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36-29-3
Section 36-29-3 Factors to be considered by board in design of health insurance plan. The health
insurance plan provided for in this chapter shall be designed by the State Employees' Insurance
Board to provide a reasonable relationship between the hospital, surgical, and medical benefits
to be included and the expected hospital, surgical, and medical expenses to be incurred by
the affected employee and retiree and dependents and to include reasonable controls, which
may include, but are not limited to, deductible, copayment, coinsurance, and other cost containment
measures to prevent unnecessary utilization of the various hospital, surgical, and medical
services available and to provide reasonable assurance of stability in future years for the
plan. (Acts 1965, No. 833, p. 1564, §5; Act 2004-647, 1st Sp. Sess., p. 17, §1.)...
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16-25A-4
Section 16-25A-4 Relationship between benefits and expenses; reasonable controls on utilization
and for stability. The health insurance plan provided for in this article shall be designed
by the board to provide a reasonable relationship between the hospital, surgical, and medical
benefits to be included and the expected hospital, surgical, and medical expenses to be incurred
by the affected employee and retiree and dependents and to include reasonable controls, which
may include, but are not limited to, deductible, copayment, coinsurance, and other cost containment
measures to prevent unnecessary utilization of the various hospital, surgical, and medical
services available and to provide reasonable assurance of stability in future years for the
plan. (Acts 1983, No. 83-455, p. 640, §4; Act 2004-646, 1st Sp. Sess., p. 6, §2.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/16-25A-4.htm - 1K - Match Info - Similar pages
27-54A-2
Section 27-54A-2 Treatment under certain policies and contracts. (a) As used in this section,
the following words have the following meanings: (1) APPLIED BEHAVIOR ANALYSIS. The design,
implementation, and evaluation of environmental modifications, using behavioral stimuli and
consequences, to produce socially significant improvement in human behavior, including the
use of direct observation, measurement, and functional analysis of the relationship between
environment and behavior. (2) AUTISM SPECTRUM DISORDER. Any of the pervasive developmental
disorders or autism spectrum disorders as defined by the most recent edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) or the edition that was in effect at the
time of diagnosis. (3) BEHAVIORAL HEALTH TREATMENT. Counseling and treatment programs, including
applied behavior analysis that are both of the following: a. Necessary to develop, maintain,
or restore, to the maximum extent practicable, the functioning of an...
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27-19-103
would result in economies of acquisition or administration. 3. The benefits are reasonable
in relation to the premiums charged. (5) LONG-TERM CARE INSURANCE. Any insurance policy or
rider advertised, marketed, offered, or designed to provide coverage for not less than 12
consecutive months for each covered person on an expense incurred, indemnity, prepaid, or
other basis for one or more necessary or medically necessary diagnostic, preventive, therapeutic,
rehabilitative, maintenance, or personal care services, provided in a setting other
than an acute care unit of a hospital. This term includes group and individual annuities and
life insurance policies or riders that provide directly or that supplement long-term care
insurance. This term also includes a policy or rider that provides for payment of benefits
based upon cognitive impairment or the loss of functional capacity. The term shall also include
qualified long-term care insurance contracts. Long-term care insurance may be...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19-103.htm - 9K - Match Info - Similar pages
22-21-265
Section 22-21-265 Certificates of need - Required for new institutional health service. (a)
On or after July 30, 1979, no person to which this article applies shall acquire, construct,
or operate a new institutional health service, as defined in this article, or furnish or offer,
or purport to furnish a new institutional health service, as defined in this article, or make
an arrangement or commitment for financing the offering of a new institutional health service,
unless the person shall first obtain from the SHPDA a certificate of need therefor. Notwithstanding
any provisions of this article to the contrary, those facilities and distinct units operated
by the Department of Mental Health, and those facilities and distinct units operating under
contract or subcontract with the Department of Mental Health where the contract constitutes
the primary source of income to the facility, shall not be required to obtain a certificate
of need under this article. (b) Notwithstanding all other...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-265.htm - 15K - Match Info - Similar pages
16-25A-5
Section 16-25A-5 Authorization for health insurance plan; election of optional or supplemental
coverage. (a) The board is hereby empowered and authorized to establish a fully insured or
self-insured health insurance plan for employees and, under certain conditions, retired employees
and to adopt and promulgate rules and regulations for the administration of such plan subject
to such limitations as may be contained in this article. Such plan may provide for group hospitalization,
surgical, medical, cancer, cash indemnity, and dental insurance against the financial costs
of hospitalization, surgical, and medical treatment and care and may also include, among other
things, prescribed drugs, medicines, prosthetic appliances, hospital inpatient and outpatient
service benefits, and hospital/medical expenses indemnity benefits, including major medical
benefits or such other coverage or benefits as may be deemed appropriate and desirable by
the board, within the limits of such funds as may be...
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36-29-4
Section 36-29-4 Establishment and provisions of health insurance plan; rules and regulations.
The board is hereby empowered and authorized to establish a fully insured or self-insured
health insurance plan for employees and retirees of the State of Alabama and to adopt and
promulgate rules and regulations for the administration of such plan, subject to such limitations
as may be contained in this chapter. Such plan may provide for group hospitalization, surgical,
and medical insurance against the financial costs of hospitalization, surgical, and medical
treatment and care and may also include, among other things, prescribed drugs, medicines,
prosthetic appliances, hospital inpatient and outpatient service benefits, and medical expenses
indemnity benefits, including major medical benefits or such other coverage or benefits as
may be deemed appropriate and desirable by the board. (Acts 1965, No. 833, p. 1564, §3; Act
2004-647, 1st Sp. Sess., p. 17, §1.)...
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25-5-312
Section 25-5-312 Powers and duties of the board. The board shall exercise general supervision
in all matters related to the provision of medical services provided by physicians, as defined
in Section 25-5-310, rendered to workers under this article. The duties of the board shall
include, but are not limited to, the following: (1) Study, develop, and implement any necessary
and reasonable guidelines for medical services and physician care provided by physicians.
In addition, with respect to services provided by physicians, the board shall study, develop,
and recommend to the secretary uniform medical criteria and policies for the conduct of utilization
review, bill screenings, and medical necessity determinations for use by insurance carriers,
self-insurers, and claims administrators. (2) Study, design, and implement standardized uniform
claims processing forms and forms for the reporting of medical information to employers and
insurance companies by physicians. (3) Address and give...
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27-44-5
territories, or protectorates that do not have an association similar to the association created
by this chapter, shall be deemed residents of the state of domicile of the insurer that issued
the policies or contracts. (19) STATE. A state, the District of Columbia, Puerto Rico, and
a United States possession, territory, or protectorate. (20) STRUCTURED SETTLEMENT ANNUITY.
An annuity purchased in order to fund periodic payments for a plaintiff or other claimant
in payment for or with respect to personal injury suffered by the plaintiff
or other claimant. (21) SUPPLEMENTAL CONTRACT. A written agreement entered into for the distribution
of proceeds under a life, disability, or annuity policy or contract. (22) UNALLOCATED ANNUITY
CONTRACT. An annuity contract or group annuity certificate which is not issued to and owned
by an individual, except to the extent of any annuity benefits guaranteed to an individual
by an insurer under the contract or certificate. (Acts 1982, No. 82-561, p. 922,...
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34-25A-3
and require the generation of an image, form, or mold that replicates the patient's body or
body segment and involves the rectification of dimensions, contours, and volumes to achieve
proper fit, comfort, and function for that specific patient. Except for the treatment of scoliosis,
orthosis does not include prefabricated or direct-formed orthotic devices, as defined in this
subdivision and does not include any of the following items: Commercially available knee orthoses
used following injury or surgery; upper extremity adaptive equipment; finger splints;
leather wrist gauntlets; face masks used following burns; wheelchair seating that is an integral
part of the wheelchair and not worn by the patient independent of the wheelchair; fabric or
elastic supports; corsets; arch supports, also known as non-custom or prefabricated orthotics;
low-temperature formed plastic splints; trusses; elastic hose; canes; crutches; cervical collars;
dental appliances, and other similar devices as...
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