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27-15-77
Section 27-15-77 Calculation of adjusted premiums - Industrial policies. (a) This section shall
not apply to industrial policies to be issued on or after the operative date of Section 27-15-78,
as defined therein. (b) The adjusted premiums and present values referred to in this article
for all policies of industrial insurance shall be calculated on the basis of the Commissioners
1961 Standard Industrial Mortality Table. All calculations shall be made on the basis of the
rate of interest specified in the policy for calculating cash surrender values and paid-up
nonforfeiture benefits; provided, that such rate of interest shall not exceed three and one-half
percent per annum; provided further, that a rate of interest not exceeding four percent per
annum may be used for policies issued on or after August 23, 1976, and prior to July 30, 1979,
and a rate of interest not exceeding five and one-half percent per annum may be used for policies
issued on or after July 30, 1979; provided, however,...
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27-19A-2
Section 27-19A-2 Definitions. As used in this chapter, 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 chapter. (7) HEALTH INSURANCE POLICY. Any individual,
group, blanket, or franchise insurance policy, insurance agreement, or group hospital service
contract providing benefits for dental care expenses incurred as a result of an accident or
sickness. (8) EMPLOYEE BENEFIT PLAN. Any plan, fund, or program...
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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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27-58-1
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...
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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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27-15-81
Section 27-15-81 Consistency of progression of cash surrender values with increasing policy
duration. (a) This section, in addition to all other applicable sections of this article,
shall apply to all policies issued on or after January 1, 1985. Any cash surrender value available
under the policy in the event of default in a premium payment due on any policy anniversary
shall be in an amount which does not differ by more than two-tenths of one percent of either
the amount of insurance, if the insurance be uniform in amount, or the average amount of insurance
at the beginning of each of the first 10 policy years, from the sum of: (1) The greater of
zero and the basic cash value hereinafter specified. (2) The present value of any existing
paid-up additions, less the amount of any indebtedness to the insurer on account of or secured
by the policy. (b) The basic cash value shall be equal to the present value, on such anniversary,
of the future guaranteed benefits which would have been...
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27-15-53
Section 27-15-53 Requirements for death master file comparisons. (a) An insurer shall perform
a comparison of its insureds' in-force life insurance policies, annuity contracts, and retained
asset accounts against a death master file, to identify potential death master file matches
of its insureds. Such comparison shall be completed by January 1, 2019. Thereafter, an insurer
shall maintain a program designed to compare each such policy, contract, or account with a
death master file no less frequently than every three years, it being the intent that insurers
fashion a program that best fits their business systems while at the same time protecting
consumers by assuring reasonable checks are being performed to identify unreported deaths.
For those potential death master file matches identified as a result of a death master file
comparison, the insurer shall do all of the following: (1) Within 90 days of a death master
file match: a. Complete a commercially reasonable effort, which shall be...
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27-56-10
Section 27-56-10 Vision care providers - Contract requirements; rates; reimbursements; discounts.
(a) As used in this section, the following words shall have the following meanings: (1) CONTRACTUAL
DISCOUNT. A percentage reduction from a provider's usual and customary rate for covered services
and materials required under a participating provider agreement. (2) COVERED MATERIALS. Materials
for which reimbursement from the insurer or vision care plan is provided to a vision care
provider by an enrollee's plan contract, or for which a reimbursement would be available but
for the application of the enrollee's contractual limitations of deductibles, copayments,
or coinsurance. (3) COVERED SERVICES. Services for which reimbursement from the insurer or
vision care plan is provided to a vision care provider by an enrollee's plan contract, or
for which a reimbursement would be available but for the application of the enrollee's contractual
plan limitations of deductibles, copayments, or...
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22-21-7
Section 22-21-7 Itemized statement of services rendered to be furnished patient upon request;
provisions of statement; itemization of services and expenses; action by Attorney General;
payment of claims by insurance companies. (a) For the purposes of this section, the term "hospital"
shall mean any hospital in which human patients are given medical care. It shall include all
emergency rooms or outpatient facilities connected thereto. (b) Within 10 days following discharge
or release from confinement in a hospital or nursing home, or within 10 days after the earliest
date at which the expense from the confinement or service may be determined, which in the
case of long-term confinement may be the monthly charge, the hospital or nursing home providing
the service shall submit to the patient, or to his survivor or legal guardian as may be appropriate,
upon written request, an itemized statement detailing in language comprehensible to an ordinary
layman the specific nature of charges or...
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27-19-56
Section 27-19-56 Outline of coverage; disclosure of information. (a) In order to provide for
full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement
policy shall be delivered or issued for delivery in this state and no certificate shall be
delivered pursuant to a group Medicare supplement policy delivered or issued for delivery
in this state unless an outline of coverage is delivered to the applicant at the time application
is made. (b) The commissioner shall prescribe the format and content of the outline of coverage
required by subsection (a) of this section. For purposes of this section, "format"
means style, arrangements, and overall appearance, including, but not limited to, the size,
color, and prominence of type and the arrangement of text and captions. This outline of coverage
shall include all of the following: (1) A description of the principal benefits and coverage
provided in the policy. (2) A statement of the renewal provisions...
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