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22-21-361
Section 22-21-361 Definitions. The following terms shall have the meanings respectively
ascribed by this section unless the context clearly indicates otherwise: (1) COMMISSIONER.
The commissioner of insurance of this state. (2) DENTAL SERVICE PLAN or PLAN. Any plan or
other arrangement whereby dental services are provided in whole or in part through a dental
service corporation by dentists participating in the plan to provide dental services to those
members of the public who become subscribers to the plan under a contract with such corporation.
The terms "dental service plan" or "plan" do not include an insurer authorized
by the insurance department to transact insurance in this state or to a nonprofit health insurance
plan organized pursuant to Section 10-4-100, or to any policy of insurance or contract
which includes dental benefits issued by such insurer or nonprofit health insurance plan.
(3) DEPARTMENT. The Department of Insurance. (4) LICENSE. The certificate of authority issued...
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22-21-367
Section 22-21-367 License prerequisite to contracts with subscribers. No corporation
subject to the provisions of this article shall issue contracts to subscribers for dental
services pursuant to a dental service plan until the department has, by formal licenses, authorized
it to do so. (Acts 1982, No. 82-463, p. 741, §8.)...
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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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22-21-365
Section 22-21-365 Consent of commissioner to charter or certificate of incorporation.
If the charter or certificate of incorporation of any proposed corporation specifies among
its purposes the establishment, maintenance, and operation of a dental service plan, such
charter or certificate of incorporation shall be referred by the Secretary of State to the
Department of Insurance, and such charter or certificate shall not be filed until the consent
of the commissioner shall be endorsed thereon and affixed thereto. (Acts 1982, No. 82-463,
p. 741, §6.)...
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22-21-389
Section 22-21-389 Nonprofit corporations organized prior to May 4, 1982. No nonprofit
corporation, organized under the laws of this state prior to May 4, 1982 to operate a dental
service plan in the state or any of the counties thereof, the charter or certificate of incorporation
of which has been approved or consented to by the insurance commissioner prior to May 4, 1982,
shall be required to incorporate or reincorporate as provided herein. However, every such
corporation desiring to operate such a plan shall file with the insurance commissioner its
acceptance of this article within six months from May 4, 1982, and every such corporation
so accepting this article shall continue, shall have all the powers, authority, and exemptions
of this article, and shall be subject to all the provisions hereof except as otherwise provided
herein. At the time of filing its acceptance, each such corporation must demonstrate to the
satisfaction of the department that it is in compliance with the...
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27-17A-15
Section 27-17A-15 Examination by commissioner. (a) The commissioner shall, as often
as he or she may deem necessary, examine the business of any person writing preneed contracts
under this chapter to the extent applicable. The examination shall be made by designated representatives
or examiners of the Department of Insurance. (b) The written report of each examination, when
completed, shall be filed in the office of the commissioner and, when so filed, shall not
constitute a public record. (c) Any person being examined shall produce, upon request, all
records of the person. The designated representative of the commissioner may at any time examine
the records and affairs of the person, whether in connection with a formal examination or
not. (d) The commissioner may waive the examination requirements of this section if
the certificate holder submits audited financial statements. (e) The person examined shall
pay the examination expenses, travel expense and per diem subsistence allowance...
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27-48-1
Section 27-48-1 Definitions. As used in this chapter, the following terms shall have
the following meanings: (1) HEALTH BENEFIT PLAN. A health insurance policy 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 health care services to patients, insureds, or beneficiaries in this state. For
the purpose of this chapter, a health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to the provisions of this chapter if it receives, processes,
adjudicates, pays, or denies claims for health care services submitted by or on behalf of
the State of Alabama or who receive health care services in the State of Alabama. The term
includes, but is not limited to, entities created pursuant to Article 6 of...
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27-2-20
Section 27-2-20 Examinations - Power generally. (a) If he has reason to believe that
any such person has violated or is violating any provision of this title or upon complaint
by any resident of this state indicating that any such violation may exist, the commissioner
may examine the accounts, records, documents, and transactions pertaining to or affecting
the insurance affairs of any: (1) General agent, agent, broker, surplus line broker, solicitor,
or adjuster; (2) Person having a contract or power of attorney under which he enjoys in fact
the exclusive or dominant right to manage or control an insurer; or (3) Person engaged in
or proposing to be engaged in or assisting in the promotion or formation of a domestic insurer,
insurance holding corporation, or corporation to finance a domestic insurer or the production
of its business. (b) The commissioner may examine the insurance affairs and transactions of
the attorney-in-fact of a reciprocal insurer in the same manner and on the same...
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27-58-1
Section 27-58-1 Definitions. As used in this chapter, the following terms shall have
the following meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare
benefit plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases
shall have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health.
(2) ENROLLEE. An individual who has contracted for or who participates in coverage under an
insurance policy, a health maintenance organization contract, a health service corporation
contract, an employee welfare benefit plan, a hospital or medical services plan, or any other
benefit program providing payment, reimbursement, or indemnification for health care costs
for the individual or the eligible dependents of the individual. (3) PROVIDER. A health care
provider duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system
for prospective and concurrent review of the necessity and appropriateness in the allocation
of health care resources and services given or proposed to be given to an individual within
this state. The term does not include elective requests for clarification of...
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