22-6-224
Section 22-6-224 Medicaid Agency to contract for medical care; enrollment; delivery of services;
reimbursement. (a) Subject to approval of the federal Centers for Medicare and Medicaid Services,
the Medicaid Agency shall enter into contracts with one or more integrated care networks to
provide, pursuant to a risk contract under which the Medicaid Agency makes a capitated payment,
medical care to Medicaid beneficiaries assigned to the integrated care network. 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. Pursuant to the contract, the Medicaid
Agency shall set capitation payments for the integrated care network. (b) The Medicaid Agency
shall enroll beneficiaries it designates into an integrated care network consistent with guidance
from the Center for Medicare and Medicaid Services. (c)...
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16-25A-8
Section 16-25A-8 Funding of health insurance plan; participation; Public Education Employees'
Health Insurance Fund. (a) The Public Education Employees' Health Insurance Board is hereby
authorized to provide under the contract or contracts entered into under the provisions of
this article an insurance benefit plan for each covered employee and, under certain conditions,
retired employees; the cost of such plan may be funded in part or in full through monthly
premiums per active employee from the same source of funds as those used for the payment of
salaries of active members and in part from other funds. (b) On or before January 1 next preceding
each regular meeting of the Legislature, the board shall certify to the Governor and to the
Legislature the amount or amounts necessary to fund coverage for benefits authorized by this
article for the following fiscal year for employees and for retired employees as a monthly
premium per active member per month. The Legislature shall set the...
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27-47-2
Section 27-47-2 Deduction for premiums paid for long-term care insurance contract; treatment
of contract; coverage. (a) The premiums paid for a long-term care insurance contract are deductible
pursuant to Section 40-18-15, if the contract meets the following requirements: (1) Offers
coverage only for qualified long-term care services and benefits incidental to the coverage.
(2) Guaranteed renewal. (3) No cash surrender value. (4) All refunds of premiums and all policyholder
dividends or similar amounts under the contract are to be applied as a reduction in future
premiums or to increase future benefits, except for a refund of premiums on surrender or cancellation
of the policy. (b) For purposes of this chapter, a long-term care insurance contract shall
be treated as an accident or health insurance contract. The amount of coverage under the long-term
care insurance contract shall be equal to or greater than Medicaid coverage for a period of
at least three years. (c) An insurance...
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27-56-3
Section 27-56-3 Payment for services. An insurance policy, plan, or contract providing for
third-party payment or prepayment of health or medical expenses shall include a provision
for the payment to a licensed optometrist for each service which falls within the scope of
the optometrist's license, if the policy, plan, or contract pays for the same service when
provided by any other provider for such services. (Act 2001-477, p. 640, §3.)...
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27-48-3
Section 27-48-3 Prohibition against plan termination of services, reduction of capitation payment,
or other penalty for health care provider in compliance with chapter; prohibition against
financial encouragement of early discharge from postpartum care. No health benefit plan subject
to the provisions of this chapter shall terminate the services, reduce capitation payment,
or otherwise penalize an attending physician, certified nurse midwife, or other health care
provider who orders medical care consistent with this chapter. No health benefit plan shall
provide, directly or indirectly, any financial incentive or disincentive or grant or deny
any special favor or advantage of any kind or nature to any person to encourage or cause early
discharge of a hospital patient from postpartum care, excluding capitation or global fee arrangements.
Provided nothing contained in this chapter is intended to expand the list or designation of
covered providers as specified in any health benefit plan or...
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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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12-5A-9
Section 12-5A-9 Participation of eligible employees in Employees' Retirement System; creditable
service; formal leave accounting system; inclusion in health insurance plan. (a) Class specifications
and rates of compensation for employees covered by this chapter, juvenile probation officers,
juvenile probation professional staff, and clerical staff, hereafter called "eligible
employees," and any future employees occupying those positions shall be established by
the Administrative Director of Courts. Notwithstanding the foregoing, the compensation of
any employee shall not be diminished as a result of his or her inclusion in the state court
system personnel system. (b) Eligible employees included in the state court system personnel
system pursuant to this chapter shall, on October 1 of the year their county transitions,
be covered by the Employees' Retirement System. An employee who on that date is participating
in a local retirement plan other than a unit administered by the Employees'...
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27-1-21
Section 27-1-21 Uniformity of limits applied to fulfillment of certain drug prescriptions.
(a) For the purposes of this section, the following words shall have the following meanings:
(1) ENROLLEE. A person enrolled in a health benefit plan. (2) 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. The term shall not include any collective bargaining agreement...
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7-9A-408
Section 7-9A-408 Restrictions on assignment of promissory notes, health-care-insurance receivables,
and certain general intangibles ineffective. (a) Term restricting assignment generally ineffective.
Except as otherwise provided in subsection (b), a term in a promissory note or in an agreement
between an account debtor and a debtor which relates to a health-care-insurance receivable
or a general intangible, including a contract, permit, license, or franchise, and which term
prohibits, restricts, or requires the consent of the person obligated on the promissory note
or the account debtor to, the assignment or transfer of, or creation, attachment, or perfection
of a security interest in, the promissory note, health-care-insurance receivable, or general
intangible, is ineffective to the extent that the term: (1) would impair the creation, attachment,
or perfection of a security interest; or (2) provides that the assignment or transfer or the
creation, attachment, or perfection of the...
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34-23-115
Section 34-23-115 Reimbursement rates. No agreement between a program administrator and a pharmacy
shall establish reimbursement rates or procedures that result in reimbursement rates for services
rendered to persons covered by the plan which are less than the usual and customary rates
paid by consumers not covered by a third party plan for the same or similar services. (Acts
1981, No. 81-337, p. 477, §6.)...
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