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37-11A-1
Section 37-11A-1 Execution and text of compact. The Governor, on behalf of this state, shall
execute a compact, in substantially the following form, with the State of Mississippi, and
the Legislature approves and ratifies the compact in the form substantially as follows: Northeast
Mississippi - Northwest Alabama Railroad Authority Compact. The contracting states solemnly
agree: Article I. The purpose of this compact is to promote and develop trade, commerce, industry,
and employment opportunities for the public good and welfare in northeast Mississippi and
northwest Alabama through the establishment of a joint interstate authority to acquire certain
railroad properties and facilities which the operator thereof has notified the Interstate
Commerce Commission of an intention to abandon and which are located in any of Franklin, Marion,
or Winston Counties, Alabama or in Alcorn or Tishomingo Counties, Mississippi. Article II.
This compact shall become effective immediately as to the State...
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27-21A-17
Section 27-21A-17 Suspension or revocation of certificate of authority. (a) The commissioner
in consultation with and with the approval of the State Health Officer, where necessary, may
suspend or revoke any certificate of authority issued to a health maintenance organization
under this chapter if he finds that any of the following conditions exist: (1) The health
maintenance organization is operating significantly in contravention of its basic organizational
document or in a manner contrary to that described in any other information submitted under
Section 27-21A-2, unless amendments to such submissions have been filed with the commissioner
and the State Health Officer and approved by the commissioner; (2) The health maintenance
organization issues evidence of coverage or uses a schedule of charges for health care services
which do not comply with requirements of Section 27-21A-7; (3) The health maintenance organization
does not provide or arrange for basic health care services; (4)...
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27-21A-15
Section 27-21A-15 Powers of insurers and health care service plans. (a) An insurance company
licensed in this state, or a health care service plan authorized to do business in this state,
may either directly or through a subsidiary or affiliate organize and operate a health maintenance
organization under the provisions of this chapter. Notwithstanding any other law which may
be inconsistent herewith, any two or more such insurance companies, health care service plans,
or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance
organization. The business of insurance is deemed to include the providing of health care
by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.
(b) Notwithstanding any provision of insurance and health care service plan laws, Title 10,
Chapter 4, Article 6 and Title 27, an insurer or a health care service plan may contract with
a health maintenance organization to provide insurance or...
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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-8
Section 27-21A-8 Reporting requirements. Every health maintenance organization shall annually,
on or before the first day of March, file a report verified by at least two principal officers
with the commissioner, with a copy to the State Health Officer, covering the preceding calendar
year. Such report shall be on forms prescribed by the commissioner, and shall include: (1)
A financial statement of the organization; (2) Any material changes in the information submitted
pursuant to subsection (c) of Section 27-21A-2; (3) The number of persons enrolled at the
beginning and end of the year; (4) A summary of information compiled pursuant to paragraph
(a)(2)c of Section 27-21A-3; (5) The amount of uncovered and covered expenditures that are
payable and more than 90 days past due; and (6) Such additional information or reports as
are deemed reasonably necessary and appropriate by the commissioner to enable him to carry
out his duties under this chapter. (Acts 1986, No. 86-471, p. 854, ยง8.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-8.htm - 1K - Match Info - Similar pages
27-21A-13
Section 27-21A-13 Prohibited practices. (a) No health maintenance organization, or representative
thereof, may cause or knowingly permit the use of advertising which is untrue or misleading,
solicitation which is untrue or misleading, or any form or evidence of coverage which is deceptive.
For purposes of this chapter: (1) A statement or item of information shall be deemed to be
untrue if it does not conform to fact in any respect which is or may be significant to an
enrollee of, or person considering enrollment with a health maintenance organization; (2)
A statement or item of information shall be deemed to be misleading, whether or not it may
be literally untrue, if, in the total context in which such statement is made or such item
of information is communicated, such statement or item of information may be reasonably understood
by a reasonable person, not possessing special knowledge regarding health care coverage, as
indicating any benefit or advantage or the absence of any...
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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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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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27-21A-1
Section 27-21A-1 Definitions. As used in this chapter, the following terms shall have the following
meanings, respectively: (1) AGENT. A person who is appointed or employed by a health maintenance
organization and who engages in solicitation of membership in such organization. This definition
does not include a person enrolling members on behalf of an employer, union, or other organization.
(2) BASIC HEALTH CARE SERVICES. Emergency care, inpatient hospital and physician care, and
outpatient medical services. (3) COMMISSIONER. The Commissioner of Insurance. (4) ENROLLEE.
An individual who is enrolled in a health maintenance organization. (5) EVIDENCE OF COVERAGE.
Any certificate, agreement, or contract issued to an enrollee setting out the coverage to
which he is entitled. (6) HEALTH CARE SERVICES. Any services included in the furnishing to
any individual of medical or dental care, or hospitalization or incident to the furnishing
of such care or hospitalization, as well as the...
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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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