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27-19A-12
Section 27-19A-12 Dental services - Coverages; fees; exceptions. (a) As used in this section,
the following terms shall have the following meanings: (1) COVERED PERSON. Any individual,
family, or family member on whose behalf third-party payment or prepayment of health or medical
expenses is provided under an insurance policy, plan, or contract providing for third-party
payment or prepayment of health care or medical expenses. (2) COVERED SERVICES. Dental care
services for which a reimbursement is available under an enrollee's plan contract, or for
which a reimbursement would be available but for the application of contractual limitations
such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums,
frequency limitations, alternative benefit payments, or any other limitation. (3) DENTAL CARE
PROVIDER. A licensed dentist. (4) DENTAL PLAN. Includes any policy of insurance which is issued
by a health care service contractor which provides for coverage of...
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36-29-23
Section 36-29-23 Authorization to establish flexible employee benefit plan; provisions of plan.
The board, with the approval of the Governor, is authorized to establish a flexible employee
benefit plan for state employees in compliance with Section 125 and any other applicable sections
of the Internal Revenue Code. The flexible employee benefit plan may provide for payments
or salary reductions for qualified benefits in accordance with Section 125 of the Internal
Revenue Code, which presently include health insurance premiums, group life insurance, disability
insurance, supplemental health and accident insurance, dependent care expenses, and such other
types of employee benefits permitted under Section 125 and any other applicable sections of
the Internal Revenue Code. Futhermore, the board may establish a long-term care plan for employees.
(Acts 1989, No. 89-644, p. 1272, §4; Act 98-639, p. 1410, §1.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/36-29-23.htm - 1K - Match Info - Similar pages
25-5-290
Section 25-5-290 Ombudsman program, creation; purpose; members; notification of service; benefit
review conferences. (a) The Department of Industrial Relations shall establish an Ombudsman
Program to assist injured or disabled employees, persons claiming death benefits, employers,
and other persons in protecting their rights and obtaining information available under the
Workers' Compensation Law. (b) Providing that the employer and the employee agree to participate
in the benefit review conference, the ombudsmen shall meet with or otherwise provide information
to injured or disabled employees, investigate complaints, and communicate with employers,
insurance carriers, and health care providers on behalf of injured or disabled employees.
(c) Ombudsmen shall be Merit System employees and demonstrate familiarity with the Workers'
Compensation Law. An ombudsman shall not be an advocate for any person who shall assist a
claimant, employer, or other person in any proceeding beyond the...
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22-11A-118
Section 22-11A-118 Health Care Data Advisory Council. (a) There is established the Health Care
Data Advisory Council to assist in developing regulations and standards necessary to implement
the provisions of this article, to review and serve as consultants to the board on matters
related to any reports or publications prior to a report or publication release and to serve
as consultants to the board on matters relating to the protection, collection, and dissemination
of health care facility acquired infection data. (b) The council shall consist of 18 members
and be constituted in the following manner: (1) Six hospital members to be appointed by the
Alabama Hospital Association, two of which shall be infection control professionals. (2) Three
members to be appointed by the Medical Association of the State of Alabama. (3) Two members
to be appointed by the Business Council of Alabama, at least one of whom represents a small
business, all of whom are purchasers of health care, and none of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-11A-118.htm - 4K - 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
22-6-151
Section 22-6-151 Regional care organizations; governing board of directors; citizen's advisory
committee; solvency and financial requirements; reporting; provider standards committee. (a)
A regional care organization shall serve only Medicaid beneficiaries in providing medical
care and services. (b) Notwithstanding any other provision of law, a regional care organization
shall not be deemed an insurance company under state law. (c)(1) A regional care organization
and an organization with probationary regional care organization certification shall have
a governing board of directors composed of the following members: a. Twelve members shall
be persons representing risk-bearing participants in the regional care organization or organization
with probationary certification. A participant bears risk by contributing cash, capital, or
other assets to the regional care organization. A participant also bears risk by contracting
with the regional care organization to treat Medicaid beneficiaries...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-151.htm - 9K - Match Info - Similar pages
27-17A-14
Section 27-17A-14 Surety bond. (a) As an alternative to the trust requirement of Section 27-17A-13,
the details of which are set forth in Articles 3 and 4, a preneed provider may, with the prior
approval of the commissioner, purchase a surety bond in an amount not less than the aggregate
value of outstanding liabilities on undelivered preneed contracts for merchandise, services,
and cash advances. For the purposes of this section, the term outstanding liabilities means
the original retail amount of services and cash advances and the actual cost to the entity
to provide the undelivered merchandise sold on each contract written after April 30, 2002.
The surety bond shall be in an amount sufficient to cover the outstanding liability at the
time each contract is executed. (b) The bond shall be made payable to the State of Alabama
for the benefit of the commissioner and of all purchasers of preneed merchandise, services,
and cash advances. The bond shall be issued by an insurance company...
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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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22-21-7
Section 22-21-7 Itemized statement of services rendered to be furnished patient upon request;
provisions of statement; itemization of services and expenses; action by Attorney General;
payment of claims by insurance companies. (a) For the purposes of this section, the term "hospital"
shall mean any hospital in which human patients are given medical care. It shall include all
emergency rooms or outpatient facilities connected thereto. (b) Within 10 days following discharge
or release from confinement in a hospital or nursing home, or within 10 days after the earliest
date at which the expense from the confinement or service may be determined, which in the
case of long-term confinement may be the monthly charge, the hospital or nursing home providing
the service shall submit to the patient, or to his survivor or legal guardian as may be appropriate,
upon written request, an itemized statement detailing in language comprehensible to an ordinary
layman the specific nature of charges or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-7.htm - 3K - Match Info - Similar pages
27-1-20
Section 27-1-20 Patient Right to Know Act. (a) This section shall be known and may be cited
as the "Patient Right to Know Act." (b) As used in this section, unless the context
clearly indicates otherwise, the following words shall have the following meanings: (1) ENROLLEE.
A person who purchases individual health care coverage or an employer who purchases a group
health care plan. (2) PROVIDER. A physician, dentist, podiatrist, pharmacist, optometrist,
psychologist, clinical social worker, advanced nurse practitioner, registered optician, licensed
professional counselor, physical therapist, and chiropractor. (c)(1) All persons, firms, corporations,
associations, health maintenance organizations, health insurance services, or preferred provider
organizations, any employer-sponsored health benefit plan, or any similar organization or
entity, providing health, accident, or dental insurance coverage, either directly or indirectly,
shall provide an enrollee with a written description of the...
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