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27-57-5
Section 27-57-5 Coverage by participating providers; selection criteria and utilization protocols;
maximum benefits, exclusions, etc. (a) This chapter does not require and shall not be construed
to require the coverage of services of providers who are not designated as covered providers,
or who are not selected as a participating provider, by a group health benefit plan or insurer
having a participating network of service providers. Nothing in this chapter is intended to
expand the list or designation of participating providers as specified in any health benefit
plan. (b) Insurers or other issuers of any health benefit plan covered by this chapter shall
continue to be able to establish and apply selection criteria and utilization protocols for
health care providers including the designation of types of providers for which coverage is
provided as well as credentialing criteria used in the selection of providers. (c) A group
health benefit plan, policy, or contract that provides coverage...
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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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7-9A-102
Section 7-9A-102 Definitions and index of definitions. (a) Article 9A definitions. In this
article: (1) "Accession" means goods that are physically united with other goods
in such a manner that the identity of the original goods is not lost. (2) "Account,"
except as used in "account for," means a right to payment of a monetary obligation,
whether or not earned by performance, (i) for property that has been or is to be sold, leased,
licensed, assigned, or otherwise disposed of, (ii) for services rendered or to be rendered,
(iii) for a policy of insurance issued or to be issued, (iv) for a secondary obligation incurred
or to be incurred, (v) for energy provided or to be provided, (vi) for the use or hire of
a vessel under a charter or other contract, (vii) arising out of the use of a credit or charge
card or information contained on or for use with the card, or (viii) as winnings in a lottery
or other game of chance operated or sponsored by a State, governmental unit of a State, or...
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27-1-10.1
Section 27-1-10.1 Insurance coverage for drugs to treat life-threatening illnesses. (a) The
Legislature finds and declares the following: (1) The citizens of this state rely upon health
insurance to cover the cost of obtaining health care and it is essential that the citizens'
expectation that their health care costs will be paid by their insurance policies is not disappointed
and that they obtain the coverage necessary and appropriate for their care within the terms
of their insurance policies. (2) Some insurers deny payment for drugs that have been approved
by the Federal Food and Drug Administration, hereafter referred to as FDA, when the drugs
are used for indications other than those stated in the labelling approved by the FDA, off-label
use, while other insurers with similar coverage terms do pay for off-label use. (3) Denial
of payment for off-label use can interrupt or effectively deny access to necessary and appropriate
treatment for a person being treated for a...
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27-42-5
Section 27-42-5 Definitions. As used in this chapter, the following terms shall have the following
meanings, respectively, unless the context clearly indicates otherwise: (1) ACCOUNT. Any one
of the three accounts created by Section 27-42-6. (2) AFFILIATE. A person who directly, or
indirectly, through one or more intermediaries, controls, is controlled by, or is under common
control with another person on December 31 of the year immediately preceding the date the
insurer becomes an insolvent insurer. (3) ASSOCIATION. The Alabama Insurance Guaranty Association
created under Section 27-42-6. (4) CLAIMANT. Any insured making a first party claim or any
person instituting a liability claim. The term does not include a person who is an affiliate
of an insolvent insurer. (5) COMMISSIONER. The Commissioner of Insurance of the State of Alabama.
(6) CONTROL. The possession, direct or indirect, of the power to direct or cause the direction
of the management and policies of a person, whether...
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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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22-6-11
Section 22-6-11 Breast and cervical cancer prevention and treatment. (a) This section shall
be known and may be cited as the "2009 Breast and Cervical Cancer Prevention and Treatment
Act." (b)(1) Medicaid eligibility and coverage shall be extended to a woman who has been
determined to be eligible to participate in and has been screened for breast or cervical cancer
by any health care provider or entity, or both, that satisfies any of the following: a. Receives
direct payment for screening services by National Breast and Cervical Cancer Early Detection
Program (NBCCEDP) Title XV funds. b. Is funded at least in part by NBCCEDP grantee Title XV
funds for screening services. c. Is not funded at all by NBCCEDP grantee Title XV funds but
has been identified by the Department of Public Health as part of the Alabama Breast and Cervical
Cancer Early Detection Program and operates consistently within its guidelines. (2) Coverage
under this section shall be limited to any woman screened and...
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40-26B-70
Section 40-26B-70 Definitions. For purposes of this article, the following terms shall have
the following meanings: (1) ACCESS PAYMENT. A payment by the Medicaid program to an eligible
hospital for inpatient or outpatient hospital care, or both, provided to a Medicaid recipient.
(2) ALL PATIENT REFINED DIAGNOSIS-RELATED GROUP (APR-DRG). A statistical system of classifying
any non-Medicare inpatient stay into groups for the purposes of payment. (3) ALTERNATE CARE
PROVIDER. A contractor, other than a regional care organization, that agrees to provide a
comprehensive package of Medicaid benefits to Medicaid beneficiaries in a defined region of
the state pursuant to a risk contract. (4) CERTIFIED PUBLIC EXPENDITURE (CPE). A certification
in writing of the cost of providing medical care to Medicaid beneficiaries by publicly owned
hospitals and hospitals owned by a state agency or a state university plus the amount of uncompensated
care provided by publicly owned hospitals and hospitals...
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27-19-105
Section 27-19-105 Regulations for long-term care policies; outline of coverage, policy summary,
and monthly report. (a) The commissioner may adopt regulations that include standards for
full and fair disclosure setting forth the manner, content, and required disclosures for the
sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions
of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting
conditions, termination of insurance, continuation or conversion, probationary periods, limitations,
exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions,
and definitions of terms. Regulations under this subsection should recognize the developing
and unique nature of long-term care insurance and the distinction between group and individual
long-term insurance policies. (b) No long-term care insurance policy may do any of the following:
(1) Be cancelled, nonrenewed, or otherwise...
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27-43-8
Section 27-43-8 Filing of application for certificate of authority; contents of application;
issuance of certificate. (a) The incorporators shall file with the commissioner an application
for a certificate of authority to do business upon a form to be furnished by the department,
which shall include or have attached the following: (1) The names and, for the preceding 10
years, all addresses and all occupations of all incorporators and proposed directors and officers;
(2) A certified copy of the corporate articles and bylaws and a list of the names, addresses,
and occupations of all directors and principal officers and, if previously incorporated, for
the three most recent years, the corporation annual statements and reports; (3) All agreements
relating to the corporation to which any incorporator or proposed director or officer is a
party; (4) A statement of the amount and sources of the funds available for organization expenses
and the proposed arrangements for reimbursement and...
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