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27-19-52
Section 27-19-52 Definitions. For purposes of this article, the following terms shall have
the meaning indicated herein: (1) APPLICANT. Includes either of the following: a. In the case
of an individual Medicare supplement policy or subscriber contract, the person who seeks to
contract for insurance benefits. b. In the case of a group Medicare supplement policy or subscriber
contract, the proposed certificate holder. (2) CERTIFICATE. Any certificate issued under a
group Medicare supplement policy, which policy has been delivered or issued for delivery in
this state. (3) CERTIFICATE FORM. The form on which the certificate is delivered or issued
for delivery by the issuer. (4) ISSUER. Insurance companies, fraternal benefit societies,
health care service plans, health maintenance organizations, and any other entity delivering
or issuing for delivery in this state Medicare supplement policies or certificates. (5) MEDICARE.
The "Health Insurance for the Aged Act," Title XVIII of the Social...
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27-19A-2
Section 27-19A-2 Definitions. As used in this chapter, the following terms shall have the respective
meanings herein set forth, unless the context shall otherwise require: (1) ALABAMA INSURANCE
CODE. Title 27 of the Code of Alabama 1975. (2) INSURER. Such term shall have the meaning
ascribed in Section 27-1-2. (3) PERSON. Such term shall have the meaning ascribed in Section
27-1-2. (4) COMMISSIONER and DEPARTMENT. Such terms, respectively, shall have the meanings
ascribed in Section 27-1-2. (5) CONTRACTUAL OBLIGATION. Any obligation under covered policies
or employee benefit plans. (6) COVERED POLICY OR PLAN. Any policy, employee benefit plan,
or contract within the scope of this chapter. (7) HEALTH INSURANCE POLICY. Any individual,
group, blanket, or franchise insurance policy, insurance agreement, or group hospital service
contract providing benefits for dental care expenses incurred as a result of an accident or
sickness. (8) EMPLOYEE BENEFIT PLAN. Any plan, fund, or program...
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27-19A-12
Section 27-19A-12 Dental services - Coverages; fees; exceptions. (a) As used in this section,
the following terms shall have the following meanings: (1) COVERED PERSON. Any individual,
family, or family member on whose behalf third-party payment or prepayment of health or medical
expenses is provided under an insurance policy, plan, or contract providing for third-party
payment or prepayment of health care or medical expenses. (2) COVERED SERVICES. Dental care
services for which a reimbursement is available under an enrollee's plan contract, or for
which a reimbursement would be available but for the application of contractual limitations
such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums,
frequency limitations, alternative benefit payments, or any other limitation. (3) DENTAL CARE
PROVIDER. A licensed dentist. (4) DENTAL PLAN. Includes any policy of insurance which is issued
by a health care service contractor which provides for coverage of...
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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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27-14-11.1
Section 27-14-11.1 Contents of policies - Denial or reduction of benefits due to Medicaid eligibility
void. (a) For purposes of this section, "private insurer" is defined as any of the
following: (1) Any commercial insurance company offering health or casualty insurance to individuals
or groups, including both experience-rated contracts and indemnity contracts. (2) Any profit
or nonprofit prepaid plan offering either medical services or full or partial payment for
the diagnosis or treatment of an injury, disease, or disability. (3) Any organization administering
health or casualty insurance plans for professional associations, unions, fraternal groups,
employer-employee benefit plans, and any similar organization offering these payments or services,
including self-insured and self-funded plans. (4) Any health insurer, including group health
plans, as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974,
self-insured plans, service benefit plans, managed care...
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27-7-1
Section 27-7-1 Definitions. For the purposes of this chapter, the following terms shall have
the meanings respectively ascribed to them by this section: (1) BUSINESS ENTITY. A corporation,
association, partnership, limited liability company, limited liability partnership, or other
legal entity. (2) COMMISSIONER. The Alabama Commissioner of Insurance. (3) HOME STATE. The
District of Columbia and any state or territory of the United States in which an insurance
producer maintains his or her principal place of residence or principal place of business
and is licensed to act as an insurance producer. (4) INSURANCE. As defined in Section 27-1-2.
(5) INSURANCE PRODUCER or PRODUCER. A person required to be licensed under the laws of this
state to sell, solicit, or negotiate insurance. (6) INSURER. As defined in Section 27-1-2.
For the purposes of this chapter, insurer shall also mean an insurance company licensed pursuant
to Chapter 3, commencing with Section 27-3-1 of this title; a health...
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11-91A-2
Section 11-91A-2 Local Government Health Insurance Board; governance and administration of
program. (a) The Local Government Health Insurance Board shall govern and administer the Local
Government Health Insurance Program currently governed and administered by the State Employees'
Insurance Board (SEIB) pursuant to Chapter 29 of Title 36. The transfer of the governance
and administration to the board shall take effect at 12:01 a.m. on January 1, 2015, and thereafter
the board shall take all control and responsibility for the program under procedures and authority
set out in this chapter. (b) The program governed and administered by the board shall provide
a reasonable relationship between the health care benefits to be included and the expected
health care expenses to be incurred by affected employees, retirees, and their dependents.
The board may establish a fully insured or self-insured health care plan for employees and
retirees as defined in this chapter and may adopt rules for the...
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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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25-5-290
Section 25-5-290 Ombudsman program, creation; purpose; members; notification of service; benefit
review conferences. (a) The Department of Industrial Relations shall establish an Ombudsman
Program to assist injured or disabled employees, persons claiming death benefits, employers,
and other persons in protecting their rights and obtaining information available under the
Workers' Compensation Law. (b) Providing that the employer and the employee agree to participate
in the benefit review conference, the ombudsmen shall meet with or otherwise provide information
to injured or disabled employees, investigate complaints, and communicate with employers,
insurance carriers, and health care providers on behalf of injured or disabled employees.
(c) Ombudsmen shall be Merit System employees and demonstrate familiarity with the Workers'
Compensation Law. An ombudsman shall not be an advocate for any person who shall assist a
claimant, employer, or other person in any proceeding beyond the...
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14-14-4
Section 14-14-4 Establishment of furlough program. (a) The department shall establish a medical
furlough program. The commissioner shall adopt the rules and regulations for implementation
of the medical furlough program. For each person considered for medical furlough, the commissioner
shall determine whether the person is a geriatric inmate, permanently incapacitated inmate,
or terminally ill inmate. (b) Notwithstanding any other law to the contrary, an inmate who
has not served his or her minimum sentence shall be considered eligible for consideration
for furlough under this chapter. (c) This chapter shall not apply to inmates convicted of
capital murder or a sexual offense. (d) Medical furlough consideration shall be in addition
to any other release for which an inmate may be eligible. (e) The commissioner shall determine
the conditions of release of any inmate pursuant to this chapter, including the appropriate
level of supervision of the inmate, and shall develop a discharge plan...
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