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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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27-19A-2
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 heretofore or hereafter established or maintained by an employer
or by an employee organization, or by both, to the extent that such plan, fund, or program
was established or is maintained for the purpose of providing for its participants or their
beneficiaries, through the purchase of insurance or otherwise, dental care benefits in the
event of accident or sickness. (9) DENTAL CARE SERVICES. Any services furnished to any person
for the purpose of preventing, alleviating, curing, or healing human dental illness or injury.
(10) DENTIST. Any person who furnishes dental care services and who is licensed as a dentist
by the State of Alabama. (Acts 1984, No. 84-411, p. 960, §2.)...
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27-55-2
Section 27-55-2 Definitions. As used in this chapter, these terms shall have the following
meanings: (1) ABUSE. The occurrence of one or more of the following acts by a family or household
member, as defined by subdivision (3) of subsection (b) of Section 15-10-3: a. Attempting
to cause or intentionally, knowingly, or recklessly causing another person, including a minor
child, bodily injury, severe emotional injury, or psychological trauma or conduct
which constitutes the crime of rape. b. Intentionally following another person, including
a minor child, without proper authority, under circumstances that place the person in reasonable
fear of bodily injury or physical harm. c. Subjecting another person, including a minor
child, to false imprisonment or kidnapping. d. Attempting to cause or intentionally, knowingly,
or recklessly causing damage to property to intimidate or attempt to control the behavior
of another person, including a minor child. e. Assault, child abuse, criminal...
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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....
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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...
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22-7A-1
Section 22-7A-1 Physician agreements; dentist agreements. (a) For the purposes of this chapter,
the following words shall have the following meanings: (1) DENTIST. A person licensed to practice
dentistry in this state. (2) DENTIST AGREEMENT or AGREEMENT. A contract between a dentist
and a patient or his or her legal representative in which the dentist or the dentist's medical
practice agrees to provide dental services to the patient for an agreed upon fee and period
of time. (3) DENTIST PRACTICE. A dentist or a dental practice of a dentist that charges a
periodic fee for dental services and which does not bill a third party any additional fee
for services for patients covered under a dental agreement. The per visit charge of the practice
shall be less than the monthly equivalent of the periodic fee. (4) PHYSICIAN. A person licensed
to practice medicine in this state. (5) PHYSICIAN AGREEMENT or AGREEMENT. A contract between
a physician and a patient or his or her legal representative in...
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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...
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11-91A-7
care plan under Chapter 29 of Title 36, and in the State Employees' Retirement System under
Chapter 27 of Title 36. (j) Acquire property by purchase or lease. (k) Provide for reinsurance
of risks incurred by the program. (l)(1) Provide additional types of optional health care
coverages or services including, but not limited to, providing for the administration of the
payment of health care services on behalf of employer participants whose eligible employees
or officials suffer on-the-job injury, under such terms and conditions as the board
shall determine. (2) Participation in any service established for the administration of the
payment of health care services on behalf of an employer participant relating to on-the-job
injury shall be at the sole option of the employer participant. Refusal to participate
by an employer participant shall not affect eligibility for the program or factor into the
establishment of rates as authorized in subsection (b). (m) Adopt bylaws, policies, and...
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27-56-5
Section 27-56-5 Third-party payment. (a) No insurance policy, plan, or contract providing for
third-party payment or prepayment of health or medical expenses that provides coverage for
eye care services shall be issued or renewed after August 1, 2001, unless such insurance policy,
plan, or contract does the following: (1) Provides a covered person direct access to any eye
care provider participating in, or otherwise eligible to provide services under, the policy,
plan, or contract for all eye care services covered under the policy, plan, or contract, without
any referral or preapproval requirement, including, but not limited to, the following services,
if covered: a. Medical treatment of glaucoma. b. Postoperative eye care. (2) Ensures that
any list of medical or health care providers participating in, or otherwise eligible to provide
services under, the policy, plan, or contract includes eye care providers to the same extent
that such list includes other medical or health care...
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27-1-11
Section 27-1-11 Dentists and dental hygienists as "physicians" under health or accident
insurance policies. Whenever the terms "physician" and/or "doctor" are
used in any policy of health or accident insurance issued in this state or in any contract
for the provision of health care, services, or benefits issued by any health, medical or other
service corporation existing under, and by virtue of any laws of this state, said terms shall
include within their meaning those persons licensed under and in accordance with Chapter 9
of Title 34 in respect to any care, services, procedures, or benefits covered by said policy
of insurance or health care contract which the said persons are licensed to perform, any provisions
in any such policy of insurance or health care contract to the contrary notwithstanding. This
section shall be applicable to all policies in this state, regardless of date of issue, on
October 10, 1975. (Acts 1975, No. 1241, p. 2607, §1.)...
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