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27-20-5
Section 27-20-5 Blanket disability insurance - Power to issue; filing requirement; mandatory
policy provisions. Any insurer authorized to write disability insurance in this state shall
have the power to issue blanket disability insurance. No such blanket policy may be issued
or delivered in this state unless a copy of the form thereof shall have been filed in accordance
with Section 27-14-8. Every such blanket policy shall contain provisions which, in the opinion
of the commissioner, are at least as favorable to the policyholder and the individual insured
as the following: (1) A provision that the policy, including endorsements and a copy of the
application, if any, of the policyholder and the persons insured shall constitute the entire
contract between the parties, and that any statement made by the policyholder or by a person
insured shall, in absence of fraud, be deemed a representation and not a warranty and that
no such statements shall be used in defense to a claim under the...
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11-104-2
Section 11-104-2 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) DEPENDENTS. The spouse, children, or other dependents of the retired employee,
as defined by and covered under the documents governing the governmental entities' benefit
plans that provide post-employment benefits. (2) EMPLOYEE. Any person who is an employee of
any governmental entity located in the state who may become eligible for post-employment benefits
from the governmental entity. (3) EMPLOYER. Any governmental entity that sponsors, in whole
or in part, post-employment benefits. (4) FISCAL YEAR. The annual period at the end of which
a governmental entity determines its financial condition. (5) GASB. The Governmental Accounting
Standards Board. (6) GOVERNMENTAL ENTITY. Any political subdivision of the state, any department,
agency, board, commission, or authority of any such political subdivision, or any public corporation,
authority, agency, instrumentality, board,...
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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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35-11-371
Section 35-11-371 Perfection of lien. (a) For the purposes of this section, the following terms
shall have the following meanings: (1) HEALTH CARE PAYOR. A health care insurer, health maintenance
organization, or health care service plan organized under Article 6, Chapter 20, Title 10A,
authorized to provide health care coverage in the state. (2) SATISFY THE CLAIM. Receipt by
the hospital of either of the following: a. Full payment for services as billed. b. If the
hospital has a contract with the injured person's health care payor, payment together with
all credits, discounts, and contractual adjustments that the patient's bill would be entitled
under the contract, including recoupments, between the hospital and the patient's health care
payor which extinguish the patient's obligation for the services rendered. (b) Unless specifically
contrary to any contractual agreement between the hospital and the injured person's health
care payor or unless contrary to any statute or governmental...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/35-11-371.htm - 5K - Match Info - Similar pages
16-25A-8
Section 16-25A-8 Funding of health insurance plan; participation; Public Education Employees'
Health Insurance Fund. (a) The Public Education Employees' Health Insurance Board is hereby
authorized to provide under the contract or contracts entered into under the provisions of
this article an insurance benefit plan for each covered employee and, under certain conditions,
retired employees; the cost of such plan may be funded in part or in full through monthly
premiums per active employee from the same source of funds as those used for the payment of
salaries of active members and in part from other funds. (b) On or before January 1 next preceding
each regular meeting of the Legislature, the board shall certify to the Governor and to the
Legislature the amount or amounts necessary to fund coverage for benefits authorized by this
article for the following fiscal year for employees and for retired employees as a monthly
premium per active member per month. The Legislature shall set the...
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25-4-16
Section 25-4-16 Wages. (a) Prior to January 1, 1983, "wages," as used in this chapter,
shall mean such remuneration as was defined in this section prior to such date. (b) On and
after January 1, 1983, "wages," as used in this chapter, shall mean every form of
remuneration paid or received for personal services, including the cash value of any remuneration
paid in any medium other than cash. The reasonable cash value of remuneration paid in any
medium other than cash shall be determined in accordance with rules prescribed by the director;
except that effective on May 28, 1980, and for the purposes of reporting and computing the
amount of contributions due, back pay awarded as the result of an agreement, arbitration,
or order of a court of competent jurisdiction on a retroactive basis shall be considered "wages"
during the calendar quarter in which such retroactive payments are made. The term "wages,"
however, shall not include: (1) That part of remuneration, which after remuneration...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/25-4-16.htm - 6K - Match Info - Similar pages
27-21A-1
Section 27-21A-1 Definitions. As used in this chapter, the following terms shall have the following
meanings, respectively: (1) AGENT. A person who is appointed or employed by a health maintenance
organization and who engages in solicitation of membership in such organization. This definition
does not include a person enrolling members on behalf of an employer, union, or other organization.
(2) BASIC HEALTH CARE SERVICES. Emergency care, inpatient hospital and physician care, and
outpatient medical services. (3) COMMISSIONER. The Commissioner of Insurance. (4) ENROLLEE.
An individual who is enrolled in a health maintenance organization. (5) EVIDENCE OF COVERAGE.
Any certificate, agreement, or contract issued to an enrollee setting out the coverage to
which he is entitled. (6) HEALTH CARE SERVICES. Any services included in the furnishing to
any individual of medical or dental care, or hospitalization or incident to the furnishing
of such care or hospitalization, as well as the...
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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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-7.htm - 3K - Match Info - Similar pages
25-4-145
Section 25-4-145 Penalties; limitation of actions; collection of overpayments; waiver of overpayments.
(a) Penalties. (1) Whoever willfully makes a false statement or representation or who willfully
fails to disclose a material fact to obtain or increase any benefit or payment under this
chapter, or under an unemployment insurance law of any other state or government, either for
himself or herself or for any other person, whether such benefit or payment is actually received
or not, shall be guilty of an offense as follows and each such false statement or representation
shall constitute a separate and distinct offense: a. If the aggregate amount involved in the
offense exceeds two thousand five hundred dollars ($2,500) in value, that shall constitute
a Class B felony. b. If the aggregate amount involved in the offense exceeds five hundred
dollars ($500) but does not exceed two thousand five hundred dollars ($2,500), that shall
constitute a Class C felony. c. If the aggregate amount...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/25-4-145.htm - 8K - 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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