Code of Alabama - Title 27: Insurance - Chapter 21A - Health Maintenance Organizations

• Section 27-21A-1 Definitions
  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...
• Section 27-21A-2 Establishment of health maintenance organizations
  (a) Notwithstanding any law of this state to the contrary, any person may apply to the commissioner for and obtain a certificate of authority to...
• Section 27-21A-3 Issuance of certificate of authority
  (a)(1) Upon receipt of an application for issuance of a certificate of authority, the commissioner shall forthwith transmit copies of such application and accompanying documents...
• Section 27-21A-4 Powers of health maintenance organizations
  (a) The powers of a health maintenance organization include, but are not limited to the following: (1) The purchase, lease, construction, renovation, operation, or maintenance...
• Section 27-21A-5 Governing body
  The governing body of any health maintenance organization may include providers, or other individuals, or both.
• Section 27-21A-6 Fiduciary responsibilities of directors, officers, employees, and partners
  (a) Any director, officer, employee, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of...
• Section 27-21A-7 Evidence of coverage and charges for health care services
  (a)(1) Every enrollee residing in this state is entitled to an evidence of coverage. If the enrollee obtains such coverage through an insurance policy or...
• Section 27-21A-8 Reporting requirements
  Every health maintenance organization shall annually, on or before the first day of March, file a report verified by at least two principal officers with...
• Section 27-21A-9 Information to enrollees
  Every health maintenance organization shall provide promptly to its enrollees notice of any material change in the operation of the organization that will affect them
• Section 27-21A-10 Complaint system
  (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...
• Section 27-21A-11 Investments
  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...
• Section 27-21A-12 Protection against insolvency
  (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...
• Section 27-21A-13 Prohibited practices
  (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...
• Section 27-21A-14 Regulation of producers
  (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...
• Section 27-21A-15 Powers of insurers and health care service plans
  (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...
• Section 27-21A-16 Examination
  (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...
• Section 27-21A-17 Suspension or revocation of certificate of authority
  (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...
• Section 27-21A-18 Rehabilitation, liquidation, or conservation of a health maintenance organization
  (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...
• Section 27-21A-19 Regulations
  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...
• Section 27-21A-20 Administrative procedures
  (a) When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds...
• Section 27-21A-21 Fees
  (a) Every health maintenance organization subject to this chapter shall pay to the commissioner the following fees: (1) For filing an application for certificate of...
• Section 27-21A-22 Penalties and enforcement
  (a) The commissioner may, in lieu of suspension or revocation of a certificate of authority under Section 27-21A-17, levy an administrative penalty in an amount...
• Section 27-21A-23 Statutory construction and relationship to other laws
  (a) Except as otherwise provided in this chapter, provisions of the insurance law and provisions of health care service plan laws shall not be applicable...
• Section 27-21A-24 Filings and reports as public documents
  All applications, filings, and reports required under this chapter, except those which are trade secrets or privileged or confidential commercial or financial information, other than...
• Section 27-21A-25 Confidentiality of medical information
  Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by...
• Section 27-21A-26 State Health Officer's and commissioner's authority to contract
  The State Health Officer and the commissioner, in carrying out their obligations under this chapter, may contract with qualified persons to make recommendations concerning the...
• Section 27-21A-27 Acquisition of control of or merger of a health maintenance organization
  No person may make a tender for or a request or invitation for tenders of, or enter into an agreement to exchange securities for or...
• Section 27-21A-28 Taxes
  Health maintenance organizations doing business in this state shall be subject to and pay the annual premium tax to be paid by health insurers on...
• Section 27-21A-29 Existing health maintenance organizations
  (a) Notwithstanding any other provision of this chapter, any health maintenance organization licensed by the State Board of Health and in operation on May 29,...
• Section 27-21A-30 Coordination of benefits
  (a) A health maintenance organization is entitled to coordinate benefits on the same basis as an insurer. No such coordination shall be allowed against policies...
• Section 27-21A-31 Health maintenance organization advisory council
  There shall be established a three member HMO advisory council to advise and consult with the commissioner and the State Health Officer in carrying out...
• Section 27-21A-32 HMO enrollment requirements
  (a) The state government, or any agency, board, commission, institution, or political subdivision thereof, and any city or county, or board of education, which offers...

Last modified: May 3, 2021