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27-56-2
Section 27-56-2 Definitions. As used in this chapter, the following terms shall have
the following meanings: (1) COVERED PERSON. Any individual, family, or family member on whose
behalf third-party payment or prepayment of health or medical expenses is provided under an
insurance policy, plan, or contract providing for third-party payment or prepayment of health
care or medical expenses. (2) EYE CARE PROVIDER. A licensed optometrist or a licensed ophthalmologist.
(3) INSURANCE POLICY, PLAN, OR CONTRACT PROVIDING FOR THIRD-PARTY PAYMENT OR PREPAYMENT OF
HEALTH OR MEDICAL EXPENSES. Includes an individual or group policy for accident or health
insurance, an individual or group hospital or health care service contract, an individual
or group health maintenance organization contract, an organized delivery system contract,
or a preferred provider organization contract, and any other similar policy, plan, or contract.
This term shall not include any employee welfare benefit plan, as defined...
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27-58-1
Section 27-58-1 Definitions. As used in this chapter, the following terms shall have
the following meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare
benefit plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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27-59-1
Section 27-59-1 Definitions. As used in this chapter, the following terms shall have
the following meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare
benefit plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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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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34-19-21
Section 34-19-21 Coverage or reimbursement for services not required. Nothing contained
in this chapter shall be construed to create a requirement that any health benefit plan, group
insurance plan, policy, or contract for health care services that covers hospital, medical,
or surgical expenses, health maintenance organizations, preferred provider organizations,
medical service organizations, physician-hospital organizations, or any other person, firm,
corporation, joint venture, or other similar business entity that pays for, purchases, or
furnishes group health care services to patients, insureds, or beneficiaries in this state,
including entities created pursuant to Article 6, commencing with Section 10A-20-6.01,
of Chapter 20, Title 10A, provide coverage or reimbursement for the services described or
authorized in this chapter. (Act 2017-383, ยง4.)...
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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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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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22-6-153
Section 22-6-153 Contract to provide medical care to Medicaid beneficiaries; enrollment;
grievance procedures; duties of Medicaid Agency. (a) Subject to approval of the federal Centers
for Medicare and Medicaid Services, the Medicaid Agency shall enter into a contract in each
Medicaid region for at least one fully certified regional care organization to provide, pursuant
to a risk contract under which the Medicaid Agency makes a capitated payment, medical care
to Medicaid beneficiaries. However, the Medicaid Agency may enter into a contract pursuant
to this section only if, in the judgment of the Medicaid Agency, care of Medicaid beneficiaries
would be better, more efficient, and less costly than under the then existing care delivery
system. The Medicaid Agency may contract with more than one regional care organization in
a Medicaid region. Pursuant to the contract, the Medicaid Agency shall set capitation payments
for the regional care organization. (b) The Medicaid Agency shall...
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22-8A-9
Section 22-8A-9 Withholding or withdrawal of treatment, etc., not suicide; execution
of advance directive not to affect sale, etc., of life or health insurance nor be condition
for receipt of treatment, etc.; provisions of chapter cumulative. (a) The withholding or withdrawal
of life-sustaining treatment or artificially provided nutrition and hydration from a patient
in accordance with the provisions of this chapter shall not, for any purpose, constitute a
suicide and shall not constitute assisting suicide. (b) The making of an advance directive
for health care pursuant to this chapter shall not affect in any manner the sale, procurement,
or issuance of any policy of life or health insurance, nor shall it be deemed to modify the
terms of an existing policy of life or health insurance. No policy of life or health insurance
shall be legally impaired or invalidated in any manner by the withholding or withdrawal of
life-sustaining treatment or artificially provided nutrition and hydration...
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27-19A-2
Section 27-19A-2 Definitions. As used in this chapter, the following terms shall have
the respective meanings herein set forth, unless the context shall otherwise require: (1)
ALABAMA INSURANCE CODE. Title 27 of the Code of Alabama 1975. (2) INSURER. Such term shall
have the meaning ascribed in Section 27-1-2. (3) PERSON. Such term shall have the meaning
ascribed in Section 27-1-2. (4) COMMISSIONER and DEPARTMENT. Such terms, respectively,
shall have the meanings ascribed in Section 27-1-2. (5) CONTRACTUAL OBLIGATION. Any
obligation under covered policies or employee benefit plans. (6) COVERED POLICY OR PLAN. Any
policy, employee benefit plan, or contract within the scope of this chapter. (7) HEALTH INSURANCE
POLICY. Any individual, group, blanket, or franchise insurance policy, insurance agreement,
or group hospital service contract providing benefits for dental care expenses incurred as
a result of an accident or sickness. (8) EMPLOYEE BENEFIT PLAN. Any plan, fund, or program...
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