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22-21-390
Section 22-21-390 Violations; penalties; injunctive relief. (a) Any person or corporation engaging
in the business of operating a dental service plan without first having procured a license
from the Department of Insurance, as required by this article, and any person or corporation
violating any of the provisions of this article is guilty of a misdemeanor of the first degree
and upon conviction thereof shall be punished as provided by law. (b) Any person making any
willfully false statement in any written document required by this article to be filed with
the department, or with any examiner at any investigation or hearing conducted by the department
or examiner, is guilty of perjury and shall be punished as provided by law. (c) In addition
to any other penalties provided for in this article, the department is authorized to apply
to the appropriate circuit court by sworn affidavit that it has reason to believe that a violation
of any of the provisions of this article, or of any rules...
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27-2B-2
Section 27-2B-2 Definitions. As used in this chapter, these terms shall have the following
meanings: (1) ADJUSTED RBC REPORT. An RBC report which has been adjusted by the commissioner
in accordance with subsection (e) of Section 27-2B-3. (2) CORRECTIVE ORDER. An order issued
by the commissioner specifying corrective actions which the commissioner has determined are
required. (3) DOMESTIC INSURER. Any insurer domiciled in this state. (4) FOREIGN INSURER.
Any insurer which is licensed to do business in this state but not domiciled in this state.
(5) FRATERNAL BENEFIT SOCIETY. Any insurer licensed under Chapter 34. (6) HEALTH ORGANIZATION.
Any health care service plan, health maintenance organization, limited health service organization,
dental services corporation, or other managed care organization licensed under this title.
This term does not include any life and disability insurer or property and casualty insurer.
(7) INSURER. As defined in Section 27-1-2, including, without...
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22-21-386
Section 22-21-386 Examination and investigation of corporations by department; power to summon
and examine witnesses; payment of expenses. (a) The Department of Insurance, any agent or
examiner of the department, or any other person appointed by the department shall have the
power of visitation and examination into the affairs, transactions, accounts, business records,
and assets of any such dental service plan corporation, shall have free access to all of the
books, papers, and documents that relate to the business of the corporation, may summon and
qualify witnesses under oath, and may examine its officers, agents, and employees or other
relative persons regarding the affairs, transactions, and condition of the corporation. The
corporation whose affairs are examined shall pay to the department for deposit into the State
Treasury the traveling expenses and any other expenses of the examiner or other person making
the examination which shall be credited as provided by Section...
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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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22-21-371
Section 22-21-371 Individual, group, blanket or franchise contracts authorized; certificates
of coverage; filing and approval of contracts and certificates; requirements; grounds for
disapproval. (a) Dental service plan contracts may be written on individual, group, blanket
or franchise basis. Each contractual obligation for such dental service(s) must be evidenced
by a contract. Each person covered under a group contract must be issued a certificate of
coverage. (b) No contract or certificate of dental service benefits may be issued in this
state unless a copy of the form has been filed and approved by the commissioner. (c) The commissioner
may not approve any form that does not meet the following requirements: (1) Contracts must
contain a list and description of the dental service payments promised or the dental work
for which expenses are to be reimbursed, and any limits on the amounts to be paid or reimbursed;
(2) Contracts and certificates must indicate the name of the dental...
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22-21-375
Section 22-21-375 Issuance of license; revocation; procedures for review and mediation of complaints.
(a) The Department of Insurance shall issue a license to each applicant upon payment of the
prescribed fees and upon being satisfied that: (1) The applicant has been organized in a bona
fide manner for the purpose of establishing, maintaining, and operating a dental service plan.
(2) Each contract executed, or proposed to be executed, by the applicant and a dentist obligates,
or will when executed obligate, such dentist to render the service or accept payment for the
service to which each subscriber may be entitled under the terms of the contract issued to
the subscriber. (3) Each contract issued, or proposed to be issued, to subscribers is in a
form approved by the department and that the rates charged, or proposed to be charged, for
each form of such contract and benefits to be provided pursuant thereto are fair and reasonable
and are actuarially sound. (4) No contributions to the...
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27-1-11
Section 27-1-11 Dentists and dental hygienists as "physicians" under health or accident
insurance policies. Whenever the terms "physician" and/or "doctor" are
used in any policy of health or accident insurance issued in this state or in any contract
for the provision of health care, services, or benefits issued by any health, medical or other
service corporation existing under, and by virtue of any laws of this state, said terms shall
include within their meaning those persons licensed under and in accordance with Chapter 9
of Title 34 in respect to any care, services, procedures, or benefits covered by said policy
of insurance or health care contract which the said persons are licensed to perform, any provisions
in any such policy of insurance or health care contract to the contrary notwithstanding. This
section shall be applicable to all policies in this state, regardless of date of issue, on
October 10, 1975. (Acts 1975, No. 1241, p. 2607, §1.)...
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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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34-23-116
Section 34-23-116 Article not applicable to certain services. This article shall not apply
to any services rendered pursuant to provisions of the Alabama Medicaid Program, to the Public
Education Employees' Health Insurance Plan, or to any corporation organized under the provisions
of Title 10, Chapter 4, Article 6, for establishment and operation of health care service
plans. (Acts 1981, No. 81-337, p. 477, §7; Acts 1983, No. 83-637, p. 986, §§1, 2; Act 2012-478,
p. 1325, §1.)...
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27-21A-15
Section 27-21A-15 Powers of insurers and health care service plans. (a) An insurance company
licensed in this state, or a health care service plan authorized to do business in this state,
may either directly or through a subsidiary or affiliate organize and operate a health maintenance
organization under the provisions of this chapter. Notwithstanding any other law which may
be inconsistent herewith, any two or more such insurance companies, health care service plans,
or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance
organization. The business of insurance is deemed to include the providing of health care
by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.
(b) Notwithstanding any provision of insurance and health care service plan laws, Title 10,
Chapter 4, Article 6 and Title 27, an insurer or a health care service plan may contract with
a health maintenance organization to provide insurance or...
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