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27-21B-2
Section 27-21B-2 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) AGENCY. Any state agency responsible for administering programs under Title
IV-D or Title XIX of the Social Security Act. (2) INSURER. A health insurer, including a group
health plan as defined in Section 607(1) of the Employee Retirement Income Security Act of
1974, a health maintenance organization, or an entity offering a service benefit plan. (Acts
1994, No. 94-710, p. 1377, ยง2.)...
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27-45A-5
Section 27-45A-5 Disclosure of cost share information; discussion and sale of prescription
drug alternatives; prohibited payment practices. (a) A pharmacy or pharmacist may provide
a covered person with information regarding the amount of the covered person's cost share
for a prescription drug. Neither a pharmacy nor a pharmacist shall be proscribed by a pharmacy
benefits manager from discussing any such information or for selling a more affordable alternative
to the covered person if such an alternative is available. (b) A health benefit plan that
covers prescription drugs may not include a provision that requires an enrollee to make a
payment for a prescription drug at the point of sale in an amount that exceeds the lessor
of: (1) the contracted co-payment amount; or (2) the amount an individual would pay for a
prescription if that individual were paying with cash. (c) For purposes of this section, the
following words have the following meanings: (1) COVERED PERSON. Any individual,...
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27-19-2
Section 27-19-2 Scope and format of policy. No policy of disability insurance shall be delivered,
or issued for delivery, to any person in this state unless it otherwise complies with this
title and complies with the following: (1) The entire money and other considerations therefor
shall be expressed therein; (2) The time when the insurance takes effect and terminates shall
be expressed therein; (3) It shall purport to insure only one person, except that a policy
may insure, originally or by subsequent amendment, upon the application of an adult member
of the family, who shall be deemed the policyholder, any two or more eligible members of that
family, including husband, wife, dependent children, or any children under a specified age,
and any other person dependent upon the policyholder; (4) The style, arrangement, and overall
appearance of the policy shall give no undue prominence to any portion of the text, and every
printed portion of the text of the policy and of any endorsements...
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27-21A-23
Section 27-21A-23 Statutory construction and relationship to other laws. (a) Except as otherwise
provided in this chapter, provisions of the insurance law and provisions of health care service
plan laws shall not be applicable to any health maintenance organization granted a certificate
of authority under this chapter. This provision shall not apply to an insurer or health care
service plan licensed and regulated pursuant to the insurance law or the health care service
plan laws of this state except with respect to its health maintenance organization activities
authorized and regulated pursuant to this chapter. (b) Solicitation of enrollees by a health
maintenance organization granted a certificate of authority shall not be construed to violate
any provision of law relating to solicitation or advertising by health professionals. (c)
Any health maintenance organization authorized under this chapter shall not be deemed to be
practicing medicine and shall be exempt from the provisions of...
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27-52-2
Section 27-52-2 Authority. The plan shall have the general powers and authority granted under
the laws of this state to health insurers and in addition thereto, the specific authority
to do all of the following: (1) Enter into contracts as are necessary or proper to carry out
the provisions and purposes of this article, including the authority, with the approval of
the commissioner, to enter into contracts with similar plans of other states for the joint
performance of common administrative functions, or with persons or other organizations for
the performance of administrative functions. (2) Sue or be sued, including taking any legal
actions necessary or proper to recover or collect assessments due the plan. (3) Take legal
action as necessary to do any of the following: a. To avoid the payment of improper claims
against the plan or the coverage provided by or through the plan. b. To recover any amounts
erroneously or improperly paid by the plan. c. To recover any amounts paid by the...
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36-29-19.2
Section 36-29-19.2 The State Employees' Insurance Board may offer supplemental coverage. The
board may no later than January 1, 2006, offer employees a supplemental coverage to other
employer group health insurance coverage. (1) For employees who have spouses with other employer
group health insurance coverage available to them through their employer, or previous employer,
the board may provide such employees with a supplemental coverage to the other employer group
health insurance coverage in lieu of coverage in the basic medical plan of the State Employees'
Health Insurance Plan. (2) An employer that provides its employees and their spouses with
other employer group health insurance coverage may not exclude an employee, as defined under
Section 36-29-1, or his or her spouse from coverage by application of a provision which does
not also apply on the same terms and conditions to other employees or their spouses. No provision
of this section requires an employer to amend its plan to...
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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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27-1-10
Section 27-1-10 Payment for health services of chiropractor; insured to have exclusive right
to select practitioner of healing arts. Any contract or policy of insurance or any plan or
agreement for health services providing for reimbursement or payment for health services performed
by a medical doctor or physician or upon the certification of a medical doctor, surgeon, osteopath
or physician, shall also reimburse or pay for such health services performed by a doctor of
chiropractic or upon his certificate; provided, that the health services performed by the
doctor of chiropractic are within the scope of his license and he is duly licensed by the
State of Alabama. The insured or such other person entitled to benefits under such contract
or policy of insurance or plan or agreement for health services shall have the exclusive right
to choose or select any practitioner or member of the healing arts of Alabama to perform such
services, notwithstanding any provisions of such contract or...
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27-12-10
Section 27-12-10 Financial inducements to purchase insurance. (a) No person shall issue or
deliver, or permit its agents, officers, or employees to issue or deliver, agency company
stock or other capital stock, or benefit certificates or shares in any common-law corporation,
or securities, or any special or advisory board contract or other contract of any kind promising
returns and profits as an inducement to insurance. The commissioner shall refuse to issue
a certificate of authority or license to any insurer or other person that is in violation
of this section and shall revoke the certificate of authority or license of any such violating
insurer or person if such authority or license is already outstanding. (b) No person shall
issue or deliver, or permit its agents, officers, or employees to issue or deliver, in this
state, any life insurance policy or contract of annuity in which are used such words as "investment
plan," "expansion plan," "profit-sharing," "charter plan,"
"founders'...
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27-21A-2
Section 27-21A-2 Establishment of health maintenance organizations. (a) Notwithstanding any
law of this state to the contrary, any person may apply to the commissioner for and obtain
a certificate of authority to establish and operate a health maintenance organization in compliance
with this chapter. No person shall establish or operate a health maintenance organization
in this state without obtaining a certificate of authority under this chapter. A foreign corporation
may qualify under this chapter, subject to its registration to do business in this state as
a foreign corporation under the provisions of Sections 10-2A-220, et seq. (b) Health maintenance
organizations licensed as of May 29, 1986, shall be issued a certificate of authority in accordance
with Section 27-21A-29. (c) Each application for a certificate of authority shall be verified
by an officer or authorized representative of the applicant, shall be in a form prescribed
by the commissioner, and shall set forth or be...
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