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27-21A-10
Section 27-21A-10 Complaint system. (a)(1) Every health maintenance organization shall establish
and maintain a complaint system which has been approved by the commissioner, after consultation
with the State Health Officer, to provide reasonable procedures for the resolution of written
complaints initiated by enrollees. (2) Each health maintenance organization shall submit to
the commissioner and the State Health Officer an annual report in a form prescribed by the
commissioner, after consultation with the State Health Officer, which shall include: a. A
description of the procedures of such complaint system; b. The total number of complaints
handled through such complaint system and a compilation of causes underlying the complaints
filed; and c. The number, amount, and disposition of malpractice claims and other claims relating
to the service or care rendered by the health maintenance organization made by enrollees of
the organization that were settled during the year by the health...
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22-1-14
Section 22-1-14 Licensure Freedom Act. (a) State licensure requirements for physicians, chiropractors,
optometrists, and dentists in this state shall be granted based on demonstrated skill and
academic competence. Licensure approval for physicians, chiropractors, optometrists, and dentists
in this state may not be conditioned upon or related to participation in any public or private
health insurance plan, public health care system, public service initiative, or emergency
room coverage. (b) The licensure of dentists, osteopaths, chiropractors, optometrists, and
physicians shall be conducted exclusively pursuant to Chapter 9 of Title 34; Division 1, commencing
with Section 34-24-50, of Article 3 of Chapter 24 of Title 34; Article 4, commencing with
Section 34-24-120, of Chapter 24 of Title 34; Chapter 22 of Title 34; and Division 1, commencing
with Section 34-24-310, of Article 8 of Title 34, respectively. (c) Physician or optometric
licensure shall not be conditioned upon or related to...
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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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27-56-7
Section 27-56-7 Applicability to certain providers. (a) This chapter does not require and shall
not be construed to require any insurance policy, plan, or contract to provide health care
coverage for eye care. The provisions of this chapter are applicable only to those insurance
policies, plans, or contracts which provide coverage for eye care. (b) Insurers or other issuers
of any insurance policy, plan, or contract which provides coverage for eye care shall continue
to be able to establish and apply selection criteria and utilization protocols for health
care providers as well as credentialing criteria used in the selection of providers. (c) This
chapter does not require and shall not be construed to require the coverage of eye care services
by providers who are not designated as covered providers, or who are not selected as participating
providers, by an insurance policy, plan, or contract, or the issuer thereof having a participating
network of service providers. Provided, however,...
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34-23-183
Section 34-23-183 Application. This article shall apply to any audit of the records of a pharmacy
conducted by a managed care company, nonprofit hospital or medical service organization, health
benefit plan, third-party payor, pharmacy benefit manager, a health program administered by
a department of the state, except the Alabama Medicaid Agency, or any entity that represents
those companies, groups, or department. (Act 2012-306, p. 668, §4; Act 2018-457, §1.)...
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27-21A-32
Section 27-21A-32 HMO enrollment requirements. (a) The state government, or any agency, board,
commission, institution, or political subdivision thereof, and any city or county, or board
of education, which offers its employees a health benefits plan may make available to and
inform its employees or members of the option to enroll in at least one health maintenance
organization holding a valid certificate of authority which provides health care services
in the geographic areas in which such employees or members reside. (b) The first time a health
maintenance organization is offered by an employer, either public or private, each covered
employee must make an affirmative written selection among the different alternatives included
in the health benefits plan. Thereafter, those who wish to change from one plan to another
will be allowed to do so annually, provided, that nothing in this section shall prevent any
health maintenance organization or insurer from requiring evidence of...
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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-3
Section 27-19A-3 Prohibited provisions. No health insurance policy or employee benefit plan
which is delivered, renewed, issued for delivery, or otherwise contracted for in this state
shall: (1) Prevent any person who is a party to or beneficiary of any such health insurance
policy or employee benefit plan from selecting the dentist of his choice to furnish the dental
care services offered by said policy or plan or interfere with said selection provided the
dentist is licensed to furnish such dental care services in this state; (2) Deny any dentist
the right to participate as a contracting provider for such policy or plan provided the dentist
is licensed to furnish the dental care services offered by said policy or plan; (3) Authorize
any person to regulate, interfere, or intervene in any manner in the diagnosis or treatment
rendered by a dentist to his patient for the purpose of preventing, alleviating, curing, or
healing dental illness or injury provided said dentist practices within...
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45-37A-241
Section 45-37A-241 Participation in employee health insurance during certain military service.
For any employee of the city called into military service during the war on terrorism, the
City of Hoover in Jefferson County and Shelby County may permit the employee and his or her
eligible dependents to continue participation in any employee health insurance provided for
city employees and may pay the employer's share of the costs of the insurance plan, provided
the employee in military service continues to pay the employee's share of the cost of the
insurance, including any costs for dependent coverage. This section in no way limits the rights
of any employee in military service under the Servicemembers Civil Relief Act. The terms military
service and period of military service shall have the same meanings ascribed to those terms
in §511 of the Servicemembers Civil Relief Act, 50 Appendix United States Code Annotated
§§501, et seq. (Act 2006-367, p. 963, §1; Act 2006-567, p. 1325,...
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36-29-52
Section 36-29-52 Assignment of attachment of health benefits. In the case of any state law
authorizing the assignment of benefits or a lien against benefits under a health insurance
policy, the health benefits covered under any policy or plan of health insurance may not be
assigned by the insured or attached by lien if the policy provides coverage for excepted benefits,
as defined in Section 2791(c)(2), (3), and (4) of the Public Health Service Act. (Act 2013-245,
p. 593, §3.)...
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