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27-21A-3
Section 27-21A-3 Issuance of certificate of authority. (a)(1) Upon receipt of an application
for issuance of a certificate of authority, the commissioner shall forthwith transmit copies
of such application and accompanying documents to the State Health Officer. (2) The State
Health Officer shall determine whether the applicant for a certificate of authority, with
respect to health care services to be furnished: a. Has demonstrated the willingness and potential
ability to assure that such health care services will be provided in a manner to assure both
availability and accessibility of adequate personnel and facilities and in a manner enhancing
availability, accessibility, and continuity of service; b. Has arrangements, established in
accordance with the regulations promulgated by the State Health Officer, for an on-going quality
assurance program concerning health care processes and outcomes; and c. Has a procedure, established
in accordance with regulations of the State Health...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-3.htm - 7K - Match Info - Similar pages
27-21A-1
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 furnishing to
any person of any and all other services for the purpose of preventing, alleviating, curing,
or healing human illness, injury, or physical disability. (7) HEALTH MAINTENANCE ORGANIZATION.
Any person that undertakes to provide or arrange for basic health care services through an
organized system which combines the delivery and financing of health care to enrollees. The
organization shall provide physician services directly through physician employees or under
contractual arrangements with either individual physicians or a group or groups of physicians.
The organization shall provide basic health care services...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-1.htm - 3K - Match Info - Similar pages
27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive denials,
adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health benefit
plan that issues or renews any policy of accident or health insurance providing benefits for
medical or hospital expenses for its insured persons shall pay for services rendered by Alabama
health care providers within 45 calendar days upon receipt of a clean written claim or 30
calendar days upon receipt of a clean electronic claim. If the insurer, health service corporation,
or health benefit plan is denying or pending the claim, the insurer, health service corporation,
or health benefit plan shall, within 45 calendar days for a written claim and 30 calendar
days for an electronic claim, notify the health care provider or certificate holder of the
reason for denying or pending the claim and what, if any, additional information is required
to process the claim. Any undisputed portion of the claim...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-17.htm - 17K - Match Info - Similar pages
27-44-5
territories, or protectorates that do not have an association similar to the association created
by this chapter, shall be deemed residents of the state of domicile of the insurer that issued
the policies or contracts. (19) STATE. A state, the District of Columbia, Puerto Rico, and
a United States possession, territory, or protectorate. (20) STRUCTURED SETTLEMENT ANNUITY.
An annuity purchased in order to fund periodic payments for a plaintiff or other claimant
in payment for or with respect to personal injury suffered by the plaintiff
or other claimant. (21) SUPPLEMENTAL CONTRACT. A written agreement entered into for the distribution
of proceeds under a life, disability, or annuity policy or contract. (22) UNALLOCATED ANNUITY
CONTRACT. An annuity contract or group annuity certificate which is not issued to and owned
by an individual, except to the extent of any annuity benefits guaranteed to an individual
by an insurer under the contract or certificate. (Acts 1982, No. 82-561, p. 922,...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-44-5.htm - 7K - Match Info - Similar pages
27-19-103
would result in economies of acquisition or administration. 3. The benefits are reasonable
in relation to the premiums charged. (5) LONG-TERM CARE INSURANCE. Any insurance policy or
rider advertised, marketed, offered, or designed to provide coverage for not less than 12
consecutive months for each covered person on an expense incurred, indemnity, prepaid, or
other basis for one or more necessary or medically necessary diagnostic, preventive, therapeutic,
rehabilitative, maintenance, or personal care services, provided in a setting other
than an acute care unit of a hospital. This term includes group and individual annuities and
life insurance policies or riders that provide directly or that supplement long-term care
insurance. This term also includes a policy or rider that provides for payment of benefits
based upon cognitive impairment or the loss of functional capacity. The term shall also include
qualified long-term care insurance contracts. Long-term care insurance may be...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19-103.htm - 9K - Match Info - Similar pages
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)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-17.htm - 3K - Match Info - Similar pages
27-21A-16
Section 27-21A-16 Examination. (a) The commissioner may make an examination of the affairs
of any health maintenance organization and providers with whom such organization has contracts
or agreements as often as is reasonably necessary for the protection of the interests of the
people of this state, but not less frequently than once every three years. (b) The State Health
Officer may make an examination concerning health care service of any health maintenance organization
and providers with whom such organization has contracts, agreements, or other arrangements
as often as is reasonably necessary for the protection of the interests of the people of this
state, but not less frequently than once every three years. (c) Every health maintenance organization
shall submit its relevant books and records for such examinations and in every way facilitate
these examinations. For the purpose of examinations, the commissioner and the State Health
Officer may administer oaths to, and examine the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-16.htm - 2K - Match Info - Similar pages
27-21A-10
Section 27-21A-10 Complaint system. (a)(1) Every health maintenance organization shall establish
and maintain a complaint system which has been approved by the commissioner, after consultation
with the State Health Officer, to provide reasonable procedures for the resolution of written
complaints initiated by enrollees. (2) Each health maintenance organization shall submit to
the commissioner and the State Health Officer an annual report in a form prescribed by the
commissioner, after consultation with the State Health Officer, which shall include: a. A
description of the procedures of such complaint system; b. The total number of complaints
handled through such complaint system and a compilation of causes underlying the complaints
filed; and c. The number, amount, and disposition of malpractice claims and other claims relating
to the service or care rendered by the health maintenance organization made by enrollees of
the organization that were settled during the year by the health...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-10.htm - 1K - Match Info - Similar pages
27-21A-2
Section 27-21A-2 Establishment of health maintenance organizations. (a) Notwithstanding any
law of this state to the contrary, any person may apply to the commissioner for and obtain
a certificate of authority to establish and operate a health maintenance organization in compliance
with this chapter. No person shall establish or operate a health maintenance organization
in this state without obtaining a certificate of authority under this chapter. A foreign corporation
may qualify under this chapter, subject to its registration to do business in this state as
a foreign corporation under the provisions of Sections 10-2A-220, et seq. (b) Health maintenance
organizations licensed as of May 29, 1986, shall be issued a certificate of authority in accordance
with Section 27-21A-29. (c) Each application for a certificate of authority shall be verified
by an officer or authorized representative of the applicant, shall be in a form prescribed
by the commissioner, and shall set forth or be...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-2.htm - 6K - Match Info - Similar pages
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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