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27-1-21
Section 27-1-21 Uniformity of limits applied to fulfillment of certain drug prescriptions.
(a) For the purposes of this section, the following words shall have the following meanings:
(1) ENROLLEE. A person enrolled in a health benefit plan. (2) 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. The term shall not include any collective bargaining agreement...
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10A-20-6.13
Section 10A-20-6.13 Deposit of securities with State Treasurer. Every health care service corporation
shall deposit with, and thereafter maintain on deposit with, the Treasurer of the State of
Alabama bonds of the United States government or of the State of Alabama, or of any subdivision
thereof, or first mortgages on real estate situated in Alabama securing an indebtedness not
in excess of 50 percent of the appraised value thereof, subject to the approval of the Commissioner
of Insurance, in an amount to be determined as of the first day of January of each year as
follows: (1) Every company whose gross annual premium receipts from business done within this
state for the preceding year ending December 31 are less than fifty thousand dollars ($50,000)
shall so deposit and maintain securities of par and market value not less than five thousand
dollars ($5,000); (2) Every company whose gross annual premium receipts so computed are in
excess of fifty thousand dollars ($50,000) and less...
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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...
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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...
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6-5-548
Section 6-5-548 Burden of proof; reasonable care as similarly situated health care provider;
no evidence admitted of medical liability insurance. (a) In any action for injury or damages
or wrongful death, whether in contract or in tort, against a health care provider for breach
of the standard of care, the plaintiff shall have the burden of proving by substantial evidence
that the health care provider failed to exercise such reasonable care, skill, and diligence
as other similarly situated health care providers in the same general line of practice ordinarily
have and exercise in a like case. (b) Notwithstanding any provision of the Alabama Rules of
Evidence to the contrary, if the health care provider whose breach of the standard of care
is claimed to have created the cause of action is not certified by an appropriate American
board as being a specialist, is not trained and experienced in a medical specialty, or does
not hold himself or herself out as a specialist, a "similarly...
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6-5-549.1
Section 6-5-549.1 Limits of liability insurance coverage in legal action against health care
providers; testimony of health care providers as specialists. (a) This section and Sections
6-5-548 and 6-5-549 shall be known and may be cited as "The Alabama Medical Liability
Act of 1996." (b) The Legislature of the State of Alabama finds and declares that a crisis
continues to threaten the delivery and availability of medical services to the people of Alabama
and the health and safety of the citizens of this state are in jeopardy as a result of this
crisis. In accordance with the previous declarations of the Legislature of Alabama in Sections
6-5-480 to 6-5-488, inclusive, 27-26-1 to 27-26-4, inclusive, and 27-26-20 to 27-26-43, inclusive,
and Sections 6-5-540 to 6-5-552, inclusive, it is the declared intent of this Legislature
to ensure that quality medical services continue to be available at reasonable costs to the
citizens of the State of Alabama. The continuing and ever increasing...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/6-5-549.1.htm - 4K - Match Info - Similar pages
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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27-19A-9
Section 27-19A-9 Nonconforming policies and plans not to be approved by commissioner. The Commissioner
of Insurance shall not approve for sale in this state any health insurance policy or employee
benefit plan providing for dental care services which does not conform to the provisions of
this chapter or to the provisions of Sections 27-14-8 and 27-14-9. (Acts 1984, No. 84-411,
p. 960, §8.)...
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27-19-55
Section 27-19-55 Standards for loss ratios. Medicare supplement policies shall return to policyholders
benefits which are reasonable in relation to the premium charged. The commissioner shall issue
reasonable regulations to establish minimum standards for loss ratios of Medicare supplement
policies on the basis of incurred claims experience, or incurred health care expenses where
coverage is provided by a health maintenance organization on a service rather than reimbursement
basis, and earned premiums in accordance with accepted actuarial principles and practices.
(Acts 1981, No. 81-560, p. 940, §6; Act 2000-795, p. 1876, §3.)...
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27-21A-16
Section 27-21A-16 Examination. (a) The commissioner may make an examination of the affairs
of any health maintenance organization and providers with whom such organization has contracts
or agreements as often as is reasonably necessary for the protection of the interests of the
people of this state, but not less frequently than once every three years. (b) The State Health
Officer may make an examination concerning health care service of any health maintenance organization
and providers with whom such organization has contracts, agreements, or other arrangements
as often as is reasonably necessary for the protection of the interests of the people of this
state, but not less frequently than once every three years. (c) Every health maintenance organization
shall submit its relevant books and records for such examinations and in every way facilitate
these examinations. For the purpose of examinations, the commissioner and the State Health
Officer may administer oaths to, and examine the...
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