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27-57-1
Section 27-57-1 Definitions. As used in this chapter, the following words and terms shall have
the following meanings: (1) COLORECTAL CANCER EXAMINATIONS. Examinations and laboratory tests
specified in current American Cancer Society guidelines for colorectal cancer screening of
asymptomatic individuals. (2) HEALTH BENEFIT PLAN. A group 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 purposes of this chapter, 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...
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34-23-116
Section 34-23-116 Article not applicable to certain services. This article shall not apply
to any services rendered pursuant to provisions of the Alabama Medicaid Program, to the Public
Education Employees' Health Insurance Plan, or to any corporation organized under the provisions
of Title 10, Chapter 4, Article 6, for establishment and operation of health care service
plans. (Acts 1981, No. 81-337, p. 477, §7; Acts 1983, No. 83-637, p. 986, §§1, 2; Act 2012-478,
p. 1325, §1.)...
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27-21A-18
Section 27-21A-18 Rehabilitation, liquidation, or conservation of a health maintenance organization.
(a) Any rehabilitation, liquidation, or conservation of a health maintenance organization
shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company
and shall be conducted under the supervision of the commissioner pursuant to the law governing
the rehabilitation, liquidation, or conservation of insurance companies. The commissioner
may apply for an order directing him to rehabilitate, liquidate, or conserve a health maintenance
organization upon any one or more grounds set out in Section 27-32-6, or when in his opinion
the continued operation of the health maintenance organization would be hazardous either to
the enrollees or to the people of this state. Enrollees shall have the same priority in the
event of liquidation or rehabilitation as the law provides to policyholders of an insurer.
(b) A claim by a health care provider for an uncovered...
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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
10A-20-6.07
Section 10A-20-6.07 Certificates of authority; contracts with public. Every corporation organized
under this article shall procure from the Commissioner of Insurance a certificate of authority
to do business, for which the corporation shall pay the sum of two hundred dollars ($200),
and the certificates of authority shall be renewed thereafter on or before the first day of
March of each year. The corporation may then enter into contracts with the public, subject
to the restrictions contained in this article, for benefits under its health service plan.
It shall be the duty of the corporation to enter into contracts with and issue certificates
to those of the public who may desire to avail themselves of the benefits of the health service
plan and who, under its rules and regulations, make application and are eligible therefor.
The contracts may provide for more than one class of services or benefits, may designate the
person or persons, or the class of persons, entitled thereto, may...
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27-19A-7
Section 27-19A-7 Contracting directly with patient; distribution of information about policy
or plan; payment and reimbursement procedures. The provisions of this chapter do not prohibit
the following conduct and shall be construed to provide that: (1) A dentist may contract directly
with a patient for the furnishing of dental care services to said patient as may be otherwise
authorized by law; (2) Any person providing a health insurance policy or employee benefit
plan, or an employer, or an employee organization may: a. Make available to its insureds,
beneficiaries, participants, employees, or members information relating to dental care services
by the distribution of factually accurate information regarding dental care services, rates,
fees, location, and hours of service, provided such distribution is made upon the request
of any dentist licensed by this state; or b. Establish an administrative mechanism which facilitates
payment for dental care services by insureds, beneficiaries,...
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27-52-3
Section 27-52-3 Additional powers; guidelines. (a) The commissioner shall, by regulation, establish
additional powers and duties of the plan and may adopt such rules as are necessary and proper
to implement this article. For the purpose of this section, the term "insurer" means
any entity covered by the Health Insurance Portability Act, including, but not limited to,
as the terms are defined in the Health Insurance Portability Act, a health insurance issuer,
a health maintenance organization and, notwithstanding Section 10-4-115, any health benefit
plan. In the case of a self-funded health benefit plan operating through a third party administrator,
the third party administrator shall be the insurer for the purpose of this section. The commissioner
may, by regulation, define health insurance premiums consistent with the purpose of this section.
(b) The regulations shall set forth coverage eligibility criteria consistent with the requirements
of Health Insurance Portability and...
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27-53-1
Section 27-53-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) GENETIC CHARACTERISTICS. A scientifically or medically identifiable gene or
chromosome, or alteration thereof, that is known to be a cause of a disease or disorder, or
determined to be associated with a statistically increased risk of development of a disease
or disorder. (2) GENETIC TEST. A pre-symptomatic laboratory test which is generally accepted
in the scientific and medical communities for the determination of the presence or absence
of the genetic characteristics that cause or are associated with risk of a disease or disorder.
(3) HEALTH BENEFIT PLAN. A health insurance policy, including a self-insured health plan,
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...
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36-36-3
Section 36-36-3 Definitions. As used in this chapter, the following words and phrases shall
have the following respective meanings: (1) ALABAMA RETIRED EDUCATION EMPLOYEES' HEALTH CARE
TRUST. The Alabama Retired Education Employees' Health Care Trust created by the state and
the Public Education Employees' Health Insurance Board pursuant to this chapter. (2) ALABAMA
RETIRED STATE EMPLOYEES' HEALTH CARE TRUST. The Alabama Retired State Employees' Health Care
Trust created by the state and the State Employees' Insurance Board pursuant to this chapter.
(3) BOARDS. The State Employees' Insurance Board and the Public Education Employees' Health
Insurance Board. (4) DEPENDENTS. The spouse and dependent children, as defined by the rules
and regulations of the respective boards, of a retired employee who are covered by either
the Public Education Employees' Health Insurance Plan pursuant to Chapter 25A of Title 16,
as amended from time to time, or the State Employees' Health Insurance Plan...
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25-5-8
Section 25-5-8 Employers' options to secure payment of compensation. (a) Option to insure risks.
An employer subject to this chapter may secure the payment of compensation under this chapter
by insuring and keeping insured his or her liability in some insurance corporation, association,
organization, insurance association, corporation, or association formed of employers and workers
or formed by a group of employers to insure the risks under this chapter, operating by mutual
assessment or other plans or otherwise. Notwithstanding the foregoing, the insurance association,
organization, or corporation shall have first had its contract and plan of business approved
in writing by the Commissioner of the Department of Insurance of Alabama and have been authorized
by the Department of Insurance to transact the business of workers' compensation insurance
in this state and under the plan. Notwithstanding any other provision of the law to the contrary,
the obligations of employers under law for...
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