Alabama Administrative Code

Rates must not be excessive, inadequate or unfairly discriminatory. Rates may not be changed without prior approval of the Commissioner and without thirty (30) days notice of the proposed change given to enrollees. It is therefore recommended that the proposed rate be filed as fa…

Advertising includes printed and published material, descriptive literature and sales aids, sales talks and sales materials, booklets, forms and pamphlets, illustrations, depictions and form letters, newspaper, radio, television or direct mail advertising. Advertising must be tru…

(1) The manner of merchandising enrollee contracts must be fully explained by the HMO prior to certification and any subsequent changes in this area must be approved by the Commissioner before use. All salesmen or representatives of the HMO engaged in soliciting enrollees are bou…

For individual contracts, an enrollee may, if the contract is not satisfactory for any reason, return it within ten days of its receipt, and receive a full refund of any deposit paid. This right of return shall not act as a cure for misleading or deceptive advertising or selling …

Every contract, rider, endorsement, certificate, application or other form to be used or issued must be filed by the HMO for approval by the Commissioner. The Commissioner shall disapprove any form, or withdraw previous approval thereof if the form: (1) In any respect is in viola…

Each HMO shall furnish to the Commissioner, with a copy to the Department of Public Health, an accurate report annually on or before the first day of March providing the information required by law for the preceding year, in the convention form as approved by the National Associa…

Checks for the original filing or amendments thereto, and for filing of each annual report shall be made payable to the "Commissioner of Insurance." All expenses of examination, travel and per diem charges authorized by Alabama Insurance Regulation Chapter 482-1-003 entitled "Per…

No name other than that approved by the Commissioner may be used. The name of the HMO may not be changed without prior approval of the Commissioner. Any name which is misleading as to the purpose or type of organization or which is deceptively similar to the name of another licen…

Each HMO which desires to transfer ownership of more than 5% of the stock or ownership interest or control in the HMO shall not do so without first submitting the proposed plan to the Commissioner for review and approval or disapproval in accordance with Section 27-29-3, Code of …

Evidence of the existence of insurance or a plan for self-insurance approved by the Commissioner must be submitted at least 30 days prior to the expiration date of the policy and with each annual report. Unless the Commissioner grants an exemption from requirements of this sectio…

An Alabama domiciled (domestic) HMO shall keep all necessary records in an Alabama location required for the efficient examination of its financial condition and health care delivery system. These records shall include but not be limited to the general ledger and subsidiary ledge…

The initial $100,000 deposit and any subsequent annual deposit requirements of an HMO shall be deposited, through the Commissioner, with the State Treasurer. The deposit shall be in the form of certificates of deposit with solvent, United States banks, or any combination of secur…

Any HMO licensed in Alabama shall, before increasing its service area, make application in duplicate to the State Health Officer and the Commissioner for the expansion of their geographic service area. This application shall include but not be limited to a graphic description in …

All licensed HMO's shall consider claims made under their health care contracts and, if found to be valid and proper, shall pay such claims within forty-five (45) days after the receipt of proof of the fact and amount of loss sustained under such contracts. If reasonable proof is…

If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of this chapter and the application of such provision to other persons or circumstances shall not be affected thereby. Author: Commissione…

The effective date of this chapter is May 8, 1987. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-079-.20 New Rule: Filed April 22, 1987; effective May 8, 1987. Filed for codification in the Alabama Administrative Code by the Department of Insurance on April 23…

The purpose of this chapter is to provide for consistent accounting for liabilities of Health Maintenance Organizations (HMO) licensed in Alabama. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-080-.01 New Rule: Filed April 22, 1987; effective May 8, 1987. Revi…

This chapter is made and promulgated by the undersigned Commissioner pursuant to the authority set forth in Sections 27-21A-19 and 27-2-17 Code of Ala. 1975 and to replace Regulation No. 80 promulgated on October 20, 1988. Author: Commissioner of Insurance Notes Ala. Admin. Code …

Except as otherwise specifically provided, this chapter shall apply to Health Maintenance Organizations licensed in Alabama. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-080-.03 New Rule: Filed April 22, 1987; effective May 8, 1987. Revised: Filed October 3, …

The following are the meanings to be applied to the terms used in this chapter: (1) Uncovered Expenditures. The costs of health care services which are covered by a health maintenance organization, for which an enrollee would also be liable in the event of the organization's inso…

(1) In any determination of the financial condition of a Health Maintenance Organization, capital and liabilities to be charged against its admitted assets shall include: (a) The amount of its capital account which consists of minimum capital stock of $100,000 in the form of paid…

If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of such provision to other persons or circumstances shall not be affected thereby. Author: Commissioner…

The effective date of this chapter is May 1, 1996. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-080-.07 New Rule: Filed April 22, 1987; effective May 8, 1987. Revised: Filed October 3, 1988; effective October 20, 1988. Revised: Filed April 19, 1996; effective…

The purpose of this chapter is to provide for the licensing of sales producers for health maintenance organizations licensed in Alabama. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-081-.01 New Rule: Filed April 22, 1987; effective May 8, 1987. Revised: Filed…

This chapter is made and promulgated by the undersigned Commissioner pursuant to the authority set forth in Sections 27-2-17 and 27-21A-19, Code of Ala. 1975. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-081-.02 New Rule: Filed April 22, 1987; effective May 8…

This chapter shall apply to all Health Maintenance Organizations (HMOs) licensed in Alabama under the authority vested in the Commissioner by Section 27-21A-1 et seq., Code of Ala. 1975. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-081-.03 New Rule: Filed Apr…

PRODUCER. 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 other organization. Author: Commiss…

(1) Any producer who acts as, holds himself out as representing an HMO, or claims to be a producer of the HMO must comply with all the requirements of a disability producer as set forth in Sections 27-7-1 et seq., Code of Ala. 1975, and have a current appointment to represent the…

If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of such provision to other persons or circumstances shall not be affected thereby. Author: Commissioner…

This chapter shall become effective upon its approval by the Commissioner of Insurance and upon its having been on file as a public document in the office of the Secretary of State for ten days. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-081-.07 New Rule: F…

The purpose of this chapter is to provide for the implementation of a health maintenance organization guaranty association which was established under Section 27-21A-12(i), Code of Ala. 1975 and the approval of the operation plan of such organization by the Commissioner. Author: …

This chapter is made and promulgated by the undersigned Commissioner pursuant to the authority set forth in Sections 27-2-17 and 27-21A-19, Code of Ala. 1975. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-082-.02 New Rule: Filed April 22, 1987; effective May 8…

This chapter shall apply to all Health Maintenance Organizations licensed in Alabama under the authority vested in the Commissioner and the State Health Officer by Sections 27-21A-12(i), Code of Ala. 1975. All licensed health maintenance organizations shall be and remain members …

Within one month of the effective date of this chapter and after notice by the Commissioner of the time and place of the organizational meeting, the members of the guaranty association shall elect with the approval of the Commissioner at least five and not more than nine members …

The powers and duties of the association shall be the same as the life and disability guaranty association as enumerated in Sections 27-44-1 et seq. Code of Ala. 1975. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-082-.05 New Rule: Filed April 22, 1987; effect…

If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of such provision to other persons or circumstances shall not be affected thereby. Author: Commissioner…

The effective date of this chapter is May 8, 1987. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-082-.07 New Rule: Filed April 22, 1987; effective May 8, 1987. Filed for codification in the Alabama Administrative Code by the Department of Insurance on April 23…

This chapter is adopted and promulgated by the Commissioner of Insurance pursuant to the provisions of Sections 27-2-17, 27-21A-19, Code of Ala. 1975 which govern the promulgation of insurance regulations by the Commissioner, and 27-21A-12(i), Code of Ala. 1975 which provides tha…

As used in this chapter: (a) ASSOCIATION. The Health Maintenance Organization Guaranty Association created under Section 27-21A-12(i), Code of Ala. 1975. (b) COMMISSIONER. The Commissioner of Insurance of this state. (c) CONTRACTUAL OBLIGATION. Any covered health care services ow…

The Association, acting by and through its Board of Directors, shall have the following powers and duties. (a) Insolvency: If a member HMO becomes an insolvent HMO, as that term is herein defined, the Association shall, subject to any reasonable conditions imposed by the Associat…

(1) For the purpose of providing the funds necessary to carry out the powers and duties of the Association, the Board of Directors shall assess the member HMOs at such time and for such amounts as the Board finds necessary. Assessments shall be due not less than thirty (30) days …

There shall be no liability on the part of and no cause of action of any nature shall arise against any member HMO or its agents or employees, the association or its agents or employees, members of the board of directors, or the representatives of the Commissioner for any action …

With the concurrence of and the order of the proper court, all proceedings in which the insolvent HMO is a party in any court in this state shall be stayed 60 days from the date an order of liquidation, rehabilitation, or conservation is final to permit proper legal action by the…

(1) For the purpose of carrying out its obligations under this Plan, the Association shall be deemed to be a creditor of the insolvent HMO to the extent of assets attributable to covered contracts reduced by any amount collected by the Association as subrogee. All assets of the i…

(1) Any person receiving covered health care services under Section 27-21A-12(i), Code of Ala. 1975 or the Plan shall be deemed to have assigned the rights under the covered evidence of coverage to the Association to the extent of the benefits received because of the Act or the P…

The Association shall be subject to examination and regulation by the Commissioner. The board of directors shall submit to the Commissioner, not later than May 1 of each year, a financial report for the preceding calendar year in a form approved by the Commissioner and a report o…

Pursuant to Section 27-21A-12(i), Code of Ala. 1975 ("the Act"), the HMOs which are authorized by the Commissioner to transact business in the State of Alabama shall be members of the Alabama Health Maintenance Guaranty Association ("the Association"). Each HMO obtaining a certif…

This chapter shall become effective October 20, 1988. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-083-.11 New Rule: Filed October 3, 1988; effective October 20, 1988. Filed for codification in the Alabama Administrative Code by the Department of Insurance on…

If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of such provision to other persons or circumstances shall not be affected thereby. Author: Commissioner…

(Repealed 7/18/05). Notes Ala. Admin. Code r. 482-1-084-.01