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
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
27-19-103
Section 27-19-103 Definitions. Unless the context requires otherwise, the definitions in this section apply throughout this article. (1) APPLICANT. In the case of: a. An individual long-term care insurance policy, the person who seeks to contract for benefits. b. A group long-term care insurance policy, the proposed certificate holder. (2) CERTIFICATE. Any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this state. (3) COMMISSIONER. The Alabama Commissioner of Insurance. (4) GROUP LONG-TERM CARE INSURANCE. A long-term care insurance policy which is delivered or issued for delivery in this state and issued to any of the following: a. One or more employers or labor organizations, or to a trust or to the trustees of a fund established by one or more employers or labor organizations, or a combination thereof, for employees or former employees or a combination thereof, or for members or former members or a...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19-103.htm - 9K - Match Info - Similar pages
34-23-184
Section 34-23-184 Audit procedures; report. (a) The entity conducting an audit shall follow these procedures: (1) The pharmacy contract shall identify and describe in detail the audit procedures. (2) The entity conducting the on-site audit shall give the pharmacy written notice at least two weeks before conducting the initial on-site audit for each audit cycle. If the pharmacy benefit manager does not include their auditing guidelines within their provider manual, then the notice must include a documented checklist of all items being audited and the manual, including the name, date, and edition or volume, applicable to the audit and auditing guidelines. For on-site audits a pharmacy benefit manager shall also provide a list of material that is copied or removed during the course of an audit to the pharmacy. The pharmacy benefit manager may document this material on either a checklist or on an audit acknowledgement form. The pharmacy shall produce any items during the course of the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-184.htm - 9K - Match Info - Similar pages
9-18-1
Section 9-18-1 Enactment of Southern Interstate Nuclear Compact. The Southern Interstate Nuclear Compact is hereby enacted into law and entered into by the state of Alabama with any and all states legally joining therein in accordance with its terms, in the form substantially as follows: "SOUTHERN INTERSTATE NUCLEAR COMPACT "Article I. Policy and Purpose "The party states recognize that the proper employment of nuclear energy, facilities, materials, and products can assist substantially in the industrialization of the south and the development of a balanced economy for the region. They also recognize that optimum benefit from and acquisition of nuclear resources and facilities requires systematic encouragement, guidance, and assistance from the party states on a cooperative basis. It is the policy of the party states to undertake such cooperation on a continuing basis; it is the purpose of this compact to provide the instruments and framework for such a cooperative effort to improve...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/9-18-1.htm - 16K - Match Info - Similar pages
9-18A-1
Section 9-18A-1 Enactment of Southern States Energy Compact. The Legislature hereby enacts, and the State of Alabama hereby enters into, the Southern States Energy Compact with any and all states legally joining therein in accordance with its terms, in the form substantially as follows: "SOUTHERN STATES ENERGY COMPACT "Article I. Policy and Purpose. "The party states recognize that the proper employment and conservation of energy and employment of energy-related facilities, materials, and products, within the context of a responsible regard for the environment, can assist substantially in the industrialization of the south and the development of a balanced economy for the region. They also recognize that optimum benefit from an acquisition of energy resources and facilities require systematic encouragement, guidance and assistance from the party states on a cooperative basis. It is the policy of the party states to undertake such cooperation on a continuing basis; it is the purpose of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/9-18A-1.htm - 17K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-3A-3.htm - 3K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-181.htm - 3K - Match Info - Similar pages
35-11-371
Section 35-11-371 Perfection of lien. (a) For the purposes of this section, the following terms shall have the following meanings: (1) HEALTH CARE PAYOR. A health care insurer, health maintenance organization, or health care service plan organized under Article 6, Chapter 20, Title 10A, authorized to provide health care coverage in the state. (2) SATISFY THE CLAIM. Receipt by the hospital of either of the following: a. Full payment for services as billed. b. If the hospital has a contract with the injured person's health care payor, payment together with all credits, discounts, and contractual adjustments that the patient's bill would be entitled under the contract, including recoupments, between the hospital and the patient's health care payor which extinguish the patient's obligation for the services rendered. (b) Unless specifically contrary to any contractual agreement between the hospital and the injured person's health care payor or unless contrary to any statute or governmental...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/35-11-371.htm - 5K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-21.htm - 3K - Match Info - Similar pages
|