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27-1-22
Section 27-1-22 Uniform prescription drug information card or technology. (a) Every health
benefit plan that provides coverage for prescription drugs or devices, or administers a plan,
including, but not limited to, third party administrators for self-insured plans and state
administered plans, excluding the Alabama Medicaid Program, shall issue to its insureds a
card or other technology containing prescription drug information. The uniform prescription
drug information card or technology shall be in the format approved by the National Council
for Prescription Drug Programs (NCPDP) and shall include all of the required fields and conform
to the most recent pharmacy ID card or technology implementation guide produced by NCPDP or
conform to a national format acceptable to the Commissioner of Insurance. If a health care
plan includes a conditional or situational field, it shall conform to the most recent pharmacy
information card or technology implementation guide by the NCPDP or conform...
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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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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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22-56-4
Section 22-56-4 Rights. (a) Consumers of mental health services have the same general rights
as other citizens of Alabama. These rights include but are not limited to the following: (1)
The right to exercise rights as a citizen of the United States and the State of Alabama. (2)
The right to be served through general services available to all citizens. (3) The right to
choose to live, work, be educated, and recreate with persons who do not have disabilities.
(4) The right to be presumed competent until a court of competent jurisdiction, abiding by
statutory and constitutional provisions, determines otherwise. (5) The right to vote and otherwise
participate in the political process. (6) The right to free exercise of religion. (7) The
right to own and possess real and personal property. Nothing in this section shall affect
existing laws pertaining to conveyance of real or personal property. (8) The right to make
contracts. (9) The right to obtain a driver's license on the same basis as...
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22-12A-3
Section 22-12A-3 Plan to reduce infant mortality and handicapping conditions; procedure, contents,
etc. The Bureau of Maternal and Child Health under the direction of the State Board of Health
shall, in coordination with the State Health Planning and Development Agency, the State Health
Coordinating Council, the Alabama Council on Maternal and Infant Health and the regional and
State Perinatal Advisory Committees, annually prepare a plan, consistent with the legislative
intent of Section 22-12A-2, to reduce infant mortality and handicapping conditions to be presented
to legislative health and finance committees prior to each regular session of the Legislature.
Such a plan shall include: primary care, hospital and prenatal; secondary and tertiary levels
of care both in hospital and on an out-patient basis; transportation of patients for medical
services and care and follow-up and evaluation of infants through the first year of life;
and optional educational programs, including pupils in...
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27-21A-4
Section 27-21A-4 Powers of health maintenance organizations. (a) The powers of a health maintenance
organization include, but are not limited to the following: (1) The purchase, lease, construction,
renovation, operation, or maintenance of hospitals, medical facilities, or both, and their
ancillary equipment; (2) The making of loans other than in the ordinary course of business,
to providers under contract with it in furtherance of its program or the making of loans to
a corporation or corporations in which it owns a majority interest for the purpose of acquiring
or constructing medical facilities and hospitals or in furtherance of a program providing
health care services to enrollees. (3) The furnishing of health care services through providers
which are under contract with or employed by the health maintenance organization. (4) The
contracting with any person for the performance on its behalf of certain functions such as
marketing, enrollment, and administration. (5) The purchase,...
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27-50-3
Section 27-50-3 Health benefit plan. As used in this chapter, the term "health benefit
plan" has the following meaning: 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 business entity that
pays for, purchases, or furnishes health care services to patients, insureds, or beneficiaries
in this state. The term does not include accident-only, specified disease, individual hospital
indemnity, credit, dental-only, Medicare-supplement, long-term care, or disability income
insurance; coverage issued as a supplement to liability insurance, workers' compensation or
similar insurance; or automobile medical-payment insurance. For the purpose of this chapter,
a health benefit plan located or domiciled outside of the State of...
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27-58-1
Section 27-58-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (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 chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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27-59-1
Section 27-59-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (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 chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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22-6-120
Section 22-6-120 Legislative findings. The Legislature finds the following: (1) The availability
of appropriate pharmaceutical benefits to every Alabama citizen is a critical component to
the overall health of its population. (2) Alabama should strive to provide appropriate, safe,
effective, and cost-efficient pharmaceutical care to those who depend on health benefits through
state funded programs. (3) The Alabama Medicaid Agency should endeavor to manage the Medicaid
Pharmacy Program utilizing clinical management tools in a manner to foster optimal health
outcomes at reasonable costs. (4) State Medicaid programs and private insurance plans across
the country utilize preferred drug lists as an effective way to foster and encourage clinically
appropriate and safe use of pharmaceuticals in a cost-effective manner. (5) Based on the proven
effectiveness of preferred drug programs to foster appropriate use of drugs, it is in the
best interests of Alabama and its citizens for the Alabama...
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