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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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27-7-1
Section 27-7-1 Definitions. For the purposes of this chapter, the following terms shall have
the meanings respectively ascribed to them by this section: (1) BUSINESS ENTITY. A corporation,
association, partnership, limited liability company, limited liability partnership, or other
legal entity. (2) COMMISSIONER. The Alabama Commissioner of Insurance. (3) HOME STATE. The
District of Columbia and any state or territory of the United States in which an insurance
producer maintains his or her principal place of residence or principal place of business
and is licensed to act as an insurance producer. (4) INSURANCE. As defined in Section 27-1-2.
(5) INSURANCE PRODUCER or PRODUCER. A person required to be licensed under the laws of this
state to sell, solicit, or negotiate insurance. (6) INSURER. As defined in Section 27-1-2.
For the purposes of this chapter, insurer shall also mean an insurance company licensed pursuant
to Chapter 3, commencing with Section 27-3-1 of this title; a health...
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34-23-184
Section 34-23-184 Audit procedures; report. (a) The entity conducting an audit shall follow
these procedures: (1) The pharmacy contract shall identify and describe in detail the audit
procedures. (2) The entity conducting the on-site audit shall give the pharmacy written notice
at least two weeks before conducting the initial on-site audit for each audit cycle. If the
pharmacy benefit manager does not include their auditing guidelines within their provider
manual, then the notice must include a documented checklist of all items being audited and
the manual, including the name, date, and edition or volume, applicable to the audit and auditing
guidelines. For on-site audits a pharmacy benefit manager shall also provide a list of material
that is copied or removed during the course of an audit to the pharmacy. The pharmacy benefit
manager may document this material on either a checklist or on an audit acknowledgement form.
The pharmacy shall produce any items during the course of the...
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25-4-78
Section 25-4-78 Disqualifications for benefits. An individual shall be disqualified for total
or partial unemployment for any of the following: (1) LABOR DISPUTE IN PLACE OF EMPLOYMENT.
For any week in which an individual's total or partial unemployment is directly due to a labor
dispute still in active progress in the establishment in which he or she is or was last employed.
For the purposes of this section only, the term labor dispute includes any controversy concerning
terms, tenure, or conditions of employment, or concerning the association or representation
of persons in negotiating, fixing, maintaining, changing, or seeking to arrange terms or conditions
of employment, regardless of whether the disputants stand in the proximate relation of employer
and employee. This definition shall not relate to a dispute between an individual worker and
his or her employer. (2) VOLUNTARILY QUITTING WORK. If an individual has left his or her most
recent bona fide work voluntarily without good...
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22-6-163
Section 22-6-163 Legislative findings; rules; collaboration; approval of agreements and contracts;
state action immunity; confidentiality of records; additional duties. (a) The Legislature
declares that collaboration among public payers, private health carriers, third party purchasers,
and providers to identify appropriate service delivery systems and reimbursement methods in
order to align incentives in support of integrated and coordinated health care delivery is
in the best interest of the public. Collaboration pursuant to this article is to provide quality
health care at the lowest possible cost to Alabama citizens who are Medicaid eligible. The
Legislature, therefore, declares that this health care delivery system affirmatively contemplates
the foreseeable displacement of competition, such that any anti-competitive effect may be
attributed to the state's policy to displace competition in the delivery of a coordinated
system of health care for the public benefit. In furtherance of...
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22-6-233
Section 22-6-233 Legislative findings; certification of collaborators; powers of Medicaid Agency;
state action immunity. (a) The Legislature declares that collaboration among public payers,
private health carriers, third party purchasers, and providers to identify appropriate service
delivery systems and reimbursement methods in order to align incentives in support of integrated
and coordinated health care delivery is in the best interest of the public. Collaboration
pursuant to this article is to provide quality health care at the lowest possible cost to
Alabama citizens who are Medicaid eligible. The Legislature, therefore, declares that this
health care delivery system affirmatively contemplates the foreseeable displacement of competition,
such that any anti-competitive effect may be attributed to the state's policy to displace
competition in the delivery of a coordinated system of health care for the public benefit.
In furtherance of this goal, the Legislature declares its intent...
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27-34-37
Section 27-34-37 Annual statements - Valuation of certificates; reserves. (a) As a part of
the annual statement required under Section 27-34-36, each society shall, on or before March
1, file with the commissioner a valuation of its certificates in force on December 31 last
preceding; provided, however, that the commissioner may, in his discretion for cause shown,
extend the time for filing such valuation for not more than two calendar months. Such report
of valuation shall show, as reserve liabilities, the difference between the present midyear
value of the promised benefits provided in the certificates of such society in force and the
present midyear value of the future net premiums as the same are in practice actually collected,
not including therein any value for the right to make extra assessments and not including
any amount by which the present midyear value of future net premiums exceeds the present midyear
value of promised benefits on individual certificates. At the option of...
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27-60-2
Section 27-60-2 Interstate Insurance Product Regulation Compact. The State of Alabama hereby
agrees to the following interstate compact known as the Interstate Insurance Product Regulation
Compact: ARTICLE I. PURPOSES. The purposes of this compact are, through means of joint and
cooperative action among the compacting states: 1. To promote and protect the interest of
consumers of individual and group annuity, life insurance, disability income, and long-term
care insurance products; 2. To develop uniform standards for insurance products covered under
the compact; 3. To establish a central clearinghouse to receive and provide prompt review
of insurance products covered under the compact and, in certain cases, advertisements related
thereto, submitted by insurers authorized to do business in one or more compacting states;
4. To give appropriate regulatory approval to those product filings and advertisements satisfying
the applicable uniform standard; 5. To improve coordination of...
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8-32-2
Section 8-32-2 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) ADMINISTRATOR. The person designated by a provider to be responsible for the
administration of service contracts or the service contracts plan or to make the filings required
by this chapter. (2) COMMISSIONER. The Commissioner of Insurance of this state. (3) CONSUMER.
A natural person who buys, primarily for personal, family, or household purposes, and not
for resale, any tangible personal property normally used for personal, family, or household
purposes and not for commercial or research purposes. (4) MAINTENANCE AGREEMENT. A contract
of limited duration that provides for scheduled maintenance only. (5) MANUFACTURER. A person
that is one of the following: a. A manufacturer or producer of property that sells the property
under its own name or label. b. A subsidiary of the person who manufactures or produces the
property. c. A corporation which owns at least 80 percent of the...
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16-8-42.1
Section 16-8-42.1 Authority for risk management cooperative. (a) Definitions. For the purpose
of this section, the following terms shall have the meanings subscribed to them by this section:
(1) RISK MANAGEMENT COOPERATIVE. An entity or entities, to be formed by local boards of education
in any combination of 25 or more for the purpose of pooling resources and funds to jointly
purchase insurance or to self-insure such boards of education, their members and employees,
against risks to which they are exposed. (2) MEMBER BOARDS OF EDUCATION. A city board of education,
county board of education, Department of Youth Services School District, Alabama Institute
for Deaf and Blind, State Board of Education or other public education governing board which
elects to pool its resources and funds with one or more other boards of education for the
purpose of forming a risk management cooperative. (b) Boards of education in any combination
of 25 or more may establish a risk management cooperative for...
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