postsecondary
institution, or other employer with employees as defined by Sections 16-25A-1 and 16-25A-11
participating in a state health insurance program. (3) EMPLOYER. Any local board of education
within the State of Alabama or other public institution of education within the state that
provides instruction at any combination of grades K-14 exclusively, under the auspices of
the State Board of Education, or the Alabama Institute for Deaf and Blind, or entities whose
employees are covered by the Public Education Employees' Health Insurance Plan pursuant to
Section 16-25A-11. (4) INTERNAL REVENUE CODE. The Internal Revenue Code of 1986, as amended.
(5) PARTICIPATING EMPLOYEE. An employee who elects to participate in...
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27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive denials,
adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health benefit
plan that issues or renews any policy of accident or health insurance providing benefits for
medical or hospital expenses for its insured persons shall pay for services rendered by Alabama
health care providers within 45 calendar days upon receipt of a clean written claim or 30
calendar days upon receipt of a clean electronic claim. If the insurer, health service corporation,
or health benefit plan is denying or pending the claim, the insurer, health service corporation,
or health benefit plan shall, within 45 calendar days for a written claim and 30 calendar
days for an electronic claim, notify the health care provider or certificate holder of the
reason for denying or pending the claim and what, if any, additional information is required
to process the claim. Any undisputed portion of the claim...
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16-25A-21
Section 16-25A-21 Flexible employees' benefits programs. Employee premium contributions shall
be deducted, by all employers, from payroll on a pretax basis as permitted under Section 125
of the Internal Revenue Code. The board is authorized to transfer the necessary funds from
the Public Education Employees' Health Insurance Plan to the fund established by the Public
Education Flexible Employees Benefit Board for the administration of the Public Education
Flexible Employees Benefits Program. All public education employees shall be offered flexible
spending accounts by employers for pretax deductions for medical and childcare expenses. (Act
2004-646, 1st Sp. Sess., p. 6, ยง4.)...
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16-25A-1
Section 16-25A-1 Definitions. When used in this article, the following terms shall have the
following meanings, respectively, unless the context clearly indicates otherwise: (1) EMPLOYEE.
Any person covered by the Public Education Employees' Health Insurance Plan pursuant to Section
16-25A-11 or person who is employed full-time in any public institution of education within
the State of Alabama which provides instruction at any combination of grades K through 14,
exclusively, under the auspices of the State Board of Education or the Alabama Institute for
Deaf and Blind; provided, any person employed part-time by any public institution of education
within the State of Alabama which provides instruction at any combination of grades K through
14, exclusively, under the auspices of the State Board of Education or the Alabama Institute
for Deaf and Blind, shall be included in the definition of employee if such person shall agree
to have deducted from his or her compensation a pro rata...
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27-19A-12
Section 27-19A-12 Dental services - Coverages; fees; exceptions. (a) As used in this section,
the following terms shall have the following meanings: (1) COVERED PERSON. Any individual,
family, or family member on whose behalf third-party payment or prepayment of health or medical
expenses is provided under an insurance policy, plan, or contract providing for third-party
payment or prepayment of health care or medical expenses. (2) COVERED SERVICES. Dental care
services for which a reimbursement is available under an enrollee's plan contract, or for
which a reimbursement would be available but for the application of contractual limitations
such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums,
frequency limitations, alternative benefit payments, or any other limitation. (3) DENTAL CARE
PROVIDER. A licensed dentist. (4) DENTAL PLAN. Includes any policy of insurance which is issued
by a health care service contractor which provides for coverage of...
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27-46-1
Section 27-46-1 Reimbursement or payment for services. Notwithstanding any other provision
of law, when any contract or plan of health insurance, or any plan or agreement for health
care services provides for the reimbursement or payment for services which are within the
scope of practice of registered nurses who have passed or who are qualified to take the national
certification examination for the specialty practice of nurse anesthetist as recognized by
the Alabama Board of Nursing, then the insured, or any other person covered by the policy,
plan, contract, or certificate shall be entitled to reimbursement or payment for such services
performed by the certified registered nurse anesthetist, and said certified registered nurse
anesthetist shall be entitled to direct reimbursement by the insurer, unless the certified
registered nurse anesthetist is employed by contract with a group practice of anesthesiologist
or a hospital, then such services shall be reimbursed through the employer....
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27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases shall
have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health. (2)
ENROLLEE. An individual who has contracted for or who participates in coverage under an insurance
policy, a health maintenance organization contract, a health service corporation contract,
an employee welfare benefit plan, a hospital or medical services plan, or any other benefit
program providing payment, reimbursement, or indemnification for health care costs for the
individual or the eligible dependents of the individual. (3) PROVIDER. A health care provider
duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system for prospective
and concurrent review of the necessity and appropriateness in the allocation of health care
resources and services given or proposed to be given to an individual within this state. The
term does not include elective requests for clarification of...
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11-91A-2
Section 11-91A-2 Local Government Health Insurance Board; governance and administration of
program. (a) The Local Government Health Insurance Board shall govern and administer the Local
Government Health Insurance Program currently governed and administered by the State Employees'
Insurance Board (SEIB) pursuant to Chapter 29 of Title 36. The transfer of the governance
and administration to the board shall take effect at 12:01 a.m. on January 1, 2015, and thereafter
the board shall take all control and responsibility for the program under procedures and authority
set out in this chapter. (b) The program governed and administered by the board shall provide
a reasonable relationship between the health care benefits to be included and the expected
health care expenses to be incurred by affected employees, retirees, and their dependents.
The board may establish a fully insured or self-insured health care plan for employees and
retirees as defined in this chapter and may adopt rules for the...
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27-56-2
Section 27-56-2 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) COVERED PERSON. Any individual, family, or family member on whose behalf third-party
payment or prepayment of health or medical expenses is provided under an insurance policy,
plan, or contract providing for third-party payment or prepayment of health care or medical
expenses. (2) EYE CARE PROVIDER. A licensed optometrist or a licensed ophthalmologist. (3)
INSURANCE POLICY, PLAN, OR CONTRACT PROVIDING FOR THIRD-PARTY PAYMENT OR PREPAYMENT OF HEALTH
OR MEDICAL EXPENSES. Includes an individual or group policy for accident or health insurance,
an individual or group hospital or health care service contract, an individual or group health
maintenance organization contract, an organized delivery system contract, or a preferred provider
organization contract, and any other similar policy, plan, or contract. This term shall not
include any employee welfare benefit plan, as defined...
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36-1-6.2
Section 36-1-6.2 Insurance coverage for state instrumentalities and agencies; prior contracts
and policies ratified. (a) Any instrumentality or agency of the State of Alabama, whose principal
activity consists of distributing goods or services by contract with the United States, or
any federal governmental corporation, and which are not covered by the provisions of Chapter
29 of this title, shall be subject to all the provisions of this section. Such instrumentality
or agency is hereby empowered to purchase and pay for group health, accident or hospitalization
insurance coverage for its officers and employees. Such instrumentality or agency is hereby
further authorized to contract with the State Employees' Insurance Board for group health,
accident or hospitalization insurance coverage, and under such terms, conditions, and costs
as the State Employees' Insurance Board and the instrumentality or agency shall mutually determine.
The cost or premium for such group health, accident or...
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