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27-54-2
Section 27-54-2 Definitions. For purposes of this chapter, the following terms have the following
meanings: (1) DAY TREATMENT SERVICES. Includes, but is not limited to: Physiological, psychological,
and psychosocial concepts, techniques, and processes necessary to maintain or develop functional
skills of clients, provided to individuals and groups for periods of more than two hours but
less than 24 hours a day. (2) HEALTH BENEFIT PLAN. A health care service plan governed by
the provisions of Article 6, Chapter 4, Title 10, and a group health insurance policy, including
an employee welfare health benefit plan, that covers hospital, medical, or surgical expenses,
issued by insurers, 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 health
care services to patients, insureds, or...
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27-44-3
Section 27-44-3 Scope of chapter. (a) This chapter shall provide coverage for the policies
and contracts specified in subsection (b) as follows: (1) To persons who, regardless of where
they reside (except for non-resident certificate holders under group policies or contracts),
are the beneficiaries, assignees, or payees of the persons covered under subdivision (2).
(2) To persons who are owners of or certificate holders under the policies or contracts, other
than structured settlement annuities, and in each case who are either of the following: a.
Residents b. Not residents, but only under all of the following conditions: 1. The insurer
that issued the policies or contracts is domiciled in this state. 2. The states in which the
persons reside have associations similar to the association created by this chapter. 3. The
persons are not eligible for coverage by an association in any other state due to the fact
the insurer was not licensed in the state at the time specified in the state's...
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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...
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22-7A-1
Section 22-7A-1 Physician agreements; dentist agreements. (a) For the purposes of this chapter,
the following words shall have the following meanings: (1) DENTIST. A person licensed to practice
dentistry in this state. (2) DENTIST AGREEMENT or AGREEMENT. A contract between a dentist
and a patient or his or her legal representative in which the dentist or the dentist's medical
practice agrees to provide dental services to the patient for an agreed upon fee and period
of time. (3) DENTIST PRACTICE. A dentist or a dental practice of a dentist that charges a
periodic fee for dental services and which does not bill a third party any additional fee
for services for patients covered under a dental agreement. The per visit charge of the practice
shall be less than the monthly equivalent of the periodic fee. (4) PHYSICIAN. A person licensed
to practice medicine in this state. (5) PHYSICIAN AGREEMENT or AGREEMENT. A contract between
a physician and a patient or his or her legal representative in...
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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...
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27-56-5
Section 27-56-5 Third-party payment. (a) No insurance policy, plan, or contract providing for
third-party payment or prepayment of health or medical expenses that provides coverage for
eye care services shall be issued or renewed after August 1, 2001, unless such insurance policy,
plan, or contract does the following: (1) Provides a covered person direct access to any eye
care provider participating in, or otherwise eligible to provide services under, the policy,
plan, or contract for all eye care services covered under the policy, plan, or contract, without
any referral or preapproval requirement, including, but not limited to, the following services,
if covered: a. Medical treatment of glaucoma. b. Postoperative eye care. (2) Ensures that
any list of medical or health care providers participating in, or otherwise eligible to provide
services under, the policy, plan, or contract includes eye care providers to the same extent
that such list includes other medical or health care...
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27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases shall
have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health. (2)
ENROLLEE. An individual who has contracted for or who participates in coverage under an insurance
policy, a health maintenance organization contract, a health service corporation contract,
an employee welfare benefit plan, a hospital or medical services plan, or any other benefit
program providing payment, reimbursement, or indemnification for health care costs for the
individual or the eligible dependents of the individual. (3) PROVIDER. A health care provider
duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system for prospective
and concurrent review of the necessity and appropriateness in the allocation of health care
resources and services given or proposed to be given to an individual within this state. The
term does not include elective requests for clarification of...
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27-21A-7
Section 27-21A-7 Evidence of coverage and charges for health care services. (a)(1) Every enrollee
residing in this state is entitled to an evidence of coverage. If the enrollee obtains such
coverage through an insurance policy or a contract issued by a health care service plan, the
insurer or the health care service plan shall issue the evidence of coverage. Otherwise, the
health maintenance organization shall issue the evidence of coverage. (2) No evidence of coverage,
or amendment thereto, shall be issued or delivered to any person in this state until a copy
of the basic form of the evidence of coverage, or amendment thereto, has been filed with the
commissioner and the State Health Officer, and approved by the commissioner. (3) An evidence
of coverage shall contain: a. No provisions or statements which encourage misrepresentation,
or which are untrue, misleading, or deceptive as defined in subsection (a) of Section 27-21A-13;
and b. A clear and concise statement, if a contract, or a...
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35-11-371
Section 35-11-371 Perfection of lien. (a) For the purposes of this section, the following terms
shall have the following meanings: (1) HEALTH CARE PAYOR. A health care insurer, health maintenance
organization, or health care service plan organized under Article 6, Chapter 20, Title 10A,
authorized to provide health care coverage in the state. (2) SATISFY THE CLAIM. Receipt by
the hospital of either of the following: a. Full payment for services as billed. b. If the
hospital has a contract with the injured person's health care payor, payment together with
all credits, discounts, and contractual adjustments that the patient's bill would be entitled
under the contract, including recoupments, between the hospital and the patient's health care
payor which extinguish the patient's obligation for the services rendered. (b) Unless specifically
contrary to any contractual agreement between the hospital and the injured person's health
care payor or unless contrary to any statute or governmental...
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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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