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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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27-54-4
Section 27-54-4 Illnesses covered; requirements of benefit plans, etc. (a) All group
health benefit plans shall offer to provide, at a minimum, additional benefits according to
this chapter for a person receiving medical treatment for any of the following mental illnesses
diagnosed by an appropriately licensed provider. (1) Schizophrenia, schizophrenia form disorder,
schizo affective disorder. (2) Bipolar disorder. (3) Panic disorder. (4) Obsessive-compulsive
disorder. (5) Major depressive disorder. (6) Anxiety disorders. (7) Mood disorders. (8) Any
condition or disorder involving mental illness, excluding alcohol and substance abuse, that
falls under any of the diagnostic categories listed in the mental disorders section
of the International Classification of Disease, as periodically revised. (b) All group health
benefit plans, policies, contracts, and certificates executed, delivered, issued for delivery,
continue, or renewed in this state on or after January 1, 2001, shall offer, at...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-54-4.htm - 3K - Match Info - Similar pages
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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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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22-21-361
Section 22-21-361 Definitions. The following terms shall have the meanings respectively
ascribed by this section unless the context clearly indicates otherwise: (1) COMMISSIONER.
The commissioner of insurance of this state. (2) DENTAL SERVICE PLAN or PLAN. Any plan or
other arrangement whereby dental services are provided in whole or in part through a dental
service corporation by dentists participating in the plan to provide dental services to those
members of the public who become subscribers to the plan under a contract with such corporation.
The terms "dental service plan" or "plan" do not include an insurer authorized
by the insurance department to transact insurance in this state or to a nonprofit health insurance
plan organized pursuant to Section 10-4-100, or to any policy of insurance or contract
which includes dental benefits issued by such insurer or nonprofit health insurance plan.
(3) DEPARTMENT. The Department of Insurance. (4) LICENSE. The certificate of authority issued...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-361.htm - 1K - Match Info - Similar pages
27-1-10.1
Section 27-1-10.1 Insurance coverage for drugs to treat life-threatening illnesses.
(a) The Legislature finds and declares the following: (1) The citizens of this state rely
upon health insurance to cover the cost of obtaining health care and it is essential that
the citizens' expectation that their health care costs will be paid by their insurance policies
is not disappointed and that they obtain the coverage necessary and appropriate for their
care within the terms of their insurance policies. (2) Some insurers deny payment for drugs
that have been approved by the Federal Food and Drug Administration, hereafter referred to
as FDA, when the drugs are used for indications other than those stated in the labelling approved
by the FDA, off-label use, while other insurers with similar coverage terms do pay for off-label
use. (3) Denial of payment for off-label use can interrupt or effectively deny access to necessary
and appropriate treatment for a person being treated for a...
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27-54-2
Section 27-54-2 Definitions. For purposes of this chapter, the following terms have
the following meanings: (1) DAY TREATMENT SERVICES. Includes, but is not limited to: Physiological,
psychological, and psychosocial concepts, techniques, and processes necessary to maintain
or develop functional skills of clients, provided to individuals and groups for periods of
more than two hours but less than 24 hours a day. (2) HEALTH BENEFIT PLAN. A health care service
plan governed by the provisions of Article 6, Chapter 4, Title 10, and a group health insurance
policy, including an employee welfare health benefit plan, that covers hospital, medical,
or surgical expenses, issued by insurers, health maintenance organizations, preferred provider
organizations, medical service organizations, physician-hospital organizations, or any other
person, firm, corporation, joint venture, or other similar business entity that pays for,
purchases, or furnishes health care services to patients, insureds, or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-54-2.htm - 3K - Match Info - Similar pages
27-51-1
Section 27-51-1 Payment for services of licensed physician assistant. (a) An insurance
policy or contract providing for third-party payment or prepayment of health or medical expenses
shall include a provision for the payment to a supervising physician for necessary medical
or surgical services that are provided by a licensed physician assistant practicing under
the supervision of the physician, and pursuant to the rules, regulations, and parameters for
physician assistants, if the policy or contract pays for the same care and treatment provided
by a licensed physician or doctor of osteopathy. (b) An insurance policy or contract subject
to this section shall not impose a practice or supervision restriction which is inconsistent
with or more restrictive than provided by law. (c) This section shall apply to services
provided under a policy or contract delivered, continued, or renewed in this state on or after
August 1, 1997, and to any existing policy or contract, on the policy's or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-51-1.htm - 2K - Match Info - Similar pages
36-29-5
Section 36-29-5 Expenses, treatment, etc., not to be included under plan. (a) Such health
insurance shall not include any of the following: (1) Expenses incurred by or on account of
an individual prior to the effective date of the plan. (2) Cosmetic surgery or treatment,
except to the extent necessary for correction of damages caused by accidental injury while
covered by the plan or as a direct result of disease covered by the plan. (3) Services received
in a hospital owned or operated by the United States government for which no charge is made.
(4) Services received for injury or sickness due to war or any act of war, whether declared
or undeclared, which war or act of war shall have occurred after the effective date of this
plan. (5) Expenses for which the individual is not required to make payment. (6) Expenses
to the extent of benefits provided under any employer group plan other than the plan in which
the state participates in the cost thereof. (7) Such other expenses as may be...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/36-29-5.htm - 1K - Match Info - Similar pages
27-14-11.1
Section 27-14-11.1 Contents of policies - Denial or reduction of benefits due to Medicaid
eligibility void. (a) For purposes of this section, "private insurer" is
defined as any of the following: (1) Any commercial insurance company offering health or casualty
insurance to individuals or groups, including both experience-rated contracts and indemnity
contracts. (2) Any profit or nonprofit prepaid plan offering either medical services or full
or partial payment for the diagnosis or treatment of an injury, disease, or disability. (3)
Any organization administering health or casualty insurance plans for professional associations,
unions, fraternal groups, employer-employee benefit plans, and any similar organization offering
these payments or services, including self-insured and self-funded plans. (4) Any health insurer,
including group health plans, as defined in Section 607(1) of the Employee Retirement
Income Security Act of 1974, self-insured plans, service benefit plans, managed care...
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