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27-1-11
Section 27-1-11 Dentists and dental hygienists as "physicians" under health or accident
insurance policies. Whenever the terms "physician" and/or "doctor" are
used in any policy of health or accident insurance issued in this state or in any contract
for the provision of health care, services, or benefits issued by any health, medical or other
service corporation existing under, and by virtue of any laws of this state, said terms shall
include within their meaning those persons licensed under and in accordance with Chapter 9
of Title 34 in respect to any care, services, procedures, or benefits covered by said policy
of insurance or health care contract which the said persons are licensed to perform, any provisions
in any such policy of insurance or health care contract to the contrary notwithstanding. This
section shall be applicable to all policies in this state, regardless of date of issue, on
October 10, 1975. (Acts 1975, No. 1241, p. 2607, §1.)...
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27-21A-7
Section 27-21A-7 Evidence of coverage and charges for health care services. (a)(1) Every enrollee
residing in this state is entitled to an evidence of coverage. If the enrollee obtains such
coverage through an insurance policy or a contract issued by a health care service plan, the
insurer or the health care service plan shall issue the evidence of coverage. Otherwise, the
health maintenance organization shall issue the evidence of coverage. (2) No evidence of coverage,
or amendment thereto, shall be issued or delivered to any person in this state until a copy
of the basic form of the evidence of coverage, or amendment thereto, has been filed with the
commissioner and the State Health Officer, and approved by the commissioner. (3) An evidence
of coverage shall contain: a. No provisions or statements which encourage misrepresentation,
or which are untrue, misleading, or deceptive as defined in subsection (a) of Section 27-21A-13;
and b. A clear and concise statement, if a contract, or a...
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8-32-5
Section 8-32-5 Required provisions, service contracts. (a) Service contracts sold or offered
for sale in this state, in their entirety, shall be written, printed, or typed in eight point
type size, or larger, and shall comply with the requirements set forth in this section, as
applicable. (b) Service contracts insured under a reimbursement insurance policy pursuant
to subdivision (1) of subsection (f) of Section 8-32-3 shall contain a statement in substantially
the following form: "Obligations of the provider under this service contract are guaranteed
under a service contract reimbursement insurance policy." If the provider fails to pay
or to provide service on a claim within 60 days after proof of loss has been filed, the service
contract holder is entitled to make a claim directly against the reimbursement insurance company.
The service contract shall state the name and address of the reimbursement insurance company.
(c) Service contracts not insured under a reimbursement insurance...
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22-6-220
Section 22-6-220 Definitions. For the purposes of this article, the following words shall have
the following meanings: (1) CAPITATION PAYMENT. A payment the state Medicaid Agency makes
periodically to the integrated care network on behalf of each recipient enrolled under a contract
for the provision of medical services pursuant to this article. (2) COLLABORATOR. A private
health carrier, third party purchaser, provider, health care center, health care facility,
state and local governmental entity, or other public payers, corporations, individuals, and
consumers who are expecting to collectively cooperate, negotiate, or contract with another
collaborator, or integrated care network in the health care system. (3) INTEGRATED CARE NETWORK.
One or more statewide organizations of health care providers, with offices in each regional
care organization region, that contracts with the Medicaid Agency to provide Medicaid benefits
to certain Medicaid beneficiaries as defined in subdivision (4) and...
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27-45-2
Section 27-45-2 Definitions. As used in this article, 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 article. (7) HEALTH INSURANCE POLICY. Any individual,
group, blanket, or franchise insurance policy, insurance agreement, or group hospital service
contract providing for pharmaceutical services, including without limitation, prescription
drugs, incurred as a result of accident or sickness, or to prevent same....
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27-21A-15
Section 27-21A-15 Powers of insurers and health care service plans. (a) An insurance company
licensed in this state, or a health care service plan authorized to do business in this state,
may either directly or through a subsidiary or affiliate organize and operate a health maintenance
organization under the provisions of this chapter. Notwithstanding any other law which may
be inconsistent herewith, any two or more such insurance companies, health care service plans,
or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance
organization. The business of insurance is deemed to include the providing of health care
by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.
(b) Notwithstanding any provision of insurance and health care service plan laws, Title 10,
Chapter 4, Article 6 and Title 27, an insurer or a health care service plan may contract with
a health maintenance organization to provide insurance or...
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40-26B-26
Section 40-26B-26 Reduction of revenues; reimbursement computations; quality incentive program.
THIS SECTION WAS AMENDED BY ACT 2020-147 IN THE 2020 REGULAR SESSION, EFFECTIVE MAY 18, 2020.
THIS IS NOT IN THE CURRENT CODE SUPPLEMENT. (a) No revenues resulting from the privilege assessment
established by this article and applied to increases in covered services or reimbursement
levels or other enhancements of the Medicaid program shall be subject to reduction or elimination
while the privilege assessment is in effect. (b) Every nursing facility participating in the
Medicaid program in the State of Alabama shall be reimbursed according to the reimbursement
methodology contained in Chapter 560-X-22 of the Alabama Medicaid Agency Administrative Code
(Supp. 12/31/95) on January 31, 1998, which methodology is incorporated by reference herein,
except that the following shall apply: (1) The ceiling for the operating cost center described
in Title 560-X-22-.06 (2)(a) of the Alabama Medicaid...
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25-5-314
Section 25-5-314 Contracts for medical services at mutually agreed rates. Notwithstanding any
other provisions of this article to the contrary, any employer, workers' compensation insurance
carrier, self-insured employer, or group fund, may contract with physicians, hospitals, and
any other health care provider for the provision of medical services to injured workers at
any rates, fees, or levels of reimbursement which shall be mutually agreed upon between the
physician, hospitals, and any other health care provider and the employer, workers' compensation
insurance carrier, self-insured employer, or group fund. (Acts 1992, No. 92-537, p. 1082,
§46.)...
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27-19A-4
Section 27-19A-4 Required provisions. Any health insurance policy or employee benefit plan
which is delivered, renewed, issued for delivery, or otherwise contracted for in this state
shall, to the extent that it provides benefits for dental care expenses: (1) Disclose, if
applicable, that the benefit offered is limited to the least costly treatment; (2) Define
and explain the standard upon which the payment of benefits or reimbursement for the cost
of dental care services is based, such as "usual and customary," "reasonable
and customary," "usual, customary, and reasonable," fees or words of similar
import or specify in dollars and cents the amount of the payment or reimbursement for dental
care services to be provided. Said payment or reimbursement for a noncontracting provider
dentist shall be the same as the payment or reimbursement for a contracting provider dentist;
provided, however, that the health insurance policy or the employee benefit plan shall not
be required to make...
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26-10B-8
Section 26-10B-8 Department to provide coverage and benefits not provided by residence state;
procedure for reimbursement. The State Department of Human Resources shall provide coverage
and benefits for a child who is in another state and who is covered by an adoption assistance
agreement made by the State Department of Human Resources for coverage or benefits, if any,
not provided by the residence state. To this end, the adoptive parents acting for the child
must obtain prior approval from the State Department of Human Resources and may submit evidence
of payment for services or benefit amounts not payable in the residence state and shall be
reimbursed therefor. However, there shall be no reimbursement for services or benefit amounts
covered under any insurance or other third party medical contract or arrangement held by the
child or the adoptive parents. The State Department of Human Resources shall make regulations
implementing this section. Among other things, such regulations...
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