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27-48-4
Section 27-48-4 Penalties for noncompliance with chapter; suspension or revocation of
insurance company or health maintenance organization license. A license issued by the Department
of Insurance to an insurance company or a health maintenance organization shall be subject
to suspension, revocation, or imposition or other administrative penalty authorized by law,
within the discretion of the Commissioner of Insurance, for any violation of the provisions
of this chapter. (Acts 1996, No. 96-578, p. 915, §4.)...
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27-21A-23
Section 27-21A-23 Statutory construction and relationship to other laws. (a) Except
as otherwise provided in this chapter, provisions of the insurance law and provisions of health
care service plan laws shall not be applicable to any health maintenance organization granted
a certificate of authority under this chapter. This provision shall not apply to an insurer
or health care service plan licensed and regulated pursuant to the insurance law or the health
care service plan laws of this state except with respect to its health maintenance organization
activities authorized and regulated pursuant to this chapter. (b) Solicitation of enrollees
by a health maintenance organization granted a certificate of authority shall not be construed
to violate any provision of law relating to solicitation or advertising by health professionals.
(c) Any health maintenance organization authorized under this chapter shall not be deemed
to be practicing medicine and shall be exempt from the provisions of...
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27-21A-4
Section 27-21A-4 Powers of health maintenance organizations. (a) The powers of a health
maintenance organization include, but are not limited to the following: (1) The purchase,
lease, construction, renovation, operation, or maintenance of hospitals, medical facilities,
or both, and their ancillary equipment; (2) The making of loans other than in the ordinary
course of business, to providers under contract with it in furtherance of its program or the
making of loans to a corporation or corporations in which it owns a majority interest for
the purpose of acquiring or constructing medical facilities and hospitals or in furtherance
of a program providing health care services to enrollees. (3) The furnishing of health care
services through providers which are under contract with or employed by the health maintenance
organization. (4) The contracting with any person for the performance on its behalf of certain
functions such as marketing, enrollment, and administration. (5) The purchase,...
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27-45-20
Section 27-45-20 No agreement for services until written verification of registration
obtained. No insurance company, health maintenance organization (HMO), employer or organization
offering a pharmaceutical prescription program to their employees or members in Alabama, shall
enter into an agreement for services until they have obtained written verification that the
provider pharmacies are registered with the Alabama State Board of Pharmacy. Such verification
must be filed with the Alabama Department of Insurance within 10 days of initiating such agreement.
Said department shall provide a copy of the verification to the Alabama State Board of Pharmacy.
Failure to comply with such verification requirement shall result in a fine to the sponsor
of such prescription program, of $100.00 per day, from the date that such agreement was signed
until such verification requirement is satisfied. (Acts 1991, No. 91-595, p. 1098, §1.)...
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27-50-6
Section 27-50-6 License suspension, etc. A license issued by the Department of Insurance
to an insurance company or a health maintenance organization shall be subject to suspension,
revocation, or imposition or other administrative penalty authorized by law, within the discretion
of the Commissioner of Insurance, for any violation of the provisions of this chapter. (Acts
1997, No. 97-414, p. 685, §6.)...
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27-53-3
Section 27-53-3 Violation of chapter. A license issued by the Department of Insurance
to an insurance company or a health maintenance organization shall be subject to suspension,
revocation, or imposition or other administrative penalty authorized by law, within the discretion
of the Commissioner of Insurance, for any violation of the provisions of this chapter. (Acts
1997, No. 97-721, p. 1492, §3.)...
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27-52-3
Section 27-52-3 Additional powers; guidelines. (a) The commissioner shall, by regulation,
establish additional powers and duties of the plan and may adopt such rules as are necessary
and proper to implement this article. For the purpose of this section, the term "insurer"
means any entity covered by the Health Insurance Portability Act, including, but not limited
to, as the terms are defined in the Health Insurance Portability Act, a health insurance issuer,
a health maintenance organization and, notwithstanding Section 10-4-115, any health
benefit plan. In the case of a self-funded health benefit plan operating through a third party
administrator, the third party administrator shall be the insurer for the purpose of this
section. The commissioner may, by regulation, define health insurance premiums consistent
with the purpose of this section. (b) The regulations shall set forth coverage eligibility
criteria consistent with the requirements of Health Insurance Portability and...
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27-20A-2
Section 27-20A-2 Chapter applicable to group, etc., policies. No group, blanket, franchise,
or association health insurance policy providing coverage on an expense incurred basis, nor
group, blanket, franchise, or association service or indemnity type contract issued by a nonprofit
corporation, nor group-type self insurance plan providing protection, insurance, or indemnity
against hospital, medical, or surgical expenses, nor health maintenance organization plan
shall be issued, delivered, executed, or renewed in this state, or approved for issuance or
renewal in this state by the Commissioner of Insurance after 90 days beyond the effective
date of this chapter, unless such policy, contract, or plan, at the option of the policyholder
or sponsor, provides benefits to any insured, subscriber, or other person covered under the
policy, contract, or plan for expenses incurred in connection with the treatment of alcoholism
when such treatment is prescribed by a duly licensed doctor of...
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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...
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27-19-52
Section 27-19-52 Definitions. For purposes of this article, the following terms shall
have the meaning indicated herein: (1) APPLICANT. Includes either of the following: a. In
the case of an individual Medicare supplement policy or subscriber contract, the person who
seeks to contract for insurance benefits. b. In the case of a group Medicare supplement policy
or subscriber contract, the proposed certificate holder. (2) CERTIFICATE. Any certificate
issued under a group Medicare supplement policy, which policy has been delivered or issued
for delivery in this state. (3) CERTIFICATE FORM. The form on which the certificate is delivered
or issued for delivery by the issuer. (4) ISSUER. Insurance companies, fraternal benefit societies,
health care service plans, health maintenance organizations, and any other entity delivering
or issuing for delivery in this state Medicare supplement policies or certificates. (5) MEDICARE.
The "Health Insurance for the Aged Act," Title XVIII of the Social...
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