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27-12A-20
Section 27-12A-20 Fraud warning. (a) A fraud warning shall be included on at least one of the
following: Claim release forms, applications, reinstatements for insurance, participation
agreements, declaration pages, and claim documents, regardless of the method or form of transmission
and shall contain the following statement or a substantially similar statement: "Any
person who knowingly presents a false or fraudulent claim for payment of a loss or benefit
or who knowingly presents false information in an application for insurance is guilty of a
crime and may be subject to restitution, fines, or confinement in prison, or any combination
thereof." (b) The lack of a statement required by subsection (a) shall not constitute
a defense in any prosecution for insurance fraud. (c) Policies issued by unauthorized insurers
shall contain a statement disclosing the status of the insurer to do business in the state
where the policy is delivered or issued for delivery or the state where coverage is...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-12A-20.htm - 2K - Match Info - Similar pages
27-19-105
Section 27-19-105 Regulations for long-term care policies; outline of coverage, policy summary,
and monthly report. (a) The commissioner may adopt regulations that include standards for
full and fair disclosure setting forth the manner, content, and required disclosures for the
sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions
of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting
conditions, termination of insurance, continuation or conversion, probationary periods, limitations,
exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions,
and definitions of terms. Regulations under this subsection should recognize the developing
and unique nature of long-term care insurance and the distinction between group and individual
long-term insurance policies. (b) No long-term care insurance policy may do any of the following:
(1) Be cancelled, nonrenewed, or otherwise...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19-105.htm - 11K - Match Info - Similar pages
34-23-184
Section 34-23-184 Audit procedures; report. (a) The entity conducting an audit shall follow
these procedures: (1) The pharmacy contract shall identify and describe in detail the audit
procedures. (2) The entity conducting the on-site audit shall give the pharmacy written notice
at least two weeks before conducting the initial on-site audit for each audit cycle. If the
pharmacy benefit manager does not include their auditing guidelines within their provider
manual, then the notice must include a documented checklist of all items being audited and
the manual, including the name, date, and edition or volume, applicable to the audit and auditing
guidelines. For on-site audits a pharmacy benefit manager shall also provide a list of material
that is copied or removed during the course of an audit to the pharmacy. The pharmacy benefit
manager may document this material on either a checklist or on an audit acknowledgement form.
The pharmacy shall produce any items during the course of the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-184.htm - 9K - Match Info - Similar pages
27-44-8
Section 27-44-8 Powers and duties of association. (a) If a member insurer is an impaired insurer,
the association may, in its discretion and subject to any conditions imposed by the association
that do not impair the contractual obligations of the impaired insurer, and that are approved
by the commissioner: (1) Guarantee or reinsure, or cause to be guaranteed, assumed, or reinsured,
any or all of the covered policies of the impaired insurers. (2) Provide such moneys, pledges,
notes, guarantees, or other means as are proper to effectuate subdivision (1), and assure
payment of the contractual obligations of the impaired insurer pending action under subdivision
(1). (b) If a member insurer is an insolvent insurer, the association shall, in its discretion
and subject to the approval of the commissioner, do either of the following: (1)a. Guarantee,
assume, or reinsure, or cause to be guaranteed, assumed, or reinsured, the covered policies
of the insolvent insurer. b. Assure payment of the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-44-8.htm - 24K - Match Info - Similar pages
27-36A-4
Section 27-36A-4 Actuarial opinion of reserves. (a) Actuarial opinion prior to the operative
date of the valuation manual as defined by Section 27-36A-15. (1) GENERAL. Every life insurance
company doing business in this state shall annually submit the opinion of a qualified actuary
as to whether the reserves and related actuarial items held in support of the policies and
contracts specified by the commissioner by regulation are computed appropriately, are based
on assumptions which satisfy contractual provisions, are consistent with prior reported amounts,
and comply with applicable laws of this state. The commissioner, by regulation, shall define
the specifics of this opinion and add any other items deemed to be necessary to its scope.
(2) ACTUARIAL ANALYSIS OF RESERVES AND ASSETS SUPPORTING RESERVES. a. Every life insurance
company, except as exempted pursuant to regulation, shall also annually include in the opinion
required by subdivision (1) an opinion of the same qualified...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-36A-4.htm - 12K - Match Info - Similar pages
27-20-5
Section 27-20-5 Blanket disability insurance - Power to issue; filing requirement; mandatory
policy provisions. Any insurer authorized to write disability insurance in this state shall
have the power to issue blanket disability insurance. No such blanket policy may be issued
or delivered in this state unless a copy of the form thereof shall have been filed in accordance
with Section 27-14-8. Every such blanket policy shall contain provisions which, in the opinion
of the commissioner, are at least as favorable to the policyholder and the individual insured
as the following: (1) A provision that the policy, including endorsements and a copy of the
application, if any, of the policyholder and the persons insured shall constitute the entire
contract between the parties, and that any statement made by the policyholder or by a person
insured shall, in absence of fraud, be deemed a representation and not a warranty and that
no such statements shall be used in defense to a claim under the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-20-5.htm - 4K - Match Info - Similar pages
27-31A-4
Section 27-31A-4 Risk retention groups not chartered in this state. Risk retention groups chartered
and licensed in states other than this state and seeking to do business as a risk retention
group in this state shall comply with the laws of this state as follows: (1) NOTICE OF OPERATIONS
AND DESIGNATION OF COMMISSIONER AS AGENT. a. Before offering insurance in this state, a risk
retention group shall submit to the commissioner both of the following: 1. A statement identifying
the state or states in which the risk retention group is chartered and licensed as a liability
insurance company, charter date, its principal place of business, and other information, including
information on its membership, as the commissioner of this state may require to verify that
the risk retention group is qualified pursuant to subdivision (11) of Section 27-31A-2. 2.
A copy of its plan of operations or feasibility study and revisions of the plan or study submitted
to the state in which the risk retention...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-31A-4.htm - 8K - Match Info - Similar pages
27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive denials,
adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health benefit
plan that issues or renews any policy of accident or health insurance providing benefits for
medical or hospital expenses for its insured persons shall pay for services rendered by Alabama
health care providers within 45 calendar days upon receipt of a clean written claim or 30
calendar days upon receipt of a clean electronic claim. If the insurer, health service corporation,
or health benefit plan is denying or pending the claim, the insurer, health service corporation,
or health benefit plan shall, within 45 calendar days for a written claim and 30 calendar
days for an electronic claim, notify the health care provider or certificate holder of the
reason for denying or pending the claim and what, if any, additional information is required
to process the claim. Any undisputed portion of the claim...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-17.htm - 17K - Match Info - Similar pages
27-29A-8
Section 27-29A-8 Confidentiality. (a) Documents, materials, or other information, including
the ORSA Summary Report, in the possession of or control of the Department of Insurance that
are obtained by, created by, or disclosed to the commissioner or any other person under this
chapter, are recognized by this state as being proprietary and to contain trade secrets. All
such documents, materials, or other information shall be confidential by law and privileged,
shall not be subject to any open records, freedom of information, sunshine, or other public
record disclosure laws, shall not be subject to subpoena, and shall not be subject to discovery
or admissible in evidence in any private civil action. However, the commissioner is authorized
to use the documents, materials, or other information in the furtherance of any regulatory
or legal action brought as a part of the commissioner's official duties. The commissioner
shall not otherwise make the documents, materials, or other information...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-29A-8.htm - 6K - Match Info - Similar pages
27-27-7
Section 27-27-7 Solicitation permit - Issuance; contents; compliance with terms. (a) Upon the
filing of any bond required by Sections 27-27-10 or 27-27-16, after notice by the commissioner
provided for in subsection (a) of Section 27-27-6, or upon his decision to grant a solicitation
permit if such a bond is not so required, the commissioner shall issue to the applicant or
to the newly formed corporation, if the application is on behalf of a newly formed incorporated
domestic insurer, a solicitation permit. Every solicitation permit issued by the commissioner
shall contain provisions in substance as follows: (1) State the securities or other rights
or interests for which subscriptions are to be solicited, the number, classes, par value,
and selling price thereof, or identify the insurance contract, or contracts, for which applications
and advance premiums or deposits of premium are to be solicited in the case of mutual or reciprocal
insurers; (2) Require that any particular class of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-27-7.htm - 5K - Match Info - Similar pages
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