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25-5-312
Section 25-5-312 Powers and duties of the board. The board shall exercise general supervision
in all matters related to the provision of medical services provided by physicians, as defined
in Section 25-5-310, rendered to workers under this article. The duties of the board shall
include, but are not limited to, the following: (1) Study, develop, and implement any necessary
and reasonable guidelines for medical services and physician care provided by physicians.
In addition, with respect to services provided by physicians, the board shall study, develop,
and recommend to the secretary uniform medical criteria and policies for the conduct of utilization
review, bill screenings, and medical necessity determinations for use by insurance carriers,
self-insurers, and claims administrators. (2) Study, design, and implement standardized uniform
claims processing forms and forms for the reporting of medical information to employers and
insurance companies by physicians. (3) Address and give...
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27-52-2
Section 27-52-2 Authority. The plan shall have the general powers and authority granted under
the laws of this state to health insurers and in addition thereto, the specific authority
to do all of the following: (1) Enter into contracts as are necessary or proper to carry out
the provisions and purposes of this article, including the authority, with the approval of
the commissioner, to enter into contracts with similar plans of other states for the joint
performance of common administrative functions, or with persons or other organizations for
the performance of administrative functions. (2) Sue or be sued, including taking any legal
actions necessary or proper to recover or collect assessments due the plan. (3) Take legal
action as necessary to do any of the following: a. To avoid the payment of improper claims
against the plan or the coverage provided by or through the plan. b. To recover any amounts
erroneously or improperly paid by the plan. c. To recover any amounts paid by the...
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36-29-5
Section 36-29-5 Expenses, treatment, etc., not to be included under plan. (a) Such health insurance
shall not include any of the following: (1) Expenses incurred by or on account of an individual
prior to the effective date of the plan. (2) Cosmetic surgery or treatment, except to the
extent necessary for correction of damages caused by accidental injury while covered by the
plan or as a direct result of disease covered by the plan. (3) Services received in a hospital
owned or operated by the United States government for which no charge is made. (4) Services
received for injury or sickness due to war or any act of war, whether declared or undeclared,
which war or act of war shall have occurred after the effective date of this plan. (5) Expenses
for which the individual is not required to make payment. (6) Expenses to the extent of benefits
provided under any employer group plan other than the plan in which the state participates
in the cost thereof. (7) Such other expenses as may be...
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36-29-6
Section 36-29-6 Authorization and execution of contracts; documentation of benefits. (a) The
board is hereby authorized to execute a contract or contracts to provide the plan determined
in accordance with the provisions of this chapter. Such contract or contracts may be executed
with one or more agencies or corporations licensed to transact or administer group health
insurance business in this state. All of the benefits to be provided under this chapter may
be included in one or more similar contracts issued by the same or different companies. (b)
Before entering into any contract or contracts authorized by subsection (a) of this section,
the board shall invite competitive bids from all qualified entities who may wish to administer
or offer plans for the health insurance coverage desired. The board shall award such contract
or contracts on a competitive basis as determined by the benefits afforded, administrative
costs, the costs to be incurred by employee, retiree, and employer, the...
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16-25A-12
Section 16-25A-12 Employees may elect not to participate; full state funding; subsequent election
to participate. (a) Any board of education, institution, or other employer with employees
as defined by Section 16-25A-1, may, upon a majority vote of its employees, elect not to participate
in the basic medical plan authorized by the provisions of this article; provided, however,
that for any fiscal year ending September 30 the Legislature appropriates the full amount
certified pursuant to Section 16-25A-8(b), the board shall declare the plan of insurance coverage
to be fully state-funded whereupon all employees of any board of education, institution, or
other employer as defined hereinabove shall for that fiscal year and all subsequent fiscal
years be declared members of the Public Education Employees' Health Insurance Plan. (b) Any
employer electing not to participate in the basic medical plan shall certify to the board
the names of their employees otherwise electing hospital/medical...
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21-9-2
Section 21-9-2 Definitions. For the purposes of this chapter, the following words and phrases
shall have the respective meanings ascribed to them by this section: (1) BOARD. The Board
of Rehabilitation Services. (2) COMMISSIONER. The Commissioner of the Department of Rehabilitation
Services, who shall administer the department. (3) COMPONENT PROGRAMS. The following programs
administered by the department: a. Children's Rehabilitation Service. A service program that
provides educational, medical, and habilitative services including recreational and physical
fitness services for children with special health care needs, including coordination and support
for their families through statewide community-based programs. b. Early Intervention Program.
A program that provides early intervention services for children, up to the age of three years,
who are born with disabling conditions or who are at risk for developmental delay. c. Adult
Vocational Rehabilitation Service. A service program that...
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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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27-14-11.1
Section 27-14-11.1 Contents of policies - Denial or reduction of benefits due to Medicaid eligibility
void. (a) For purposes of this section, "private insurer" is defined as any of the
following: (1) Any commercial insurance company offering health or casualty insurance to individuals
or groups, including both experience-rated contracts and indemnity contracts. (2) Any profit
or nonprofit prepaid plan offering either medical services or full or partial payment for
the diagnosis or treatment of an injury, disease, or disability. (3) Any organization administering
health or casualty insurance plans for professional associations, unions, fraternal groups,
employer-employee benefit plans, and any similar organization offering these payments or services,
including self-insured and self-funded plans. (4) Any health insurer, including group health
plans, as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974,
self-insured plans, service benefit plans, managed care...
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27-20A-2
Section 27-20A-2 Chapter applicable to group, etc., policies. No group, blanket, franchise,
or association health insurance policy providing coverage on an expense incurred basis, nor
group, blanket, franchise, or association service or indemnity type contract issued by a nonprofit
corporation, nor group-type self insurance plan providing protection, insurance, or indemnity
against hospital, medical, or surgical expenses, nor health maintenance organization plan
shall be issued, delivered, executed, or renewed in this state, or approved for issuance or
renewal in this state by the Commissioner of Insurance after 90 days beyond the effective
date of this chapter, unless such policy, contract, or plan, at the option of the policyholder
or sponsor, provides benefits to any insured, subscriber, or other person covered under the
policy, contract, or plan for expenses incurred in connection with the treatment of alcoholism
when such treatment is prescribed by a duly licensed doctor of...
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27-4A-2
Section 27-4A-2 Definitions. For the purposes of this chapter only, the following terms, unless
the context clearly indicates otherwise, shall have the meanings: (1) ANNUITY CONSIDERATIONS.
All sums received as consideration for annuity contracts. (2) COMMISSIONER. The Commissioner
of Insurance of the State of Alabama. (3) DEPARTMENT. The Department of Insurance of the State
of Alabama. (4) DOMESTIC INSURER. Any insurer organized under the laws of the State of Alabama
which maintains its principal office and chief place of business in the State of Alabama.
(5) FOREIGN INSURER. Any insurer organized under the laws of any country or of any state of
the United States other than the State of Alabama and any insurer organized under the laws
of Alabama which maintains its principal office or chief place of business outside the State
of Alabama. (6) INSURER. Every insurer as defined in Section 27-1-2, and every other insurance
company or association charging a premium for contracts entered...
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