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11-91A-8
Section 11-91A-8 Awarding of contracts. (a) Before entering into any contract or contracts
for a carrier or third party administrator, the board shall solicit competitive proposals
from companies or agencies qualified to administer or offer plans for group health care coverage.
The board shall carefully evaluate all proposals received and award the contract or contracts
to the most qualified company or agency taking into consideration all relevant factors, including,
but not limited to, the following: The benefits offered; the proposed administrative costs
and the costs to be incurred by the employer participant and its employees, retirees, and
dependents; and the experience of the companies or agencies submitting proposals. In evaluating
these factors, the board may employ the services of impartial professional insurance analysts
or actuaries. The contract or contracts executed by the board with the selected carrier or
third party administrator shall be a contract to offer coverage to...
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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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19-105.htm - 11K - Match Info - Similar pages
27-19-28
Section 27-19-28 Exclusion of hospitalization benefits for mental patients in tax-supported
institutions. (a) No policy of health, sickness, or accident insurance delivered, or issued
for delivery, in this state, including both individual and group policies, which provide coverage
for psychiatric treatment or mental illness shall exclude hospitalization benefits for mental
patients in tax-supported institutions of the State of Alabama, or any county or municipality
thereof. (b) The provisions of this section shall not apply to any policy of insurance in
effect prior to September 20, 1971, nor shall the provisions of this section apply to any
employee benefit plan providing hospital benefits for mental patients where such employee
benefit plan is established by the employer and contributions to the plan are provided by
the employer and the employee, or either of them, and such plan is not evidenced by individual,
or group or blanket policies of health, sickness, or accident insurance...
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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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36-29-17
Section 36-29-17 Election by employees and officers of Alabama Sports Hall of Fame Board to
receive coverage. (a) Notwithstanding the provisions of Section 36-29-1, an employee or executive
officer of the Alabama Sports Hall of Fame Board and his or her dependents shall be eligible
for coverage under the State Employees' Health Insurance Plan and upon the expiration of the
employment may continue the coverage for a maximum of 36 months. (b) Preexisting conditions
shall not be covered until the insured has been covered under the plan for a period of 12
months. An employee enrolling within 30 days of August 7, 1995 or within 30 days of the beginning
of a calendar year thereafter shall not be subject to this limitation of benefits. A preexisting
condition is a condition for which the insured or their covered dependent received medical
treatment, advice, or consultation, or received a prescribed medication within 12 months of
the effective date of the insured's coverage under the plan. (c)...
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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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16-22-17
Section 16-22-17 Payroll deductions for participation in statewide programs. (a) When used
in this section, the following terms shall have the following meanings, respectively: (1)
EMPLOYEE. Any person employed full-time as provided by law by those employers enumerated in
this section and adult bus drivers. (2) EMPLOYER. All public city and county boards of education;
the Board of Trustees of the Alabama Institute for Deaf and Blind; the Alabama Youth Services
Department District Board in its capacity as the Board of Education for the Youth Services
Department District; the Board of Directors of the Alabama School of Fine Arts; the Board
of Trustees of the Alabama High School of Mathematics and Science; the State Board of Education
as applied to the payroll office of two-year postsecondary education institutions; and the
Board of Trustees of Alabama A and M University. (3) PROFESSIONAL ORGANIZATION or ORGANIZATION.
The employees' local professional organization representing the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/16-22-17.htm - 4K - Match Info - Similar pages
36-29-14.1
Section 36-29-14.1 Election by soil and water conservation districts to receive coverage for
officers and employees. (a) The governing body of any county soil and water conservation district
may, by resolution legally adopted to conform to rules prescribed by the State Employees'
Insurance Board, elect to have its officers and employees who are full-time employees working
at least a 40-hour work week and its retiring employees who worked full time at least a 40-hour
work week during their active employment become eligible to participate in the State Employees'
Health Insurance Plan. The term "officers" and "employees" as used in
this section shall include those persons appointed or employed by the individual officers
and performing their duties in public offices, but shall not include members of soil and water
conservation district boards, known as district supervisors who are expressly prohibited from
participating in said health insurance plan. (b) Each employee who is covered by the...
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27-12A-1
Section 27-12A-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) COMMISSIONER. The Alabama Commissioner of Insurance or his or her designee.
(2) DEPARTMENT. The Alabama Department of Insurance. (3) INSURANCE. As defined in Section
27-1-2, and specifically including any contract, arrangement, or agreement, in which one undertakes
to do any one of the following: a. Pay or indemnify another as to loss from certain contingencies
called risks. b. Pay or grant a specified amount or determinable benefit to another in connection
with ascertainable risk contingencies. c. Pay an annuity to another. d. Act as surety. For
the purposes of this chapter, insurance also includes any health benefit plan as defined in
Section 27-53-1. (4) INSURANCE PRODUCER or PRODUCER. As defined in Section 27-7-1. (5) INSURER.
A person entering into agreements, contracts of insurance, arrangements, or reinsurance, or
a health benefit plan, or a group health plan as...
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27-21A-1
Section 27-21A-1 Definitions. As used in this chapter, the following terms shall have the following
meanings, respectively: (1) AGENT. A person who is appointed or employed by a health maintenance
organization and who engages in solicitation of membership in such organization. This definition
does not include a person enrolling members on behalf of an employer, union, or other organization.
(2) BASIC HEALTH CARE SERVICES. Emergency care, inpatient hospital and physician care, and
outpatient medical services. (3) COMMISSIONER. The Commissioner of Insurance. (4) ENROLLEE.
An individual who is enrolled in a health maintenance organization. (5) EVIDENCE OF COVERAGE.
Any certificate, agreement, or contract issued to an enrollee setting out the coverage to
which he is entitled. (6) HEALTH CARE SERVICES. Any services included in the furnishing to
any individual of medical or dental care, or hospitalization or incident to the furnishing
of such care or hospitalization, as well as the...
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