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27-58-4
Section 27-58-4 Benefits subject to annual deductible, coinsurance, exclusions, reductions,
etc. (a) The benefits provided in this chapter shall be subject to the same annual deductible
or coinsurance established for all covered benefits within a given policy. Private third party
payors may not reduce or eliminate coverage due to the requirements of this chapter. (b) A
health benefit plan subject to this chapter shall not terminate services, reduce capitation
payment, or otherwise penalize an attending physician or health care provider who orders medical
care consistent with this chapter. (c) Nothing in this chapter is intended to expand the list
of designations of covered providers as specified in any health benefit plan. (Act 2007-389,
p. 778, §4.)...
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27-59-3
Section 27-59-3 Implementation of coverage. (a) The benefits provided in this chapter shall
be subject to the same annual deductible or co-insurance established for all covered benefits
within a given policy. Private third party payors may not reduce or eliminate coverage due
to the requirements of this chapter. (b) A health benefit plan subject to this chapter may
not terminate services, reduce capitation payment, or otherwise penalize an attending physician
or health care provider who orders medical care consistent with this chapter. (c) Nothing
in this chapter is intended to expand the list of designations of covered providers as specified
in any health benefit plan. (Act 2008-502, p. 1106, §3.)...
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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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27-57-6
Section 27-57-6 Additional benefit costs. (a) The issuer of a group health benefit plan, policy,
or contract may either disclose the additional premium for such additional colorectal examination
benefits to the prospective contract holder and allow the contract holder to elect such additional
benefits on an optional basis; or conform its policies, contracts, or certificates issued
on or after August 1, 2004, and adjust its premium cost to reflect the additional benefit
cost. (b) Employer sponsors of group health benefit plans are not required to purchase the
additional benefits for colorectal examinations that are offered pursuant to this chapter.
(Act 2004-502, p. 969, §6.)...
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16-25A-8
Section 16-25A-8 Funding of health insurance plan; participation; Public Education Employees'
Health Insurance Fund. (a) The Public Education Employees' Health Insurance Board is hereby
authorized to provide under the contract or contracts entered into under the provisions of
this article an insurance benefit plan for each covered employee and, under certain conditions,
retired employees; the cost of such plan may be funded in part or in full through monthly
premiums per active employee from the same source of funds as those used for the payment of
salaries of active members and in part from other funds. (b) On or before January 1 next preceding
each regular meeting of the Legislature, the board shall certify to the Governor and to the
Legislature the amount or amounts necessary to fund coverage for benefits authorized by this
article for the following fiscal year for employees and for retired employees as a monthly
premium per active member per month. The Legislature shall set the...
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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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22-52-34
Section 22-52-34 Proceedings for reevaluation and civil commitment or transfer of certain persons
in custody of Department of Mental Health. (a) Where any person is in the custody of the Department
of Mental Health pursuant to the provisions of Article 4 of this chapter, the commissioner
shall direct the superintendent of Bryce or Searcy Hospital or any other facility so designated
by the commissioner to reevaluate the mental condition of such person for a determination
as to whether or not he or she meets the minimum standards for civil commitment as defined
in Section 22-52-37. Where the sentence for which said person was committed has expired and
where said person meets the minimum standards for involuntary civil commitment, the commissioner
or his designee is hereby authorized to petition the judges of probate of Tuscaloosa or Mobile
Counties or any judge of probate where such facility exists for an order of civil commitment
to the Department of Mental Health. All of the subsequent...
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27-12A-1
Section 27-12A-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) COMMISSIONER. The Alabama Commissioner of Insurance or his or her designee.
(2) DEPARTMENT. The Alabama Department of Insurance. (3) INSURANCE. As defined in Section
27-1-2, and specifically including any contract, arrangement, or agreement, in which one undertakes
to do any one of the following: a. Pay or indemnify another as to loss from certain contingencies
called risks. b. Pay or grant a specified amount or determinable benefit to another in connection
with ascertainable risk contingencies. c. Pay an annuity to another. d. Act as surety. For
the purposes of this chapter, insurance also includes any health benefit plan as defined in
Section 27-53-1. (4) INSURANCE PRODUCER or PRODUCER. As defined in Section 27-7-1. (5) INSURER.
A person entering into agreements, contracts of insurance, arrangements, or reinsurance, or
a health benefit plan, or a group health plan as...
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27-21A-10
Section 27-21A-10 Complaint system. (a)(1) Every health maintenance organization shall establish
and maintain a complaint system which has been approved by the commissioner, after consultation
with the State Health Officer, to provide reasonable procedures for the resolution of written
complaints initiated by enrollees. (2) Each health maintenance organization shall submit to
the commissioner and the State Health Officer an annual report in a form prescribed by the
commissioner, after consultation with the State Health Officer, which shall include: a. A
description of the procedures of such complaint system; b. The total number of complaints
handled through such complaint system and a compilation of causes underlying the complaints
filed; and c. The number, amount, and disposition of malpractice claims and other claims relating
to the service or care rendered by the health maintenance organization made by enrollees of
the organization that were settled during the year by the health...
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27-3A-2
Section 27-3A-2 Purposes. The purposes of this chapter are to: (1) Promote the delivery of
quality health care in a cost-effective manner. (2) Assure that utilization review agents
adhere to reasonable standards for conducting utilization review. (3) Foster greater coordination
and cooperation between health care providers and utilization review agents. (4) Improve communications
and knowledge of benefit plan requirements among all parties concerned before expenses are
incurred. (5) Ensure that utilization review agents maintain the confidentiality of medical
records in accordance with applicable laws. (Acts 1994, 1st Ex. Sess., No. 94-786, p. 80,
§2.)...
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