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27-1-10.1
Section 27-1-10.1 Insurance coverage for drugs to treat life-threatening illnesses.
(a) The Legislature finds and declares the following: (1) The citizens of this state rely
upon health insurance to cover the cost of obtaining health care and it is essential that
the citizens' expectation that their health care costs will be paid by their insurance policies
is not disappointed and that they obtain the coverage necessary and appropriate for their
care within the terms of their insurance policies. (2) Some insurers deny payment for drugs
that have been approved by the Federal Food and Drug Administration, hereafter referred to
as FDA, when the drugs are used for indications other than those stated in the labelling approved
by the FDA, off-label use, while other insurers with similar coverage terms do pay for off-label
use. (3) Denial of payment for off-label use can interrupt or effectively deny access to necessary
and appropriate treatment for a person being treated for a...
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36-29-1
Section 36-29-1 Definitions. When used in this chapter, the following terms shall have
the following meanings, respectively, unless the context clearly indicates otherwise: (1)
BOARD. The State Employees' Insurance Board. (2) CLASS. An employee or retiree shall be included
in one of the following classes: (i) active employee single, (ii) active employee family,
(iii) non-Medicare retiree single, (iv) non-Medicare retiree family, (v) Medicare retiree
single, (vi) Medicare retiree family, (vii) non-Medicare retiree with Medicare eligible dependent(s),
or (viii) Medicare retiree with non-Medicare dependent(s). (3) EMPLOYEE. A person who works
full time for the State of Alabama or for a county health department and who receives his
or her full compensation on a monthly basis through means of a state warrant drawn upon the
State Treasury or by check drawn by the Treasurer of the Alabama State Port Authority or by
check drawn by the treasurer of the Alabama state agency for surplus property...
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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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16-25A-1
Section 16-25A-1 Definitions. When used in this article, the following terms shall have
the following meanings, respectively, unless the context clearly indicates otherwise: (1)
EMPLOYEE. Any person covered by the Public Education Employees' Health Insurance Plan pursuant
to Section 16-25A-11 or person who is employed full-time in any public institution
of education within the State of Alabama which provides instruction at any combination of
grades K through 14, exclusively, under the auspices of the State Board of Education or the
Alabama Institute for Deaf and Blind; provided, any person employed part-time by any public
institution of education within the State of Alabama which provides instruction at any combination
of grades K through 14, exclusively, under the auspices of the State Board of Education or
the Alabama Institute for Deaf and Blind, shall be included in the definition of employee
if such person shall agree to have deducted from his or her compensation a pro rata...
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27-44-8
Section 27-44-8 Powers and duties of association. (a) If a member insurer is an impaired
insurer, the association may, in its discretion and subject to any conditions imposed by the
association that do not impair the contractual obligations of the impaired insurer, and that
are approved by the commissioner: (1) Guarantee or reinsure, or cause to be guaranteed, assumed,
or reinsured, any or all of the covered policies of the impaired insurers. (2) Provide such
moneys, pledges, notes, guarantees, or other means as are proper to effectuate subdivision
(1), and assure payment of the contractual obligations of the impaired insurer pending action
under subdivision (1). (b) If a member insurer is an insolvent insurer, the association shall,
in its discretion and subject to the approval of the commissioner, do either of the following:
(1)a. Guarantee, assume, or reinsure, or cause to be guaranteed, assumed, or reinsured, the
covered policies of the insolvent insurer. b. Assure payment of the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-44-8.htm - 24K - 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
27-19A-12
Section 27-19A-12 Dental services - Coverages; fees; exceptions. (a) As used in this
section, 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) COVERED SERVICES.
Dental care services for which a reimbursement is available under an enrollee's plan contract,
or for which a reimbursement would be available but for the application of contractual limitations
such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums,
frequency limitations, alternative benefit payments, or any other limitation. (3) DENTAL CARE
PROVIDER. A licensed dentist. (4) DENTAL PLAN. Includes any policy of insurance which is issued
by a health care service contractor which provides for coverage of...
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27-44-5
Section 27-44-5 Definitions. As used in this chapter, the following terms shall have
the following meanings, respectively, unless the context clearly indicates otherwise: (1)
ACCOUNT. Either of the three accounts created under Section 27-44-6. (2) ASSOCIATION.
The Alabama Life and Disability Insurance Guaranty Association created under Section
27-44-6. (3) AUTHORIZED ASSESSMENT or the term AUTHORIZED when used in the context of assessments.
A resolution by the board of directors has been passed whereby an assessment will be called
immediately or in the future from member insurers for a specified amount. An assessment is
authorized when the resolution is passed. (4) BENEFIT PLAN. A specific employee, union, or
association of natural persons benefit plan. (5) CALLED ASSESSMENT or the term CALLED when
used in the context of assessments. A notice that has been issued by the association to member
insurers requiring that an authorized assessment be paid within the time frame set forth within...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-44-5.htm - 7K - Match Info - Similar pages
35-8A-313
Section 35-8A-313 Insurance. (a) Commencing not later than the time of the first conveyance
of a unit to a person other than a declarant, the association shall maintain, to the extent
reasonably available: (1) Property insurance on the common elements insuring against all risks
of direct physical loss commonly insured against or, in the case of a conversion building,
against fire and extended coverage perils. The total amount of insurance after application
of any deductibles shall be not less than the greater of 80 percent of the actual cash value
of the insured property at the time the insurance is purchased or such greater percentage
of such actual cash value as may be necessary to prevent the applicability of any co-insurance
provision and at each renewal date, exclusive of land, excavations, foundations, and other
items normally excluded from property policies; and (2) Liability insurance, including medical
payments insurance, in an amount determined by the board but not less than...
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25-4-51
Section 25-4-51 Rates of contributions, etc., by employers. (a) Contributions. Except
as hereinafter provided and subject to the provisions of Section 25-4-54, every employer
shall pay contributions, or payments in lieu of contributions, equal to the percentages of
wages payable or paid as hereinafter set out, with respect to employment by him. (1) With
respect to employment during calendar years after December 31, 1975, every employer who has
been liable to the provisions of this chapter during a period of time sufficient to have his
rate of contribution determined under the experience rating provisions of Section 25-4-54
shall pay contributions at the rate prescribed thereby. (2) With respect to employment after
December 31, 1975, every employer who has not been liable to the provisions of this chapter
for a sufficient length of time to have his rate determined under the experience rating provisions
of Section 25-4-54 shall pay contributions at the rate of 2.70 percent of such wages...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/25-4-51.htm - 33K - Match Info - Similar pages
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