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22-57-5
Section 22-57-5 Alabama Interagency Autism Coordinating Council - Powers and duties. The council
shall have the following duties and authority: (1) To make recommendations to the Governor
regarding the designation of the lead agency. (2) To define the roles and responsibilities
of all participating agencies. (3) To adopt rules for the internal operation of the council.
(4) To recommend to the Governor the appointment of additional members to serve on the council
as deemed necessary and appropriate. (5) To develop a long-term plan, reviewed annually, for
a comprehensive statewide system of care, which, to the extent practical, is derived from
scientific based research and nationally recognized best practices. The council shall provide
a copy of the plan and a detailed summary of any progress toward implementation of the plan
to the Governor and the Legislature on or before the 10th legislative day of each regular
session. The plan should include, but not be limited to, all of the...
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25-5-290
Section 25-5-290 Ombudsman program, creation; purpose; members; notification of service; benefit
review conferences. (a) The Department of Industrial Relations shall establish an Ombudsman
Program to assist injured or disabled employees, persons claiming death benefits, employers,
and other persons in protecting their rights and obtaining information available under the
Workers' Compensation Law. (b) Providing that the employer and the employee agree to participate
in the benefit review conference, the ombudsmen shall meet with or otherwise provide information
to injured or disabled employees, investigate complaints, and communicate with employers,
insurance carriers, and health care providers on behalf of injured or disabled employees.
(c) Ombudsmen shall be Merit System employees and demonstrate familiarity with the Workers'
Compensation Law. An ombudsman shall not be an advocate for any person who shall assist a
claimant, employer, or other person in any proceeding beyond the...
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27-12A-20
Section 27-12A-20 Fraud warning. (a) A fraud warning shall be included on at least one of the
following: Claim release forms, applications, reinstatements for insurance, participation
agreements, declaration pages, and claim documents, regardless of the method or form of transmission
and shall contain the following statement or a substantially similar statement: "Any
person who knowingly presents a false or fraudulent claim for payment of a loss or benefit
or who knowingly presents false information in an application for insurance is guilty of a
crime and may be subject to restitution, fines, or confinement in prison, or any combination
thereof." (b) The lack of a statement required by subsection (a) shall not constitute
a defense in any prosecution for insurance fraud. (c) Policies issued by unauthorized insurers
shall contain a statement disclosing the status of the insurer to do business in the state
where the policy is delivered or issued for delivery or the state where coverage is...
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27-15-75
Section 27-15-75 Calculation of adjusted premiums. (a)(1) This section shall not apply to policies
issued on or after the operative date of Section 27-15-78, as defined therein. Except as provided
in subsection (c), the adjusted premiums for any policy shall be calculated on an annual basis
and shall be such uniform percentage of the respective premiums specified in the policy for
each policy year, excluding extra premiums on a substandard policy, that the present value
at the date of issue of the policy, of all such adjusted premiums shall be equal to the sum
of: a. The then present value of the future guaranteed benefits provided for by the policy.
b. Two percent of the amount of the insurance if the insurance be uniform in amount, or of
the equivalent uniform amount, as defined in this article, if the amount of insurance varies
with the duration of the policy. c. Forty percent of the adjusted premium for the first policy
year. d. Twenty-five percent of either the adjusted premium...
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27-19A-12
Section 27-19A-12 Dental services - Coverages; fees; exceptions. (a) As used in this section,
the following terms shall have the following meanings: (1) COVERED PERSON. Any individual,
family, or family member on whose behalf third-party payment or prepayment of health or medical
expenses is provided under an insurance policy, plan, or contract providing for third-party
payment or prepayment of health care or medical expenses. (2) COVERED SERVICES. Dental care
services for which a reimbursement is available under an enrollee's plan contract, or for
which a reimbursement would be available but for the application of contractual limitations
such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums,
frequency limitations, alternative benefit payments, or any other limitation. (3) DENTAL CARE
PROVIDER. A licensed dentist. (4) DENTAL PLAN. Includes any policy of insurance which is issued
by a health care service contractor which provides for coverage of...
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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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27-45-2
Services ordinarily and customarily rendered by a pharmacy or pharmacist, including without
limitation, the dispensing of prescriptions, drugs, medicines, chemicals, or poisons. (12)
DRUGS. All medical substances, preparations, and devices recognized by the United States Pharmacopoeia
and National Formulary, or any revision thereof, and all substances and preparations intended
for external and internal use in the cure, diagnosis, mitigation, treatment, or prevention
of disease in man or animal and all substances and preparations other than food intended
to affect the structure or any function of the body of man or animal. (13) PRESCRIPTION.
Any order for drug or medical supplies, written or signed or transmitted by word of mouth,
telephone, telegraph, closed circuit, television, or other means of communication by a legally
competent practitioner, licensed by law to prescribe and administer such drugs and medical
supplies intended to be filled, compounded, or dispensed by a...
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27-7-4.2
Section 27-7-4.2 Licenses - Applicability to insurance producer. (a) Nothing in this chapter
shall be construed to require an insurer to obtain an insurance producer license. In this
section, the term "insurer" does not include an insurer's officers, directors, employees,
subsidiaries, or affiliates. (b) A license as an insurance producer shall not be required
of any of the following: (1) An officer, director, or employee of an insurer or of an insurance
producer, provided that the officer, director, or employee does not receive any commission
on policies written or sold to insure risks residing, located, or to be performed in this
state and any of the following: a. The officer, director, or employee's activities are executive,
administrative, managerial, clerical, or a combination of these, and are only indirectly related
to the sale, solicitation, or negotiation of insurance. b. The officer, director, or employee's
function relates to underwriting, loss control, inspection, or the...
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27-12A-1
Section 27-12A-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) COMMISSIONER. The Alabama Commissioner of Insurance or his or her designee.
(2) DEPARTMENT. The Alabama Department of Insurance. (3) INSURANCE. As defined in Section
27-1-2, and specifically including any contract, arrangement, or agreement, in which one undertakes
to do any one of the following: a. Pay or indemnify another as to loss from certain contingencies
called risks. b. Pay or grant a specified amount or determinable benefit to another in connection
with ascertainable risk contingencies. c. Pay an annuity to another. d. Act as surety. For
the purposes of this chapter, insurance also includes any health benefit plan as defined in
Section 27-53-1. (4) INSURANCE PRODUCER or PRODUCER. As defined in Section 27-7-1. (5) INSURER.
A person entering into agreements, contracts of insurance, arrangements, or reinsurance, or
a health benefit plan, or a group health plan as...
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27-21A-1
Section 27-21A-1 Definitions. As used in this chapter, the following terms shall have the following
meanings, respectively: (1) AGENT. A person who is appointed or employed by a health maintenance
organization and who engages in solicitation of membership in such organization. This definition
does not include a person enrolling members on behalf of an employer, union, or other organization.
(2) BASIC HEALTH CARE SERVICES. Emergency care, inpatient hospital and physician care, and
outpatient medical services. (3) COMMISSIONER. The Commissioner of Insurance. (4) ENROLLEE.
An individual who is enrolled in a health maintenance organization. (5) EVIDENCE OF COVERAGE.
Any certificate, agreement, or contract issued to an enrollee setting out the coverage to
which he is entitled. (6) HEALTH CARE SERVICES. Any services included in the furnishing to
any individual of medical or dental care, or hospitalization or incident to the furnishing
of such care or hospitalization, as well as the...
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