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27-1-21
Section 27-1-21 Uniformity of limits applied to fulfillment of certain drug prescriptions.
(a) For the purposes of this section, the following words shall have the following
meanings: (1) ENROLLEE. A person enrolled in a health benefit plan. (2) HEALTH BENEFIT PLAN.
Any individual or group plan, policy, or contract for health care services issued, delivered,
issued for delivery, 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, purchases, or
furnishes health care services to patients, insureds, or beneficiaries in this state. The
term includes, but is not limited to, entities created pursuant to Article 6 of Chapter 4
of Title 10. The term shall not include any collective bargaining agreement...
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27-54A-2
Section 27-54A-2 Treatment under certain policies and contracts. (a) As used in this
section, the following words have the following meanings: (1) APPLIED BEHAVIOR ANALYSIS.
The design, implementation, and evaluation of environmental modifications, using behavioral
stimuli and consequences, to produce socially significant improvement in human behavior, including
the use of direct observation, measurement, and functional analysis of the relationship between
environment and behavior. (2) AUTISM SPECTRUM DISORDER. Any of the pervasive developmental
disorders or autism spectrum disorders as defined by the most recent edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) or the edition that was in effect at the
time of diagnosis. (3) BEHAVIORAL HEALTH TREATMENT. Counseling and treatment programs, including
applied behavior analysis that are both of the following: a. Necessary to develop, maintain,
or restore, to the maximum extent practicable, the functioning of an...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-54A-2.htm - 10K - Match Info - Similar pages
34-23-181
Section 34-23-181 Definitions. The following words shall have the following meanings
as used in this article: (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 article if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or...
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27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive
denials, adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health
benefit plan that issues or renews any policy of accident or health insurance providing benefits
for medical or hospital expenses for its insured persons shall pay for services rendered by
Alabama health care providers within 45 calendar days upon receipt of a clean written claim
or 30 calendar days upon receipt of a clean electronic claim. If the insurer, health service
corporation, or health benefit plan is denying or pending the claim, the insurer, health service
corporation, or health benefit plan shall, within 45 calendar days for a written claim and
30 calendar days for an electronic claim, notify the health care provider or certificate holder
of the reason for denying or pending the claim and what, if any, additional information is
required to process the claim. Any undisputed portion of the claim...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-17.htm - 17K - Match Info - Similar pages
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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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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-20.htm - 3K - Match Info - Similar pages
27-55-3
Section 27-55-3 Prohibited practices; disclosure of information. (a) No insurer may:
(1) Deny, refuse to issue, renew, or reissue, cancel, or otherwise terminate, restrict, or
exclude coverage on an insurance policy or health benefit plan on the basis of an applicant's
or insured's abuse status, or on the basis of any association, relationship, or assistance
to a subject of abuse. (2) Exclude or limit coverage for a loss, deny benefits, or deny a
claim on the basis of the insured's abuse status, or on the basis of any association, relationship,
or assistance to a subject of abuse, except as otherwise permitted or required by the laws
of this state relating to acts of abuse committed by a life insurance beneficiary. Notwithstanding
anything to the contrary in this section, a liability insurer may include policy provisions
providing that a payment required by this subsection may be denied or, if paid, recovered
by the insurer from the insured, if the claim arose out of an act of abuse by...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-55-3.htm - 8K - Match Info - Similar pages
22-21-260
Section 22-21-260 Definitions. As used in this article, the following words and terms,
and the plurals thereof, shall have the meanings ascribed to them in this section,
unless otherwise required by their respective context: (1) ACQUISITION. Obtaining the legal
equitable title to a freehold or leasehold estate or otherwise obtaining the substantial benefit
of such titles or estates, whether by purchase, lease, loan or suffrage, gift, devise, legacy,
settlement of a trust or means whatever, and shall include any act of acquisition. The term
"acquisition" shall not mean or include any conveyance, or creation of any lien
or security interest by mortgage, deed of trust, security agreement, or similar financing
instrument, nor shall it mean or include any transfer of title or rights as a result of the
foreclosure, or conveyance or transfer in lieu of the foreclosure, of any such mortgage, deed
of trust, security agreement, or similar financing instrument, nor shall it mean or include
any...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-260.htm - 11K - Match Info - Similar pages
27-19-103
Section 27-19-103 Definitions. Unless the context requires otherwise, the definitions
in this section apply throughout this article. (1) APPLICANT. In the case of: a. An
individual long-term care insurance policy, the person who seeks to contract for benefits.
b. A group long-term care insurance policy, the proposed certificate holder. (2) CERTIFICATE.
Any certificate issued under a group long-term care insurance policy, which policy has been
delivered or issued for delivery in this state. (3) COMMISSIONER. The Alabama Commissioner
of Insurance. (4) GROUP LONG-TERM CARE INSURANCE. A long-term care insurance policy which
is delivered or issued for delivery in this state and issued to any of the following: a. One
or more employers or labor organizations, or to a trust or to the trustees of a fund established
by one or more employers or labor organizations, or a combination thereof, for employees or
former employees or a combination thereof, or for members or former members or a...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19-103.htm - 9K - Match Info - Similar pages
45-49A-63
Section 45-49A-63 Definitions. As used in this part, the following words and terms shall
have meanings as follows: (1) ANNUITY STARTING DATE. The first day for which a benefit is
payable as an annuity or any other form under Section 45-49A-63.80. (2) BENEFICIARY.
The person or persons named by a member by written designation filed with the board to receive
payments under this plan after the member's death. The member may not change his or her beneficiary
after his or her annuity starting date. If no beneficiary designation is in effect at the
member's death, or if no person so designated survives the member, the member's surviving
spouse, if any, shall be deemed to be the beneficiary, otherwise the beneficiary shall be
the member's estate. (3) BOARD. The Police and Fire Pension Board as constituted under Section
45-49A-63.120, or its delegate. (4) BREAK IN SERVICE. A period of absence which would constitute
a break in the member's service under the Mobile County Personnel Board rules;...
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