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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...
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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
27-49-3
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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27-59-1
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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27-57-2
Section 27-57-2 Coverage; applicability. (a) All group health benefit plans, policies,
contracts, and certificates executed, delivered, issued for delivery, continued, or renewed
in this state on or after August 1, 2004, shall offer, at the time of proposal, sale, or renewal
of a policy subject to this chapter, to include colorectal cancer examinations within the
coverage. Such offer of coverage shall include colorectal cancer examinations for covered
persons who are 50 years of age or older, or for covered persons who are less than 50 years
of age and at high risk for colorectal cancer according to current American Cancer Society
colorectal cancer screening guidelines. (b) This chapter shall apply to group accident and
sickness insurance policies issued by a fraternal benefit society, a nonprofit hospital service
corporation, a nonprofit medical service corporation, a group health care plan, a health maintenance
organization, or any similar entity. (Act 2004-502, p. 969, §2.)...
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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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27-19A-2
Section 27-19A-2 Definitions. As used in this chapter, the following terms shall have
the respective meanings herein set forth, unless the context shall otherwise require: (1)
ALABAMA INSURANCE CODE. Title 27 of the Code of Alabama 1975. (2) INSURER. Such term shall
have the meaning ascribed in Section 27-1-2. (3) PERSON. Such term shall have the meaning
ascribed in Section 27-1-2. (4) COMMISSIONER and DEPARTMENT. Such terms, respectively,
shall have the meanings ascribed in Section 27-1-2. (5) CONTRACTUAL OBLIGATION. Any
obligation under covered policies or employee benefit plans. (6) COVERED POLICY OR PLAN. Any
policy, employee benefit plan, or contract within the scope of this chapter. (7) HEALTH INSURANCE
POLICY. Any individual, group, blanket, or franchise insurance policy, insurance agreement,
or group hospital service contract providing benefits for dental care expenses incurred as
a result of an accident or sickness. (8) EMPLOYEE BENEFIT PLAN. Any plan, fund, or program...
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27-12A-1
Section 27-12A-1 Definitions. As used in this chapter, the following terms shall have
the following meanings: (1) COMMISSIONER. The Alabama Commissioner of Insurance or his or
her designee. (2) DEPARTMENT. The Alabama Department of Insurance. (3) INSURANCE. As defined
in Section 27-1-2, and specifically including any contract, arrangement, or agreement,
in which one undertakes to do any one of the following: a. Pay or indemnify another as to
loss from certain contingencies called risks. b. Pay or grant a specified amount or determinable
benefit to another in connection with ascertainable risk contingencies. c. Pay an annuity
to another. d. Act as surety. For the purposes of this chapter, insurance also includes any
health benefit plan as defined in Section 27-53-1. (4) INSURANCE PRODUCER or PRODUCER.
As defined in Section 27-7-1. (5) INSURER. A person entering into agreements, contracts
of insurance, arrangements, or reinsurance, or a health benefit plan, or a group health plan
as...
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27-19-103
Section 27-19-103 Definitions. Unless the context requires otherwise, the definitions
in this section apply throughout this article. (1) APPLICANT. In the case of: a. An
individual long-term care insurance policy, the person who seeks to contract for benefits.
b. A group long-term care insurance policy, the proposed certificate holder. (2) CERTIFICATE.
Any certificate issued under a group long-term care insurance policy, which policy has been
delivered or issued for delivery in this state. (3) COMMISSIONER. The Alabama Commissioner
of Insurance. (4) GROUP LONG-TERM CARE INSURANCE. A long-term care insurance policy which
is delivered or issued for delivery in this state and issued to any of the following: a. One
or more employers or labor organizations, or to a trust or to the trustees of a fund established
by one or more employers or labor organizations, or a combination thereof, for employees or
former employees or a combination thereof, or for members or former members or a...
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27-55-2
Section 27-55-2 Definitions. As used in this chapter, these terms shall have the following
meanings: (1) ABUSE. The occurrence of one or more of the following acts by a family or household
member, as defined by subdivision (3) of subsection (b) of Section 15-10-3: a. Attempting
to cause or intentionally, knowingly, or recklessly causing another person, including a minor
child, bodily injury, severe emotional injury, or psychological trauma or conduct which constitutes
the crime of rape. b. Intentionally following another person, including a minor child, without
proper authority, under circumstances that place the person in reasonable fear of bodily injury
or physical harm. c. Subjecting another person, including a minor child, to false imprisonment
or kidnapping. d. Attempting to cause or intentionally, knowingly, or recklessly causing damage
to property to intimidate or attempt to control the behavior of another person, including
a minor child. e. Assault, child abuse, criminal...
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