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.)...
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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...
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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...
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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...

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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.)...
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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...
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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...
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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...
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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.)...
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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....
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