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27-19-52
Section 27-19-52 Definitions. For purposes of this article, the following terms shall have
the meaning indicated herein: (1) APPLICANT. Includes either of the following: a. In the case
of an individual Medicare supplement policy or subscriber contract, the person who seeks to
contract for insurance benefits. b. In the case of a group Medicare supplement policy or subscriber
contract, the proposed certificate holder. (2) CERTIFICATE. Any certificate issued under a
group Medicare supplement policy, which policy has been delivered or issued for delivery in
this state. (3) CERTIFICATE FORM. The form on which the certificate is delivered or issued
for delivery by the issuer. (4) ISSUER. Insurance companies, fraternal benefit societies,
health care service plans, health maintenance organizations, and any other entity delivering
or issuing for delivery in this state Medicare supplement policies or certificates. (5) MEDICARE.
The "Health Insurance for the Aged Act," Title XVIII of the Social...
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27-19-103
Section 27-19-103 Definitions. Unless the context requires otherwise, the definitions in this
section apply throughout this article. (1) APPLICANT. In the case of: a. An individual long-term
care insurance policy, the person who seeks to contract for benefits. b. A group long-term
care insurance policy, the proposed certificate holder. (2) CERTIFICATE. Any certificate issued
under a group long-term care insurance policy, which policy has been delivered or issued for
delivery in this state. (3) COMMISSIONER. The Alabama Commissioner of Insurance. (4) GROUP
LONG-TERM CARE INSURANCE. A long-term care insurance policy which is delivered or issued for
delivery in this state and issued to any of the following: a. One or more employers or labor
organizations, or to a trust or to the trustees of a fund established by one or more employers
or labor organizations, or a combination thereof, for employees or former employees or a combination
thereof, or for members or former members or a...
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27-19-56
Section 27-19-56 Outline of coverage; disclosure of information. (a) In order to provide for
full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement
policy shall be delivered or issued for delivery in this state and no certificate shall be
delivered pursuant to a group Medicare supplement policy delivered or issued for delivery
in this state unless an outline of coverage is delivered to the applicant at the time application
is made. (b) The commissioner shall prescribe the format and content of the outline of coverage
required by subsection (a) of this section. For purposes of this section, "format"
means style, arrangements, and overall appearance, including, but not limited to, the size,
color, and prominence of type and the arrangement of text and captions. This outline of coverage
shall include all of the following: (1) A description of the principal benefits and coverage
provided in the policy. (2) A statement of the renewal provisions...
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27-58-1
Section 27-58-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit
plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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27-59-1
Section 27-59-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit
plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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27-19-52.1
Section 27-19-52.1 Applicability of article. (a) Except as otherwise specifically provided,
this article shall apply to both of the following: (1) All Medicare supplement policies delivered
or issued for delivery in this state on or after August 1, 2000. (2) All certificates issued
under group Medicare supplement policies, which certificates have been delivered or issued
for delivery in this state. (b) This article shall not apply to a policy of one or more employers
or labor organizations, or of the trustees of a fund established by one or more employees
or labor organizations, or combination thereof, for employees or former employees or a combination
thereof, or for members or former members, or a combination thereof, of the labor organizations.
(c) Except as otherwise specifically provided in subsection (d) of Section 27-19-56, this
article is not intended to prohibit or apply to insurance policies or health care benefit
plans, including group conversion policies, provided to...
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27-19-101
Section 27-19-101 Applicability of article. The requirements of this article shall apply to
policies delivered or issued for delivery in this state on or after August 1, 2000. This article
is not intended to supersede the obligations of entities subject to this article to comply
with the substance of other applicable insurance laws insofar as they do not conflict with
this article, except that laws and regulations designed and intended to apply to Medicare
supplement insurance policies shall not be applied to long-term care insurance. Entities subject
to this article shall continue to comply with other applicable insurance legislation not in
conflict with this article. (Act 2000-795, p. 1876, ยง5.)...
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27-14-8
Section 27-14-8 Forms - Filing and approval or disapproval. (a) No basic insurance policy or
annuity contract form or application form where written application is required and is to
be made a part of the policy, or contract, or printed rider, or endorsement form or form of
renewal certificate shall be delivered or issued for delivery in this state unless the form
has been filed with, and approved by, the commissioner. This subsection shall not apply to
surety bonds or to specially rated inland marine risks, nor to policies, riders, endorsements,
or forms of unique character designed for, and used with, relation to insurance upon a particular
subject or which relate to the manner of distribution of benefits or to the reservation of
rights and benefits under life or disability insurance policies and are used at the request
or with the consent of the individual policyholder, contract holder, or certificate holder.
As to group insurance policies effectuated and delivered outside this...
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27-54A-2
Section 27-54A-2 Treatment under certain policies and contracts. (a) As used in this section,
the following words have the following meanings: (1) APPLIED BEHAVIOR ANALYSIS. The design,
implementation, and evaluation of environmental modifications, using behavioral stimuli and
consequences, to produce socially significant improvement in human behavior, including the
use of direct observation, measurement, and functional analysis of the relationship between
environment and behavior. (2) AUTISM SPECTRUM DISORDER. Any of the pervasive developmental
disorders or autism spectrum disorders as defined by the most recent edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) or the edition that was in effect at the
time of diagnosis. (3) BEHAVIORAL HEALTH TREATMENT. Counseling and treatment programs, including
applied behavior analysis that are both of the following: a. Necessary to develop, maintain,
or restore, to the maximum extent practicable, the functioning of an...
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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...
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