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16-25A-5.2
Section 16-25A-5.2 Supplemental policy to provide secondary coverage for retirees. The board
may offer retirees a supplemental policy that provides secondary coverage to other employer
group coverage and certain requirements shall be maintained regarding retiree health coverage
and cost sharing. (1) For employees who retire after September 30, 2005, and who become employed
by an employer that provides employees at least 50 percent of the cost of single health insurance
coverage and that qualify to receive other employer group health insurance coverage through
that employer shall be required to use the employer's health benefit plan for primary coverage
and the Public Education Employees' Health Insurance Plan may provide supplemental secondary
coverage. (2) For retirees who have spouses with other employer group health insurance coverage
available to them through their employer or previous employer, the board may provide such
retirees with a supplemental coverage policy to the other...
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22-1-18
Section 22-1-18 Autism Spectrum Disorder coverage and reimbursement under Children's Health
Insurance Plan. In the administration of and provision of benefits for the Children's Health
Insurance Plan (ALL Kids), the Alabama Department of Public Health, on and after December
31, 2018, shall provide coverage and reimbursement for the treatment of Autism Spectrum Disorder
in the same manner and same levels as health benefit plans. (Act 2017-337, §2.)...
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27-19A-8
Section 27-19A-8 Plans not in conformance with chapter unlawful. It shall be unlawful for any
insurer or any person to provide any health insurance policy or employee benefit plan providing
for dental care services that does not conform to the provisions of this chapter. (Acts 1984,
No. 84-411, p. 960, §7.)...
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27-45-6
Section 27-45-6 Compliance with article. It shall be unlawful for any insurer or any person
to provide any health insurance policy or employee benefit plan providing for pharmaceutical
services, including without limitation, prescription drugs, that does not conform to the provisions
of this article. (Acts 1988, No. 88-379, p. 565, §6.)...
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27-49-4
Section 27-49-4 Obstetricians and gynecologists as primary care physicians; direct access to
obstetrician and gynecologist not used as primary care physicians. (a) Each health benefit
plan which is issued, delivered, issued for delivery, or renewed in this state on or after
October 1, 1996, shall allow obstetricians and gynecologists as primary care physicians. This
subsection shall not be construed to require an individual obstetrician or gynecologist to
accept primary care physician status if the obstetrician or gynecologist does not wish to
be designated as a primary care physician, nor to interfere with the credentialing and other
selection criteria usually applied by a health benefit plan with respect to other physicians
within its network. (b) For women not using an obstetrician or gynecologist as their primary
care physician, no health benefit plan which is issued, delivered, issued for delivery, or
renewed in this state on or after October 1, 1996, shall require as a condition...
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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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36-29-19.8
Section 36-29-19.8 Supplemental coverage for certain retirees. The board may offer a retiree
a supplemental coverage to other employer group health insurance coverage and certain requirements
shall be maintained regarding retiree health coverage and cost sharing. (1) For employees
who retire after September 30, 2005, and who become employed by an employer that provides
employees at least 50 percent of the cost of single health insurance coverage and that qualify
to receive other employer group health insurance coverage through that employer shall be required
to use the employer's health benefit plan for primary coverage and the State Employees' Health
Insurance Plan may provide supplemental coverage. (2) For retirees who have spouses with other
employer group health insurance coverage available to them through their employer or previous
employer, the board may provide such retirees with a supplemental coverage to other employer
group health insurance coverage in lieu of coverage in the...
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27-55-4
Section 27-55-4 Statement of reasons for adverse action. An insurer that takes an action which
adversely affects a subject of abuse, or a related individual or entity, based on an abuse-related
medical condition, abuse-related claim, abuse status, or association or relationship with
a subject of abuse, pursuant to an individual or group insurance policy or health benefit
plan, shall advise the applicant or the insured of the specific reasons for the action in
writing. Reference to general underwriting practices or guidelines shall constitute a specific
reason. The specific reason for the actions of the insurer shall be stated in writing. The
actions of the health carrier or insurer, and any applicable policy provisions, shall be applied
equally to all applicants or insureds with similar medical conditions or similar claim or
claims history without regard to whether the condition or the claims are abuse related. (Act
2000-595, p. 1185, §4.)...
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27-56-7
Section 27-56-7 Applicability to certain providers. (a) This chapter does not require and shall
not be construed to require any insurance policy, plan, or contract to provide health care
coverage for eye care. The provisions of this chapter are applicable only to those insurance
policies, plans, or contracts which provide coverage for eye care. (b) Insurers or other issuers
of any insurance policy, plan, or contract which provides coverage for eye care shall continue
to be able to establish and apply selection criteria and utilization protocols for health
care providers as well as credentialing criteria used in the selection of providers. (c) This
chapter does not require and shall not be construed to require the coverage of eye care services
by providers who are not designated as covered providers, or who are not selected as participating
providers, by an insurance policy, plan, or contract, or the issuer thereof having a participating
network of service providers. Provided, however,...
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16-25A-43
Section 16-25A-43 Establishment of flexible employee benefit plan; long-term care plan. The
board is authorized to establish a flexible employee benefit plan for employees in compliance
with Section 125 and any other applicable sections of the Internal Revenue Code. The flexible
employee benefit plan may provide for payments or salary reductions for qualified benefits
in accordance with Section 125 of the Internal Revenue Code, which presently include health
insurance premiums, group life insurance, disability insurance, supplemental health and accident
insurance, dependent care expenses, and such other types of employee benefits permitted under
Section 125 and any other applicable sections of the Internal Revenue Code. Furthermore, the
board may establish a long-term care plan for employees. (Act 2004-650, 1st Sp. Sess., p.
31, §4.)...
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