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34-19-21
Section 34-19-21 Coverage or reimbursement for services not required. Nothing contained in
this chapter shall be construed to create a requirement that any health benefit plan, group
insurance plan, policy, or contract for health care services 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 group health care services to patients, insureds, or beneficiaries in this state,
including entities created pursuant to Article 6, commencing with Section 10A-20-6.01, of
Chapter 20, Title 10A, provide coverage or reimbursement for the services described or authorized
in this chapter. (Act 2017-383, §4.)...
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22-6-163
Section 22-6-163 Legislative findings; rules; collaboration; approval of agreements and contracts;
state action immunity; confidentiality of records; additional duties. (a) The Legislature
declares that collaboration among public payers, private health carriers, third party purchasers,
and providers to identify appropriate service delivery systems and reimbursement methods in
order to align incentives in support of integrated and coordinated health care delivery is
in the best interest of the public. Collaboration pursuant to this article is to provide quality
health care at the lowest possible cost to Alabama citizens who are Medicaid eligible. The
Legislature, therefore, declares that this health care delivery system affirmatively contemplates
the foreseeable displacement of competition, such that any anti-competitive effect may be
attributed to the state's policy to displace competition in the delivery of a coordinated
system of health care for the public benefit. In furtherance of...
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22-6-221
Section 22-6-221 Service by integrated care network; board of directors. (a) An integrated
care network shall serve only Medicaid beneficiaries in providing medical care and services.
For the purposes of this article, a beneficiary cannot be a member of both an integrated care
network and a regional care organization. (b) An integrated care network shall provide required
medical care and services to Medicaid beneficiaries and may coordinate care provided by or
through an affiliation of other health care providers or other programs as the Medicaid Agency
shall determine. (c) Notwithstanding any other provision of law, the integrated care network
shall not be deemed an insurance company under state law. (d)(1) An integrated care network
shall have a governing board of directors composed of the following members: a. Twelve members
shall be persons representing risk bearing participants. A participant bears risk by contributing
cash, capital, or other assets to the integrated care network....
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27-19A-12
Section 27-19A-12 Dental services - Coverages; fees; exceptions. (a) As used in this section,
the following terms shall have the following meanings: (1) COVERED PERSON. Any individual,
family, or family member on whose behalf third-party payment or prepayment of health or medical
expenses is provided under an insurance policy, plan, or contract providing for third-party
payment or prepayment of health care or medical expenses. (2) COVERED SERVICES. Dental care
services for which a reimbursement is available under an enrollee's plan contract, or for
which a reimbursement would be available but for the application of contractual limitations
such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums,
frequency limitations, alternative benefit payments, or any other limitation. (3) DENTAL CARE
PROVIDER. A licensed dentist. (4) DENTAL PLAN. Includes any policy of insurance which is issued
by a health care service contractor which provides for coverage of...
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34-25A-4
Section 34-25A-4 Referral and consultation limits. (a) A licensed prosthetist, licensed orthotist,
or licensed prosthetist/orthotist may provide services utilizing new prostheses or orthoses
for which he or she is licensed and only under a written order from an authorized health care
practitioner. A consultation with and periodic review by an authorized health care practitioner
is not required for the evaluation, repair, adjusting, or servicing of a prosthesis by a licensed
prosthetist, or licensed prosthetist/orthotist and for the evaluation, repair, adjusting,
or servicing of an orthosis by a licensed orthotist, or licensed prosthetist/orthotist; nor
is an order from an authorized health care practitioner required for maintenance or replacement
of an orthosis or prosthesis to the level of its original prescription for an indefinite period
of time if the original order remains appropriate for the patient's medical needs. (b) Prosthetists
and orthotists must refer persons receiving...
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40-26B-20
Section 40-26B-20 Definitions. The following words, terms, and phrases shall have the following
meanings: (1) BED. Any bed that is licensed by the Alabama Department of Health and its successor
agency to provide nursing home care which is in a nursing facility. (2) DEPARTMENT. The Department
of Revenue of the State of Alabama. (3) FISCAL YEAR. An accounting period of 12 months beginning
on the first day of the first month of the state fiscal year. (4) MEDICAID PROGRAM. The medical
assistance program as established in Title XIX of the Social Security Act and as administered
in the State of Alabama by the Alabama Medicaid Agency pursuant to executive order and Title
560 of the Alabama Administrative Code. (5) NURSING FACILITY. An institution which is licensed
under the laws of the State of Alabama as a skilled nursing facility or an intermediate nursing
facility. Nursing facility shall not include any facility owned or operated by, or operating
under an exclusive contract with, the State...
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11-91A-2
Section 11-91A-2 Local Government Health Insurance Board; governance and administration of
program. (a) The Local Government Health Insurance Board shall govern and administer the Local
Government Health Insurance Program currently governed and administered by the State Employees'
Insurance Board (SEIB) pursuant to Chapter 29 of Title 36. The transfer of the governance
and administration to the board shall take effect at 12:01 a.m. on January 1, 2015, and thereafter
the board shall take all control and responsibility for the program under procedures and authority
set out in this chapter. (b) The program governed and administered by the board shall provide
a reasonable relationship between the health care benefits to be included and the expected
health care expenses to be incurred by affected employees, retirees, and their dependents.
The board may establish a fully insured or self-insured health care plan for employees and
retirees as defined in this chapter and may adopt rules for the...
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16-25A-43
Section 16-25A-43 Establishment of flexible employee benefit plan; long-term care plan. The
board is authorized to establish a flexible employee benefit plan for employees in compliance
with Section 125 and any other applicable sections of the Internal Revenue Code. The flexible
employee benefit plan may provide for payments or salary reductions for qualified benefits
in accordance with Section 125 of the Internal Revenue Code, which presently include health
insurance premiums, group life insurance, disability insurance, supplemental health and accident
insurance, dependent care expenses, and such other types of employee benefits permitted under
Section 125 and any other applicable sections of the Internal Revenue Code. Furthermore, the
board may establish a long-term care plan for employees. (Act 2004-650, 1st Sp. Sess., p.
31, §4.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/16-25A-43.htm - 1K - Match Info - Similar pages
16-25A-8
Section 16-25A-8 Funding of health insurance plan; participation; Public Education Employees'
Health Insurance Fund. (a) The Public Education Employees' Health Insurance Board is hereby
authorized to provide under the contract or contracts entered into under the provisions of
this article an insurance benefit plan for each covered employee and, under certain conditions,
retired employees; the cost of such plan may be funded in part or in full through monthly
premiums per active employee from the same source of funds as those used for the payment of
salaries of active members and in part from other funds. (b) On or before January 1 next preceding
each regular meeting of the Legislature, the board shall certify to the Governor and to the
Legislature the amount or amounts necessary to fund coverage for benefits authorized by this
article for the following fiscal year for employees and for retired employees as a monthly
premium per active member per month. The Legislature shall set 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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