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16-25A-6
Section 16-25A-6 Exclusions. Such health insurance shall not include the following:
(1) Expenses incurred by or on account of an individual prior to the effective date of the
plan as to him; (2) Hearing aids and examinations for the prescription or fitting thereof;
(3) Cosmetic surgery or treatment, except to the extent necessary for correction of damage
caused by accidental injury while covered by the plan or as a direct result of disease covered
by the plan; (4) Services received in a hospital owned or operated by the United States government
for which no charge is made; (5) 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; (6) Expenses for which the individual is not required to
make payment; (7) Expenses to the extent of benefits provided under any employer group plan
other than this plan in which the state participates in the cost thereof; (8)...
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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...
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27-1-22
Section 27-1-22 Uniform prescription drug information card or technology. (a) Every
health benefit plan that provides coverage for prescription drugs or devices, or administers
a plan, including, but not limited to, third party administrators for self-insured plans and
state administered plans, excluding the Alabama Medicaid Program, shall issue to its insureds
a card or other technology containing prescription drug information. The uniform prescription
drug information card or technology shall be in the format approved by the National Council
for Prescription Drug Programs (NCPDP) and shall include all of the required fields and conform
to the most recent pharmacy ID card or technology implementation guide produced by NCPDP or
conform to a national format acceptable to the Commissioner of Insurance. If a health care
plan includes a conditional or situational field, it shall conform to the most recent pharmacy
information card or technology implementation guide by the NCPDP or conform...
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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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45-37-123.01
Section 45-37-123.01 Definitions. For the purposes of this part, the following terms
shall have the following meanings: (1) ACT. The act adding this part, to be called the General
Retirement System for Employees of Jefferson County Act. (2) ACTIVE MEMBER. An individual
who currently is employed by the county or other entities set forth in subdivision (20) and
is making employee contributions to the system. (3) ACTUARIAL EQUIVALENT. Effective July 30,
1984, or such other dates as set forth in Exhibit A, which is maintained in the office of
the pension board, a form of benefit differing in time, period, or manner of payment from
a specific benefit provided under the plan but having the same value when computed using the
mortality tables, the interest rate, and any other assumptions last adopted by the pension
board, which assumptions shall clearly preclude any discretion in the determination of the
amount of a member's benefit. (4) ACTUARIAL GAIN. As defined in Section...
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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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27-54A-2
Section 27-54A-2 Treatment under certain policies and contracts. (a) As used in this
section, the following words have the following meanings: (1) APPLIED BEHAVIOR ANALYSIS.
The design, implementation, and evaluation of environmental modifications, using behavioral
stimuli and consequences, to produce socially significant improvement in human behavior, including
the use of direct observation, measurement, and functional analysis of the relationship between
environment and behavior. (2) AUTISM SPECTRUM DISORDER. Any of the pervasive developmental
disorders or autism spectrum disorders as defined by the most recent edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) or the edition that was in effect at the
time of diagnosis. (3) BEHAVIORAL HEALTH TREATMENT. Counseling and treatment programs, including
applied behavior analysis that are both of the following: a. Necessary to develop, maintain,
or restore, to the maximum extent practicable, the functioning of an...
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25-5-293
Section 25-5-293 Duties of secretary; continuing education, accounting; recovery of
expenses; advisory committees; legislative intent regarding reimbursements. (a) The Secretary
of the Department of Labor may prescribe rules and regulations for the purpose of conducting
continuing education seminars for all personnel associated with workers' compensation claims
and collect registration fees in order to cover the related expenditures. The secretary may
adopt rules and regulations setting continuing education standards for workers' compensation
claims personnel employed by insurance companies and self-insured employers and groups. (b)
The secretary shall file annually with the Governor and the presiding officer of each house
of the Legislature a complete and detailed written report accounting for all funds received
and disbursed during the preceding fiscal year. The annual report shall be in the form and
reported in the time provided by law. (c) The secretary shall establish reasonable...
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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...
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27-44-5
Section 27-44-5 Definitions. As used in this chapter, the following terms shall have
the following meanings, respectively, unless the context clearly indicates otherwise: (1)
ACCOUNT. Either of the three accounts created under Section 27-44-6. (2) ASSOCIATION.
The Alabama Life and Disability Insurance Guaranty Association created under Section
27-44-6. (3) AUTHORIZED ASSESSMENT or the term AUTHORIZED when used in the context of assessments.
A resolution by the board of directors has been passed whereby an assessment will be called
immediately or in the future from member insurers for a specified amount. An assessment is
authorized when the resolution is passed. (4) BENEFIT PLAN. A specific employee, union, or
association of natural persons benefit plan. (5) CALLED ASSESSMENT or the term CALLED when
used in the context of assessments. A notice that has been issued by the association to member
insurers requiring that an authorized assessment be paid within the time frame set forth within...
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