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36-29-19.8
Section 36-29-19.8 Supplemental coverage for certain retirees. The board may offer a
retiree a supplemental coverage to other employer group health insurance coverage and certain
requirements shall be maintained regarding retiree health coverage and cost sharing. (1) For
employees who retire after September 30, 2005, and who become employed by an employer that
provides employees at least 50 percent of the cost of single health insurance coverage and
that qualify to receive other employer group health insurance coverage through that employer
shall be required to use the employer's health benefit plan for primary coverage and the State
Employees' Health Insurance Plan may provide supplemental coverage. (2) For retirees who have
spouses with other employer group health insurance coverage available to them through their
employer or previous employer, the board may provide such retirees with a supplemental coverage
to other employer group health insurance coverage in lieu of coverage in the...
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36-35-3
Section 36-35-3 Alabama Prescription Cost Initiative Board. (a) The Alabama Prescription
Cost Initiative Board is created. (b) The board shall consist of the following voting members:
The executive director or chief staff person of the State Employees Insurance Board (SEIB)
and the Public Education Employees Health Insurance Plan (PEEHIP), the Chair of the Board
of Directors of SEIB, the Chair of the Board of Directors of PEEHIP, and the State Health
Officer. The Director of the Medicaid Agency may serve in a nonvoting capacity. (c) The board
shall promulgate policies to implement this chapter and may hire an executive director and
necessary staff to implement and administer this chapter with or without regard to the state
Merit System. (d) The board through its executive director may enter into agreements with
a prescription drug buying group or manufacturer to negotiate price discounts or rebates on
behalf of the board or any participating department or governmental entity. (e) The...
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27-45-5
Section 27-45-5 Article does not mandate that pharmaceutical services be provided. The
provisions of this article do not mandate that any type of benefits for pharmaceutical services,
including without limitation, prescription drugs, be provided by a health insurance policy
or an employee benefit plan. (Acts 1988, No. 88-379, p. 565, §5.)...
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27-59-3
Section 27-59-3 Implementation of coverage. (a) The benefits provided in this chapter
shall be subject to the same annual deductible or co-insurance established for all covered
benefits within a given policy. Private third party payors may not reduce or eliminate coverage
due to the requirements of this chapter. (b) A health benefit plan subject to this chapter
may not terminate services, reduce capitation payment, or otherwise penalize an attending
physician or health care provider who orders medical care consistent with this chapter. (c)
Nothing in this chapter is intended to expand the list of designations of covered providers
as specified in any health benefit plan. (Act 2008-502, p. 1106, §3.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-59-3.htm - 1K - 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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27-21A-13
Section 27-21A-13 Prohibited practices. (a) No health maintenance organization, or representative
thereof, may cause or knowingly permit the use of advertising which is untrue or misleading,
solicitation which is untrue or misleading, or any form or evidence of coverage which is deceptive.
For purposes of this chapter: (1) A statement or item of information shall be deemed to be
untrue if it does not conform to fact in any respect which is or may be significant to an
enrollee of, or person considering enrollment with a health maintenance organization; (2)
A statement or item of information shall be deemed to be misleading, whether or not it may
be literally untrue, if, in the total context in which such statement is made or such item
of information is communicated, such statement or item of information may be reasonably understood
by a reasonable person, not possessing special knowledge regarding health care coverage, as
indicating any benefit or advantage or the absence of any...
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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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27-55-2
Section 27-55-2 Definitions. As used in this chapter, these terms shall have the following
meanings: (1) ABUSE. The occurrence of one or more of the following acts by a family or household
member, as defined by subdivision (3) of subsection (b) of Section 15-10-3: a. Attempting
to cause or intentionally, knowingly, or recklessly causing another person, including a minor
child, bodily injury, severe emotional injury, or psychological trauma or conduct which constitutes
the crime of rape. b. Intentionally following another person, including a minor child, without
proper authority, under circumstances that place the person in reasonable fear of bodily injury
or physical harm. c. Subjecting another person, including a minor child, to false imprisonment
or kidnapping. d. Attempting to cause or intentionally, knowingly, or recklessly causing damage
to property to intimidate or attempt to control the behavior of another person, including
a minor child. e. Assault, child abuse, criminal...
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27-58-4
Section 27-58-4 Benefits subject to annual deductible, coinsurance, exclusions, reductions,
etc. (a) The benefits provided in this chapter shall be subject to the same annual deductible
or coinsurance established for all covered benefits within a given policy. Private third party
payors may not reduce or eliminate coverage due to the requirements of this chapter. (b) A
health benefit plan subject to this chapter shall not terminate services, reduce capitation
payment, or otherwise penalize an attending physician or health care provider who orders medical
care consistent with this chapter. (c) Nothing in this chapter is intended to expand the list
of designations of covered providers as specified in any health benefit plan. (Act 2007-389,
p. 778, §4.)...
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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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