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27-48-1
Section 27-48-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. A health insurance policy 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 health care services to patients, insureds, or beneficiaries in this state. For
the purpose of this chapter, a health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to the provisions of this chapter if it receives, processes,
adjudicates, pays, or denies claims for health care services submitted by or on behalf of
the State of Alabama or who receive health care services in the State of Alabama. The term
includes, but is not limited to, entities created pursuant to Article 6 of...
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27-1-10
Section 27-1-10 Payment for health services of chiropractor; insured to have exclusive right
to select practitioner of healing arts. Any contract or policy of insurance or any plan or
agreement for health services providing for reimbursement or payment for health services performed
by a medical doctor or physician or upon the certification of a medical doctor, surgeon, osteopath
or physician, shall also reimburse or pay for such health services performed by a doctor of
chiropractic or upon his certificate; provided, that the health services performed by the
doctor of chiropractic are within the scope of his license and he is duly licensed by the
State of Alabama. The insured or such other person entitled to benefits under such contract
or policy of insurance or plan or agreement for health services shall have the exclusive right
to choose or select any practitioner or member of the healing arts of Alabama to perform such
services, notwithstanding any provisions of such contract or...
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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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36-29-17
Section 36-29-17 Election by employees and officers of Alabama Sports Hall of Fame Board to
receive coverage. (a) Notwithstanding the provisions of Section 36-29-1, an employee or executive
officer of the Alabama Sports Hall of Fame Board and his or her dependents shall be eligible
for coverage under the State Employees' Health Insurance Plan and upon the expiration of the
employment may continue the coverage for a maximum of 36 months. (b) Preexisting conditions
shall not be covered until the insured has been covered under the plan for a period of 12
months. An employee enrolling within 30 days of August 7, 1995 or within 30 days of the beginning
of a calendar year thereafter shall not be subject to this limitation of benefits. A preexisting
condition is a condition for which the insured or their covered dependent received medical
treatment, advice, or consultation, or received a prescribed medication within 12 months of
the effective date of the insured's coverage under the plan. (c)...
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27-49-3
Section 27-49-3 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, policy, or contract for health
care services issued, delivered, issued for delivery, 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, purchases, or furnishes health care services to patients, insureds,
or beneficiaries in this state. The term includes, but is not limited to, entities created
pursuant to Article 6 of Chapter 4 of Title 10. For the purposes of this chapter, a health
benefit plan located or domiciled outside of the State of Alabama is deemed to be subject
to the provisions of this chapter if it receives, processes,...
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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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25-5-313
Section 25-5-313 Schedule of maximum fees. Within 60 days from May 19, 1992, the Workers' Compensation
Medical Services Board shall submit to the Governor an initial schedule of maximum fees for
medical services covered by this article, which schedule shall become effective immediately
upon submission to the Governor. The initial schedule of maximum fees shall be established
by the board in the manner prescribed in this section. The fee for each service in the schedule
shall be exactly equal to an amount derived by multiplying the preferred provider reimbursement
customarily paid on May 19, 1992, by the largest health care service plan incorporated pursuant
to Sections 10-4-100 to 10-4-115, inclusive, by a factor of 1.075, which product shall be
the maximum fee for each such service. In addition the board may submit to the Governor for
approval on or before January 31, 1993, a revised schedule of selected fees for medical services
covered by this article, which fees shall not exceed...
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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...
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27-51-1
Section 27-51-1 Payment for services of licensed physician assistant. (a) An insurance policy
or contract providing for third-party payment or prepayment of health or medical expenses
shall include a provision for the payment to a supervising physician for necessary medical
or surgical services that are provided by a licensed physician assistant practicing under
the supervision of the physician, and pursuant to the rules, regulations, and parameters for
physician assistants, if the policy or contract pays for the same care and treatment provided
by a licensed physician or doctor of osteopathy. (b) An insurance policy or contract subject
to this section shall not impose a practice or supervision restriction which is inconsistent
with or more restrictive than provided by law. (c) This section shall apply to services provided
under a policy or contract delivered, continued, or renewed in this state on or after August
1, 1997, and to any existing policy or contract, on the policy's or...
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38-3-1
Section 38-3-1 Creation; advisory board of directors. (a) There is hereby created the Department
of Senior Services of the State of Alabama, which shall be under the direction and control
of the Commissioner of the Department of Senior Services. (b) There is created an advisory
board of directors which shall consist of 16 members, which shall advise the commissioner
in the administration of the department. The advisory board shall be composed of two members
of the Senate to be appointed by the President of the Senate; two members of the House of
Representatives to be appointed by the Speaker of the House; the Commissioner of the State
Department of Labor, the State Health Officer, and the Commissioner of the State Department
of Human Resources as ex officio members; and nine members to be appointed by the Governor
for terms concurrent with the term of the Governor. Of the members appointed by the Governor,
one shall be a representative of business, one shall be a representative of...
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