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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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27-1-21
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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27-49-3
Section 27-49-3 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) 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. 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 the provisions of this chapter if it receives, processes,...
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27-19A-3
Section 27-19A-3 Prohibited provisions. No health insurance policy or employee benefit plan
which is delivered, renewed, issued for delivery, or otherwise contracted for in this state
shall: (1) Prevent any person who is a party to or beneficiary of any such health insurance
policy or employee benefit plan from selecting the dentist of his choice to furnish the dental
care services offered by said policy or plan or interfere with said selection provided the
dentist is licensed to furnish such dental care services in this state; (2) Deny any dentist
the right to participate as a contracting provider for such policy or plan provided the dentist
is licensed to furnish the dental care services offered by said policy or plan; (3) Authorize
any person to regulate, interfere, or intervene in any manner in the diagnosis or treatment
rendered by a dentist to his patient for the purpose of preventing, alleviating, curing, or
healing dental illness or injury provided said dentist practices within...
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27-48-1
Section 27-48-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. A 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 purpose of this chapter, a health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to the provisions of this chapter if it receives, processes,
adjudicates, pays, or denies claims for health care services submitted by or on behalf of
the State of Alabama or who receive health care services in the State of Alabama. The term
includes, but is not limited to, entities created pursuant to Article 6 of...
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27-54-6
Section 27-54-6 Cost report. Every issuer of a group health benefit plan subject to this chapter
shall provide a cost report for each calendar year to the Commissioner of Insurance no later
than April 30th of the following year. The report shall be in a form prescribed by the commissioner
and shall include certification of parity in mental health benefits and total annual costs
of mental health services relative to total health costs. The commissioner shall compile this
data for all health benefit plans in an annual report solely for the purpose of demonstrating
the health cost impact of the requirements of this chapter. (Act 2000-386, p. 605, §7.)...
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27-19-38
Section 27-19-38 Coverage of newly born children in health insurance policies. (a) All individual
and group health insurance policies providing coverage on an expense-incurred basis and individual
and group service or indemnity type contracts issued by a nonprofit service corporation which
provide coverage for a family member of the insured or subscriber shall, as to such family
members' coverage, also provide that the health insurance benefits applicable for children
shall be payable with respect to a newly born child of the insured or subscriber from the
moment of birth. (b) The coverage for newly born children shall consist of coverage of injury
or sickness including the necessary care and treatment of medically diagnosed congenital defects
and birth abnormalities, but need not include benefits for routine well-baby care. (c) The
requirements of this section shall apply to all insurance policies and subscriber contracts
renewed, delivered, or issued for delivery in this state, 60...
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27-21A-23
Section 27-21A-23 Statutory construction and relationship to other laws. (a) Except as otherwise
provided in this chapter, provisions of the insurance law and provisions of health care service
plan laws shall not be applicable to any health maintenance organization granted a certificate
of authority under this chapter. This provision shall not apply to an insurer or health care
service plan licensed and regulated pursuant to the insurance law or the health care service
plan laws of this state except with respect to its health maintenance organization activities
authorized and regulated pursuant to this chapter. (b) Solicitation of enrollees by a health
maintenance organization granted a certificate of authority shall not be construed to violate
any provision of law relating to solicitation or advertising by health professionals. (c)
Any health maintenance organization authorized under this chapter shall not be deemed to be
practicing medicine and shall be exempt from the provisions of...
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27-45-3
Section 27-45-3 Choice of pharmaceutical services; right to participate as contracting provider.
No health insurance policy or employee benefit plan which is delivered, renewed, issued for
delivery, or otherwise contracted for in this state shall: (1) Prevent any person who is a
party to or beneficiary of any such health insurance policy or employee benefit plan from
selecting the pharmacy or pharmacist of his choice to furnish the pharmaceutical services,
including without limitation, prescription drugs, offered by said policy or plan or interfere
with said selection provided the pharmacy or pharmacist is licensed to furnish such pharmaceutical
services in this state; or (2) Deny any pharmacy or pharmacist the right to participate as
a contracting provider for such policy or plan provided the pharmacist is licensed to furnish
pharmaceutical services, including without limitation, prescription drugs offered by said
policy or plan. (Acts 1988, No. 88-379, p. 565, §3.)...
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36-29-4
Section 36-29-4 Establishment and provisions of health insurance plan; rules and regulations.
The board is hereby empowered and authorized to establish a fully insured or self-insured
health insurance plan for employees and retirees of the State of Alabama and to adopt and
promulgate rules and regulations for the administration of such plan, subject to such limitations
as may be contained in this chapter. Such plan may provide for group hospitalization, surgical,
and medical insurance against the financial costs of hospitalization, surgical, and medical
treatment and care and may also include, among other things, prescribed drugs, medicines,
prosthetic appliances, hospital inpatient and outpatient service benefits, and medical expenses
indemnity benefits, including major medical benefits or such other coverage or benefits as
may be deemed appropriate and desirable by the board. (Acts 1965, No. 833, p. 1564, §3; Act
2004-647, 1st Sp. Sess., p. 17, §1.)...
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