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27-19A-2
Section 27-19A-2 Definitions. As used in this chapter, the following terms shall have the respective
meanings herein set forth, unless the context shall otherwise require: (1) ALABAMA INSURANCE
CODE. Title 27 of the Code of Alabama 1975. (2) INSURER. Such term shall have the meaning
ascribed in Section 27-1-2. (3) PERSON. Such term shall have the meaning ascribed in Section
27-1-2. (4) COMMISSIONER and DEPARTMENT. Such terms, respectively, shall have the meanings
ascribed in Section 27-1-2. (5) CONTRACTUAL OBLIGATION. Any obligation under covered policies
or employee benefit plans. (6) COVERED POLICY OR PLAN. Any policy, employee benefit plan,
or contract within the scope of this chapter. (7) HEALTH INSURANCE POLICY. Any individual,
group, blanket, or franchise insurance policy, insurance agreement, or group hospital service
contract providing benefits for dental care expenses incurred as a result of an accident or
sickness. (8) EMPLOYEE BENEFIT PLAN. Any plan, fund, or program...
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27-48-1
Section 27-48-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. A health insurance policy that covers hospital, medical,
or surgical expenses, health maintenance organizations, preferred provider organizations,
medical service organizations, physician-hospital organizations, or any other person, firm,
corporation, joint venture, or other similar business entity that pays for, purchases, or
furnishes health care services to patients, insureds, or beneficiaries in this state. For
the purpose of this chapter, a health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to the provisions of this chapter if it receives, processes,
adjudicates, pays, or denies claims for health care services submitted by or on behalf of
the State of Alabama or who receive health care services in the State of Alabama. The term
includes, but is not limited to, entities created pursuant to Article 6 of...
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27-49-3
Section 27-49-3 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, policy, or contract for health
care services issued, delivered, issued for delivery, 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, purchases, or furnishes health care services to patients, insureds,
or beneficiaries in this state. The term includes, but is not limited to, entities created
pursuant to Article 6 of Chapter 4 of Title 10. For the purposes of this chapter, a health
benefit plan located or domiciled outside of the State of Alabama is deemed to be subject
to the provisions of this chapter if it receives, processes,...
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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
33-1-5.2
Section 33-1-5.2 Life and health insurance for certain salaried officers and employees of state
docks. (a) The Alabama State Port Authority is hereby authorized to provide and establish
a plan of life and health insurance for the salaried officers and employees of Alabama state
docks who work full time for the Alabama state docks and receive their compensation on a bi-weekly
basis and also a plan of health insurance for the spouses and dependent children of such officers
and employees and to pay the costs and premiums of such life and health insurance from the
revenues of the Alabama State Port Authority. (b) Such health insurance plan may provide for
group hospitalization, surgical, medical and dental insurance against the financial costs
of hospitalization, surgical, medical and dental treatment and care, and may also include,
among other things, prescribed drugs, medicines, prosthetic appliances, hospital in-patient
and out-patient service benefits, including major medical benefits,...
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6-5-333
Section 6-5-333 Dentists, chiropractors, and physicians serving on utilization and quality
control committees, peer review committees, or professional standards review committees; consultants
thereto and employees thereof; dental, chiropractic and medical societies and associations;
appeal to Alabama Dental Association; confidentiality. (a) Any dentist, chiropractor, or physician
licensed to practice medicine in Alabama who serves on a peer review or a utilization and
quality control committee or professional standards review committee or a similar committee
or a committee of similar purpose or any dentist, physician, chiropractor, or individual who
serves as a consultant or employee to one of said committees established either by a dental
society or dental association or by a chiropractic society or chiropractic association or
by a state medical association or county medical society to review any aspect of dental care,
chiropractic care, or medical care at the request of a government...
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45-37A-51.136
Section 45-37A-51.136 Powers and duties of the board. The board shall have such powers as are
necessary for the proper administration of the system including, but not limited to, the following:
(1) To prescribe procedures to be followed by participants, and their beneficiaries, in filing
applications for benefits and for the furnishing of evidence necessary to establish employees'
rights to such benefits. (2) To make determinations as to the rights of any participant or
their beneficiaries applying for or receiving benefits, and to afford any such individual
dissatisfied with any such determination the right of a hearing thereon. (3) To develop procedures
for the establishment of credited service of participants; and, after affording participants
an opportunity to make objection with respect thereto, to establish such service conclusively
in advance of retirement. (4) To retain and pay from the fund the services of a consultant
and actuary. (5) To receive and pay from the fund...
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11-91A-7
Section 11-91A-7 Jurisdiction of board; funding; powers of board. The board shall have full,
complete, and exclusive jurisdiction over the program and shall allocate funds from its treasury
for the fulfillment and accomplishment of its duties and responsibilities in a manner as may
be necessary and appropriate to carry out the purposes of this chapter. The board shall have
the general powers and authority granted under the laws of this state for health insurers,
and in addition thereto, the specific authority to do all of the following: (a) Subject to
compliance with Section 11-91A-8 where applicable, execute a contract or contracts to provide
for the administration of the program in accordance with this chapter. The contract or contracts
may be executed with one or more agencies or corporations licensed to transact or administer
group health care business in this state with similar plans of the state for the joint performance
of common administrative functions. (b) Establish, and...
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22-6-153
Section 22-6-153 Contract to provide medical care to Medicaid beneficiaries; enrollment; grievance
procedures; duties of Medicaid Agency. (a) Subject to approval of the federal Centers for
Medicare and Medicaid Services, the Medicaid Agency shall enter into a contract in each Medicaid
region for at least one fully certified regional care organization to provide, pursuant to
a risk contract under which the Medicaid Agency makes a capitated payment, medical care to
Medicaid beneficiaries. However, the Medicaid Agency may enter into a contract pursuant to
this section only if, in the judgment of the Medicaid Agency, care of Medicaid beneficiaries
would be better, more efficient, and less costly than under the then existing care delivery
system. The Medicaid Agency may contract with more than one regional care organization in
a Medicaid region. Pursuant to the contract, the Medicaid Agency shall set capitation payments
for the regional care organization. (b) The Medicaid Agency shall...
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22-18-50
Section 22-18-50 Enactment and text of Emergency Medical Services Personnel Licensure Interstate
Compact. The Emergency Medical Services Personnel Licensure Interstate Compact is hereby enacted
into law and entered into with all other jurisdictions legally joining therein in form substantially
as follows: SECTION 1. PURPOSE In order to protect the public through verification of competency
and ensure accountability for patient care related activities all states license emergency
medical services (EMS) personnel, such as emergency medical technicians (EMTs), advanced EMTs
and paramedics. This Compact is intended to facilitate the day to day movement of EMS personnel
across state boundaries in the performance of their EMS duties as assigned by an appropriate
authority and authorize state EMS offices to afford immediate legal recognition to EMS personnel
licensed in a member state. This Compact recognizes that states have a vested interest in
protecting the public's health and safety...
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