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27-20A-2
Section 27-20A-2 Chapter applicable to group, etc., policies. No group, blanket, franchise,
or association health insurance policy providing coverage on an expense incurred basis, nor
group, blanket, franchise, or association service or indemnity type contract issued by a nonprofit
corporation, nor group-type self insurance plan providing protection, insurance, or indemnity
against hospital, medical, or surgical expenses, nor health maintenance organization plan
shall be issued, delivered, executed, or renewed in this state, or approved for issuance or
renewal in this state by the Commissioner of Insurance after 90 days beyond the effective
date of this chapter, unless such policy, contract, or plan, at the option of the policyholder
or sponsor, provides benefits to any insured, subscriber, or other person covered under the
policy, contract, or plan for expenses incurred in connection with the treatment of alcoholism
when such treatment is prescribed by a duly licensed doctor of...
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27-1-21
Section 27-1-21 Uniformity of limits applied to fulfillment of certain drug prescriptions.
(a) For the purposes of this section, the following words shall have the following meanings:
(1) ENROLLEE. A person enrolled in a health benefit plan. (2) HEALTH BENEFIT PLAN. Any individual
or group plan, policy, or contract for health care services issued, delivered, issued for
delivery, renewed in this state by a health care insurer, health maintenance organization,
accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation,
nonprofit medical service corporation, health care service plan, 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 beneficiaries in this state. The
term includes, but is not limited to, entities created pursuant to Article 6 of Chapter 4
of Title 10. The term shall not include any collective bargaining agreement...
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27-58-1
Section 27-58-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit
plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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27-59-1
Section 27-59-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit
plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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27-1-17.1
Section 27-1-17.1 Payment of providers through electronic funds transfer methods. (a) As used
in this section, the following words shall have the following meanings: (1) ACH ELECTRONIC
FUNDS TRANSFER. An electronic funds transfer through the Health Insurance Portability and
Accountability Act (HIPPA) standard Automated Clearing House network. (2) COVERED HEALTH CARE
PROVIDER. A physician as defined in Section 34-24-50.1; a dentist as defined in Section 34-9-1;
a chiropractor as defined in Section 34-24-120; an individual engaged in the practice of optometry
as defined in Section 34-22-1; other licensed health care professionals as defined in Title
34; a hospital as defined in Section 22-21-20; and a health care facility, or other provider
who or that is accredited, licensed, or certified and who or that is performing within the
scope of that accreditation, license, or certification. (3) HEALTH INSURANCE PLAN. Any hospital
and medical expense incurred policy, health maintenance...
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27-1-20
Section 27-1-20 Patient Right to Know Act. (a) This section shall be known and may be cited
as the "Patient Right to Know Act." (b) As used in this section, unless the context
clearly indicates otherwise, the following words shall have the following meanings: (1) ENROLLEE.
A person who purchases individual health care coverage or an employer who purchases a group
health care plan. (2) PROVIDER. A physician, dentist, podiatrist, pharmacist, optometrist,
psychologist, clinical social worker, advanced nurse practitioner, registered optician, licensed
professional counselor, physical therapist, and chiropractor. (c)(1) All persons, firms, corporations,
associations, health maintenance organizations, health insurance services, or preferred provider
organizations, any employer-sponsored health benefit plan, or any similar organization or
entity, providing health, accident, or dental insurance coverage, either directly or indirectly,
shall provide an enrollee with a written description of the...
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27-45A-5
Section 27-45A-5 Disclosure of cost share information; discussion and sale of prescription
drug alternatives; prohibited payment practices. (a) A pharmacy or pharmacist may provide
a covered person with information regarding the amount of the covered person's cost share
for a prescription drug. Neither a pharmacy nor a pharmacist shall be proscribed by a pharmacy
benefits manager from discussing any such information or for selling a more affordable alternative
to the covered person if such an alternative is available. (b) A health benefit plan that
covers prescription drugs may not include a provision that requires an enrollee to make a
payment for a prescription drug at the point of sale in an amount that exceeds the lessor
of: (1) the contracted co-payment amount; or (2) the amount an individual would pay for a
prescription if that individual were paying with cash. (c) For purposes of this section, the
following words have the following meanings: (1) COVERED PERSON. Any individual,...
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27-19A-2
of this chapter. (7) HEALTH INSURANCE POLICY. Any individual, group, blanket, or franchise
insurance policy, insurance agreement, or group hospital service contract providing benefits
for dental care expenses incurred as a result of an accident or sickness. (8) EMPLOYEE BENEFIT
PLAN. Any plan, fund, or program heretofore or hereafter established or maintained by an employer
or by an employee organization, or by both, to the extent that such plan, fund, or program
was established or is maintained for the purpose of providing for its participants or their
beneficiaries, through the purchase of insurance or otherwise, dental care benefits in the
event of accident or sickness. (9) DENTAL CARE SERVICES. Any services furnished to any person
for the purpose of preventing, alleviating, curing, or healing human dental illness or injury.
(10) DENTIST. Any person who furnishes dental care services and who is licensed as a dentist
by the State of Alabama. (Acts 1984, No. 84-411, p. 960, §2.)...
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35-11-371
persons, firms, or corporations claimed by the injured person, or the legal representative
of the person, to be liable for damages arising from the injuries. The claimant shall also
within one day after the filing of the claim or lien, mail a copy thereof by registered or
certified mail, postage prepaid, for each person, firm, or corporation so claimed to be liable
on account of the injuries, at the addresses so given in the statement, and to the patient,
his or her guardian, or his or her personal representative at the address given at
the time of admission. (d) The filing of a claim or lien shall be notice thereof to all persons,
firms, or corporations liable for damages, whether or not they are named in the claim or lien.
Nothing shall be deemed to preclude the hospital from perfecting its lien outside of the time
limits stated in this section through providing actual notice to persons, firms, or corporations.
(e) The judge of probate shall endorse thereon the date and hour of...
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36-29-3
Section 36-29-3 Factors to be considered by board in design of health insurance plan. The health
insurance plan provided for in this chapter shall be designed by the State Employees' Insurance
Board to provide a reasonable relationship between the hospital, surgical, and medical benefits
to be included and the expected hospital, surgical, and medical expenses to be incurred by
the affected employee and retiree and dependents and to include reasonable controls, which
may include, but are not limited to, deductible, copayment, coinsurance, and other cost containment
measures to prevent unnecessary utilization of the various hospital, surgical, and medical
services available and to provide reasonable assurance of stability in future years for the
plan. (Acts 1965, No. 833, p. 1564, §5; Act 2004-647, 1st Sp. Sess., p. 17, §1.)...
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