27-56-4
Section 27-56-4 Prohibited activities. An insurance policy, plan, or contract providing for third-party payment or prepayment of health or medical expenses shall not do any of the following: (1) Impose a practice restriction for optometrists which is inconsistent with or more restrictive than provided by law. (2) Discriminate between classes of eye care providers with respect to any covered service which falls within the scope of the eye care provider's license. (3) Require an eye care provider to hold hospital privileges as a condition of participation in or receiving payment from the policy, plan, or contract. (4) Impose any restriction not required by law based on the eye care provider's professional degree. (5) Discriminate between eye care providers in connection with the amount of reimbursement for the provision of the same services. (6) Require an eye care provider to purchase or maintain a minimum quantity or minimum dollar amount of a specified brand of ophthalmic materials as...
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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
27-19A-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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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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-181.htm - 3K - Match Info - Similar pages
27-1-10.1
Section 27-1-10.1 Insurance coverage for drugs to treat life-threatening illnesses. (a) The Legislature finds and declares the following: (1) The citizens of this state rely upon health insurance to cover the cost of obtaining health care and it is essential that the citizens' expectation that their health care costs will be paid by their insurance policies is not disappointed and that they obtain the coverage necessary and appropriate for their care within the terms of their insurance policies. (2) Some insurers deny payment for drugs that have been approved by the Federal Food and Drug Administration, hereafter referred to as FDA, when the drugs are used for indications other than those stated in the labelling approved by the FDA, off-label use, while other insurers with similar coverage terms do pay for off-label use. (3) Denial of payment for off-label use can interrupt or effectively deny access to necessary and appropriate treatment for a person being treated for a...
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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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27-54-4
Section 27-54-4 Illnesses covered; requirements of benefit plans, etc. (a) All group health benefit plans shall offer to provide, at a minimum, additional benefits according to this chapter for a person receiving medical treatment for any of the following mental illnesses diagnosed by an appropriately licensed provider. (1) Schizophrenia, schizophrenia form disorder, schizo affective disorder. (2) Bipolar disorder. (3) Panic disorder. (4) Obsessive-compulsive disorder. (5) Major depressive disorder. (6) Anxiety disorders. (7) Mood disorders. (8) Any condition or disorder involving mental illness, excluding alcohol and substance abuse, that falls under any of the diagnostic categories listed in the mental disorders section of the International Classification of Disease, as periodically revised. (b) All group health benefit plans, policies, contracts, and certificates executed, delivered, issued for delivery, continue, or renewed in this state on or after January 1, 2001, shall offer, at...
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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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27-44-5
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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40-26B-70
Section 40-26B-70 Definitions. For purposes of this article, the following terms shall have the following meanings: (1) ACCESS PAYMENT. A payment by the Medicaid program to an eligible hospital for inpatient or outpatient hospital care, or both, provided to a Medicaid recipient. (2) ALL PATIENT REFINED DIAGNOSIS-RELATED GROUP (APR-DRG). A statistical system of classifying any non-Medicare inpatient stay into groups for the purposes of payment. (3) ALTERNATE CARE PROVIDER. A contractor, other than a regional care organization, that agrees to provide a comprehensive package of Medicaid benefits to Medicaid beneficiaries in a defined region of the state pursuant to a risk contract. (4) CERTIFIED PUBLIC EXPENDITURE (CPE). A certification in writing of the cost of providing medical care to Medicaid beneficiaries by publicly owned hospitals and hospitals owned by a state agency or a state university plus the amount of uncompensated care provided by publicly owned hospitals and hospitals...
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