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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
RETIREMENT BENEFIT. A benefit payable pursuant to the terms of subsection (a) of Section 45-37-123.100.
(52) SYSTEM or PLAN. The General Retirement System for Employees of Jefferson County, which
system or plan may sue or be sued, and in such name all of its business shall be transacted.
(53) SPOUSE. The legal wife or husband of a member as determined in accordance with federal
law. (54) TOTAL DISABILITY. A permanent physical or mental condition of a member resulting
from bodily injury, disease, or mental disorder which renders such member incapable
of continuing usual and customary employment with the county. The disability of a member shall
be determined by a licensed medical advisor. (55) TRUSTEE. The pension board or the person
or entity appointed by the pension board and named as trustee herein or in any separate trust
forming a part of the plan, and any successors. (56) TRUST FUND. The tax-qualified trust in
which certain plan funds are held, disbursed, transferred,...
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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
and insurers operating in Alabama shall, at the secretary's request, provide the secretary
such data as he or she deems necessary to evaluate costs and quality. The data shall be provided
in the form and content to the secretary's specifications and in a manner deemed timely by
the secretary. The secretary may gather from health care claims intermediaries that operate
in Alabama any claims data related to diagnoses and procedures encountered in the treatment
of workers'-compensation-type injury and illness in Alabama. Results from all data
gathered shall be made available to employers or their representatives for use in decisions
regarding the direction of care or to determine appropriateness of reimbursement. (i) Beginning
immediately after May 19, 1992, and to be completed within six months thereafter, the secretary
may engage an independent firm to identify the initial costs for the program. These initial
expenses shall include, but not be limited to, the establishment of a data...
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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
territories, or protectorates that do not have an association similar to the association created
by this chapter, shall be deemed residents of the state of domicile of the insurer that issued
the policies or contracts. (19) STATE. A state, the District of Columbia, Puerto Rico, and
a United States possession, territory, or protectorate. (20) STRUCTURED SETTLEMENT ANNUITY.
An annuity purchased in order to fund periodic payments for a plaintiff or other claimant
in payment for or with respect to personal injury suffered by the plaintiff
or other claimant. (21) SUPPLEMENTAL CONTRACT. A written agreement entered into for the distribution
of proceeds under a life, disability, or annuity policy or contract. (22) UNALLOCATED ANNUITY
CONTRACT. An annuity contract or group annuity certificate which is not issued to and owned
by an individual, except to the extent of any annuity benefits guaranteed to an individual
by an insurer under the contract or certificate. (Acts 1982, No. 82-561, p. 922,...
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