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16-25A-7
Section 16-25A-7 Authorization and execution of contracts; evidence of coverage; denial of
claims. (a) The board is hereby authorized to execute a contract or contracts to provide for
the benefits or the administration of the plan determined in accordance with the provisions
of this article. Such contract or contracts may be executed with one or more agencies or corporations
licensed to transact or administer group health insurance business in this state. All of the
benefits to be provided under this article may be included in one or more similar contracts
issued by the same or different companies. The board is further authorized to develop a plan
whereby it may become self-insured upon its finding that such arrangement would be financially
advantageous to the state and plan participants. (b) Before entering into any contract or
contracts authorized by subsection (a), the board shall invite competitive bids from all qualified
entities who may wish to administer or offer plans for the...
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27-12-13
Section 27-12-13 Life, annuity, and disability insurance - Exceptions to discrimination, rebates,
or special inducements. Nothing in Sections 27-12-11 and 27-12-12 shall be construed as including
within the definition of discrimination, rebates, or special inducements any of the following
practices: (1) In the case of any contract of life insurance or annuity, paying bonuses to
policyholders or otherwise abating their premiums in whole or in part out of surplus accumulated
from nonparticipating insurance, provided, that any such bonuses or abatement of premiums
is fair and equitable to policyholders and for the best interests of the insurer and its policyholders;
(2) In the case of life or disability insurance policies issued on the industrial debit or
weekly premium plan, making allowance to policyholders who have continuously for a specified
period made premium payments directly to an office of the insurer in an amount which fairly
represents the saving in collection expense; (3)...
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27-54-2
Section 27-54-2 Definitions. For purposes of this chapter, the following terms have the following
meanings: (1) DAY TREATMENT SERVICES. Includes, but is not limited to: Physiological, psychological,
and psychosocial concepts, techniques, and processes necessary to maintain or develop functional
skills of clients, provided to individuals and groups for periods of more than two hours but
less than 24 hours a day. (2) HEALTH BENEFIT PLAN. A health care service plan governed by
the provisions of Article 6, Chapter 4, Title 10, and a group health insurance policy, including
an employee welfare health benefit plan, that covers hospital, medical, or surgical expenses,
issued by insurers, 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...
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27-1-10.1
Section 27-1-10.1 Insurance coverage for drugs to treat life-threatening illnesses. (a) The
Legislature finds and declares the following: (1) The citizens of this state rely upon health
insurance to cover the cost of obtaining health care and it is essential that the citizens'
expectation that their health care costs will be paid by their insurance policies is not disappointed
and that they obtain the coverage necessary and appropriate for their care within the terms
of their insurance policies. (2) Some insurers deny payment for drugs that have been approved
by the Federal Food and Drug Administration, hereafter referred to as FDA, when the drugs
are used for indications other than those stated in the labelling approved by the FDA, off-label
use, while other insurers with similar coverage terms do pay for off-label use. (3) Denial
of payment for off-label use can interrupt or effectively deny access to necessary and appropriate
treatment for a person being treated for a...
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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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27-12-14
Section 27-12-14 Inducements as to property, casualty, or surety insurance. (a) No property,
casualty, or surety insurer, or any employee thereof, and no broker, agent, or solicitor shall
pay, allow, or give, or offer to pay, allow, or give, directly or indirectly, as an inducement
to insurance or after insurance has been effected, any rebate, discount, abatement, credit,
or reduction of the premium named in a policy of insurance, or any special favor or advantage
in the dividends or other benefits to accrue thereon or any valuable consideration or inducement
whatever not specified in the policy except to the extent provided for in rating systems filed
with the commissioner by, or on behalf of, the insurer and approved by the commissioner. (b)
No insured named in a policy nor any employee of such insured shall knowingly receive or accept,
directly or indirectly, any such rebate, discount, abatement, credit, or reduction of premium.
(c) Nothing in this section shall be construed as...
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27-15-29
Section 27-15-29 Prohibited policy plans. (a) No insurer shall hereafter deliver or issue for
delivery in this state any policy or contract providing for the establishment of its policyholders
or members into divisions and classes and for payment of benefits from special funds created
for such purpose to the oldest member of the division and class or to the member of the division
and class whose policy has been in force the longest period of time upon the death of a member
in such division and class, or under any other similar plan; except, that any insurer heretofore
operating on such a plan in this state, whether by conversion from a fraternal benefit society
or otherwise, may continue to do so upon the condition that the insurer shall not hereafter
establish its policyholders or members into any new divisions, classes or groupings of any
kind, other than those heretofore established and containing subsisting policies heretofore
issued, and that the insurer, if a stock insurer, shall...
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27-15-52
Section 27-15-52 Definitions. The following terms shall have the following meanings: (1) COMMERCIALLY
REASONABLE EFFORT. The plans, processes, or procedures necessary to confirm the death of the
insured, contract owner or annuitant, or retained asset account holder against other available
records and information and, as applicable, to locate the beneficiary or beneficiaries or
other person entitled to payment pursuant to the terms of the policy or contract which have
been developed by each insurer and submitted to and approved by the department. (2) CONTRACT.
An annuity contract. The term contract shall not include an annuity used to fund an employment-based
retirement plan or program where the insurer is not committed by terms of the annuity contract
to pay death benefits to the beneficiaries of specific plan participants. (3) DEATH MASTER
FILE. The United States Social Security Administration's Death Master File or any other database
or service that is at least as comprehensive as...
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36-29-6
Section 36-29-6 Authorization and execution of contracts; documentation of benefits. (a) The
board is hereby authorized to execute a contract or contracts to provide the plan determined
in accordance with the provisions of this chapter. Such contract or contracts may be executed
with one or more agencies or corporations licensed to transact or administer group health
insurance business in this state. All of the benefits to be provided under this chapter may
be included in one or more similar contracts issued by the same or different companies. (b)
Before entering into any contract or contracts authorized by subsection (a) of this section,
the board shall invite competitive bids from all qualified entities who may wish to administer
or offer plans for the health insurance coverage desired. The board shall award such contract
or contracts on a competitive basis as determined by the benefits afforded, administrative
costs, the costs to be incurred by employee, retiree, and employer, the...
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25-5-8
Section 25-5-8 Employers' options to secure payment of compensation. (a) Option to insure risks.
An employer subject to this chapter may secure the payment of compensation under this chapter
by insuring and keeping insured his or her liability in some insurance corporation, association,
organization, insurance association, corporation, or association formed of employers and workers
or formed by a group of employers to insure the risks under this chapter, operating by mutual
assessment or other plans or otherwise. Notwithstanding the foregoing, the insurance association,
organization, or corporation shall have first had its contract and plan of business approved
in writing by the Commissioner of the Department of Insurance of Alabama and have been authorized
by the Department of Insurance to transact the business of workers' compensation insurance
in this state and under the plan. Notwithstanding any other provision of the law to the contrary,
the obligations of employers under law for...
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