27-19-104
Section 27-19-104 Coverage under policy issued in other state. No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in Section 27-19-103(4)d, unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that these requirements have been met. (Act 2000-795, p. 1876, ยง5.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19-104.htm - 800 bytes - 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
27-19-105
Section 27-19-105 Regulations for long-term care policies; outline of coverage, policy summary, and monthly report. (a) The commissioner may adopt regulations that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, and definitions of terms. Regulations under this subsection should recognize the developing and unique nature of long-term care insurance and the distinction between group and individual long-term insurance policies. (b) No long-term care insurance policy may do any of the following: (1) Be cancelled, nonrenewed, or otherwise...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19-105.htm - 11K - Match Info - Similar pages
27-60-2
Section 27-60-2 Interstate Insurance Product Regulation Compact. The State of Alabama hereby agrees to the following interstate compact known as the Interstate Insurance Product Regulation Compact: ARTICLE I. PURPOSES. The purposes of this compact are, through means of joint and cooperative action among the compacting states: 1. To promote and protect the interest of consumers of individual and group annuity, life insurance, disability income, and long-term care insurance products; 2. To develop uniform standards for insurance products covered under the compact; 3. To establish a central clearinghouse to receive and provide prompt review of insurance products covered under the compact and, in certain cases, advertisements related thereto, submitted by insurers authorized to do business in one or more compacting states; 4. To give appropriate regulatory approval to those product filings and advertisements satisfying the applicable uniform standard; 5. To improve coordination of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-60-2.htm - 45K - Match Info - Similar pages
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
27-44-5
Section 27-44-5 Definitions. As used in this chapter, the following terms shall have the following meanings, respectively, unless the context clearly indicates otherwise: (1) ACCOUNT. Either of the three accounts created under Section 27-44-6. (2) ASSOCIATION. The Alabama Life and Disability Insurance Guaranty Association created under Section 27-44-6. (3) AUTHORIZED ASSESSMENT or the term AUTHORIZED when used in the context of assessments. A resolution by the board of directors has been passed whereby an assessment will be called immediately or in the future from member insurers for a specified amount. An assessment is authorized when the resolution is passed. (4) BENEFIT PLAN. A specific employee, union, or association of natural persons benefit plan. (5) CALLED ASSESSMENT or the term CALLED when used in the context of assessments. A notice that has been issued by the association to member insurers requiring that an authorized assessment be paid within the time frame set forth within...
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27-44-3
Section 27-44-3 Scope of chapter. (a) This chapter shall provide coverage for the policies and contracts specified in subsection (b) as follows: (1) To persons who, regardless of where they reside (except for non-resident certificate holders under group policies or contracts), are the beneficiaries, assignees, or payees of the persons covered under subdivision (2). (2) To persons who are owners of or certificate holders under the policies or contracts, other than structured settlement annuities, and in each case who are either of the following: a. Residents b. Not residents, but only under all of the following conditions: 1. The insurer that issued the policies or contracts is domiciled in this state. 2. The states in which the persons reside have associations similar to the association created by this chapter. 3. The persons are not eligible for coverage by an association in any other state due to the fact the insurer was not licensed in the state at the time specified in the state's...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-44-3.htm - 12K - Match Info - Similar pages
27-54-2
Section 27-54-2 Definitions. For purposes of this chapter, the following terms have the following meanings: (1) DAY TREATMENT SERVICES. Includes, but is not limited to: Physiological, psychological, and psychosocial concepts, techniques, and processes necessary to maintain or develop functional skills of clients, provided to individuals and groups for periods of more than two hours but less than 24 hours a day. (2) HEALTH BENEFIT PLAN. A health care service plan governed by the provisions of Article 6, Chapter 4, Title 10, and a group health insurance policy, including an employee welfare health benefit plan, that covers hospital, medical, or surgical expenses, issued by insurers, 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...
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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...
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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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