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22-2-10
Section 22-2-10 Council on Dental Health, Council on Animal and Environmental Health, Council
on Prevention of Disease and Medical Care and Council on Health Costs, Administration and
Organization - Chairmen; vacancies; meetings; quorum; compensation. Each such council shall
select from among its members, by majority vote, a chairman; and the chairman of each such
council, by virtue of his selection as chairman, shall be a member of the State Committee
of Public Health with full voting privileges, rights and responsibilities of membership. As
each term expires on each council, the designated association or person responsible for the
original appointment shall fill the vacancy for a five-year term. Appointees who serve less
than five-year terms shall be eligible for reappointment for only one five-year term. A council
member who ceases to be a member of the appointing authority or who no longer is a resident
of the State of Alabama shall automatically cease to be a member of the council...
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22-6A-2
Section 22-6A-2 Health care sharing ministry. (a) Health care sharing ministry means a faith-based
nonprofit organization that is tax exempt under the Internal Revenue Code and which does all
of the following: (1) Limits its participants to those who are of a similar faith. (2) Acts
as a facilitator among participants who have financial or medical needs and matches those
participants with other participants with the present ability to assist those with financial
or medical needs in accordance with criteria established by the health care sharing ministry.
(3) Provides for the financial or medical needs of a participant through contributions from
one participant to another. (b) The health care sharing ministry shall specify to participants
that participants may contribute with no assumption of risk or promise to pay among the participants
and no assumption of risk or promise to pay by the health care sharing ministry to the participants.
(c) The health care sharing ministry shall provide...
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27-21A-30
Section 27-21A-30 Coordination of benefits. (a) A health maintenance organization is entitled
to coordinate benefits on the same basis as an insurer. No such coordination shall be allowed
against policies covering individuals on other than a group basis. (b) A health maintenance
organization providing medical benefits or payments to an enrollee who suffers injury, disease,
or illness by virtue of the negligent act or omission of a third party is entitled to reimbursement
from such third party for the reasonable value of the benefits or payments provided. (Acts
1986, No. 86-471, p. 854, §30.)...
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27-51-1
Section 27-51-1 Payment for services of licensed physician assistant. (a) An insurance policy
or contract providing for third-party payment or prepayment of health or medical expenses
shall include a provision for the payment to a supervising physician for necessary medical
or surgical services that are provided by a licensed physician assistant practicing under
the supervision of the physician, and pursuant to the rules, regulations, and parameters for
physician assistants, if the policy or contract pays for the same care and treatment provided
by a licensed physician or doctor of osteopathy. (b) An insurance policy or contract subject
to this section shall not impose a practice or supervision restriction which is inconsistent
with or more restrictive than provided by law. (c) This section shall apply to services provided
under a policy or contract delivered, continued, or renewed in this state on or after August
1, 1997, and to any existing policy or contract, on the policy's or...
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22-6-151
Section 22-6-151 Regional care organizations; governing board of directors; citizen's advisory
committee; solvency and financial requirements; reporting; provider standards committee. (a)
A regional care organization shall serve only Medicaid beneficiaries in providing medical
care and services. (b) Notwithstanding any other provision of law, a regional care organization
shall not be deemed an insurance company under state law. (c)(1) A regional care organization
and an organization with probationary regional care organization certification shall have
a governing board of directors composed of the following members: a. Twelve members shall
be persons representing risk-bearing participants in the regional care organization or organization
with probationary certification. A participant bears risk by contributing cash, capital, or
other assets to the regional care organization. A participant also bears risk by contracting
with the regional care organization to treat Medicaid beneficiaries...
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27-1-17.1
Section 27-1-17.1 Payment of providers through electronic funds transfer methods. (a) As used
in this section, the following words shall have the following meanings: (1) ACH ELECTRONIC
FUNDS TRANSFER. An electronic funds transfer through the Health Insurance Portability and
Accountability Act (HIPPA) standard Automated Clearing House network. (2) COVERED HEALTH CARE
PROVIDER. A physician as defined in Section 34-24-50.1; a dentist as defined in Section 34-9-1;
a chiropractor as defined in Section 34-24-120; an individual engaged in the practice of optometry
as defined in Section 34-22-1; other licensed health care professionals as defined in Title
34; a hospital as defined in Section 22-21-20; and a health care facility, or other provider
who or that is accredited, licensed, or certified and who or that is performing within the
scope of that accreditation, license, or certification. (3) HEALTH INSURANCE PLAN. Any hospital
and medical expense incurred policy, health maintenance...
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27-21A-25
Section 27-21A-25 Confidentiality of medical information. Any data or information pertaining
to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person
or from any provider by any health maintenance organization shall be held in confidence and
shall not be disclosed to any person except to the extent that it may be necessary to carry
out the purposes of this chapter; or upon the express consent of the enrollee or applicant;
or pursuant to statute or court order for the production of evidence or the discovery thereof;
or in the event of claim or litigation between such person and the health maintenance organization
wherein such data or information is pertinent. A health maintenance organization shall be
entitled to claim any statutory privileges against such disclosure which the provider who
furnished such information to the health maintenance organization is entitled to claim. (Acts
1986, No. 86-471, p. 854, §25.)...
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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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22-3A-6
Section 22-3A-6 Members; officers; terms; records; meetings; appointment of Governor's designee.
(a) The applicants named in the application and their respective successors in office shall
constitute the members of the authority. The State Health Officer shall be the president of
the authority, the Governor or his designee shall serve as vice-president of the authority,
the Director of Finance of the state shall serve as secretary of the authority, and the State
Treasurer shall be the treasurer of the authority. The State Treasurer shall act as custodian
of the funds of the authority and shall pay the principal of and the interest and premium
(if any) on the bonds of the authority out of the funds hereinafter provided for. The State
Treasurer shall act as paying agent with respect to any series of bonds issued under this
chapter. (b) The service of each of the Governor, the State Health Officer, the Director of
Finance and the State Treasurer as a member of the authority and as an...
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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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