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34-23-111
Section 34-23-111 "Third Party Prescription Program" defined. As used in this article,
the term "Third Party Prescription Program" shall mean any system of providing for
the reimbursement of pharmaceutical services under a contractual arrangement or agreement
between a provider of such services and another party who is not the consumer of those services.
Such programs may include, but not be limited to, employee benefit plans whereby a consumer
receives prescription drugs or other pharmaceutical services and those services are paid for
by an agent of the employer or others. (Acts 1981, No. 81-337, p. 477, §2.)...
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27-45-2
Section 27-45-2 Definitions. As used in this article, 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 article. (7) HEALTH INSURANCE POLICY. Any individual,
group, blanket, or franchise insurance policy, insurance agreement, or group hospital service
contract providing for pharmaceutical services, including without limitation, prescription
drugs, incurred as a result of accident or sickness, or to prevent same....
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34-23-181
Section 34-23-181 Definitions. The following words shall have the following meanings as used
in this article: (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 article if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or...
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37-2A-2
Section 37-2A-2 Definitions. When used in this chapter, the following words have the following
meanings: (1) BASIC TELEPHONE SERVICE. Refers to a service that, as provided by an incumbent
local exchange carrier, may be through any technology and through any affiliate or service
arrangement and includes the functionalities described in 47 C.F.R. 54.101(a). (2) BROADBAND
SERVICE or BROADBAND ENABLED SERVICE. Any service that consists of or includes a high-speed
access capability to transmit at a rate that is not less than 200 kilobits per second either
in the upstream or downstream direction, and either of the following: a. Provides computer
processing, information storage, information content or protocol conversion, including any
service applications or information service provided over such high-speed access service.
b. Is used to provide access to the Internet. (3) BUNDLED OFFERING. A combination of retail
services offered as a package, whether at a single price or with the...
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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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34-23-112
Section 34-23-112 Required contractual provisions. Any agreement or contract entered into in
this state between the program administrator of a third party program and a pharmacy shall
include a statement of the method and amount of reimbursement to the pharmacy for services
rendered to persons enrolled in the program, the frequency of payment by the program administrator
to the pharmacy for such services rendered, and a method for the adjudication of complaints
or the settlement of disputes between the parties. (Acts 1981, No. 81-337, p. 477, §3.)...
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27-19A-12
Section 27-19A-12 Dental services - Coverages; fees; exceptions. (a) As used in this section,
the following terms shall have the following meanings: (1) COVERED PERSON. Any individual,
family, or family member on whose behalf third-party payment or prepayment of health or medical
expenses is provided under an insurance policy, plan, or contract providing for third-party
payment or prepayment of health care or medical expenses. (2) COVERED SERVICES. Dental care
services for which a reimbursement is available under an enrollee's plan contract, or for
which a reimbursement would be available but for the application of contractual limitations
such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums,
frequency limitations, alternative benefit payments, or any other limitation. (3) DENTAL CARE
PROVIDER. A licensed dentist. (4) DENTAL PLAN. Includes any policy of insurance which is issued
by a health care service contractor which provides for coverage of...
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27-1-16
Section 27-1-16 Standard health insurance claim form; electronic claims form; various claim
forms. (a)(1) The Commissioner of the Department of Insurance shall prescribe a standard health
insurance claim form to be used by all hospitals. The forms shall be prescribed in a format
which allows for the use of generally accepted diagnosis and treatment coding systems by providers
of health care and payors. The standard form shall be accepted and used by all insurers doing
business in the State of Alabama and by all state agencies which pay providers of health care
for hospital services. (2) The Commissioner of the Department of Insurance shall also prescribe
a format for all health insurance claims transmitted or submitted for payment by electronic
or electro-mechanical means. Such a format shall be used by all insurers doing business in
the State of Alabama and by all state agencies which pay providers of health care for hospital
services. (b) An advisory committee of five persons, two...
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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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25-5-293
Section 25-5-293 Duties of secretary; continuing education, accounting; recovery of expenses;
advisory committees; legislative intent regarding reimbursements. (a) The Secretary of the
Department of Labor may prescribe rules and regulations for the purpose of conducting continuing
education seminars for all personnel associated with workers' compensation claims and collect
registration fees in order to cover the related expenditures. The secretary may adopt rules
and regulations setting continuing education standards for workers' compensation claims personnel
employed by insurance companies and self-insured employers and groups. (b) The secretary shall
file annually with the Governor and the presiding officer of each house of the Legislature
a complete and detailed written report accounting for all funds received and disbursed during
the preceding fiscal year. The annual report shall be in the form and reported in the time
provided by law. (c) The secretary shall establish reasonable...
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