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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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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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27-2B-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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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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27-14-11.1
Section 27-14-11.1 Contents of policies - Denial or reduction of benefits due to Medicaid
eligibility void. (a) For purposes of this section, "private insurer" is
defined as any of the following: (1) Any commercial insurance company offering health or casualty
insurance to individuals or groups, including both experience-rated contracts and indemnity
contracts. (2) Any profit or nonprofit prepaid plan offering either medical services or full
or partial payment for the diagnosis or treatment of an injury, disease, or disability. (3)
Any organization administering health or casualty insurance plans for professional associations,
unions, fraternal groups, employer-employee benefit plans, and any similar organization offering
these payments or services, including self-insured and self-funded plans. (4) Any health insurer,
including group health plans, as defined in Section 607(1) of the Employee Retirement
Income Security Act of 1974, self-insured plans, service benefit plans, managed care...
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27-56-4
Section 27-56-4 Prohibited activities. An insurance policy, plan, or contract providing
for third-party payment or prepayment of health or medical expenses shall not do any of the
following: (1) Impose a practice restriction for optometrists which is inconsistent with or
more restrictive than provided by law. (2) Discriminate between classes of eye care providers
with respect to any covered service which falls within the scope of the eye care provider's
license. (3) Require an eye care provider to hold hospital privileges as a condition of participation
in or receiving payment from the policy, plan, or contract. (4) Impose any restriction not
required by law based on the eye care provider's professional degree. (5) Discriminate between
eye care providers in connection with the amount of reimbursement for the provision of the
same services. (6) Require an eye care provider to purchase or maintain a minimum quantity
or minimum dollar amount of a specified brand of ophthalmic materials as...
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27-57-2
Section 27-57-2 Coverage; applicability. (a) All group health benefit plans, policies,
contracts, and certificates executed, delivered, issued for delivery, continued, or renewed
in this state on or after August 1, 2004, shall offer, at the time of proposal, sale, or renewal
of a policy subject to this chapter, to include colorectal cancer examinations within the
coverage. Such offer of coverage shall include colorectal cancer examinations for covered
persons who are 50 years of age or older, or for covered persons who are less than 50 years
of age and at high risk for colorectal cancer according to current American Cancer Society
colorectal cancer screening guidelines. (b) This chapter shall apply to group accident and
sickness insurance policies issued by a fraternal benefit society, a nonprofit hospital service
corporation, a nonprofit medical service corporation, a group health care plan, a health maintenance
organization, or any similar entity. (Act 2004-502, p. 969, ยง2.)...
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27-7-1
Section 27-7-1 Definitions. For the purposes of this chapter, the following terms shall
have the meanings respectively ascribed to them by this section: (1) BUSINESS ENTITY.
A corporation, association, partnership, limited liability company, limited liability partnership,
or other legal entity. (2) COMMISSIONER. The Alabama Commissioner of Insurance. (3) HOME STATE.
The District of Columbia and any state or territory of the United States in which an insurance
producer maintains his or her principal place of residence or principal place of business
and is licensed to act as an insurance producer. (4) INSURANCE. As defined in Section
27-1-2. (5) INSURANCE PRODUCER or PRODUCER. A person required to be licensed under the laws
of this state to sell, solicit, or negotiate insurance. (6) INSURER. As defined in Section
27-1-2. For the purposes of this chapter, insurer shall also mean an insurance company licensed
pursuant to Chapter 3, commencing with Section 27-3-1 of this title; a health...
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27-56-10
Section 27-56-10 Vision care providers - Contract requirements; rates; reimbursements;
discounts. (a) As used in this section, the following words shall have the following
meanings: (1) CONTRACTUAL DISCOUNT. A percentage reduction from a provider's usual and customary
rate for covered services and materials required under a participating provider agreement.
(2) COVERED MATERIALS. Materials for which reimbursement from the insurer or vision care plan
is provided to a vision care provider by an enrollee's plan contract, or for which a reimbursement
would be available but for the application of the enrollee's contractual limitations of deductibles,
copayments, or coinsurance. (3) COVERED SERVICES. Services for which reimbursement from the
insurer or vision care plan is provided to a vision care provider by an enrollee's plan contract,
or for which a reimbursement would be available but for the application of the enrollee's
contractual plan limitations of deductibles, copayments, or...
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27-12A-1
Section 27-12A-1 Definitions. As used in this chapter, the following terms shall have
the following meanings: (1) COMMISSIONER. The Alabama Commissioner of Insurance or his or
her designee. (2) DEPARTMENT. The Alabama Department of Insurance. (3) INSURANCE. As defined
in Section 27-1-2, and specifically including any contract, arrangement, or agreement,
in which one undertakes to do any one of the following: a. Pay or indemnify another as to
loss from certain contingencies called risks. b. Pay or grant a specified amount or determinable
benefit to another in connection with ascertainable risk contingencies. c. Pay an annuity
to another. d. Act as surety. For the purposes of this chapter, insurance also includes any
health benefit plan as defined in Section 27-53-1. (4) INSURANCE PRODUCER or PRODUCER.
As defined in Section 27-7-1. (5) INSURER. A person entering into agreements, contracts
of insurance, arrangements, or reinsurance, or a health benefit plan, or a group health plan
as...
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