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27-57-1
Section 27-57-1 Definitions. As used in this chapter, the following words and terms
shall have the following meanings: (1) COLORECTAL CANCER EXAMINATIONS. Examinations and laboratory
tests specified in current American Cancer Society guidelines for colorectal cancer screening
of asymptomatic individuals. (2) HEALTH BENEFIT PLAN. A group 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 purposes of this chapter, 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...
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27-57-5
Section 27-57-5 Coverage by participating providers; selection criteria and utilization
protocols; maximum benefits, exclusions, etc. (a) This chapter does not require and shall
not be construed to require the coverage of services of providers who are not designated as
covered providers, or who are not selected as a participating provider, by a group health
benefit plan or insurer having a participating network of service providers. Nothing in this
chapter is intended to expand the list or designation of participating providers as specified
in any health benefit plan. (b) Insurers or other issuers of any health benefit plan covered
by this chapter shall continue to be able to establish and apply selection criteria and utilization
protocols for health care providers including the designation of types of providers for which
coverage is provided as well as credentialing criteria used in the selection of providers.
(c) A group health benefit plan, policy, or contract that provides coverage...
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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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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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22-21-263
Section 22-21-263 New institutional health services subject to review. (a) All new institutional
health services which are subject to this article and which are proposed to be offered or
developed within the state shall be subject to review under this article. No institutional
health services which are subject to this article shall be permitted which are inconsistent
with the State Health Plan. For the purposes of this article, new institutional health services
shall include any of the following: (1) The construction, development, acquisition through
lease or purchase, or other establishment of a new health care facility or health maintenance
organization. A transaction involving the sale, lease, or other transfer or change of control
of an existing health care facility, existing health maintenance organization, or existing
institutional health service is not subject to certificate of need review or approval under
this article unless the transaction also involves implementing one or...
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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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22-21A-1
Section 22-21A-1 Definitions. As used in this compact, unless the context clearly indicates
otherwise: (1) COMMISSION. The Interstate Advisory Health Care Commission. (2) EFFECTIVE DATE.
The date upon which this compact shall become effective for purposes of the operation of state
and federal law in a member state, which shall be the later of: a. The date upon which this
compact shall be adopted under the laws of the member state. b. The date upon which this compact
receives the consent of Congress pursuant to Article I, Section 10, of the United States
Constitution, after at least two member states adopt this compact. (3) HEALTH CARE. Care,
services, supplies, or plans related to the health of an individual and includes, but is not
limited to: a. Preventive, diagnostic, therapeutic, rehabilitative, maintenance, or palliative
care and counseling, service, assessment, or procedure with respect to the physical or mental
condition or functional status of an individual or that affects the...
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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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27-19A-2
Section 27-19A-2 Definitions. As used in this chapter, the following terms shall have
the respective meanings herein set forth, unless the context shall otherwise require: (1)
ALABAMA INSURANCE CODE. Title 27 of the Code of Alabama 1975. (2) INSURER. Such term shall
have the meaning ascribed in Section 27-1-2. (3) PERSON. Such term shall have the meaning
ascribed in Section 27-1-2. (4) COMMISSIONER and DEPARTMENT. Such terms, respectively,
shall have the meanings ascribed in Section 27-1-2. (5) CONTRACTUAL OBLIGATION. Any
obligation under covered policies or employee benefit plans. (6) COVERED POLICY OR PLAN. Any
policy, employee benefit plan, or contract within the scope of this chapter. (7) HEALTH INSURANCE
POLICY. Any individual, group, blanket, or franchise insurance policy, insurance agreement,
or group hospital service contract providing benefits for dental care expenses incurred as
a result of an accident or sickness. (8) EMPLOYEE BENEFIT PLAN. Any plan, fund, or program...
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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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