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27-19-55
Section 27-19-55 Standards for loss ratios. Medicare supplement policies shall return
to policyholders benefits which are reasonable in relation to the premium charged. The commissioner
shall issue reasonable regulations to establish minimum standards for loss ratios of Medicare
supplement policies on the basis of incurred claims experience, or incurred health care expenses
where coverage is provided by a health maintenance organization on a service rather than reimbursement
basis, and earned premiums in accordance with accepted actuarial principles and practices.
(Acts 1981, No. 81-560, p. 940, §6; Act 2000-795, p. 1876, §3.)...
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22-21-171
Section 22-21-171 Purpose and construction of article. It is the intention of the Legislature
by the passage of this article to authorize in each of the several counties of the state the
organization of a public corporation or corporations for the purpose of acquiring, owning
and operating public hospitals and other health-care and related facilities in the county
in which such corporation shall be organized. It is the legislative intent to confer on corporations
organized under this article all the powers requisite for the fulfillment of the purposes
of their organization, including the power to do whatever financing may be necessary to accomplish
such purposes. This article shall be liberally construed to give effect to its purpose. Corporations
organized under this article shall be public, nonprofit corporations, and no part of the net
earnings thereof shall inure to the benefit of any individual or private corporation. (Acts
1975, 3rd Ex. Sess., No. 183, p. 442, §1.)...
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22-21-324
Section 22-21-324 Use of proceeds. (a) The principal proceeds derived from any borrowing
made by an authority shall be used solely for the purpose or purposes for which such borrowing
was authorized to be made. If any securities are issued for the purpose of financing costs
of acquiring, constructing, improving, enlarging and equipping health care facilities, such
costs shall be deemed to include the following: (1) The cost of any land forming a part of
such health care facilities; (2) The cost of the labor, materials and supplies used in any
such construction, improvement or enlargement, including architectural and engineering fees
and the cost of preparing contract documents advertising for bids; (3) The purchase price
of, and the cost of installing, equipment for such health care facilities; (4) The cost of
landscaping the lands forming a part of such health care facilities and of constructing and
installing roads, sidewalks, curbs, gutters, utilities and parking places in...
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22-6-233
Section 22-6-233 Legislative findings; certification of collaborators; powers of Medicaid
Agency; state action immunity. (a) The Legislature declares that collaboration among public
payers, private health carriers, third party purchasers, and providers to identify appropriate
service delivery systems and reimbursement methods in order to align incentives in support
of integrated and coordinated health care delivery is in the best interest of the public.
Collaboration pursuant to this article is to provide quality health care at the lowest possible
cost to Alabama citizens who are Medicaid eligible. The Legislature, therefore, declares that
this health care delivery system affirmatively contemplates the foreseeable displacement of
competition, such that any anti-competitive effect may be attributed to the state's policy
to displace competition in the delivery of a coordinated system of health care for the public
benefit. In furtherance of this goal, the Legislature declares its intent...
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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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34-23-183
Section 34-23-183 Application. This article shall apply to any audit of the records
of a pharmacy conducted by a managed care company, nonprofit hospital or medical service organization,
health benefit plan, third-party payor, pharmacy benefit manager, a health program administered
by a department of the state, except the Alabama Medicaid Agency, or any entity that represents
those companies, groups, or department. (Act 2012-306, p. 668, §4; Act 2018-457, §1.)...
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22-6-150
Section 22-6-150 Definitions. For the purposes of this article, the following words
shall have the following meanings: (1) ALTERNATE CARE PROVIDER. A contractor, other than a
regional care organization, that agrees to provide a comprehensive package of Medicaid benefits
to Medicaid beneficiaries in a defined region of the state pursuant to a risk contract. (2)
CAPITATION PAYMENT. A payment the state Medicaid Agency makes periodically to a contractor
on behalf of each recipient enrolled under a contract for the provision of medical services.
(3) CARE DELIVERY SYSTEM. The manner in which the benefits and services set forth in the state
Medicaid plan are provided to Medicaid beneficiaries. (4) COLLABORATOR. A private health carrier,
third party purchaser, provider, health care center, health care facility, state and local
governmental entity, or other public payers, corporations, individuals, and consumers who
are expecting to collectively cooperate, negotiate, or contract with another...
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27-56-2
Section 27-56-2 Definitions. As used in this chapter, 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) EYE CARE PROVIDER. A licensed optometrist or a licensed ophthalmologist.
(3) INSURANCE POLICY, PLAN, OR CONTRACT PROVIDING FOR THIRD-PARTY PAYMENT OR PREPAYMENT OF
HEALTH OR MEDICAL EXPENSES. Includes an individual or group policy for accident or health
insurance, an individual or group hospital or health care service contract, an individual
or group health maintenance organization contract, an organized delivery system contract,
or a preferred provider organization contract, and any other similar policy, plan, or contract.
This term shall not include any employee welfare benefit plan, as defined...
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34-19-21
Section 34-19-21 Coverage or reimbursement for services not required. Nothing contained
in this chapter shall be construed to create a requirement that any health benefit plan, group
insurance plan, policy, or contract for health care services that covers hospital, medical,
or surgical expenses, 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 group health care services to patients, insureds, or beneficiaries in this state,
including entities created pursuant to Article 6, commencing with Section 10A-20-6.01,
of Chapter 20, Title 10A, provide coverage or reimbursement for the services described or
authorized in this chapter. (Act 2017-383, §4.)...
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22-19-161
Section 22-19-161 Definitions. In this article: (1) "Adult" means an individual
who is at least 18 years of age. (2) "Agent" means an individual: (A) authorized
to make health care decisions on the principal's behalf by a power of attorney for health
care; or (B) expressly authorized to make an anatomical gift on the principal's behalf by
any other record signed by the principal. (3) "Anatomical gift" means a donation
of all or part of a human body to take effect after the donor's death for the purpose of transplantation,
therapy, research, or education. (4) "Coroner" means an elected or appointed official
who determines, with the assistance of other forensic scientists and investigators, the cause,
manner, and circumstances surrounding death. (5) "Decedent" means a deceased individual
whose body or part is or may be the source of an anatomical gift. The term includes a stillborn
infant and, subject to restrictions imposed by law other than this article, a fetus. (6) "Disinterested...
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