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22-21-265
Section 22-21-265 Certificates of need - Required for new institutional health service.
(a) On or after July 30, 1979, no person to which this article applies shall acquire, construct,
or operate a new institutional health service, as defined in this article, or furnish or offer,
or purport to furnish a new institutional health service, as defined in this article, or make
an arrangement or commitment for financing the offering of a new institutional health service,
unless the person shall first obtain from the SHPDA a certificate of need therefor. Notwithstanding
any provisions of this article to the contrary, those facilities and distinct units operated
by the Department of Mental Health, and those facilities and distinct units operating under
contract or subcontract with the Department of Mental Health where the contract constitutes
the primary source of income to the facility, shall not be required to obtain a certificate
of need under this article. (b) Notwithstanding all other...
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27-14-3
Section 27-14-3 Insurable interest - Personal insurance; preneed contracts. (a) Insurable
interest with reference to personal insurance is an interest based upon a reasonable expectation
of pecuniary advantage through the continued life, health, or bodily safety of another person
and consequent loss by reason of his or her death or disability or a substantial interest
engendered by love and affection in the case of individuals closely related by blood or by
law. (b) An individual has an unlimited insurable interest in his or her own life, health,
and bodily safety and may lawfully take out a policy of insurance on his or her own life,
health, or bodily safety and have the same made payable to whomsoever he or she pleases, regardless
of whether the beneficiary so designated has an insurable interest. (c) A corporation, foreign
or domestic, has an insurable interest in the life or physical or mental ability of any of
its directors, officers, or employees, or the directors, officers, or...
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27-36A-2
Section 27-36A-2 Definitions. For purposes of this chapter, the following definitions
shall apply on or after the operative date of the valuation manual as defined by Section
27-36A-15: (1) ACCIDENT AND HEALTH INSURANCE. Contracts that incorporate morbidity risk and
provide protection against economic loss resulting from accident, sickness, or medical conditions
and as may be specified in the valuation manual. (2) APPOINTED ACTUARY. A qualified actuary
who is appointed in accordance with the valuation manual to prepare the actuarial opinion
required in subsection (b) of Section 27-36A-4. (3) COMPANY. An entity, which (i) has
written, issued, or reinsured life insurance contracts, accident and health insurance contracts,
or deposit-type contracts in this state and has at least one such policy in force or on claim
or (ii) has written, issued, or reinsured life insurance contracts, accident and health insurance
contracts, or deposit-type contracts in any state and is required to hold a...
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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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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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11-91A-2
Section 11-91A-2 Local Government Health Insurance Board; governance and administration
of program. (a) The Local Government Health Insurance Board shall govern and administer the
Local Government Health Insurance Program currently governed and administered by the State
Employees' Insurance Board (SEIB) pursuant to Chapter 29 of Title 36. The transfer of the
governance and administration to the board shall take effect at 12:01 a.m. on January 1, 2015,
and thereafter the board shall take all control and responsibility for the program under procedures
and authority set out in this chapter. (b) The program governed and administered by the board
shall provide a reasonable relationship between the health care benefits to be included and
the expected health care expenses to be incurred by affected employees, retirees, and their
dependents. The board may establish a fully insured or self-insured health care plan for employees
and retirees as defined in this chapter and may adopt rules for the...
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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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27-21A-7
Section 27-21A-7 Evidence of coverage and charges for health care services. (a)(1) Every
enrollee residing in this state is entitled to an evidence of coverage. If the enrollee obtains
such coverage through an insurance policy or a contract issued by a health care service plan,
the insurer or the health care service plan shall issue the evidence of coverage. Otherwise,
the health maintenance organization shall issue the evidence of coverage. (2) No evidence
of coverage, or amendment thereto, shall be issued or delivered to any person in this state
until a copy of the basic form of the evidence of coverage, or amendment thereto, has been
filed with the commissioner and the State Health Officer, and approved by the commissioner.
(3) An evidence of coverage shall contain: a. No provisions or statements which encourage
misrepresentation, or which are untrue, misleading, or deceptive as defined in subsection
(a) of Section 27-21A-13; and b. A clear and concise statement, if a contract, or a...
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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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27-19A-7
Section 27-19A-7 Contracting directly with patient; distribution of information about
policy or plan; payment and reimbursement procedures. The provisions of this chapter do not
prohibit the following conduct and shall be construed to provide that: (1) A dentist may contract
directly with a patient for the furnishing of dental care services to said patient as may
be otherwise authorized by law; (2) Any person providing a health insurance policy or employee
benefit plan, or an employer, or an employee organization may: a. Make available to its insureds,
beneficiaries, participants, employees, or members information relating to dental care services
by the distribution of factually accurate information regarding dental care services, rates,
fees, location, and hours of service, provided such distribution is made upon the request
of any dentist licensed by this state; or b. Establish an administrative mechanism which facilitates
payment for dental care services by insureds, beneficiaries,...
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