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27-21A-23
Section 27-21A-23 Statutory construction and relationship to other laws. (a) Except as otherwise
provided in this chapter, provisions of the insurance law and provisions of health care service
plan laws shall not be applicable to any health maintenance organization granted a certificate
of authority under this chapter. This provision shall not apply to an insurer or health care
service plan licensed and regulated pursuant to the insurance law or the health care service
plan laws of this state except with respect to its health maintenance organization activities
authorized and regulated pursuant to this chapter. (b) Solicitation of enrollees by a health
maintenance organization granted a certificate of authority shall not be construed to violate
any provision of law relating to solicitation or advertising by health professionals. (c)
Any health maintenance organization authorized under this chapter shall not be deemed to be
practicing medicine and shall be exempt from the provisions of...
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36-36-3
Section 36-36-3 Definitions. As used in this chapter, the following words and phrases shall
have the following respective meanings: (1) ALABAMA RETIRED EDUCATION EMPLOYEES' HEALTH CARE
TRUST. The Alabama Retired Education Employees' Health Care Trust created by the state and
the Public Education Employees' Health Insurance Board pursuant to this chapter. (2) ALABAMA
RETIRED STATE EMPLOYEES' HEALTH CARE TRUST. The Alabama Retired State Employees' Health Care
Trust created by the state and the State Employees' Insurance Board pursuant to this chapter.
(3) BOARDS. The State Employees' Insurance Board and the Public Education Employees' Health
Insurance Board. (4) DEPENDENTS. The spouse and dependent children, as defined by the rules
and regulations of the respective boards, of a retired employee who are covered by either
the Public Education Employees' Health Insurance Plan pursuant to Chapter 25A of Title 16,
as amended from time to time, or the State Employees' Health Insurance Plan...
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26-16-111
Section 26-16-111 Legislative findings. The Legislature finds and declares all the following:
(1) Protection of the health and welfare of the infants of this state is a goal of its people
and the unexpected or unexplained death of an infant is an important public health concern
that requires legislative action. (2) Death scene investigations and findings thereof can
be particularly important in accurately diagnosing the manners and causes of infant deaths.
(3) Collecting accurate data on the cause and manner of unexpected infant deaths will better
enable the state to protect infants from preventable deaths and will help reduce the incidence
of infant deaths. (Act 2011-705, p. 2184, ยง2.)...
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27-1-19
Section 27-1-19 Reimbursement of health care providers. (a) The insured, or health or dental
plan beneficiary may assign reimbursement for health or dental care services directly to the
provider of services. Health benefits include medical, pharmacy, podiatric, chiropractic,
optometric, durable medical equipment, and home care services. The company or agency, when
authorized by the insured, or health or dental plan beneficiary, shall pay directly to the
health care provider the amount of the claim, under the same criteria and payment schedule
that would have been reimbursed directly to the contract provider, and any applicable interest.
This amount only applies to assigned claims. Any company or agency making a payment to the
insured, or health or dental plan beneficiary, after the rights of reimbursement have been
assigned to the provider of services, shall be liable to the provider for the payment. If
the company or agency fails to reimburse the provider in accordance with the terms...
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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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27-21A-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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27-54-2
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...
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36-36-9
Section 36-36-9 Applicability of chapter. Nothing in this chapter shall be construed to define
or otherwise grant any right or privilege to health care benefits or other post-employment
benefits to any person other than those health care benefits or other post-employment benefits,
rights, and privileges previously or already granted to employees and retired employees and
their dependents by the state's health care benefit plan or its post-employment benefit plan,
if any. Such rights and privileges, if any, shall be governed by the terms of the state's
post-employment benefit plan, if any. This chapter is not intended to assure or deny any existing
or future employee, retired employee, any of their dependents, or any other person of any
right of employment or entitlement to any health care benefit or other post-employment benefit
or limit or otherwise restrict the ability of the state to modify or eliminate any existing
or future health care benefit or other post-employment benefit....
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16-25A-5
Section 16-25A-5 Authorization for health insurance plan; election of optional or supplemental
coverage. (a) The board is hereby empowered and authorized to establish a fully insured or
self-insured health insurance plan for employees and, under certain conditions, retired employees
and to adopt and promulgate rules and regulations for the administration of such plan subject
to such limitations as may be contained in this article. Such plan may provide for group hospitalization,
surgical, medical, cancer, cash indemnity, and dental insurance against the financial costs
of hospitalization, surgical, and medical treatment and care and may also include, among other
things, prescribed drugs, medicines, prosthetic appliances, hospital inpatient and outpatient
service benefits, and hospital/medical expenses indemnity benefits, including major medical
benefits or such other coverage or benefits as may be deemed appropriate and desirable by
the board, within the limits of such funds as may be...
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22-21-312
Section 22-21-312 Legislative findings and intent. The Legislature hereby finds and declares:
(1) That publicly-owned (as distinguished from investor-owned and community-nonprofit) hospitals
and other health care facilities furnish a substantial part of the indigent and reduced-rate
care and other health care services furnished to residents of the state by hospitals and other
health care facilities generally; (2) That as a result of current significant fiscal and budgetary
limitations or restrictions, the state and the various counties, municipalities, and educational
institutions therein are no longer able to provide, from taxes and other general fund moneys,
all the revenues and funds necessary to operate such publicly-owned hospitals and other health
care facilities adequately and efficiently; and (3) That to enable such publicly-owned hospitals
and other health care facilities to continue to operate adequately and efficiently, it is
necessary that the entities and agencies...
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