36-29-6
Section 36-29-6 Authorization and execution of contracts; documentation of benefits. (a) The board is hereby authorized to execute a contract or contracts to provide the plan determined in accordance with the provisions of this chapter. Such contract or contracts may be executed with one or more agencies or corporations licensed to transact or administer group health insurance business in this state. All of the benefits to be provided under this chapter may be included in one or more similar contracts issued by the same or different companies. (b) Before entering into any contract or contracts authorized by subsection (a) of this section, the board shall invite competitive bids from all qualified entities who may wish to administer or offer plans for the health insurance coverage desired. The board shall award such contract or contracts on a competitive basis as determined by the benefits afforded, administrative costs, the costs to be incurred by employee, retiree, and employer, the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/36-29-6.htm - 3K - Match Info - Similar pages
16-25A-7
Section 16-25A-7 Authorization and execution of contracts; evidence of coverage; denial of claims. (a) The board is hereby authorized to execute a contract or contracts to provide for the benefits or the administration of the plan determined in accordance with the provisions of this article. Such contract or contracts may be executed with one or more agencies or corporations licensed to transact or administer group health insurance business in this state. All of the benefits to be provided under this article may be included in one or more similar contracts issued by the same or different companies. The board is further authorized to develop a plan whereby it may become self-insured upon its finding that such arrangement would be financially advantageous to the state and plan participants. (b) Before entering into any contract or contracts authorized by subsection (a), the board shall invite competitive bids from all qualified entities who may wish to administer or offer plans for the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/16-25A-7.htm - 4K - Match Info - Similar pages
27-45-2
Section 27-45-2 Definitions. As used in this article, 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 article. (7) HEALTH INSURANCE POLICY. Any individual, group, blanket, or franchise insurance policy, insurance agreement, or group hospital service contract providing for pharmaceutical services, including without limitation, prescription drugs, incurred as a result of accident or sickness, or to prevent same....
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-45-2.htm - 3K - Match Info - Similar pages
27-58-1
Section 27-58-1 Definitions. As used in this chapter, the following terms shall have the following meanings: (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 chapter if it receives, processes, adjudicates, pays, or denies claims for health care services submitted by or on...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-58-1.htm - 1K - Match Info - Similar pages
27-59-1
Section 27-59-1 Definitions. As used in this chapter, the following terms shall have the following meanings: (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 chapter if it receives, processes, adjudicates, pays, or denies claims for health care services submitted by or on...
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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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36-29-5
Section 36-29-5 Expenses, treatment, etc., not to be included under plan. (a) Such health insurance shall not include any of the following: (1) Expenses incurred by or on account of an individual prior to the effective date of the plan. (2) Cosmetic surgery or treatment, except to the extent necessary for correction of damages caused by accidental injury while covered by the plan or as a direct result of disease covered by the plan. (3) Services received in a hospital owned or operated by the United States government for which no charge is made. (4) Services received for injury or sickness due to war or any act of war, whether declared or undeclared, which war or act of war shall have occurred after the effective date of this plan. (5) Expenses for which the individual is not required to make payment. (6) Expenses to the extent of benefits provided under any employer group plan other than the plan in which the state participates in the cost thereof. (7) Such other expenses as may be...
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16-25A-6
Section 16-25A-6 Exclusions. Such health insurance shall not include the following: (1) Expenses incurred by or on account of an individual prior to the effective date of the plan as to him; (2) Hearing aids and examinations for the prescription or fitting thereof; (3) Cosmetic surgery or treatment, except to the extent necessary for correction of damage caused by accidental injury while covered by the plan or as a direct result of disease covered by the plan; (4) Services received in a hospital owned or operated by the United States government for which no charge is made; (5) Services received for injury or sickness due to war or any act of war, whether declared or undeclared, which war or act of war shall have occurred after the effective date of this plan; (6) Expenses for which the individual is not required to make payment; (7) Expenses to the extent of benefits provided under any employer group plan other than this plan in which the state participates in the cost thereof; (8)...
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22-6-120
Section 22-6-120 Legislative findings. The Legislature finds the following: (1) The availability of appropriate pharmaceutical benefits to every Alabama citizen is a critical component to the overall health of its population. (2) Alabama should strive to provide appropriate, safe, effective, and cost-efficient pharmaceutical care to those who depend on health benefits through state funded programs. (3) The Alabama Medicaid Agency should endeavor to manage the Medicaid Pharmacy Program utilizing clinical management tools in a manner to foster optimal health outcomes at reasonable costs. (4) State Medicaid programs and private insurance plans across the country utilize preferred drug lists as an effective way to foster and encourage clinically appropriate and safe use of pharmaceuticals in a cost-effective manner. (5) Based on the proven effectiveness of preferred drug programs to foster appropriate use of drugs, it is in the best interests of Alabama and its citizens for the Alabama...
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27-1-17.1
Section 27-1-17.1 Payment of providers through electronic funds transfer methods. (a) As used in this section, the following words shall have the following meanings: (1) ACH ELECTRONIC FUNDS TRANSFER. An electronic funds transfer through the Health Insurance Portability and Accountability Act (HIPPA) standard Automated Clearing House network. (2) COVERED HEALTH CARE PROVIDER. A physician as defined in Section 34-24-50.1; a dentist as defined in Section 34-9-1; a chiropractor as defined in Section 34-24-120; an individual engaged in the practice of optometry as defined in Section 34-22-1; other licensed health care professionals as defined in Title 34; a hospital as defined in Section 22-21-20; and a health care facility, or other provider who or that is accredited, licensed, or certified and who or that is performing within the scope of that accreditation, license, or certification. (3) HEALTH INSURANCE PLAN. Any hospital and medical expense incurred policy, health maintenance...
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