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27-19-39
Section 27-19-39 Policies, etc., providing for reimbursement for visual service. Whenever
any policy of insurance or any medical service plan or hospital service contract or hospital
and medical service contract provides for reimbursement for any visual service in Alabama
which is within the lawful scope of practice of a duly licensed optometrist, as defined in
Section 34-22-1, the insured or other person entitled to benefits under such policy
shall be entitled to reimbursement for such services, whether such services are performed
by a duly licensed physician or by a duly licensed optometrist, whichever the insured selects,
notwithstanding any provision to the contrary in any statute or in such policy, plan, or contract.
Duly licensed optometrists shall be entitled to participate in such policies, plans, or contracts
providing for visual services to the same extent as fully licensed physicians. (Acts 1967,
No. 508, p. 1224.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19-39.htm - 1K - Match Info - Similar pages
27-1-18
Section 27-1-18 Contract providing for mental health services to entitle insured to
reimbursement for outpatient and inpatient services by qualified psychiatrist or psychologist.
(a) Whenever any group, or blanket hospital or medical expense insurance policy or hospital
or medical service contract issued for delivery in this state provides for the reimbursement
of health or health related services which includes mental health services, and such services
are within the lawful scope of practice of a duly qualified psychiatrist or psychologist,
the insured or other person entitled to benefits under such policy or contract shall be entitled
to reimbursement for outpatient services, and inpatient services if requested by the attending
physician, performed by a duly qualified psychiatrist or psychologist notwithstanding any
provisions of the policy or contract to the contrary. (b) For purposes of this section,
a duly qualified psychologist means, one who is duly licensed or certified at the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-18.htm - 2K - Match Info - Similar pages
27-20A-2
Section 27-20A-2 Chapter applicable to group, etc., policies. No group, blanket, franchise,
or association health insurance policy providing coverage on an expense incurred basis, nor
group, blanket, franchise, or association service or indemnity type contract issued by a nonprofit
corporation, nor group-type self insurance plan providing protection, insurance, or indemnity
against hospital, medical, or surgical expenses, nor health maintenance organization plan
shall be issued, delivered, executed, or renewed in this state, or approved for issuance or
renewal in this state by the Commissioner of Insurance after 90 days beyond the effective
date of this chapter, unless such policy, contract, or plan, at the option of the policyholder
or sponsor, provides benefits to any insured, subscriber, or other person covered under the
policy, contract, or plan for expenses incurred in connection with the treatment of alcoholism
when such treatment is prescribed by a duly licensed doctor of...
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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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19A-12.htm - 2K - Match Info - Similar pages
27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases
shall have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health.
(2) ENROLLEE. An individual who has contracted for or who participates in coverage under an
insurance policy, a health maintenance organization contract, a health service corporation
contract, an employee welfare benefit plan, a hospital or medical services plan, or any other
benefit program providing payment, reimbursement, or indemnification for health care costs
for the individual or the eligible dependents of the individual. (3) PROVIDER. A health care
provider duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system
for prospective and concurrent review of the necessity and appropriateness in the allocation
of health care resources and services given or proposed to be given to an individual within
this state. The term does not include elective requests for clarification of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-3A-3.htm - 3K - Match Info - Similar pages
27-1-10
Section 27-1-10 Payment for health services of chiropractor; insured to have exclusive
right to select practitioner of healing arts. Any contract or policy of insurance or any plan
or agreement for health services providing for reimbursement or payment for health services
performed by a medical doctor or physician or upon the certification of a medical doctor,
surgeon, osteopath or physician, shall also reimburse or pay for such health services performed
by a doctor of chiropractic or upon his certificate; provided, that the health services performed
by the doctor of chiropractic are within the scope of his license and he is duly licensed
by the State of Alabama. The insured or such other person entitled to benefits under such
contract or policy of insurance or plan or agreement for health services shall have the exclusive
right to choose or select any practitioner or member of the healing arts of Alabama to perform
such services, notwithstanding any provisions of such contract or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-10.htm - 1K - 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
27-1-19
Section 27-1-19 Reimbursement of health care providers. (a) The insured, or health or
dental plan beneficiary may assign reimbursement for health or dental care services directly
to the provider of services. Health benefits include medical, pharmacy, podiatric, chiropractic,
optometric, durable medical equipment, and home care services. The company or agency, when
authorized by the insured, or health or dental plan beneficiary, shall pay directly to the
health care provider the amount of the claim, under the same criteria and payment schedule
that would have been reimbursed directly to the contract provider, and any applicable interest.
This amount only applies to assigned claims. Any company or agency making a payment to the
insured, or health or dental plan beneficiary, after the rights of reimbursement have been
assigned to the provider of services, shall be liable to the provider for the payment. If
the company or agency fails to reimburse the provider in accordance with the terms...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-19.htm - 2K - 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
27-21A-4
Section 27-21A-4 Powers of health maintenance organizations. (a) The powers of a health
maintenance organization include, but are not limited to the following: (1) The purchase,
lease, construction, renovation, operation, or maintenance of hospitals, medical facilities,
or both, and their ancillary equipment; (2) The making of loans other than in the ordinary
course of business, to providers under contract with it in furtherance of its program or the
making of loans to a corporation or corporations in which it owns a majority interest for
the purpose of acquiring or constructing medical facilities and hospitals or in furtherance
of a program providing health care services to enrollees. (3) The furnishing of health care
services through providers which are under contract with or employed by the health maintenance
organization. (4) The contracting with any person for the performance on its behalf of certain
functions such as marketing, enrollment, and administration. (5) The purchase,...
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