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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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27-19A-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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27-1-10
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...
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27-54-2
Section 27-54-2 Definitions. For purposes of this chapter, the following terms have the following
meanings: (1) DAY TREATMENT SERVICES. Includes, but is not limited to: Physiological, psychological,
and psychosocial concepts, techniques, and processes necessary to maintain or develop functional
skills of clients, provided to individuals and groups for periods of more than two hours but
less than 24 hours a day. (2) HEALTH BENEFIT PLAN. A health care service plan governed by
the provisions of Article 6, Chapter 4, Title 10, and a group health insurance policy, including
an employee welfare health benefit plan, that covers hospital, medical, or surgical expenses,
issued by insurers, health maintenance organizations, preferred provider organizations, medical
service organizations, physician-hospital organizations, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for, purchases, or furnishes health
care services to patients, insureds, or...
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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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22-8A-9
Section 22-8A-9 Withholding or withdrawal of treatment, etc., not suicide; execution of advance
directive not to affect sale, etc., of life or health insurance nor be condition for receipt
of treatment, etc.; provisions of chapter cumulative. (a) The withholding or withdrawal of
life-sustaining treatment or artificially provided nutrition and hydration from a patient
in accordance with the provisions of this chapter shall not, for any purpose, constitute a
suicide and shall not constitute assisting suicide. (b) The making of an advance directive
for health care pursuant to this chapter shall not affect in any manner the sale, procurement,
or issuance of any policy of life or health insurance, nor shall it be deemed to modify the
terms of an existing policy of life or health insurance. No policy of life or health insurance
shall be legally impaired or invalidated in any manner by the withholding or withdrawal of
life-sustaining treatment or artificially provided nutrition and hydration...
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26-10B-8
Section 26-10B-8 Department to provide coverage and benefits not provided by residence state;
procedure for reimbursement. The State Department of Human Resources shall provide coverage
and benefits for a child who is in another state and who is covered by an adoption assistance
agreement made by the State Department of Human Resources for coverage or benefits, if any,
not provided by the residence state. To this end, the adoptive parents acting for the child
must obtain prior approval from the State Department of Human Resources and may submit evidence
of payment for services or benefit amounts not payable in the residence state and shall be
reimbursed therefor. However, there shall be no reimbursement for services or benefit amounts
covered under any insurance or other third party medical contract or arrangement held by the
child or the adoptive parents. The State Department of Human Resources shall make regulations
implementing this section. Among other things, such regulations...
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27-43-10
Section 27-43-10 Types of legal expense insurance; policy and certificate forms; issuance of
policies and certificates. (a) Legal expense insurance may be written as individual, group,
blanket, or franchise insurance. Each contractual obligation for legal expense insurance must
be evidenced by a policy. Each person insured under a group policy must be issued a certificate
of coverage. (b) No policy or certificate of legal expense insurance may be issued in this
state unless a copy of the form has been filed and approved by the commissioner. (c) The commissioner
may not approve any form that does not meet the following requirements: (1) Policies must
contain a list and description of the legal service payments promised or the legal matters
for which expenses are to be reimbursed and any limits on the amounts to be paid or reimbursed;
(2) Policies and certificates must indicate the name of the insurer and the full address of
its principal place of business; (3) Certificates issued under...
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27-58-4
Section 27-58-4 Benefits subject to annual deductible, coinsurance, exclusions, reductions,
etc. (a) The benefits provided in this chapter shall be subject to the same annual deductible
or coinsurance established for all covered benefits within a given policy. Private third party
payors may not reduce or eliminate coverage due to the requirements of this chapter. (b) A
health benefit plan subject to this chapter shall not terminate services, reduce capitation
payment, or otherwise penalize an attending physician or health care provider who orders medical
care consistent with this chapter. (c) Nothing in this chapter is intended to expand the list
of designations of covered providers as specified in any health benefit plan. (Act 2007-389,
p. 778, §4.)...
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