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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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27-7-1
Section 27-7-1 Definitions. For the purposes of this chapter, the following terms shall
have the meanings respectively ascribed to them by this section: (1) BUSINESS ENTITY.
A corporation, association, partnership, limited liability company, limited liability partnership,
or other legal entity. (2) COMMISSIONER. The Alabama Commissioner of Insurance. (3) HOME STATE.
The District of Columbia and any state or territory of the United States in which an insurance
producer maintains his or her principal place of residence or principal place of business
and is licensed to act as an insurance producer. (4) INSURANCE. As defined in Section
27-1-2. (5) INSURANCE PRODUCER or PRODUCER. A person required to be licensed under the laws
of this state to sell, solicit, or negotiate insurance. (6) INSURER. As defined in Section
27-1-2. For the purposes of this chapter, insurer shall also mean an insurance company licensed
pursuant to Chapter 3, commencing with Section 27-3-1 of this title; a health...
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34-23-184
Section 34-23-184 Audit procedures; report. (a) The entity conducting an audit shall
follow these procedures: (1) The pharmacy contract shall identify and describe in detail the
audit procedures. (2) The entity conducting the on-site audit shall give the pharmacy written
notice at least two weeks before conducting the initial on-site audit for each audit cycle.
If the pharmacy benefit manager does not include their auditing guidelines within their provider
manual, then the notice must include a documented checklist of all items being audited and
the manual, including the name, date, and edition or volume, applicable to the audit and auditing
guidelines. For on-site audits a pharmacy benefit manager shall also provide a list of material
that is copied or removed during the course of an audit to the pharmacy. The pharmacy benefit
manager may document this material on either a checklist or on an audit acknowledgement form.
The pharmacy shall produce any items during the course of the...
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25-4-78
Section 25-4-78 Disqualifications for benefits. An individual shall be disqualified
for total or partial unemployment for any of the following: (1) LABOR DISPUTE IN PLACE OF
EMPLOYMENT. For any week in which an individual's total or partial unemployment is directly
due to a labor dispute still in active progress in the establishment in which he or she is
or was last employed. For the purposes of this section only, the term labor dispute
includes any controversy concerning terms, tenure, or conditions of employment, or concerning
the association or representation of persons in negotiating, fixing, maintaining, changing,
or seeking to arrange terms or conditions of employment, regardless of whether the disputants
stand in the proximate relation of employer and employee. This definition shall not relate
to a dispute between an individual worker and his or her employer. (2) VOLUNTARILY QUITTING
WORK. If an individual has left his or her most recent bona fide work voluntarily without
good...
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22-6-163
Section 22-6-163 Legislative findings; rules; collaboration; approval of agreements
and contracts; state action immunity; confidentiality of records; additional duties. (a) The
Legislature declares that collaboration among public payers, private health carriers, third
party purchasers, and providers to identify appropriate service delivery systems and reimbursement
methods in order to align incentives in support of integrated and coordinated health care
delivery is in the best interest of the public. Collaboration pursuant to this article is
to provide quality health care at the lowest possible cost to Alabama citizens who are Medicaid
eligible. The Legislature, therefore, declares that this health care delivery system affirmatively
contemplates the foreseeable displacement of competition, such that any anti-competitive effect
may be attributed to the state's policy to displace competition in the delivery of a coordinated
system of health care for the public benefit. In furtherance of...
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22-6-233
Section 22-6-233 Legislative findings; certification of collaborators; powers of Medicaid
Agency; state action immunity. (a) The Legislature declares that collaboration among public
payers, private health carriers, third party purchasers, and providers to identify appropriate
service delivery systems and reimbursement methods in order to align incentives in support
of integrated and coordinated health care delivery is in the best interest of the public.
Collaboration pursuant to this article is to provide quality health care at the lowest possible
cost to Alabama citizens who are Medicaid eligible. The Legislature, therefore, declares that
this health care delivery system affirmatively contemplates the foreseeable displacement of
competition, such that any anti-competitive effect may be attributed to the state's policy
to displace competition in the delivery of a coordinated system of health care for the public
benefit. In furtherance of this goal, the Legislature declares its intent...
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27-34-37
Section 27-34-37 Annual statements - Valuation of certificates; reserves. (a) As a part
of the annual statement required under Section 27-34-36, each society shall, on or
before March 1, file with the commissioner a valuation of its certificates in force on December
31 last preceding; provided, however, that the commissioner may, in his discretion for cause
shown, extend the time for filing such valuation for not more than two calendar months. Such
report of valuation shall show, as reserve liabilities, the difference between the present
midyear value of the promised benefits provided in the certificates of such society in force
and the present midyear value of the future net premiums as the same are in practice actually
collected, not including therein any value for the right to make extra assessments and not
including any amount by which the present midyear value of future net premiums exceeds the
present midyear value of promised benefits on individual certificates. At the option of...
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27-60-2
Section 27-60-2 Interstate Insurance Product Regulation Compact. The State of Alabama
hereby agrees to the following interstate compact known as the Interstate Insurance Product
Regulation Compact: ARTICLE I. PURPOSES. The purposes of this compact are, through means of
joint and cooperative action among the compacting states: 1. To promote and protect the interest
of consumers of individual and group annuity, life insurance, disability income, and long-term
care insurance products; 2. To develop uniform standards for insurance products covered under
the compact; 3. To establish a central clearinghouse to receive and provide prompt review
of insurance products covered under the compact and, in certain cases, advertisements related
thereto, submitted by insurers authorized to do business in one or more compacting states;
4. To give appropriate regulatory approval to those product filings and advertisements satisfying
the applicable uniform standard; 5. To improve coordination of...
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8-32-2
Section 8-32-2 Definitions. As used in this chapter, the following terms shall have
the following meanings: (1) ADMINISTRATOR. The person designated by a provider to be responsible
for the administration of service contracts or the service contracts plan or to make the filings
required by this chapter. (2) COMMISSIONER. The Commissioner of Insurance of this state. (3)
CONSUMER. A natural person who buys, primarily for personal, family, or household purposes,
and not for resale, any tangible personal property normally used for personal, family, or
household purposes and not for commercial or research purposes. (4) MAINTENANCE AGREEMENT.
A contract of limited duration that provides for scheduled maintenance only. (5) MANUFACTURER.
A person that is one of the following: a. A manufacturer or producer of property that sells
the property under its own name or label. b. A subsidiary of the person who manufactures or
produces the property. c. A corporation which owns at least 80 percent of the...
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16-8-42.1
Section 16-8-42.1 Authority for risk management cooperative. (a) Definitions. For the
purpose of this section, the following terms shall have the meanings subscribed to
them by this section: (1) RISK MANAGEMENT COOPERATIVE. An entity or entities, to be
formed by local boards of education in any combination of 25 or more for the purpose of pooling
resources and funds to jointly purchase insurance or to self-insure such boards of education,
their members and employees, against risks to which they are exposed. (2) MEMBER BOARDS OF
EDUCATION. A city board of education, county board of education, Department of Youth Services
School District, Alabama Institute for Deaf and Blind, State Board of Education or other public
education governing board which elects to pool its resources and funds with one or more other
boards of education for the purpose of forming a risk management cooperative. (b) Boards of
education in any combination of 25 or more may establish a risk management cooperative for...
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