|
27-21A-15
Section 27-21A-15 Powers of insurers and health care service plans. (a) An insurance company
licensed in this state, or a health care service plan authorized to do business in this state,
may either directly or through a subsidiary or affiliate organize and operate a health maintenance
organization under the provisions of this chapter. Notwithstanding any other law which may
be inconsistent herewith, any two or more such insurance companies, health care service plans,
or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance
organization. The business of insurance is deemed to include the providing of health care
by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.
(b) Notwithstanding any provision of insurance and health care service plan laws, Title 10,
Chapter 4, Article 6 and Title 27, an insurer or a health care service plan may contract with
a health maintenance organization to provide insurance or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-15.htm - 1K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-23.htm - 2K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-2B-2.htm - 4K - Match Info - Similar pages
27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases shall
have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health. (2)
ENROLLEE. An individual who has contracted for or who participates in coverage under an insurance
policy, a health maintenance organization contract, a health service corporation contract,
an employee welfare benefit plan, a hospital or medical services plan, or any other benefit
program providing payment, reimbursement, or indemnification for health care costs for the
individual or the eligible dependents of the individual. (3) PROVIDER. A health care provider
duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system for prospective
and concurrent review of the necessity and appropriateness in the allocation of health care
resources and services given or proposed to be given to an individual within this state. The
term does not include elective requests for clarification of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-3A-3.htm - 3K - Match Info - Similar pages
22-8A-9
Section 22-8A-9 Withholding or withdrawal of treatment, etc., not suicide; execution of advance
directive not to affect sale, etc., of life or health insurance nor be condition for receipt
of treatment, etc.; provisions of chapter cumulative. (a) The withholding or withdrawal of
life-sustaining treatment or artificially provided nutrition and hydration from a patient
in accordance with the provisions of this chapter shall not, for any purpose, constitute a
suicide and shall not constitute assisting suicide. (b) The making of an advance directive
for health care pursuant to this chapter shall not affect in any manner the sale, procurement,
or issuance of any policy of life or health insurance, nor shall it be deemed to modify the
terms of an existing policy of life or health insurance. No policy of life or health insurance
shall be legally impaired or invalidated in any manner by the withholding or withdrawal of
life-sustaining treatment or artificially provided nutrition and hydration...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-8A-9.htm - 2K - 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
34-23-181
Section 34-23-181 Definitions. The following words shall have the following meanings as used
in this article: (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 article if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-181.htm - 3K - Match Info - Similar pages
27-56-2
Section 27-56-2 Definitions. As used in this chapter, 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) EYE CARE PROVIDER. A licensed optometrist or a licensed ophthalmologist. (3)
INSURANCE POLICY, PLAN, OR CONTRACT PROVIDING FOR THIRD-PARTY PAYMENT OR PREPAYMENT OF HEALTH
OR MEDICAL EXPENSES. Includes an individual or group policy for accident or health insurance,
an individual or group hospital or health care service contract, an individual or group health
maintenance organization contract, an organized delivery system contract, or a preferred provider
organization contract, and any other similar policy, plan, or contract. This term shall not
include any employee welfare benefit plan, as defined...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-2.htm - 1K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19A-12.htm - 2K - Match Info - Similar pages
27-7-1
Section 27-7-1 Definitions. For the purposes of this chapter, the following terms shall have
the meanings respectively ascribed to them by this section: (1) BUSINESS ENTITY. A corporation,
association, partnership, limited liability company, limited liability partnership, or other
legal entity. (2) COMMISSIONER. The Alabama Commissioner of Insurance. (3) HOME STATE. The
District of Columbia and any state or territory of the United States in which an insurance
producer maintains his or her principal place of residence or principal place of business
and is licensed to act as an insurance producer. (4) INSURANCE. As defined in Section 27-1-2.
(5) INSURANCE PRODUCER or PRODUCER. A person required to be licensed under the laws of this
state to sell, solicit, or negotiate insurance. (6) INSURER. As defined in Section 27-1-2.
For the purposes of this chapter, insurer shall also mean an insurance company licensed pursuant
to Chapter 3, commencing with Section 27-3-1 of this title; a health...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-7-1.htm - 7K - Match Info - Similar pages
|