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27-45A-5
Section 27-45A-5 Disclosure of cost share information; discussion and sale of prescription
drug alternatives; prohibited payment practices. (a) A pharmacy or pharmacist may provide
a covered person with information regarding the amount of the covered person's cost share
for a prescription drug. Neither a pharmacy nor a pharmacist shall be proscribed by a pharmacy
benefits manager from discussing any such information or for selling a more affordable alternative
to the covered person if such an alternative is available. (b) A health benefit plan that
covers prescription drugs may not include a provision that requires an enrollee to make a
payment for a prescription drug at the point of sale in an amount that exceeds the lessor
of: (1) the contracted co-payment amount; or (2) the amount an individual would pay for a
prescription if that individual were paying with cash. (c) For purposes of this section, the
following words have the following meanings: (1) COVERED PERSON. Any individual,...
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27-52-3
Section 27-52-3 Additional powers; guidelines. (a) The commissioner shall, by regulation, establish
additional powers and duties of the plan and may adopt such rules as are necessary and proper
to implement this article. For the purpose of this section, the term "insurer" means
any entity covered by the Health Insurance Portability Act, including, but not limited to,
as the terms are defined in the Health Insurance Portability Act, a health insurance issuer,
a health maintenance organization and, notwithstanding Section 10-4-115, any health benefit
plan. In the case of a self-funded health benefit plan operating through a third party administrator,
the third party administrator shall be the insurer for the purpose of this section. The commissioner
may, by regulation, define health insurance premiums consistent with the purpose of this section.
(b) The regulations shall set forth coverage eligibility criteria consistent with the requirements
of Health Insurance Portability and...
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27-52-21
Section 27-52-21 Commissioner of Insurance; benefits offered to small employers; "small
employer" defined. (a) The Commissioner of Insurance shall, by regulation, establish
the conditions, restrictions, requirements, and plan of operation of the Alabama Small Employer
Allocation Program consistent with the requirements of the Health Insurance Portability and
Accountability Act of 1996 and any and all federal regulations adopted pursuant thereto, which
plan benefits shall be inclusive of the provisions of Sections 27-1-10 and 27-19-39. The program
shall be patterned after the Small Employer Health Insurance Availability models developed
by the National Association of Insurance Commissioners. (b) All insurers that offer health
benefit plans to small employers in this state on and after August 1, 1997, shall be required
to meet the requirements of the program as a condition of authority to transact business in
this state. (c) For the purposes of this article, a "small employer" means any...
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36-36-3
Section 36-36-3 Definitions. As used in this chapter, the following words and phrases shall
have the following respective meanings: (1) ALABAMA RETIRED EDUCATION EMPLOYEES' HEALTH CARE
TRUST. The Alabama Retired Education Employees' Health Care Trust created by the state and
the Public Education Employees' Health Insurance Board pursuant to this chapter. (2) ALABAMA
RETIRED STATE EMPLOYEES' HEALTH CARE TRUST. The Alabama Retired State Employees' Health Care
Trust created by the state and the State Employees' Insurance Board pursuant to this chapter.
(3) BOARDS. The State Employees' Insurance Board and the Public Education Employees' Health
Insurance Board. (4) DEPENDENTS. The spouse and dependent children, as defined by the rules
and regulations of the respective boards, of a retired employee who are covered by either
the Public Education Employees' Health Insurance Plan pursuant to Chapter 25A of Title 16,
as amended from time to time, or the State Employees' Health Insurance Plan...
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27-54-2
Section 27-54-2 Definitions. For purposes of this chapter, the following terms have the following
meanings: (1) DAY TREATMENT SERVICES. Includes, but is not limited to: Physiological, psychological,
and psychosocial concepts, techniques, and processes necessary to maintain or develop functional
skills of clients, provided to individuals and groups for periods of more than two hours but
less than 24 hours a day. (2) HEALTH BENEFIT PLAN. A health care service plan governed by
the provisions of Article 6, Chapter 4, Title 10, and a group health insurance policy, including
an employee welfare health benefit plan, that covers hospital, medical, or surgical expenses,
issued by insurers, 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...
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16-25A-41
Section 16-25A-41 Definitions. The following terms shall have the following meanings, unless
the context clearly indicates otherwise: (1) BOARD. The Public Education Flexible Employees
Benefit Board. (2) EMPLOYEE. Any person employed by a state or local board of education, postsecondary
institution, or other employer with employees as defined by Sections 16-25A-1 and 16-25A-11
participating in a state health insurance program. (3) EMPLOYER. Any local board of education
within the State of Alabama or other public institution of education within the state that
provides instruction at any combination of grades K-14 exclusively, under the auspices of
the State Board of Education, or the Alabama Institute for Deaf and Blind, or entities whose
employees are covered by the Public Education Employees' Health Insurance Plan pursuant to
Section 16-25A-11. (4) INTERNAL REVENUE CODE. The Internal Revenue Code of 1986, as amended.
(5) PARTICIPATING EMPLOYEE. An employee who elects to participate in...
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27-1-20
Section 27-1-20 Patient Right to Know Act. (a) This section shall be known and may be cited
as the "Patient Right to Know Act." (b) As used in this section, unless the context
clearly indicates otherwise, the following words shall have the following meanings: (1) ENROLLEE.
A person who purchases individual health care coverage or an employer who purchases a group
health care plan. (2) PROVIDER. A physician, dentist, podiatrist, pharmacist, optometrist,
psychologist, clinical social worker, advanced nurse practitioner, registered optician, licensed
professional counselor, physical therapist, and chiropractor. (c)(1) All persons, firms, corporations,
associations, health maintenance organizations, health insurance services, or preferred provider
organizations, any employer-sponsored health benefit plan, or any similar organization or
entity, providing health, accident, or dental insurance coverage, either directly or indirectly,
shall provide an enrollee with a written description of the...
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27-53-1
Section 27-53-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) GENETIC CHARACTERISTICS. A scientifically or medically identifiable gene or
chromosome, or alteration thereof, that is known to be a cause of a disease or disorder, or
determined to be associated with a statistically increased risk of development of a disease
or disorder. (2) GENETIC TEST. A pre-symptomatic laboratory test which is generally accepted
in the scientific and medical communities for the determination of the presence or absence
of the genetic characteristics that cause or are associated with risk of a disease or disorder.
(3) HEALTH BENEFIT PLAN. 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...
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45-8A-22.118
Section 45-8A-22.118 Maximum benefits; limitations; adjustments. (a) Annual Benefit and Final
Regulations Under Internal Revenue Code Section 415. (1) Annual Benefit. For purposes of this
section, "annual benefit" means the benefit payable annually under the terms of
the plan, exclusive of any benefit not required to be considered for purposes of applying
the limitations of Internal Revenue Code Section 415 to the plan, in the form of a straight
life annuity with no ancillary benefits. If the benefit is payable in any other form, the
annual benefit shall be adjusted to the equivalent of a straight life annuity pursuant to
subsection (c). (2) Final Regulations Under Internal Revenue Code Section 415. Notwithstanding
anything in this section to the contrary, the following provisions apply beginning on or after
January 1, 1976, except as otherwise provided in this section. a. Incorporation by Reference.
The limitations, adjustments, and other requirements prescribed in the plan shall...
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27-57-2
Section 27-57-2 Coverage; applicability. (a) All group health benefit plans, policies, contracts,
and certificates executed, delivered, issued for delivery, continued, or renewed in this state
on or after August 1, 2004, shall offer, at the time of proposal, sale, or renewal of a policy
subject to this chapter, to include colorectal cancer examinations within the coverage. Such
offer of coverage shall include colorectal cancer examinations for covered persons who are
50 years of age or older, or for covered persons who are less than 50 years of age and at
high risk for colorectal cancer according to current American Cancer Society colorectal cancer
screening guidelines. (b) This chapter shall apply to group accident and sickness insurance
policies issued by a fraternal benefit society, a nonprofit hospital service corporation,
a nonprofit medical service corporation, a group health care plan, a health maintenance organization,
or any similar entity. (Act 2004-502, p. 969, ยง2.)...
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