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27-55-4
Section 27-55-4 Statement of reasons for adverse action. An insurer that takes an action which
adversely affects a subject of abuse, or a related individual or entity, based on an abuse-related
medical condition, abuse-related claim, abuse status, or association or relationship with
a subject of abuse, pursuant to an individual or group insurance policy or health benefit
plan, shall advise the applicant or the insured of the specific reasons for the action in
writing. Reference to general underwriting practices or guidelines shall constitute a specific
reason. The specific reason for the actions of the insurer shall be stated in writing. The
actions of the health carrier or insurer, and any applicable policy provisions, shall be applied
equally to all applicants or insureds with similar medical conditions or similar claim or
claims history without regard to whether the condition or the claims are abuse related. (Act
2000-595, p. 1185, §4.)...
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36-36-9
Section 36-36-9 Applicability of chapter. Nothing in this chapter shall be construed to define
or otherwise grant any right or privilege to health care benefits or other post-employment
benefits to any person other than those health care benefits or other post-employment benefits,
rights, and privileges previously or already granted to employees and retired employees and
their dependents by the state's health care benefit plan or its post-employment benefit plan,
if any. Such rights and privileges, if any, shall be governed by the terms of the state's
post-employment benefit plan, if any. This chapter is not intended to assure or deny any existing
or future employee, retired employee, any of their dependents, or any other person of any
right of employment or entitlement to any health care benefit or other post-employment benefit
or limit or otherwise restrict the ability of the state to modify or eliminate any existing
or future health care benefit or other post-employment benefit....
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22-21-264
Section 22-21-264 Criteria for state agency review. The SHPDA, pursuant to the provisions of
Section 22-21-274, shall prescribe by rules and regulations the criteria and clarifying definitions
for reviews covered by this article. These criteria shall include at least the following:
(1) Consistency with the appropriate State Health Facility and services plans effective at
the time the application was received by the State Agency, which shall include the latest
approved revisions of the following plans: a. The most recent Alabama State Health Plan which
shall include updated inventories and separate bed need methodologies for inpatient rehabilitation
beds, inpatient psychiatric beds and inpatient/residential alcohol and drug abuse beds. b.
Alabama State Health Plan for services to the mentally ill. c. Alabama State Plan for rehabilitation
facilities. d. Alabama developmental disabilities plan. e. Alabama State alcoholism plan.
f. Such other State Plans as may from time to time be...
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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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27-2B-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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27-58-4
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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12-23A-6
Section 12-23A-6 Assessments and recommendations; treatment services. (a) As part of the assessment,
each jurisdiction shall establish a system to ensure that drug offenders are placed into a
substance abuse treatment program approved by the Department of Mental Health. To accomplish
this, the entity conducting the assessment should make specific recommendations to the drug
court team regarding the level of treatment program and duration necessary so that the individualized
needs of a drug offender may be addressed. These assessments and resulting recommendations
shall be performed by a certified or licensed alcohol and drug professional in accordance
with the criteria certified by the Department of Mental Health, Substance Abuse Services Division.
Treatment recommendations accepted by the court, pursuant to this chapter, shall be deemed
to be reasonable and necessary. (b) An adequate continuum of care for drug offenders shall
be established in response to this chapter. (c) The drug...
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27-19A-7
Section 27-19A-7 Contracting directly with patient; distribution of information about policy
or plan; payment and reimbursement procedures. The provisions of this chapter do not prohibit
the following conduct and shall be construed to provide that: (1) A dentist may contract directly
with a patient for the furnishing of dental care services to said patient as may be otherwise
authorized by law; (2) Any person providing a health insurance policy or employee benefit
plan, or an employer, or an employee organization may: a. Make available to its insureds,
beneficiaries, participants, employees, or members information relating to dental care services
by the distribution of factually accurate information regarding dental care services, rates,
fees, location, and hours of service, provided such distribution is made upon the request
of any dentist licensed by this state; or b. Establish an administrative mechanism which facilitates
payment for dental care services by insureds, beneficiaries,...
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22-5D-4
Section 22-5D-4 Coverage and costs. (a) This chapter does not expand the coverage required
of an insurer. (b) A health plan, third party administrator, or governmental agency is not
required to provide coverage for the cost of an investigational drug, biological product,
or device, or the cost of services related to the use of an investigational drug, biological
product, or device under this chapter. (c) This chapter does not require any governmental
agency to pay costs associated with the use, care, or treatment of a patient with an investigational
drug, biological product, or device. (d) This chapter does not require a hospital or other
health care facility to provide new or additional services, unless approved by the hospital
or facility. (Act 2015-320, §4.)...
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27-21A-32
Section 27-21A-32 HMO enrollment requirements. (a) The state government, or any agency, board,
commission, institution, or political subdivision thereof, and any city or county, or board
of education, which offers its employees a health benefits plan may make available to and
inform its employees or members of the option to enroll in at least one health maintenance
organization holding a valid certificate of authority which provides health care services
in the geographic areas in which such employees or members reside. (b) The first time a health
maintenance organization is offered by an employer, either public or private, each covered
employee must make an affirmative written selection among the different alternatives included
in the health benefits plan. Thereafter, those who wish to change from one plan to another
will be allowed to do so annually, provided, that nothing in this section shall prevent any
health maintenance organization or insurer from requiring evidence of...
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