Alabama Administrative Code

This chapter shall become effective January 1, 1998, and shall apply to policies sold after December 31, 1997. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-114-.14 New Rule: Filed October 15, 1996; effective January 1, 1998. Filed for codification in the Alab…

This chapter is adopted pursuant to Sections 27-2-17 and 27-52-1, et seq., Code of Ala. 1975. This chapter shall be known and may be cited as the Alabama Health Insurance Plan chapter. Author: Elizabeth Bookwalter, Associate Counsel Notes Ala. Admin. Code r. 482-1-115-.01 New Rul…

The purpose and intent of this chapter is to implement the Alabama Health Insurance Plan as created in the Act. Author: Elizabeth Bookwalter, Associate Counsel Notes Ala. Admin. Code r. 482-1-115-.02 New Rule: July 23, 1997; effective August 30, 1997. Revised: November 13, 2002; …

The following definitions shall apply for purposes of this chapter: (a) BENEFIT PLAN or PLANS. The major medical indemnity plan or plans and the managed care plan or plans offered under the Plan. (b) BOARD. The Board of Directors of the Plan. The Board shall be the Plan Administr…

(1) The Plan shall operate subject to the supervision and control of a Board of Directors. The Board, which shall be the Plan Administrator, shall consist of the Commissioner, or his or her designated representative, who shall serve as an ex officio member of the Board and shall …

(1) Any individual person, who is and continues to be a resident and who has prior continuous coverage shall be eligible for Plan coverage if evidence is provided of all of the following: (a) That prior coverage was not terminated because of fraud or nonpayment of premium by the …

(1) The Board shall select an Operations Administrator to conduct the daily operations of the Board. In so doing, the Board may select an agency of the State of Alabama as Operations Administrator or may utilize a competitive bidding process for private entities. If a competitive…

(1) The Board shall select a Claims Administrator or Administrators through a competitive bidding process to process claims of members of the benefit plan or plans and other administrative duties as determined by the Board. The Board shall evaluate bids submitted based on criteri…

(1) Premiums. (a) The Board shall establish premium rates for the Plan as provided in Subparagraph (b). Separate schedules of premium rates based on age, sex and geographical location may apply for individual risks. Premium rates and schedules shall be submitted to the Commission…

(1) The Plan shall make available health care coverage consistent with the requirements of the Act and the federal Health Insurance Portability and Accountability Act of 1996. In particular, the Plan will make available two or more policy forms, at least one of which provides cov…

All bylaws, policies, guidelines or directives issued by the Board related to the delivery of medical services, including but not limited to those items specified in Subparagraphs (h), (m), (n), and (o) of Paragraph (7) of Rule 482-1-115-.04 and in Rule 482-1-115-.09, shall be pr…

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

The provisions of this chapter shall become effective upon its approval by the Commissioner of Insurance, with the concurrence of the State Board of Health, and upon its having been on file as a public document in the office of the Secretary of State for ten days. Author: Elizabe…

This regulation is adopted pursuant to Sections 27-2-17 and 27-52-20, et seq., Code of Ala. 1975. This Regulation shall be known and may be cited as the Alabama Small Employer Allocation Program Regulation. Author: Reyn Norman, Associate Counsel Notes Ala. Admin. Code r. 482-1-11…

The purpose and intent of this Regulation is to enhance the availability of health insurance coverage to small employers regardless of their health status or claims experience, to prevent abusive rating practices, to prevent segmentation of the health insurance market based upon …

(a) This Regulation shall apply to any health benefit plan that provides coverage to the employees of a small employer in this state if any of the following conditions are met: (1) Any portion of the premium or benefits is paid by or on behalf of the small employer. (2) An eligib…

The following definitions shall apply for purposes of this Regulation: (1) Actuarial certification. A written statement signed by a member of the American Academy of Actuaries or other individual acceptable to the commissioner that a small employer carrier is in compliance with t…

(a) For rating periods beginning on and after the effective date of this regulation, premium rates for health benefit plans subject to this Regulation shall be subject to all of the following provisions: (1) The small employer carrier shall develop its base rate or rates utilizin…

(a) A health benefit plan subject to this Regulation shall be renewable with respect to all eligible employees or dependents, at the option of the small employer, except in any of the following cases:(1) Nonpayment of the required premiums. (2) Fraud or intentional misrepresentat…

(a) (1) Every small employer carrier shall, as a condition of transacting business in this state with small employers, actively offer to small employers all health benefit plans it actively markets to small employers in this state. A small employer carrier shall be considered to …

(a) Subject to Subdivision (1) of Subsection (a) of Section 7, each small employer carrier shall actively market all health benefit plans sold by the carrier to eligible small employers in the state. (b) (1) Except as provided in Subdivision (2), no small employer carrier or prod…

(a) Within thirty (30) days after the effective date of the Act, each carrier providing health benefit plans in this state shall make a filing with the Commissioner indicating whether the carrier intends to operate as a small employer carrier in this state under the terms of this…

(a) (1) Except as provided in Subdivision (2), a small employer carrier shall, as a condition of continuing to transact business in this state with small employers, offer to provide a health benefit plan as described in Subsection (c) to any small employer whose coverage was term…

A restrictive rider, endorsement or other provision that would violate the provisions of Paragraph b. of Subdivision (5) of Subsection (c) of Section 7 of this Regulation and that was in force on the effective date of this regulation may not remain in force beyond the first anniv…

If any provision of this Regulation or the application thereof to any person or circumstances is for any reason held to be invalid, the remainder of the Regulation and the application of its provisions to other persons or circumstances shall not be affected thereby. Author: Reyn …

The provisions of this Regulation shall become effective October 1, 2001, upon its approval by the Commissioner of Insurance, with the concurrence of the State Board of Health, and upon its having been on file as a public document in the office of the Secretary of State for ten d…

This chapter is adopted pursuant to Section 27-2-17, Code of Ala. 1975. This chapter shall be known and may be cited as the Alabama Credit Life and Disability Insurance Regulation. Author: Reyn Norman, Associate Counsel Notes Ala. Admin. Code r. 482-1-117-.01 New Rule: October 14…

The purpose of this chapter is to: establish guidelines for insurers and creditors that offer credit life insurance and credit disability insurance, as defined in this chapter, provided by the creditors to debtors; and interpret and implement certain Alabama statutes, including, …

(1) All credit life insurance and credit disability insurance issued or sold in connection with credit transactions primarily for personal, family or household purposes shall be subject to the provisions of this chapter, except: (a) Insurance sold as an isolated transaction on th…

The following definitions shall apply for purposes of this chapter: (a) Affiliate. As defined in Section 27-29-1, Code of Ala. 1975. (b) Closed-end credit. A credit transaction that does not meet the definition of open-end credit. (c) Commissioner. The Alabama Commissioner of Ins…

(1) The types of consumer credit insurance defined in Rule 482-1-117-.04 may each be written separately, jointly, or in combination with other types of credit insurance on an individual policy or group policy basis, whether or not the other types of credit insurance are subject t…

(1) Credit Life Insurance. (a) The maximum amount of credit life insurance that may be written in connection with a consumer loan or consumer credit sale which is to be repaid in substantially equal installments shall at no time exceed the greater of the following: 1. The approxi…

(1) Effective Date of Coverage. (a) For consumer credit insurance made available to and elected by the debtor before or contemporaneous with a credit transaction to which the insurance relates, the term of the insurance shall, subject to acceptance by the insurer, commence on the…

(1) All consumer credit insurance shall be evidenced by an individual policy or a group certificate of insurance which shall be delivered to the debtor. (2) The individual policy or group certificate shall, in addition to other requirements of law, set forth all of the following:…

(1) All policies, certificates of insurance, notices of proposed insurance, applications for insurance, endorsements and riders delivered or issued for delivery in this state, and the schedules of premium rates pertaining thereto, shall be filed with the Commissioner before being…

(1) All schedules of rates, premiums or identifiable charges on all consumer credit insurance issued and sold in this State shall be filed for informational purposes with the Commissioner by the concerned insurer. An insurer may revise its schedules of rates or premiums from time…

(1) The requirements of the consumer credit insurance law that refund formulas be filed with the Commissioner shall be considered fulfilled if the refund formulas are set forth in the individual policy or group certificate filed with the Commissioner. (2) Each individual policy o…

(1) All policies of consumer credit insurance shall be delivered or issued for delivery in this state only by an insurer authorized to engage in the business of insurance in this state. Only a life insurer authorized for life insurance in this state can issue credit life insuranc…

(1) All claims shall be promptly reported to the insurer or its designated claim representative, and the insurer shall maintain adequate claim files. All claims shall be settled as soon as reasonably possible and in accordance with the terms of the insurance contract. (2) All cla…

Except as otherwise prohibited by law, duties imposed upon an insurer within this chapter may be carried out by a creditor if the creditor is acting on behalf of the insurer, but nothing herein shall be deemed to require a creditor to carry out a duty imposed upon an insurer or t…

(1) All policies of consumer credit insurance shall be solicited, negotiated and effectuated by duly licensed agents and no commission or other compensation shall be paid in connection with such insurance to any person other than such licensed agent. (2) As used in this rule, the…

(1) Termination of Group Consumer Credit Insurance Policy. (a) If a debtor is covered by a group consumer credit insurance policy providing for the payment of single premiums to the insurer, or any other premium payment method which prepays coverage beyond one month, then provisi…

(1) Premium rates for Credit Disability Insurance shall be filed with the Commissioner and the creditor (person, firm or corporation) shall not add any additional charge to the premium set by the insurance company and on file with the Commissioner, for coverage to the insured bor…

(1) Use of Maximum Rates. An insurer that files rates or has rates on file that are equivalent to the maximum rates promulgated by the Superintendent may use those rates without further proof of their reasonableness. (2) Use of Rates Higher Than Maximum Rates. In accordance with …

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

This chapter shall be effective on November 1, 1999, 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; provided, however, that, to the extent not otherwise addressed in t…

This chapter is adopted pursuant to Sections 27-2-17, 27-2-20, 27-2-21, and 27-21A-19, Code of Ala. 1975. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-118-.01 New: September 21, 1999; effective October 1, 1999. Filed for codification in the Alabama Administra…

The purpose of this chapter is to describe the requirements for record-keeping for insurance companies and related entities doing business in this state and responses to inquiries from examiners. Author: Commissioner of Insurance Notes Ala. Admin. Code r. 482-1-118-.02 New: Septe…

Every insurer, which term shall include every domestic insurer, foreign insurer, health care services corporation, health maintenance organization, prepaid dental plan, managing general agent or any other legal entity regulated by the Insurance Code and licensed to do business in…

Photographs, microfilms or other image-processing reproductions of records shall be equivalent to the originals and may be certified as same in actions or proceedings before the Department of Insurance unless inconsistent with Chapter 482-1-065. However, the maintenance or record…