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27-57-1
Section 27-57-1 Definitions. As used in this chapter, the following words and terms shall have
the following meanings: (1) COLORECTAL CANCER EXAMINATIONS. Examinations and laboratory tests
specified in current American Cancer Society guidelines for colorectal cancer screening of
asymptomatic individuals. (2) HEALTH BENEFIT PLAN. A group health insurance policy 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 health care services to patients, insureds, or beneficiaries in this
state. 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 this chapter if it receives, processes,
adjudicates, pays, or denies claims for health care services submitted...
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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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27-2B-2
Section 27-2B-2 Definitions. As used in this chapter, these terms shall have the following
meanings: (1) ADJUSTED RBC REPORT. An RBC report which has been adjusted by the commissioner
in accordance with subsection (e) of Section 27-2B-3. (2) CORRECTIVE ORDER. An order issued
by the commissioner specifying corrective actions which the commissioner has determined are
required. (3) DOMESTIC INSURER. Any insurer domiciled in this state. (4) FOREIGN INSURER.
Any insurer which is licensed to do business in this state but not domiciled in this state.
(5) FRATERNAL BENEFIT SOCIETY. Any insurer licensed under Chapter 34. (6) HEALTH ORGANIZATION.
Any health care service plan, health maintenance organization, limited health service organization,
dental services corporation, or other managed care organization licensed under this title.
This term does not include any life and disability insurer or property and casualty insurer.
(7) INSURER. As defined in Section 27-1-2, including, without...
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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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27-53-1
Section 27-53-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) GENETIC CHARACTERISTICS. A scientifically or medically identifiable gene or
chromosome, or alteration thereof, that is known to be a cause of a disease or disorder, or
determined to be associated with a statistically increased risk of development of a disease
or disorder. (2) GENETIC TEST. A pre-symptomatic laboratory test which is generally accepted
in the scientific and medical communities for the determination of the presence or absence
of the genetic characteristics that cause or are associated with risk of a disease or disorder.
(3) HEALTH BENEFIT PLAN. A health insurance policy, including a self-insured health plan,
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...
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27-19A-3
Section 27-19A-3 Prohibited provisions. No health insurance policy or employee benefit plan
which is delivered, renewed, issued for delivery, or otherwise contracted for in this state
shall: (1) Prevent any person who is a party to or beneficiary of any such health insurance
policy or employee benefit plan from selecting the dentist of his choice to furnish the dental
care services offered by said policy or plan or interfere with said selection provided the
dentist is licensed to furnish such dental care services in this state; (2) Deny any dentist
the right to participate as a contracting provider for such policy or plan provided the dentist
is licensed to furnish the dental care services offered by said policy or plan; (3) Authorize
any person to regulate, interfere, or intervene in any manner in the diagnosis or treatment
rendered by a dentist to his patient for the purpose of preventing, alleviating, curing, or
healing dental illness or injury provided said dentist practices within...
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27-19A-9
Section 27-19A-9 Nonconforming policies and plans not to be approved by commissioner. The Commissioner
of Insurance shall not approve for sale in this state any health insurance policy or employee
benefit plan providing for dental care services which does not conform to the provisions of
this chapter or to the provisions of Sections 27-14-8 and 27-14-9. (Acts 1984, No. 84-411,
p. 960, §8.)...
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36-36-7
Section 36-36-7 Legislative intent. It is the intent of the Legislature that the state and
the boards establish and the trustees operate the trusts in compliance with the Internal Revenue
Code of the United States of America in a manner which would allow the trusts to maximize
investment earnings while minimizing the costs to the state and its employees and other citizens
of satisfying the health care post-employment benefits obligation. It is also the intent of
the Legislature that the trusts be operated in a manner that satisfies the definition of other
post-employment benefits trusts under generally accepted governmental accounting principles.
The trusts shall not be subject to any provision of a law of the state (or any subdivision
thereof) which conflicts with that legislative intent or would prevent or unreasonably hinder
the accomplishment of the purposes of this chapter. (Act 2007-16, 1st Sp. Sess., p. 25, §7.)...
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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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36-36-1
Section 36-36-1 Legislative findings. The Legislature of Alabama hereby finds and determines
that the funding of accrued and accruing health care benefits to retired employees and their
dependents is a proper governmental function and purpose of the state. The Governmental Accounting
Standards Board has issued Statements 43 and 45, which set forth standards on accounting and
reporting for post-employment benefits other than pensions by governments. The new standards
will require the state to account for such post-employment benefits on an actuarial basis
during an employee's career rather than on a pay-as-you-go basis during the employee's period
of retirement. The Legislature has determined that it would be advisable for the state to
create irrevocable trusts whereby the state may begin funding those benefits in advance to
address and ultimately offset the state's accrued liabilities for such benefits. Therefore,
the state, the State Employees' Insurance Board, and the Public...
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