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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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27-19A-8
Section 27-19A-8 Plans not in conformance with chapter unlawful. It shall be unlawful for any
insurer or any person to provide any health insurance policy or employee benefit plan providing
for dental care services that does not conform to the provisions of this chapter. (Acts 1984,
No. 84-411, p. 960, §7.)...
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16-25A-45
Section 16-25A-45 Rules and regulations; contracts for services. The board shall promulgate
rules and regulations to implement the flexible benefits program, including, but not limited
to, setting policies and requirements concerning the administration of employee payments,
amounts deducted pursuant to salary reduction agreements, and advances from the Public Employees'
Health Insurance Plan and appropriations, if any. The board may contract for services with
the Flexible Employees' Benefit Board for the first year of operation of the plan regarding
pretax deductions for the payment of employee health insurance premium payments authorized
by the board and may contract for services with the Flexible Employees' Benefit Board or other
entities in subsequent years. The board may contract for necessary services to implement the
flexible benefits program including, but not limited to, the administration of salary reduction
agreements and non-health insurance premium components of the...
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27-46-1
Section 27-46-1 Reimbursement or payment for services. Notwithstanding any other provision
of law, when any contract or plan of health insurance, or any plan or agreement for health
care services provides for the reimbursement or payment for services which are within the
scope of practice of registered nurses who have passed or who are qualified to take the national
certification examination for the specialty practice of nurse anesthetist as recognized by
the Alabama Board of Nursing, then the insured, or any other person covered by the policy,
plan, contract, or certificate shall be entitled to reimbursement or payment for such services
performed by the certified registered nurse anesthetist, and said certified registered nurse
anesthetist shall be entitled to direct reimbursement by the insurer, unless the certified
registered nurse anesthetist is employed by contract with a group practice of anesthesiologist
or a hospital, then such services shall be reimbursed through the employer....
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22-21-361
Section 22-21-361 Definitions. The following terms shall have the meanings respectively ascribed
by this section unless the context clearly indicates otherwise: (1) COMMISSIONER. The commissioner
of insurance of this state. (2) DENTAL SERVICE PLAN or PLAN. Any plan or other arrangement
whereby dental services are provided in whole or in part through a dental service corporation
by dentists participating in the plan to provide dental services to those members of the public
who become subscribers to the plan under a contract with such corporation. The terms "dental
service plan" or "plan" do not include an insurer authorized by the insurance
department to transact insurance in this state or to a nonprofit health insurance plan organized
pursuant to Section 10-4-100, or to any policy of insurance or contract which includes dental
benefits issued by such insurer or nonprofit health insurance plan. (3) DEPARTMENT. The Department
of Insurance. (4) LICENSE. The certificate of authority issued...
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27-19-39
Section 27-19-39 Policies, etc., providing for reimbursement for visual service. Whenever any
policy of insurance or any medical service plan or hospital service contract or hospital and
medical service contract provides for reimbursement for any visual service in Alabama which
is within the lawful scope of practice of a duly licensed optometrist, as defined in Section
34-22-1, the insured or other person entitled to benefits under such policy shall be entitled
to reimbursement for such services, whether such services are performed by a duly licensed
physician or by a duly licensed optometrist, whichever the insured selects, notwithstanding
any provision to the contrary in any statute or in such policy, plan, or contract. Duly licensed
optometrists shall be entitled to participate in such policies, plans, or contracts providing
for visual services to the same extent as fully licensed physicians. (Acts 1967, No. 508,
p. 1224.)...
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27-45-7
Section 27-45-7 Nonconforming policies and plans not to be approved for sale. The Commissioner
of Insurance shall not approve for sale in this state any health insurance policy or employee
benefit plan providing for pharmaceutical services, including without limitation, prescription
drugs, which does not conform to the provisions of this article or to the provisions of Sections
27-14-8 and 27-14-9. (Acts 1988, No. 88-379, p. 565, §7.)...
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27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases shall
have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health. (2)
ENROLLEE. An individual who has contracted for or who participates in coverage under an insurance
policy, a health maintenance organization contract, a health service corporation contract,
an employee welfare benefit plan, a hospital or medical services plan, or any other benefit
program providing payment, reimbursement, or indemnification for health care costs for the
individual or the eligible dependents of the individual. (3) PROVIDER. A health care provider
duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system for prospective
and concurrent review of the necessity and appropriateness in the allocation of health care
resources and services given or proposed to be given to an individual within this state. The
term does not include elective requests for clarification of...
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16-25A-9
Section 16-25A-9 Eligible employees covered. (a) All employees and, under certain conditions,
retired employees as defined in Section 16-25A-1 at the time of adoption and execution by
the board of a contract or other arrangement providing for group health insurance plans and
who are eligible for coverage under the provisions of this article and the rules and regulations
of the board adopted pursuant thereto shall have the option to be included in such coverage
of the plan and shall have an option as to whether they will subscribe to such coverage for
their dependents, such option to be exercised in the manner and within the time limitation
prescribed by the board. (b) All persons who become employees, as defined by the terms of
this article and the rules and regulations promulgated by the board pursuant thereto, shall
become eligible for membership in the group health insurance plan offered by their employing
board and shall have an option as to whether they will subscribe to such...
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27-1-20
Section 27-1-20 Patient Right to Know Act. (a) This section shall be known and may be cited
as the "Patient Right to Know Act." (b) As used in this section, unless the context
clearly indicates otherwise, the following words shall have the following meanings: (1) ENROLLEE.
A person who purchases individual health care coverage or an employer who purchases a group
health care plan. (2) PROVIDER. A physician, dentist, podiatrist, pharmacist, optometrist,
psychologist, clinical social worker, advanced nurse practitioner, registered optician, licensed
professional counselor, physical therapist, and chiropractor. (c)(1) All persons, firms, corporations,
associations, health maintenance organizations, health insurance services, or preferred provider
organizations, any employer-sponsored health benefit plan, or any similar organization or
entity, providing health, accident, or dental insurance coverage, either directly or indirectly,
shall provide an enrollee with a written description of the...
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