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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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