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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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27-58-1
Section 27-58-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit
plan, policy, or contract for health care services issued, delivered, issued for delivery,
or 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 insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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27-59-1
Section 27-59-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit
plan, policy, or contract for health care services issued, delivered, issued for delivery,
or 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 insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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27-56-6
Section 27-56-6 When provisions applicable. This chapter shall apply to services provided under
a policy, plan, or contract providing for third-party payment or prepayment of health or medical
expenses delivered, continued, or renewed in this state on or after August 1, 2001, and to
any such existing policy, plan, or contract, on its anniversary or renewal date, or upon the
expiration of the applicable collective bargaining contract, if any, whichever is later. (Act
2001-477, p. 640, §6.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-6.htm - 800 bytes - Match Info - Similar pages
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, §4.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-19-21.htm - 1K - Match Info - Similar pages
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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22-6-153
Section 22-6-153 Contract to provide medical care to Medicaid beneficiaries; enrollment; grievance
procedures; duties of Medicaid Agency. (a) Subject to approval of the federal Centers for
Medicare and Medicaid Services, the Medicaid Agency shall enter into a contract in each Medicaid
region for at least one fully certified regional care organization to provide, pursuant to
a risk contract under which the Medicaid Agency makes a capitated payment, medical care to
Medicaid beneficiaries. However, 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. The Medicaid Agency may contract with more than one regional care organization in
a Medicaid region. Pursuant to the contract, the Medicaid Agency shall set capitation payments
for the regional care organization. (b) The Medicaid Agency shall...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-153.htm - 10K - Match Info - Similar pages
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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27-15-52
Section 27-15-52 Definitions. The following terms shall have the following meanings: (1) COMMERCIALLY
REASONABLE EFFORT. The plans, processes, or procedures necessary to confirm the death of the
insured, contract owner or annuitant, or retained asset account holder against other available
records and information and, as applicable, to locate the beneficiary or beneficiaries or
other person entitled to payment pursuant to the terms of the policy or contract which have
been developed by each insurer and submitted to and approved by the department. (2) CONTRACT.
An annuity contract. The term contract shall not include an annuity used to fund an employment-based
retirement plan or program where the insurer is not committed by terms of the annuity contract
to pay death benefits to the beneficiaries of specific plan participants. (3) DEATH MASTER
FILE. The United States Social Security Administration's Death Master File or any other database
or service that is at least as comprehensive as...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-15-52.htm - 3K - Match Info - Similar pages
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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