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36-29-15
Section 36-29-15 Coverage of members of Legislature, Lieutenant Governor and dependents; limitation
of benefits; payment of premiums; rules and regulations. (a) Any member of the Legislature
and the Lieutenant Governor, during their term of office, and their dependents, shall be eligible
for coverage under the State Employees' Health Insurance Plan and upon expiration of their
term of office may continue such coverage for a maximum of 36 months. (b) Preexisting conditions
shall not be covered until the insured has been covered under the plan for a period of 12
months, provided, however, that any legislator enrolling within 30 days of April 23, 1990
or within 30 days of the beginning of any calendar year thereafter shall not be subject to
this limitation of benefits. A preexisting condition is any condition for which the insured
or their covered dependent received medical treatment, advice or consultation or received
any prescribed medication within 12 months of the effective date of...
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25-14-3
Section 25-14-3 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) ADMINISTRATIVE FEE. The fee charged to a client by a professional employer organization
for professional employer services. The term does not include any amount of a fee by the professional
employer organization that is for wages and salaries, benefits, workers' compensation, payroll
taxes, withholding, or other assessments paid by the professional employer organization to
or on behalf of covered employees under the professional employer agreement. (2) CLIENT. A
person or entity that enters into a professional employer agreement with a professional employer
organization, including a worksite employer. (3) CONTROLLING PERSON. Any of the following:
a. An officer or director of a corporation operating as a professional employer organization,
a shareholder holding 25 percent or more of the voting stock of a corporation operating as
a professional employer organization, or a...
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27-19A-7
Section 27-19A-7 Contracting directly with patient; distribution of information about policy
or plan; payment and reimbursement procedures. The provisions of this chapter do not prohibit
the following conduct and shall be construed to provide that: (1) A dentist may contract directly
with a patient for the furnishing of dental care services to said patient as may be otherwise
authorized by law; (2) Any person providing a health insurance policy or employee benefit
plan, or an employer, or an employee organization may: a. Make available to its insureds,
beneficiaries, participants, employees, or members information relating to dental care services
by the distribution of factually accurate information regarding dental care services, rates,
fees, location, and hours of service, provided such distribution is made upon the request
of any dentist licensed by this state; or b. Establish an administrative mechanism which facilitates
payment for dental care services by insureds, beneficiaries,...
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16-25A-7
Section 16-25A-7 Authorization and execution of contracts; evidence of coverage; denial of
claims. (a) The board is hereby authorized to execute a contract or contracts to provide for
the benefits or the administration of the plan determined in accordance with the provisions
of this article. Such contract or contracts may be executed with one or more agencies or corporations
licensed to transact or administer group health insurance business in this state. All of the
benefits to be provided under this article may be included in one or more similar contracts
issued by the same or different companies. The board is further authorized to develop a plan
whereby it may become self-insured upon its finding that such arrangement would be financially
advantageous to the state and plan participants. (b) Before entering into any contract or
contracts authorized by subsection (a), the board shall invite competitive bids from all qualified
entities who may wish to administer or offer plans for the...
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27-1-21
Section 27-1-21 Uniformity of limits applied to fulfillment of certain drug prescriptions.
(a) For the purposes of this section, the following words shall have the following meanings:
(1) ENROLLEE. A person enrolled in a health benefit plan. (2) HEALTH BENEFIT PLAN. Any individual
or group plan, policy, or contract for health care services issued, delivered, issued for
delivery, 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, purchases, or
furnishes health care services to patients, insureds, or beneficiaries in this state. The
term includes, but is not limited to, entities created pursuant to Article 6 of Chapter 4
of Title 10. The term shall not include any collective bargaining agreement...
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27-14-11.1
Section 27-14-11.1 Contents of policies - Denial or reduction of benefits due to Medicaid eligibility
void. (a) For purposes of this section, "private insurer" is defined as any of the
following: (1) Any commercial insurance company offering health or casualty insurance to individuals
or groups, including both experience-rated contracts and indemnity contracts. (2) Any profit
or nonprofit prepaid plan offering either medical services or full or partial payment for
the diagnosis or treatment of an injury, disease, or disability. (3) Any organization administering
health or casualty insurance plans for professional associations, unions, fraternal groups,
employer-employee benefit plans, and any similar organization offering these payments or services,
including self-insured and self-funded plans. (4) Any health insurer, including group health
plans, as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974,
self-insured plans, service benefit plans, managed care...
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36-29-19.7
Section 36-29-19.7 Retiree contribution based on years of service. (a) The board shall set
forth the employer contribution to the health insurance premium for each retiree class. (b)
For employees who retire other than for disability after September 30, 2005, but before January
1, 2012, the employer contribution to the health insurance premium set forth by the board
for each retiree class shall be reduced by two percent for each year of service less than
25 and increased by two percent for each year of service over 25, subject to adjustment by
the board for changes in Medicare premium costs required to be paid by a retiree. In no case
shall the employer contribution of the health insurance premium exceed 100 percent of the
total health insurance premium cost for the retiree. (c)(1) Except as provided in subdivision
(2), for employees who retire after December 31, 2011, the employer contribution to the health
insurance premium set forth by the board for each retiree class shall be...
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36-29-6
Section 36-29-6 Authorization and execution of contracts; documentation of benefits. (a) The
board is hereby authorized to execute a contract or contracts to provide the plan determined
in accordance with the provisions of this chapter. Such contract or contracts may be executed
with one or more agencies or corporations licensed to transact or administer group health
insurance business in this state. All of the benefits to be provided under this chapter may
be included in one or more similar contracts issued by the same or different companies. (b)
Before entering into any contract or contracts authorized by subsection (a) of this section,
the board shall invite competitive bids from all qualified entities who may wish to administer
or offer plans for the health insurance coverage desired. The board shall award such contract
or contracts on a competitive basis as determined by the benefits afforded, administrative
costs, the costs to be incurred by employee, retiree, and employer, the...
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16-25A-1
Section 16-25A-1 Definitions. When used in this article, the following terms shall have the
following meanings, respectively, unless the context clearly indicates otherwise: (1) EMPLOYEE.
Any person covered by the Public Education Employees' Health Insurance Plan pursuant to Section
16-25A-11 or person who is employed full-time in any public institution of education within
the State of Alabama which provides instruction at any combination of grades K through 14,
exclusively, under the auspices of the State Board of Education or the Alabama Institute for
Deaf and Blind; provided, any person employed part-time by any public institution of education
within the State of Alabama which provides instruction at any combination of grades K through
14, exclusively, under the auspices of the State Board of Education or the Alabama Institute
for Deaf and Blind, shall be included in the definition of employee if such person shall agree
to have deducted from his or her compensation a pro rata...
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16-25A-11
Section 16-25A-11 Employees in Teachers' Retirement System may vote to be covered by article;
election irrevocable; contribution by employer. Any board, agency, organization, or association
which participates in the Teachers' Retirement System of Alabama, but whose employees are
not included in the definition of employee in Section 16-25A-1 may, by resolution legally
adopted to conform to rules prescribed by the board and upon a majority vote of its employees,
elect to have its employees and under certain conditions its retired employees covered by
the provisions of this article, provided such board, agency, organization, or association
shall contract to pay the full cost of coverage for each such employee in the amounts set
forth by the board and as defined in Section 16-25A-1 for a full-time employee; participation,
once elected, is irrevocable. Each retired employee shall be given the option to participate
under the provisions of Section 16-25A-8(c) provided any employer electing to...
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