27-48-2
Section 27-48-2 Coverage for medically necessary inpatient care for mother and newly born child. (a) Every health benefit plan that provides maternity coverage shall provide coverage for the following: (1) All medically necessary inpatient care for a mother and her newly born child as determined by the woman's prenatal care physician, obstetrician-gynecologist, certified nurse midwife, or the child's attending pediatrician and when consistent with the most recent version of the "Guidelines for Perinatal Care" prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, including the administration of medical tests recommended by the American Academy of Pediatrics or the American College of Obstetricians and Gynecologists or both on the admission and discharge of a mother and the newborn child to determine whether additional medical care is needed for the mother or newborn child or both. Included in medically necessary inpatient care is the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-48-2.htm - 2K - Match Info - Similar pages
16-25A-4
Section 16-25A-4 Relationship between benefits and expenses; reasonable controls on utilization and for stability. The health insurance plan provided for in this article shall be designed by the board to provide a reasonable relationship between the hospital, surgical, and medical benefits to be included and the expected hospital, surgical, and medical expenses to be incurred by the affected employee and retiree and dependents and to include reasonable controls, which may include, but are not limited to, deductible, copayment, coinsurance, and other cost containment measures to prevent unnecessary utilization of the various hospital, surgical, and medical services available and to provide reasonable assurance of stability in future years for the plan. (Acts 1983, No. 83-455, p. 640, §4; Act 2004-646, 1st Sp. Sess., p. 6, §2.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/16-25A-4.htm - 1K - Match Info - Similar pages
27-19A-9
Section 27-19A-9 Nonconforming policies and plans not to be approved by commissioner. The Commissioner of Insurance shall not approve for sale in this state any health insurance policy or employee benefit plan providing for dental care services which does not conform to the provisions of this chapter or to the provisions of Sections 27-14-8 and 27-14-9. (Acts 1984, No. 84-411, p. 960, §8.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19A-9.htm - 699 bytes - Match Info - Similar pages
27-20A-2
Section 27-20A-2 Chapter applicable to group, etc., policies. No group, blanket, franchise, or association health insurance policy providing coverage on an expense incurred basis, nor group, blanket, franchise, or association service or indemnity type contract issued by a nonprofit corporation, nor group-type self insurance plan providing protection, insurance, or indemnity against hospital, medical, or surgical expenses, nor health maintenance organization plan shall be issued, delivered, executed, or renewed in this state, or approved for issuance or renewal in this state by the Commissioner of Insurance after 90 days beyond the effective date of this chapter, unless such policy, contract, or plan, at the option of the policyholder or sponsor, provides benefits to any insured, subscriber, or other person covered under the policy, contract, or plan for expenses incurred in connection with the treatment of alcoholism when such treatment is prescribed by a duly licensed doctor of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-20A-2.htm - 1K - Match Info - Similar pages
27-56-3
Section 27-56-3 Payment for services. An insurance policy, plan, or contract providing for third-party payment or prepayment of health or medical expenses shall include a provision for the payment to a licensed optometrist for each service which falls within the scope of the optometrist's license, if the policy, plan, or contract pays for the same service when provided by any other provider for such services. (Act 2001-477, p. 640, §3.)...
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27-56-4
Section 27-56-4 Prohibited activities. An insurance policy, plan, or contract providing for third-party payment or prepayment of health or medical expenses shall not do any of the following: (1) Impose a practice restriction for optometrists which is inconsistent with or more restrictive than provided by law. (2) Discriminate between classes of eye care providers with respect to any covered service which falls within the scope of the eye care provider's license. (3) Require an eye care provider to hold hospital privileges as a condition of participation in or receiving payment from the policy, plan, or contract. (4) Impose any restriction not required by law based on the eye care provider's professional degree. (5) Discriminate between eye care providers in connection with the amount of reimbursement for the provision of the same services. (6) Require an eye care provider to purchase or maintain a minimum quantity or minimum dollar amount of a specified brand of ophthalmic materials as...
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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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36-35-3
Section 36-35-3 Alabama Prescription Cost Initiative Board. (a) The Alabama Prescription Cost Initiative Board is created. (b) The board shall consist of the following voting members: The executive director or chief staff person of the State Employees Insurance Board (SEIB) and the Public Education Employees Health Insurance Plan (PEEHIP), the Chair of the Board of Directors of SEIB, the Chair of the Board of Directors of PEEHIP, and the State Health Officer. The Director of the Medicaid Agency may serve in a nonvoting capacity. (c) The board shall promulgate policies to implement this chapter and may hire an executive director and necessary staff to implement and administer this chapter with or without regard to the state Merit System. (d) The board through its executive director may enter into agreements with a prescription drug buying group or manufacturer to negotiate price discounts or rebates on behalf of the board or any participating department or governmental entity. (e) The...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/36-35-3.htm - 2K - Match Info - Similar pages
12-5A-9
Section 12-5A-9 Participation of eligible employees in Employees' Retirement System; creditable service; formal leave accounting system; inclusion in health insurance plan. (a) Class specifications and rates of compensation for employees covered by this chapter, juvenile probation officers, juvenile probation professional staff, and clerical staff, hereafter called "eligible employees," and any future employees occupying those positions shall be established by the Administrative Director of Courts. Notwithstanding the foregoing, the compensation of any employee shall not be diminished as a result of his or her inclusion in the state court system personnel system. (b) Eligible employees included in the state court system personnel system pursuant to this chapter shall, on October 1 of the year their county transitions, be covered by the Employees' Retirement System. An employee who on that date is participating in a local retirement plan other than a unit administered by the Employees'...
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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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