27-21A-17
Section 27-21A-17 Suspension or revocation of certificate of authority. (a) The commissioner in consultation with and with the approval of the State Health Officer, where necessary, may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if he finds that any of the following conditions exist: (1) The health maintenance organization is operating significantly in contravention of its basic organizational document or in a manner contrary to that described in any other information submitted under Section 27-21A-2, unless amendments to such submissions have been filed with the commissioner and the State Health Officer and approved by the commissioner; (2) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services which do not comply with requirements of Section 27-21A-7; (3) The health maintenance organization does not provide or arrange for basic health care services; (4)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-17.htm - 3K - Match Info - Similar pages
27-21A-3
Section 27-21A-3 Issuance of certificate of authority. (a)(1) Upon receipt of an application for issuance of a certificate of authority, the commissioner shall forthwith transmit copies of such application and accompanying documents to the State Health Officer. (2) The State Health Officer shall determine whether the applicant for a certificate of authority, with respect to health care services to be furnished: a. Has demonstrated the willingness and potential ability to assure that such health care services will be provided in a manner to assure both availability and accessibility of adequate personnel and facilities and in a manner enhancing availability, accessibility, and continuity of service; b. Has arrangements, established in accordance with the regulations promulgated by the State Health Officer, for an on-going quality assurance program concerning health care processes and outcomes; and c. Has a procedure, established in accordance with regulations of the State Health...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-3.htm - 7K - Match Info - Similar pages
27-21A-2
Section 27-21A-2 Establishment of health maintenance organizations. (a) Notwithstanding any law of this state to the contrary, any person may apply to the commissioner for and obtain a certificate of authority to establish and operate a health maintenance organization in compliance with this chapter. No person shall establish or operate a health maintenance organization in this state without obtaining a certificate of authority under this chapter. A foreign corporation may qualify under this chapter, subject to its registration to do business in this state as a foreign corporation under the provisions of Sections 10-2A-220, et seq. (b) Health maintenance organizations licensed as of May 29, 1986, shall be issued a certificate of authority in accordance with Section 27-21A-29. (c) Each application for a certificate of authority shall be verified by an officer or authorized representative of the applicant, shall be in a form prescribed by the commissioner, and shall set forth or be...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-2.htm - 6K - Match Info - Similar pages
27-21A-20
Section 27-21A-20 Administrative procedures. (a) When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, he shall notify the health maintenance organization and the State Health Officer in writing specifically stating the grounds for denial, suspension, or revocation. If so requested in writing by the health maintenance organization, the commissioner shall set a hearing on the matter within 30 days of the receipt of such request. (b) The State Health Officer, or his designated representative, shall be in attendance at the hearing and shall participate in the proceedings. The recommendation and findings of the State Health Officer with respect to matters relating to the quality of health care services provided in connection with any decision regarding denial, suspension, or revocation of a certificate of authority, shall be...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-20.htm - 2K - Match Info - Similar pages
27-44-5
Section 27-44-5 Definitions. As used in this chapter, the following terms shall have the following meanings, respectively, unless the context clearly indicates otherwise: (1) ACCOUNT. Either of the three accounts created under Section 27-44-6. (2) ASSOCIATION. The Alabama Life and Disability Insurance Guaranty Association created under Section 27-44-6. (3) AUTHORIZED ASSESSMENT or the term AUTHORIZED when used in the context of assessments. A resolution by the board of directors has been passed whereby an assessment will be called immediately or in the future from member insurers for a specified amount. An assessment is authorized when the resolution is passed. (4) BENEFIT PLAN. A specific employee, union, or association of natural persons benefit plan. (5) CALLED ASSESSMENT or the term CALLED when used in the context of assessments. A notice that has been issued by the association to member insurers requiring that an authorized assessment be paid within the time frame set forth within...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-44-5.htm - 7K - 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
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
27-21A-22
Section 27-21A-22 Penalties and enforcement. (a) The commissioner may, in lieu of suspension or revocation of a certificate of authority under Section 27-21A-17, levy an administrative penalty in an amount not less than $500.00 nor more than $5,000.00, if reasonable notice in writing is given of the intent to levy the penalty and the health maintenance organization has a reasonable time within which to remedy the defect in its operations which gave rise to the penalty citation. The commissioner may augment this penalty by an amount equal to the sum that he calculates to be the damages suffered by enrollees or other members of the public. All moneys collected under this section shall be deposited to the credit of the General Fund. (b)(1) If the commissioner or the State Health Officer shall for any reason have cause to believe that any violation of this chapter has occurred or is threatened, the commissioner or State Health Officer may give notice to the health maintenance organization...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-22.htm - 3K - Match Info - Similar pages
27-21A-29
Section 27-21A-29 Existing health maintenance organizations. (a) Notwithstanding any other provision of this chapter, any health maintenance organization licensed by the State Board of Health and in operation on May 29, 1986, shall be granted a certificate of authority upon payment of the application fee prescribed in Section 27-21A-21 and compliance with Section 27-21A-12. Nothing in this section shall prohibit any such health maintenance organization from continuing to conduct business in this state until such certificate of authority is issued. (b) Any health maintenance organization which was licensed in this state prior to January 1, 1986, may continue to operate under existing noncontractual provider arrangements (which have been approved by the State Health Officer) for three years. (c) After issuance of a certificate of authority in accordance with subsection (a) of this section, the commissioner may require submission by the health maintenance organization of any additional...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-29.htm - 1K - Match Info - Similar pages
27-21A-1
Section 27-21A-1 Definitions. As used in this chapter, the following terms shall have the following meanings, respectively: (1) AGENT. A person who is appointed or employed by a health maintenance organization and who engages in solicitation of membership in such organization. This definition does not include a person enrolling members on behalf of an employer, union, or other organization. (2) BASIC HEALTH CARE SERVICES. Emergency care, inpatient hospital and physician care, and outpatient medical services. (3) COMMISSIONER. The Commissioner of Insurance. (4) ENROLLEE. An individual who is enrolled in a health maintenance organization. (5) EVIDENCE OF COVERAGE. Any certificate, agreement, or contract issued to an enrollee setting out the coverage to which he is entitled. (6) HEALTH CARE SERVICES. Any services included in the furnishing to any individual of medical or dental care, or hospitalization or incident to the furnishing of such care or hospitalization, as well as the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-1.htm - 3K - Match Info - Similar pages
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