|
27-21A-9
Section 27-21A-9 Information to enrollees. Every health maintenance organization shall provide
promptly to its enrollees notice of any material change in the operation of the organization
that will affect them directly. (Acts 1986, No. 86-471, p. 854, §9.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-9.htm - 563 bytes - Match Info - Similar pages
27-21A-20
Section 27-21A-20 Administrative procedures. (a) When the commissioner has cause to believe
that grounds for the denial of an application for a certificate of authority exist, or that
grounds for the suspension or revocation of a certificate of authority exist, he shall notify
the health maintenance organization and the State Health Officer in writing specifically stating
the grounds for denial, suspension, or revocation. If so requested in writing by the health
maintenance organization, the commissioner shall set a hearing on the matter within 30 days
of the receipt of such request. (b) The State Health Officer, or his designated representative,
shall be in attendance at the hearing and shall participate in the proceedings. The recommendation
and findings of the State Health Officer with respect to matters relating to the quality of
health care services provided in connection with any decision regarding denial, suspension,
or revocation of a certificate of authority, shall be...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-20.htm - 2K - Match Info - Similar pages
27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases shall
have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health. (2)
ENROLLEE. An individual who has contracted for or who participates in coverage under an insurance
policy, a health maintenance organization contract, a health service corporation contract,
an employee welfare benefit plan, a hospital or medical services plan, or any other benefit
program providing payment, reimbursement, or indemnification for health care costs for the
individual or the eligible dependents of the individual. (3) PROVIDER. A health care provider
duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system for prospective
and concurrent review of the necessity and appropriateness in the allocation of health care
resources and services given or proposed to be given to an individual within this state. The
term does not include elective requests for clarification of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-3A-3.htm - 3K - Match Info - Similar pages
27-21A-29
Section 27-21A-29 Existing health maintenance organizations. (a) Notwithstanding any other
provision of this chapter, any health maintenance organization licensed by the State Board
of Health and in operation on May 29, 1986, shall be granted a certificate of authority upon
payment of the application fee prescribed in Section 27-21A-21 and compliance with Section
27-21A-12. Nothing in this section shall prohibit any such health maintenance organization
from continuing to conduct business in this state until such certificate of authority is issued.
(b) Any health maintenance organization which was licensed in this state prior to January
1, 1986, may continue to operate under existing noncontractual provider arrangements (which
have been approved by the State Health Officer) for three years. (c) After issuance of a certificate
of authority in accordance with subsection (a) of this section, the commissioner may require
submission by the health maintenance organization of any additional...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-29.htm - 1K - Match Info - Similar pages
27-49-5
Section 27-49-5 Penalties. Any violation of this chapter shall constitute grounds for suspension
or revocation of a license by the Department of Insurance issued to an insurance company or
health maintenance organization. (Acts 1996, No. 96-671, p. 1135, §5.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-49-5.htm - 566 bytes - Match Info - Similar pages
27-21A-22
Section 27-21A-22 Penalties and enforcement. (a) The commissioner may, in lieu of suspension
or revocation of a certificate of authority under Section 27-21A-17, levy an administrative
penalty in an amount not less than $500.00 nor more than $5,000.00, if reasonable notice in
writing is given of the intent to levy the penalty and the health maintenance organization
has a reasonable time within which to remedy the defect in its operations which gave rise
to the penalty citation. The commissioner may augment this penalty by an amount equal to the
sum that he calculates to be the damages suffered by enrollees or other members of the public.
All moneys collected under this section shall be deposited to the credit of the General Fund.
(b)(1) If the commissioner or the State Health Officer shall for any reason have cause to
believe that any violation of this chapter has occurred or is threatened, the commissioner
or State Health Officer may give notice to the health maintenance organization...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-22.htm - 3K - Match Info - Similar pages
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
27-1-17.1
Section 27-1-17.1 Payment of providers through electronic funds transfer methods. (a) As used
in this section, the following words shall have the following meanings: (1) ACH ELECTRONIC
FUNDS TRANSFER. An electronic funds transfer through the Health Insurance Portability and
Accountability Act (HIPPA) standard Automated Clearing House network. (2) COVERED HEALTH CARE
PROVIDER. A physician as defined in Section 34-24-50.1; a dentist as defined in Section 34-9-1;
a chiropractor as defined in Section 34-24-120; an individual engaged in the practice of optometry
as defined in Section 34-22-1; other licensed health care professionals as defined in Title
34; a hospital as defined in Section 22-21-20; and a health care facility, or other provider
who or that is accredited, licensed, or certified and who or that is performing within the
scope of that accreditation, license, or certification. (3) HEALTH INSURANCE PLAN. Any hospital
and medical expense incurred policy, health maintenance...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-17.1.htm - 3K - Match Info - Similar pages
27-17A-17
Section 27-17A-17 Dissolution or liquidation of certificate holder. (a) Any dissolution or
liquidation of a certificate holder shall be deemed to be the liquidation of an insurance
company and shall be conducted under the supervision of the commissioner, who shall have all
powers with respect thereto granted to the commissioner under Chapter 32 with respect to the
liquidation of insurance companies. (b) The commissioner may apply for an order directing
the commissioner to liquidate a certificate holder upon any one or more grounds set out in
Section 27-32-6 or when, in the commissioner's opinion, the continued operation of the certificate
holder would be hazardous either to purchasers, beneficiaries, or to the people of this state.
(Act 2002-74, p. 221, §1.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-17A-17.htm - 1K - Match Info - Similar pages
25-5-229
Section 25-5-229 Solicitation or writing of workers' compensation insurance by insurance companies,
etc., not in compliance with Code. Any insurance corporation, organization or association,
or any officer, employee or agent of such insurance corporation, organization or association
who solicits or writes any workers' compensation insurance in this state without complying
with the law as set forth in this Code in reference to filing with the Commissioner of Insurance
its classifications of risks and premiums relating thereto or without having received from
said Commissioner of Insurance approval of its plan of business or who fails to comply with
any other requisites set out in this chapter to make reports in writing, who conducts business
in the State of Alabama, shall be guilty of a misdemeanor and, on conviction, may be imprisoned
in the county jail or sentenced to hard labor for the county for not more than 12 months and
must also be fined not more than $500.00. (Acts 1919, No....
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/25-5-229.htm - 1K - Match Info - Similar pages
|