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34-23-183
Section 34-23-183 Application. This article shall apply to any audit of the records of a pharmacy
conducted by a managed care company, nonprofit hospital or medical service organization, health
benefit plan, third-party payor, pharmacy benefit manager, a health program administered by
a department of the state, except the Alabama Medicaid Agency, or any entity that represents
those companies, groups, or department. (Act 2012-306, p. 668, §4; Act 2018-457, §1.)...
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27-55-8
Section 27-55-8 Construction. This chapter does not and shall not be construed as creating
a private cause of action and does not and shall not require insurers, including any health
benefit plan, to extend coverage to any providers or type of providers for which coverage
is not specifically provided within the policy or certificate of insurance or health benefit
plan, or to add additional providers to existing networks, or to add any health care benefits.
(Act 2000-595, p. 1185, §8.)...
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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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10A-20-6.10
Section 10A-20-6.10 Regulation of rates, charges, fees, and dues. The rates, charges, fees,
and dues to be paid by the public for benefits under a health service plan and for contracts
or certificates covering same shall not be unreasonably high or excessive, shall be adequate
to meet the liability assumed under the contracts and all expenses in connection therewith,
shall be adequate for the safeness and soundness of the corporation, and shall take into account
past and prospective loss experience. A health care service corporation shall file with the
Commissioner of Insurance any change in its rates, charges, fees, and dues, and, as soon as
reasonably possible after the filing has been made the commissioner shall, in writing, approve
or disapprove the same, provided that, unless disapproved within 30 days after filing, the
changed rates, charges, fees, or dues shall be deemed to be approved. The commissioner shall
approve the rates, charges, fees, and dues which are consistent with...
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22-4-36
Section 22-4-36 Limits on information requested. The SHPDA may not request any information
from a health care reporter that requires the submission of proprietary or confidential matters,
such as negotiated discounts with specific insurers, health service corporations, or health
benefit plans. The SHPDA may not require any reporting that could be used to identify a patient
of a covered health care reporter. (Act 2015-471, §7.)...
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25-5-313
Section 25-5-313 Schedule of maximum fees. Within 60 days from May 19, 1992, the Workers' Compensation
Medical Services Board shall submit to the Governor an initial schedule of maximum fees for
medical services covered by this article, which schedule shall become effective immediately
upon submission to the Governor. The initial schedule of maximum fees shall be established
by the board in the manner prescribed in this section. The fee for each service in the schedule
shall be exactly equal to an amount derived by multiplying the preferred provider reimbursement
customarily paid on May 19, 1992, by the largest health care service plan incorporated pursuant
to Sections 10-4-100 to 10-4-115, inclusive, by a factor of 1.075, which product shall be
the maximum fee for each such service. In addition the board may submit to the Governor for
approval on or before January 31, 1993, a revised schedule of selected fees for medical services
covered by this article, which fees shall not exceed...
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27-56-7
Section 27-56-7 Applicability to certain providers. (a) This chapter does not require and shall
not be construed to require any insurance policy, plan, or contract to provide health care
coverage for eye care. The provisions of this chapter are applicable only to those insurance
policies, plans, or contracts which provide coverage for eye care. (b) Insurers or other issuers
of any insurance policy, plan, or contract which provides coverage for eye care shall continue
to be able to establish and apply selection criteria and utilization protocols for health
care providers as well as credentialing criteria used in the selection of providers. (c) This
chapter does not require and shall not be construed to require the coverage of eye care services
by providers who are not designated as covered providers, or who are not selected as participating
providers, by an insurance policy, plan, or contract, or the issuer thereof having a participating
network of service providers. Provided, however,...
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27-59-3
Section 27-59-3 Implementation of coverage. (a) The benefits provided in this chapter shall
be subject to the same annual deductible or co-insurance established for all covered benefits
within a given policy. Private third party payors may not reduce or eliminate coverage due
to the requirements of this chapter. (b) A health benefit plan subject to this chapter may
not terminate services, reduce capitation payment, or otherwise penalize an attending physician
or health care provider who orders medical care consistent with this chapter. (c) Nothing
in this chapter is intended to expand the list of designations of covered providers as specified
in any health benefit plan. (Act 2008-502, p. 1106, §3.)...
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27-58-4
Section 27-58-4 Benefits subject to annual deductible, coinsurance, exclusions, reductions,
etc. (a) The benefits provided in this chapter shall be subject to the same annual deductible
or coinsurance established for all covered benefits within a given policy. Private third party
payors may not reduce or eliminate coverage due to the requirements of this chapter. (b) A
health benefit plan subject to this chapter shall not terminate services, reduce capitation
payment, or otherwise penalize an attending physician or health care provider who orders medical
care consistent with this chapter. (c) Nothing in this chapter is intended to expand the list
of designations of covered providers as specified in any health benefit plan. (Act 2007-389,
p. 778, §4.)...
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8-32-2
Section 8-32-2 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) ADMINISTRATOR. The person designated by a provider to be responsible for the
administration of service contracts or the service contracts plan or to make the filings required
by this chapter. (2) COMMISSIONER. The Commissioner of Insurance of this state. (3) CONSUMER.
A natural person who buys, primarily for personal, family, or household purposes, and not
for resale, any tangible personal property normally used for personal, family, or household
purposes and not for commercial or research purposes. (4) MAINTENANCE AGREEMENT. A contract
of limited duration that provides for scheduled maintenance only. (5) MANUFACTURER. A person
that is one of the following: a. A manufacturer or producer of property that sells the property
under its own name or label. b. A subsidiary of the person who manufactures or produces the
property. c. A corporation which owns at least 80 percent of the...
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