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27-50-3
Section 27-50-3 Health benefit plan. As used in this chapter, the term "health benefit
plan" has the following meaning: 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 business entity that
pays for, purchases, or furnishes health care services to patients, insureds, or beneficiaries
in this state. The term does not include accident-only, specified disease, individual hospital
indemnity, credit, dental-only, Medicare-supplement, long-term care, or disability income
insurance; coverage issued as a supplement to liability insurance, workers' compensation or
similar insurance; or automobile medical-payment insurance. For the purpose of this chapter,
a health benefit plan located or domiciled outside of the State of...
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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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34-19-21
Section 34-19-21 Coverage or reimbursement for services not required. Nothing contained in
this chapter shall be construed to create a requirement that any health benefit plan, group
insurance plan, policy, or contract for health care services 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 group health care services to patients, insureds, or beneficiaries in this state,
including entities created pursuant to Article 6, commencing with Section 10A-20-6.01, of
Chapter 20, Title 10A, provide coverage or reimbursement for the services described or authorized
in this chapter. (Act 2017-383, ยง4.)...
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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...
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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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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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34-27B-2
Section 34-27B-2 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) BOARD. The Alabama State Board of Respiratory Therapy. (2) DIRECT CLINICAL SUPERVISION.
A situation where a licensed respiratory therapist or physician is available for the purpose
of communication, consultation, and assistance. (3) HEALTHCARE FACILITY. The definition shall
be the same as in Section 22-21-260. (4) MEDICALLY APPROVED PROTOCOL. A detailed plan for
taking specific diagnostic or treatment actions, or both, authorized by the treating physician
of the patient, all of which actions shall be: a. In a hospital or other inpatient health
care facility, approved by the supervising physician of the respiratory therapist or in an
outpatient treatment setting approved by the supervising physician of the respiratory therapist.
b. Except in cases of medical emergency, instituted following an evaluation of the patient
by a physician or otherwise directed by the supervising...
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22-8B-3
Section 22-8B-3 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) AID IN DYING. The act of a person providing the means or manner for another
person to be able to commit suicide, with actual knowledge that the person deliberately intends
on committing suicide by that means or manner. (2) ARTIFICIALLY PROVIDED NUTRITIONAL HYDRATION.
A medical treatment consisting of the administration of food and water through a tube or intravenous
line, where the recipient is not required to chew or swallow voluntarily. Artificially provided
nutrition and hydration does not include assisted feeding, such as spoon or bottle feeding.
(3) DELIBERATELY. More than knowing the consequences of an act or action; meaning to consider
carefully; done on purpose; intentional; requiring premeditation; with intent to cause the
death of a person. (4) HEALTH CARE PROVIDER. Any individual who may be asked to participate
in any way in a health care service, including, but...
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27-51-1
Section 27-51-1 Payment for services of licensed physician assistant. (a) An insurance policy
or contract providing for third-party payment or prepayment of health or medical expenses
shall include a provision for the payment to a supervising physician for necessary medical
or surgical services that are provided by a licensed physician assistant practicing under
the supervision of the physician, and pursuant to the rules, regulations, and parameters for
physician assistants, if the policy or contract pays for the same care and treatment provided
by a licensed physician or doctor of osteopathy. (b) An insurance policy or contract subject
to this section shall not impose a practice or supervision restriction which is inconsistent
with or more restrictive than provided by law. (c) This section shall apply to services provided
under a policy or contract delivered, continued, or renewed in this state on or after August
1, 1997, and to any existing policy or contract, on the policy's or...
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44-1-24
Section 44-1-24 Powers and duties of department generally. The Department of Youth Services
shall perform the following: (1) Provide services for youths who have run away from their
own communities in this state or from their home communities in other states to this state,
and provide such services, care, or cost for the youths as may be required pursuant to the
provisions of the Interstate Compact on Juveniles. (2) Provide for the expansion of local
detention care for youths alleged to be delinquent pending court hearing. (3) Secure the provision
of medical, hospital, psychiatric, surgical, or dental service, or payment of the cost of
such services, as may be needed for committed youths. (4) License and subsidize foster care
facilities or group homes for youths alleged to be delinquent pending hearing before a juvenile
court or adjudged delinquent following hearing, including detention, examination, study, care,
treatment, and training. (5) Establish, maintain, and subsidize programs...
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