Code of Alabama

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16-44B-1
Section 16-44B-1 Compact. ARTICLE I PURPOSE It is the purpose of this compact to remove barriers
to education success imposed on children of military families because of frequent moves and
deployment of their parents by: A. Facilitating the timely enrollment of children of military
families and ensuring that they are not placed at a disadvantage due to difficulty in the
transfer of education records from the previous school district(s) or variations in entrance/age
requirements. B. Facilitating the student placement process through which children of military
families are not disadvantaged by variations in attendance requirements, scheduling, sequencing,
grading, course content or assessment. C. Facilitating the qualification and eligibility for
enrollment, educational programs, and participation in extracurricular academic, athletic,
and social activities. D. Facilitating the on-time graduation of children of military families.
E. Providing for the promulgation and enforcement of...
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27-1-18
Section 27-1-18 Contract providing for mental health services to entitle insured to reimbursement
for outpatient and inpatient services by qualified psychiatrist or psychologist. (a) Whenever
any group, or blanket hospital or medical expense insurance policy or hospital or medical
service contract issued for delivery in this state provides for the reimbursement of health
or health related services which includes mental health services, and such services are within
the lawful scope of practice of a duly qualified psychiatrist or psychologist, the insured
or other person entitled to benefits under such policy or contract shall be entitled to reimbursement
for outpatient services, and inpatient services if requested by the attending physician, performed
by a duly qualified psychiatrist or psychologist notwithstanding any provisions of the policy
or contract to the contrary. (b) For purposes of this section, a duly qualified psychologist
means, one who is duly licensed or certified at the...
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27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive denials,
adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health benefit
plan that issues or renews any policy of accident or health insurance providing benefits for
medical or hospital expenses for its insured persons shall pay for services rendered by Alabama
health care providers within 45 calendar days upon receipt of a clean written claim or 30
calendar days upon receipt of a clean electronic claim. If the insurer, health service corporation,
or health benefit plan is denying or pending the claim, the insurer, health service corporation,
or health benefit plan shall, within 45 calendar days for a written claim and 30 calendar
days for an electronic claim, notify the health care provider or certificate holder of the
reason for denying or pending the claim and what, if any, additional information is required
to process the claim. Any undisputed portion of the claim...
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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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27-19A-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, ยง8.)...
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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...
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27-56-2
Section 27-56-2 Definitions. As used in this chapter, 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) EYE CARE PROVIDER. A licensed optometrist or a licensed ophthalmologist. (3)
INSURANCE POLICY, PLAN, OR CONTRACT PROVIDING FOR THIRD-PARTY PAYMENT OR PREPAYMENT OF HEALTH
OR MEDICAL EXPENSES. Includes an individual or group policy for accident or health insurance,
an individual or group hospital or health care service contract, an individual or group health
maintenance organization contract, an organized delivery system contract, or a preferred provider
organization contract, and any other similar policy, plan, or contract. This term shall not
include any employee welfare benefit plan, as defined...
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27-1-19
Section 27-1-19 Reimbursement of health care providers. (a) The insured, or health or dental
plan beneficiary may assign reimbursement for health or dental care services directly to the
provider of services. Health benefits include medical, pharmacy, podiatric, chiropractic,
optometric, durable medical equipment, and home care services. The company or agency, when
authorized by the insured, or health or dental plan beneficiary, shall pay directly to the
health care provider the amount of the claim, under the same criteria and payment schedule
that would have been reimbursed directly to the contract provider, and any applicable interest.
This amount only applies to assigned claims. Any company or agency making a payment to the
insured, or health or dental plan beneficiary, after the rights of reimbursement have been
assigned to the provider of services, shall be liable to the provider for the payment. If
the company or agency fails to reimburse the provider in accordance with the terms...
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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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27-1-17.1
Section 27-1-17.1 Payment of providers through electronic funds transfer methods. (a) As used
in this section, the following words shall have the following meanings: (1) ACH ELECTRONIC
FUNDS TRANSFER. An electronic funds transfer through the Health Insurance Portability and
Accountability Act (HIPPA) standard Automated Clearing House network. (2) COVERED HEALTH CARE
PROVIDER. A physician as defined in Section 34-24-50.1; a dentist as defined in Section 34-9-1;
a chiropractor as defined in Section 34-24-120; an individual engaged in the practice of optometry
as defined in Section 34-22-1; other licensed health care professionals as defined in Title
34; a hospital as defined in Section 22-21-20; and a health care facility, or other provider
who or that is accredited, licensed, or certified and who or that is performing within the
scope of that accreditation, license, or certification. (3) HEALTH INSURANCE PLAN. Any hospital
and medical expense incurred policy, health maintenance...
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