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27-21A-16
Section 27-21A-16 Examination. (a) The commissioner may make an examination of the affairs
of any health maintenance organization and providers with whom such organization has contracts
or agreements as often as is reasonably necessary for the protection of the interests of the
people of this state, but not less frequently than once every three years. (b) The State Health
Officer may make an examination concerning health care service of any health maintenance organization
and providers with whom such organization has contracts, agreements, or other arrangements
as often as is reasonably necessary for the protection of the interests of the people of this
state, but not less frequently than once every three years. (c) Every health maintenance organization
shall submit its relevant books and records for such examinations and in every way facilitate
these examinations. For the purpose of examinations, the commissioner and the State Health
Officer may administer oaths to, and examine the...
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27-21A-1
Section 27-21A-1 Definitions. As used in this chapter, the following terms shall have the following
meanings, respectively: (1) AGENT. A person who is appointed or employed by a health maintenance
organization and who engages in solicitation of membership in such organization. This definition
does not include a person enrolling members on behalf of an employer, union, or other organization.
(2) BASIC HEALTH CARE SERVICES. Emergency care, inpatient hospital and physician care, and
outpatient medical services. (3) COMMISSIONER. The Commissioner of Insurance. (4) ENROLLEE.
An individual who is enrolled in a health maintenance organization. (5) EVIDENCE OF COVERAGE.
Any certificate, agreement, or contract issued to an enrollee setting out the coverage to
which he is entitled. (6) HEALTH CARE SERVICES. Any services included in the furnishing to
any individual of medical or dental care, or hospitalization or incident to the furnishing
of such care or hospitalization, as well as the...
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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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27-21A-7
Section 27-21A-7 Evidence of coverage and charges for health care services. (a)(1) Every enrollee
residing in this state is entitled to an evidence of coverage. If the enrollee obtains such
coverage through an insurance policy or a contract issued by a health care service plan, the
insurer or the health care service plan shall issue the evidence of coverage. Otherwise, the
health maintenance organization shall issue the evidence of coverage. (2) No evidence of coverage,
or amendment thereto, shall be issued or delivered to any person in this state until a copy
of the basic form of the evidence of coverage, or amendment thereto, has been filed with the
commissioner and the State Health Officer, and approved by the commissioner. (3) An evidence
of coverage shall contain: a. No provisions or statements which encourage misrepresentation,
or which are untrue, misleading, or deceptive as defined in subsection (a) of Section 27-21A-13;
and b. A clear and concise statement, if a contract, or a...
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27-21A-12
Section 27-21A-12 Protection against insolvency. (a) Unless otherwise provided below, each
health maintenance organization shall deposit with the commissioner, or with any organization
or trustee acceptable to him through which a custodial or controlled account is utilized,
cash, securities, or any combination of these or other measures acceptable to him in the amount
set forth in this section. (b) The amount for an organization that is beginning operation
shall be the greater of: (1) five percent of its estimated expenditures for health care services
for its first year of operation, (2) twice its estimated average monthly uncovered expenditures
for its first year of operation, or (3) $100,000. At the beginning of each succeeding year,
unless not applicable, the organization shall deposit with the commissioner, or organization,
or trustee, cash, securities, or any combination of these or other measures acceptable to
the commissioner, in an amount equal to four percent of its estimated...
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27-21A-2
Section 27-21A-2 Establishment of health maintenance organizations. (a) Notwithstanding any
law of this state to the contrary, any person may apply to the commissioner for and obtain
a certificate of authority to establish and operate a health maintenance organization in compliance
with this chapter. No person shall establish or operate a health maintenance organization
in this state without obtaining a certificate of authority under this chapter. A foreign corporation
may qualify under this chapter, subject to its registration to do business in this state as
a foreign corporation under the provisions of Sections 10-2A-220, et seq. (b) Health maintenance
organizations licensed as of May 29, 1986, shall be issued a certificate of authority in accordance
with Section 27-21A-29. (c) Each application for a certificate of authority shall be verified
by an officer or authorized representative of the applicant, shall be in a form prescribed
by the commissioner, and shall set forth or be...
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22-21-261
Section 22-21-261 Legislative findings; purpose of article. The Legislature of the State of
Alabama declares that it is the public policy of the State of Alabama that a certificate of
need program be administered in the state to assure that only those health care services and
facilities found to be in the public interest shall be offered or developed in the state.
It is the purpose of the Legislature in enacting this article to prevent the construction
of unnecessary and inappropriate health care facilities through a system of mandatory reviews
of new institutional health services, as the same are defined in this article. (Acts 1977,
1st Ex. Sess., No. 82, p. 1509, §1; Acts 1982, 2nd Ex. Sess., No. 82-770, p. 249, §2.)...
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22-11A-68
Section 22-11A-68 Immunity from liability for those involved in investigation. (a) Members
and staff of the State Board of Health, the State Committee of Public Health, the Board of
Medical Examiners, the Medical Licensure Commission, the Board of Nursing, the Board of Dental
Examiners, the Board of Podiatry, physicians, hospitals, other health care facilities, and
other entities and persons required to report or furnish information under this article and
any expert review panels, consultants to any expert review panel, and agents and employees
of the Alabama Department of Public Health shall not be subject to civil or criminal liability
for making reports or furnishing any information required by this article or for actions taken
or actions not taken in the line and scope of official or required duties during their investigations,
hearings, rulings, and decisions. (b) All information collected during the investigation of
an infected health care worker is privileged and shall be...
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22-21-318
Section 22-21-318 Powers of authority. (a) In addition to all other powers granted elsewhere
in this article, and subject to the express provisions of its certificate of incorporation,
an authority shall have the following powers, together with all powers incidental thereto
or necessary to the discharge thereof in corporate form: (1) To have succession by its corporate
name for the duration of time, which may be in perpetuity, specified in its certificate of
incorporation or until dissolved as provided in Section 22-21-339; (2) To sue and be sued
in its own name in civil suits and actions, and to defend suits and actions against it, including
suits and actions ex delicto and ex contractu, subject, however, to the provisions of Chapter
93 of Title 11, which chapter is hereby made applicable to the authority; (3) To adopt and
make use of a corporate seal and to alter the same at pleasure; (4) To adopt, alter, amend
and repeal bylaws, regulations and rules, not inconsistent with the...
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22-8A-9
Section 22-8A-9 Withholding or withdrawal of treatment, etc., not suicide; execution of advance
directive not to affect sale, etc., of life or health insurance nor be condition for receipt
of treatment, etc.; provisions of chapter cumulative. (a) The withholding or withdrawal of
life-sustaining treatment or artificially provided nutrition and hydration from a patient
in accordance with the provisions of this chapter shall not, for any purpose, constitute a
suicide and shall not constitute assisting suicide. (b) The making of an advance directive
for health care pursuant to this chapter shall not affect in any manner the sale, procurement,
or issuance of any policy of life or health insurance, nor shall it be deemed to modify the
terms of an existing policy of life or health insurance. No policy of life or health insurance
shall be legally impaired or invalidated in any manner by the withholding or withdrawal of
life-sustaining treatment or artificially provided nutrition and hydration...
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