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35-11-371
Section 35-11-371 Perfection of lien. (a) For the purposes of this section, the following terms
shall have the following meanings: (1) HEALTH CARE PAYOR. A health care insurer, health maintenance
organization, or health care service plan organized under Article 6, Chapter 20, Title 10A,
authorized to provide health care coverage in the state. (2) SATISFY THE CLAIM. Receipt by
the hospital of either of the following: a. Full payment for services as billed. b. If the
hospital has a contract with the injured person's health care payor, payment together with
all credits, discounts, and contractual adjustments that the patient's bill would be entitled
under the contract, including recoupments, between the hospital and the patient's health care
payor which extinguish the patient's obligation for the services rendered. (b) Unless specifically
contrary to any contractual agreement between the hospital and the injured person's health
care payor or unless contrary to any statute or governmental...
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36-29-14.1
Section 36-29-14.1 Election by soil and water conservation districts to receive coverage for
officers and employees. (a) The governing body of any county soil and water conservation district
may, by resolution legally adopted to conform to rules prescribed by the State Employees'
Insurance Board, elect to have its officers and employees who are full-time employees working
at least a 40-hour work week and its retiring employees who worked full time at least a 40-hour
work week during their active employment become eligible to participate in the State Employees'
Health Insurance Plan. The term "officers" and "employees" as used in
this section shall include those persons appointed or employed by the individual officers
and performing their duties in public offices, but shall not include members of soil and water
conservation district boards, known as district supervisors who are expressly prohibited from
participating in said health insurance plan. (b) Each employee who is covered by the...
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36-29-17
Section 36-29-17 Election by employees and officers of Alabama Sports Hall of Fame Board to
receive coverage. (a) Notwithstanding the provisions of Section 36-29-1, an employee or executive
officer of the Alabama Sports Hall of Fame Board and his or her dependents shall be eligible
for coverage under the State Employees' Health Insurance Plan and upon the expiration of the
employment may continue the coverage for a maximum of 36 months. (b) Preexisting conditions
shall not be covered until the insured has been covered under the plan for a period of 12
months. An employee enrolling within 30 days of August 7, 1995 or within 30 days of the beginning
of a calendar year thereafter shall not be subject to this limitation of benefits. A preexisting
condition is a condition for which the insured or their covered dependent received medical
treatment, advice, or consultation, or received a prescribed medication within 12 months of
the effective date of the insured's coverage under the plan. (c)...
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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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36-29-52
Section 36-29-52 Assignment of attachment of health benefits. In the case of any state law
authorizing the assignment of benefits or a lien against benefits under a health insurance
policy, the health benefits covered under any policy or plan of health insurance may not be
assigned by the insured or attached by lien if the policy provides coverage for excepted benefits,
as defined in Section 2791(c)(2), (3), and (4) of the Public Health Service Act. (Act 2013-245,
p. 593, §3.)...
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36-29-9
Section 36-29-9 Contracts to provide for health insurance for retiring state employees, spouses
and dependents; adoption of rules and regulations for election by retiring employees or surviving
spouses and dependents as to participation, etc., in plan. The contract or contracts shall
provide for health insurance for retiring state employees and their spouses and dependents
as defined by rules and regulations of the board on such terms as the board may deem appropriate.
The board shall adopt rules and regulations prescribing the conditions under which retiring
employees, and in the event of the death of a retired employee their spouses and dependents,
may elect to participate in or withdraw from the plan. (Acts 1965, No. 833, p. 1564, §7;
Acts 1982, No. 82-519, p. 866, §1.)...
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27-1-15
Section 27-1-15 Payment for services of podiatrist. Notwithstanding any other provision of
law, when any contract of health insurance or any plan or agreement for health services provides
for the reimbursement or payment for services which are within the scope of a podiatrist's
professional license as defined in the general laws of Alabama, such policy shall be construed
to include payment to a podiatrist who has performed such procedures. (Acts 1976, No. 678,
p. 927.)...
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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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27-21A-7
Section 27-21A-7 Evidence of coverage and charges for health care services. (a)(1) Every enrollee
residing in this state is entitled to an evidence of coverage. If the enrollee obtains such
coverage through an insurance policy or a contract issued by a health care service plan, the
insurer or the health care service plan shall issue the evidence of coverage. Otherwise, the
health maintenance organization shall issue the evidence of coverage. (2) No evidence of coverage,
or amendment thereto, shall be issued or delivered to any person in this state until a copy
of the basic form of the evidence of coverage, or amendment thereto, has been filed with the
commissioner and the State Health Officer, and approved by the commissioner. (3) An evidence
of coverage shall contain: a. No provisions or statements which encourage misrepresentation,
or which are untrue, misleading, or deceptive as defined in subsection (a) of Section 27-21A-13;
and b. A clear and concise statement, if a contract, or a...
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27-48-2
Section 27-48-2 Coverage for medically necessary inpatient care for mother and newly born child.
(a) Every health benefit plan that provides maternity coverage shall provide coverage for
the following: (1) All medically necessary inpatient care for a mother and her newly born
child as determined by the woman's prenatal care physician, obstetrician-gynecologist, certified
nurse midwife, or the child's attending pediatrician and when consistent with the most recent
version of the "Guidelines for Perinatal Care" prepared by the American Academy
of Pediatrics and the American College of Obstetricians and Gynecologists, including the administration
of medical tests recommended by the American Academy of Pediatrics or the American College
of Obstetricians and Gynecologists or both on the admission and discharge of a mother and
the newborn child to determine whether additional medical care is needed for the mother or
newborn child or both. Included in medically necessary inpatient care is the...
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