Title 27

The insurance policy shall set forth whether there is an unpaid waiting period and, if so, the terms and conditions of the unpaid waiting period, which may include, but are not limited to, all of the following: (1) Whether the waiting period runs over a consecutive calendar day p…

(a) The insurance policy shall set forth all of the following: (1) The amount of benefits that will be paid for covered family leave reasons. (2) The definition of the wages or other income upon which the amount of family leave benefits will be based. (3) How the wages or other i…

Eligibility for family leave benefits under this article may be limited, excluded, or reduced, but any limitations, exclusions, or reductions shall be set forth in the insurance policy. Permissible limitations, exclusions, or reductions may include, but are not limited to, any of…

Family leave benefits provided under this article shall be paid periodically and promptly as provided in Section 27-19-11 except as to a contested period of family leave and subject to any of the provisions of Section 27-19-158. (Act 2023-112, §1.)

(a) Premiums for policies or riders providing paid family leave benefits in accordance with state disability income insurance law shall be calculated in accordance with applicable state insurance law. (b) Insurance policies issued pursuant to this article may offer coverage for p…

(a) This article shall be known and may be cited as the Health Savings Account State-Federal Regulatory Coordination Act. (b) The purpose of this article is to protect the efficacy of Health Savings Account (HSA) qualified plans via a legislative exception or safe harbor from any…

This chapter shall apply to health insurance and employee benefit plans providing for dental care services. (Acts 1984, No. 84-411, p. 960, §1.)

It shall be the duty and responsibility of the Commissioner of Insurance to enforce the provisions of this chapter. (Acts 1984, No. 84-411, p. 960, §9.)

Each willful violation of the provisions of this chapter shall be punishable as provided in Section 27-1-12. (Acts 1984, No. 84-411, p. 960, §10.)

(a) As used in this section, 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 contrac…

As used in this chapter, the following terms shall have the respective meanings herein set forth, unless the context shall otherwise require: (1) ALABAMA INSURANCE CODE. Title 27 of the Code of Alabama 1975. (2) INSURER. Such term shall have the meaning ascribed in Section 27-1-2…

No health insurance policy or employee benefit plan which is delivered, renewed, issued for delivery, or otherwise contracted for in this state shall: (1) Prevent any person who is a party to or beneficiary of any such health insurance policy or employee benefit plan from selecti…

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 limit…

Any provision in a health insurance policy or employee benefit plan which is delivered, renewed, issued for delivery, or otherwise contracted for in this state which is contrary to this chapter shall to the extent of such conflict be void. (Acts 1984, No. 84-411, p. 960, §4.)

The provisions of this chapter do not mandate that any type of benefits for dental care expenses be provided by a health insurance policy or an employee benefit plan. (Acts 1984, No. 84-411, p. 960, §5.)

The provisions of this chapter do not prohibit the following conduct and shall be construed to provide that: (1) A dentist may contract directly with a patient for the furnishing of dental care services to said patient as may be otherwise authorized by law; (2) Any person providi…

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.)

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…

Group disability insurance is hereby declared to be that form of disability insurance covering groups of persons as defined in this section, with or without one or more members of their families or one or more of their dependents, or covering one or more members of the families o…

Each such group disability insurance policy shall contain in substance the following provisions: (1) A provision that, in the absence of fraud, all statements made by applicants, or the policyholders or by an insured person shall be deemed representations and not warranties and t…

Any group disability policy may, on request by the group policyholder, provide that all, or any portion, of any indemnities provided by any such policy on account of hospital, nursing, medical, or surgical services may, at the insurer’s option, be paid directly to the hospital or…

Blanket disability insurance is hereby declared to be that form of disability insurance covering groups of persons as enumerated in one of the following subdivisions: (1) Under a policy or contract issued to any common carrier or to any operator, owner, or lessee of a means of tr…

Any insurer authorized to write disability insurance in this state shall have the power to issue blanket disability insurance. No such blanket policy may be issued or delivered in this state unless a copy of the form thereof shall have been filed in accordance with Section 27-14-…

An individual application shall not be required from a person covered under a blanket disability policy or contract, nor shall it be necessary for the insurer to furnish each person a certificate. (Acts 1971, No. 407, p. 707, §463.)

All benefits under any blanket disability policy shall be payable to the person insured, or to his employer, or to his designated beneficiary or beneficiaries or to his estate; except, that if the person insured be a minor or mental incompetent, such benefits may be made payable …

The following words and phrases used in this chapter, and others evidently intended as the equivalent thereof, shall, in the absence of clear implication otherwise, be given the following respective interpretations herein: (1) ALCOHOLISM. A chronic disorder or illness in which th…

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 p…

The benefits to be offered under this chapter shall include inpatient or residential treatment rendered to the insured, subscriber or other person covered, at a state licensed hospital or at a short term residential alcoholism treatment facility or detoxification facility duly li…

When benefits are provided under this chapter, the benefits shall provide for a minimum of 30 days of inpatient treatment or its equivalent per calendar year with the equivalency to be computed based on a formula which equates two days of treatment in a short term residential alc…

The Legislature of Alabama takes cognizance of the existence of many Alabama citizens who are unable to obtain adequate health care protection by reason of economic, physical, or other related causes. It is the purpose of the Legislature to provide adequate health care protection…

Any insurer authorized and licensed to engage in the business of health insurance in this state may join with one or more other such insurers to offer to any resident of this state, who meets the qualifications established by the commissioner, insurance against major financial lo…

Each insurer or association electing to come under the provisions of this chapter shall charge the same premium for the same insurance coverage and be allowed the same percentage for expense of administration. Such premium rate and percentage for administration expense shall be d…

The premiums collected under the provisions of the health care plan are hereby exempt from the payment of premium tax under Chapter 4 of this title. Any losses suffered as a direct result of operation under the plan by those organizations electing to join and operate under the he…

(a) The commissioner shall set up standards and promulgate regulations concerning the qualifications of those Alabama citizens entitled to utilize this plan, and no insurer or association operating under the plan shall allow anyone to be insured under the plan unless that person …

This chapter shall be known as the Alabama Health Care Plan and may be referred to by that designation. (Acts 1971, No. 501, p. 1218.)

As used in this chapter, the following terms shall have the following meanings, respectively: (1) AGENT. 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)(1) Every health maintenance organization shall establish and maintain a complaint system which has been approved by the commissioner, after consultation with the State Health Officer, to provide reasonable procedures for the resolution of written complaints initiated by enrol…

With the exception of investments made in accordance with subdivisions (a)(1), (a)(2), (a)(5), and subsection (b) of Section 27-21A-4, the funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of this state for …

(a) Unless otherwise provided below, each health maintenance organization shall deposit with the commissioner, or with any organization or trustee acceptable to him through which a custodial or controlled account is utilized, cash, securities, or any combination of these or other…

(a) No health maintenance organization, or representative thereof, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form or evidence of coverage which is deceptive. For purposes of this chapter:…

(a) Unless exempted pursuant to subsection (c), health maintenance organizations in this state shall only solicit enrollees or otherwise market their services through producers duly licensed in accordance with Chapters 7 and 8A of this title. (b) The commissioner shall, after not…

(a) An insurance company licensed in this state, or a health care service plan authorized to do business in this state, may either directly or through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of this chapter. Notwithsta…

(a) The commissioner may make an examination of the affairs of any health maintenance organization and providers with whom such organization has contracts or agreements as often as is reasonably necessary for the protection of the interests of the people of this state, but not le…

(a) The commissioner in consultation with and with the approval of the State Health Officer, where necessary, may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if he finds that any of the following conditions exist: …

(a) Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the commissioner pursuant to the law governing …

The commissioner may, after notice and hearing, promulgate reasonable rules and regulations, in accordance with Section 27-2-17, as are necessary or proper to carry out the provisions of this chapter. The State Health Officer may promulgate such rules and regulations in accordanc…