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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...
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27-2B-5
Section 27-2B-5 Regulatory action level event; commissioner's duties; determination of corrective
actions; retention of consultants. (a) "Regulatory action level event" means, with
respect to any insurer, any of the following events: (1) The filing of an RBC report by the
insurer which indicates that the insurer's total adjusted capital is greater than or equal
to its authorized control level RBC but less than its regulatory action level RBC. (2) The
notification by the commissioner to an insurer of an adjusted RBC report that indicates the
event in subdivision (1), provided the insurer does not challenge the adjusted RBC report
under Section 27-2B-8. (3) If, pursuant to Section 27-2B-8, the insurer challenges an adjusted
RBC report that indicates the event in subdivision (1), the notification by the commissioner
to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge.
(4) The failure of the insurer to file an RBC report by the filing date, unless...
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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...
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27-2B-14.1
Section 27-2B-14.1 RBC reports with respect to 2015. For RBC reports required to be filed by
health organizations and fraternal benefit societies with respect to 2015, the following requirements
shall apply in lieu of the provisions of Sections 27-2B-4, 27-2B-5, 27-2B-6, and 27-2B-7:
(1) In the event of a company action level event with respect to a domestic insurer, the commissioner
shall take no regulatory action hereunder. (2) In the event of a regulatory action level event
under subdivisions (1), (2), or (3) of subsection (a) of Section 27-2B-5, the commissioner
shall take the actions required under Section 27-2B-4. (3) In the event of a regulatory action
level event under subdivisions (4), (5), (6), (7), (8), or (9) of subsection (a) of Section
27-2B-5, or an authorized control level event, the commissioner shall take the actions required
under Section 27-2B-5 with respect to the organization or society. (4) In the event of a mandatory
control level event with respect to an...
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6-5-691
Section 6-5-691 Definitions. For the purposes of this article, the following terms shall have
the following meanings: (1) ASBESTOS ACTION. A civil action arising out of, based on, or related
to the health effects of exposure to asbestos and any derivative claim made by or on behalf
of a person exposed to asbestos or a representative, spouse, parent, child, or other relative
of that person. The term asbestos action does not include claims alleging ovarian cancer.
(2) ASBESTOS TRUST. A government-approved or court-approved trust, qualified settlement fund,
compensation fund, or claims facility that is created as a result of an administrative or
legal action, a court-approved bankruptcy, pursuant to 11 U.S.C. §524(g), 11 U.S.C. §1121(a),
or other applicable provision of law, that is intended, in whole or in part, to provide compensation
to claimants arising out of, based on, or related to the health effects of exposure to asbestos.
(3) TRUST CLAIM MATERIALS. A final executed proof of...
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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...
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27-1-20
Section 27-1-20 Patient Right to Know Act. (a) This section shall be known and may be cited
as the "Patient Right to Know Act." (b) As used in this section, unless the context
clearly indicates otherwise, the following words shall have the following meanings: (1) ENROLLEE.
A person who purchases individual health care coverage or an employer who purchases a group
health care plan. (2) PROVIDER. A physician, dentist, podiatrist, pharmacist, optometrist,
psychologist, clinical social worker, advanced nurse practitioner, registered optician, licensed
professional counselor, physical therapist, and chiropractor. (c)(1) All persons, firms, corporations,
associations, health maintenance organizations, health insurance services, or preferred provider
organizations, any employer-sponsored health benefit plan, or any similar organization or
entity, providing health, accident, or dental insurance coverage, either directly or indirectly,
shall provide an enrollee with a written description of the...
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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...
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25-14-3
Section 25-14-3 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) ADMINISTRATIVE FEE. The fee charged to a client by a professional employer organization
for professional employer services. The term does not include any amount of a fee by the professional
employer organization that is for wages and salaries, benefits, workers' compensation, payroll
taxes, withholding, or other assessments paid by the professional employer organization to
or on behalf of covered employees under the professional employer agreement. (2) CLIENT. A
person or entity that enters into a professional employer agreement with a professional employer
organization, including a worksite employer. (3) CONTROLLING PERSON. Any of the following:
a. An officer or director of a corporation operating as a professional employer organization,
a shareholder holding 25 percent or more of the voting stock of a corporation operating as
a professional employer organization, or a...
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27-58-1
Section 27-58-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (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 chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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