reglab/housing_qa huggingface dataset:
AL Code § 27-21-2 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21 - Alabama Health Care Plan.|Section 27-21-2 - Offering of Insurance.

Section 27-21-2Offering of insurance. 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 loss from accident or disease. Such insurance may be offered by such insurers in their own names or in the name of a voluntary unincorporated association or other organization formed by such insurers solely for the purpose of this plan. The forms of applications, certifications, and policies of such insurance, the applicable premium rates, annual statement, and all other information required by the department under Alabama law for organizations in the business of health insurance shall be filed with the commissioner for his approval. Any other information which the commissioner deems necessary for the efficient operation of the plan may also be required. (Acts 1971, No. 501, p. 1218.)
AL Code § 27-21-3 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21 - Alabama Health Care Plan.|Section 27-21-3 - Premium Rates and Administration Expenses.

Section 27-21-3Premium rates and administration expenses. 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 determined and approved by the commissioner so as to maintain the nonprofit basis of the plan. (Acts 1971, No. 501, p. 1218.)
AL Code § 27-21-4 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21 - Alabama Health Care Plan.|Section 27-21-4 - Exemption From Premium Tax; Deduction of Losses Therefrom.

Section 27-21-4Exemption from premium tax; deduction of losses therefrom. 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 health care plan may be deducted from the premium tax submitted under the above-mentioned Chapter 4 which would normally be paid on individual accident and health insurance premiums collected, but total loss deduction shall not exceed 50 percent of such premium tax normally payable on premiums from individual accident and health insurance. (Acts 1971, No. 501, p. 1218.)
AL Code § 27-21-5 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21 - Alabama Health Care Plan.|Section 27-21-5 - Qualifications for Plan; Examinations; Public Hearings; Employment of Consultants, Etc.

Section 27-21-5Qualifications for plan; examinations; public hearings; employment of consultants, etc. (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 meets these qualifications. Any willful material misrepresentation by a person attempting to qualify under the plan shall be a misdemeanor and, upon conviction thereof, shall be punishable as prescribed in Section 13A-5-1. (b) The commissioner may also make other necessary rules or regulations and may conduct any examination as to insurers at any reasonable time and may also, at his discretion, hold public hearings to determine qualifications of prospective insureds or rates and expenses of insurers in furtherance of this plan. The commissioner may also employ consultants, actuaries, attorneys, or special investigators or examiners to assist him in the regulation of the plan and examination of the insurers, and the expense of these special assistants and consultants, along with any regular examination costs, will be borne by the concerned insurer. (Acts 1971, No. 501, p. 1218.)
AL Code § 27-21-6 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21 - Alabama Health Care Plan.|Section 27-21-6 - Short Title.

Section 27-21-6Short title. 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.)
AL Code § 27-21A-1 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-1 - Definitions.

Section 27-21A-1Definitions. 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 person enrolling members on behalf of an employer, union, or other organization. (2) BASIC HEALTH CARE SERVICES. Emergency care, inpatient hospital and physician care, and outpatient medical services. (3) COMMISSIONER. The Commissioner of Insurance. (4) ENROLLEE. An individual who is enrolled in a health maintenance organization. (5) EVIDENCE OF COVERAGE. Any certificate, agreement, or contract issued to an enrollee setting out the coverage to which he is entitled. (6) HEALTH CARE SERVICES. Any services included in the furnishing to any individual of medical or dental care, or hospitalization or incident to the furnishing of such care or hospitalization, as well as the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness, injury, or physical disability. (7) HEALTH MAINTENANCE ORGANIZATION. Any person that undertakes to provide or arrange for basic health care services through an organized system which combines the delivery and financing of health care to enrollees. The organization shall provide physician services directly through physician employees or under contractual arrangements with either individual physicians or a group or groups of physicians. The organization shall provide basic health care services directly or under contractual arrangements. When reasonable and appropriate, the organization may provide physician services and basic health care services through other arrangements. The organization may provide, or arrange for, health care services on a prepayment or other financial basis. (8) INSURER. Every insurer authorized in this state to issue contracts of accident and sickness insurance. Hospital service nonprofit corporations, nonprofit medical service corporations, and nonprofit health care corporations are included within such term. (9) PERSON. Any natural or artificial person including, but not limited to, individuals, partnerships, associations, trusts, or corporations. (10) PROVIDER. Any physician, hospital, or other person which is licensed or otherwise authorized in this state to furnish health care services. (11) SCHEDULE OF CHARGES. A statement of the method used by a health maintenance organization to establish rates. (12) STATE HEALTH OFFICER. The executive officer of the State Department of Public Health. (13) UNCOVERED EXPENDITURES. The costs of health care services that are covered by a health maintenance organization, for which an enrollee would also be liable in the event of the organization's insolvency. (Acts 1986, No. 86-471, p. 854, §1.)
AL Code § 27-21A-4 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-4 - Powers of Health Maintenance Organizations.

Section 27-21A-4Powers 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 of hospitals, medical facilities, or both, and their ancillary equipment; (2) The making of loans other than in the ordinary course of business, to providers under contract with it in furtherance of its program or the making of loans to a corporation or corporations in which it owns a majority interest for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees. (3) The furnishing of health care services through providers which are under contract with or employed by the health maintenance organization. (4) The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment, and administration. (5) The purchase, lease, construction, or renovation of property as may reasonably be required for its principal office or for such purposes as may be necessary in the transaction of the business of the organization; (6) The contracting with an insurance company licensed in this state to do business in this state, or a health care service plan authorized to transact business in this state, for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization. (7) The offering of other health care services, in addition to basic health care services or other required health care services. (b)(1) A health maintenance organization shall file notice, assuring compliance with any applicable state or federal laws, with adequate supporting information, with the commissioner prior to the exercise of any power granted in subsections (a)(1), (a)(2), or (a)(4). The commissioner shall disapprove such exercise of power only if in his opinion it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. If the commissioner does not disapprove within 30 days of the filing, it shall be deemed approved. (2) The commissioner may promulgate rules and regulations exempting from the filing requirement of subdivision (b)(1) those activities having a de minimis effect. (Acts 1986, No. 86-471, p. 854, §4.)
AL Code § 27-21A-5 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-5 - Governing Body.

Section 27-21A-5Governing body. The governing body of any health maintenance organization may include providers, or other individuals, or both. (Acts 1986, No. 86-471, p. 854, §5.)
AL Code § 27-21A-8 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-8 - Reporting Requirements.

Section 27-21A-8Reporting 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 the commissioner, with a copy to the State Health Officer, covering the preceding calendar year. Such report shall be on forms prescribed by the commissioner, and shall include: (1) A financial statement of the organization; (2) Any material changes in the information submitted pursuant to subsection (c) of Section 27-21A-2; (3) The number of persons enrolled at the beginning and end of the year; (4) A summary of information compiled pursuant to paragraph (a)(2)c of Section 27-21A-3; (5) The amount of uncovered and covered expenditures that are payable and more than 90 days past due; and (6) Such additional information or reports as are deemed reasonably necessary and appropriate by the commissioner to enable him to carry out his duties under this chapter. (Acts 1986, No. 86-471, p. 854, §8.)
AL Code § 27-21A-9 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-9 - Information to Enrollees.

Section 27-21A-9Information 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 directly. (Acts 1986, No. 86-471, p. 854, §9.)
AL Code § 27-21A-10 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-10 - Complaint System.

Section 27-21A-10Complaint 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 Officer, to provide reasonable procedures for the resolution of written complaints initiated by enrollees. (2) Each health maintenance organization shall submit to the commissioner and the State Health Officer an annual report in a form prescribed by the commissioner, after consultation with the State Health Officer, which shall include: a. A description of the procedures of such complaint system; b. The total number of complaints handled through such complaint system and a compilation of causes underlying the complaints filed; and c. The number, amount, and disposition of malpractice claims and other claims relating to the service or care rendered by the health maintenance organization made by enrollees of the organization that were settled during the year by the health maintenance organization. All such information shall be held in confidence by the commissioner. (b) The commissioner or the State Health Officer may examine such complaint system. (Acts 1986, No. 86-471, p. 854, §10.)
AL Code § 27-21A-11 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-11 - Investments.

Section 27-21A-11Investments. 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 the investment of assets constituting the legal reserves of life insurance companies or such other securities or investments as the commissioner may permit. (Acts 1986, No. 86-471, p. 854, §11.)
AL Code § 27-21A-14 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-14 - Regulation of Producers.

Section 27-21A-14Regulation 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 licensed in accordance with Chapters 7 and 8A of this title.  (b) The commissioner shall, after notice and hearing, promulgate such reasonable rules and regulations as are necessary to provide for the licensing of producers. (c) The commissioner may, by rule, exempt certain classes of persons from the requirement of obtaining a license for either of the following reasons: (1) If the functions they perform do not require special competence, trustworthiness, or the regulatory surveillance made possible by licensing. (2) If other existing safeguards make regulation unnecessary. (d) Nothing in this section shall be deemed to prohibit a health maintenance organization from advertising. (Acts 1986, No. 86-471, p. 854, §14; Act 2001-702, p. 1509, §15.)
AL Code § 27-21A-15 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-15 - Powers of Insurers and Health Care Service Plans.

Section 27-21A-15Powers 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 through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of this chapter. Notwithstanding any other law which may be inconsistent herewith, any two or more such insurance companies, health care service plans, or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance organization. The business of insurance is deemed to include the providing of health care by a health maintenance organization owned or operated by an insurer or a subsidiary thereof. (b) Notwithstanding any provision of insurance and health care service plan laws, Title 10, Chapter 4, Article 6 and Title 27, an insurer or a health care service plan may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. For such purposes, the enrollees of a health maintenance organization constitute a permissible group under such laws. Among other things, under such contracts, the insurer or health care service plan may make benefit payments to health maintenance organizations for health care services rendered by providers. (Acts 1986, No. 86-471, p. 854, §15.)
AL Code § 27-21A-16 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-16 - Examination.

Section 27-21A-16Examination. (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 less frequently than once every three years. (b) The State Health Officer may make an examination concerning health care service of any health maintenance organization and providers with whom such organization has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this state, but not less frequently than once every three years. (c) Every health maintenance organization shall submit its relevant books and records for such examinations and in every way facilitate these examinations. For the purpose of examinations, the commissioner and the State Health Officer may administer oaths to, and examine the officers and agents of the health maintenance organization and the principals of such providers concerning their business. (d) The expenses of examinations under this section shall be assessed against the organization being examined and such assessment shall be remitted to the commissioner to be deposited to the credit of the Special Examination Revolving Fund in Section 27-2-25, or the State Health Officer to be deposited to the credit of a fund to be known as the Health Maintenance Organization Revolving Fund. The expenses incurred by the commissioner and his examiners in the making of examinations pursuant to the provisions of this chapter, together with the compensation of such examiners, shall be paid from the Special Examination Revolving Fund. The expenses incurred by the State Health Officer and his examiners in the making of examinations pursuant to the provisions of this chapter, together with the compensation of such examiners, shall be paid from the Health Maintenance Organization Revolving Fund. (e) In lieu of such examination, the commission or State Health Officer may accept the report of an examination made by the commissioner, State Health Officer, or other appropriate agency of the state of domicile of the health maintenance organization. The health maintenance organization shall file a copy of any such report with the commissioner and the State Health Officer. (f) All records necessary for the complete examination of a health maintenance organization domiciled in this state shall be maintained in a location approved by the commissioner. (Acts 1986, No. 86-471, p. 854, §16.)
AL Code § 27-21A-18 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-18 - Rehabilitation, Liquidation, or Conservation of a Health Maintenance Organization.

Section 27-21A-18Rehabilitation, 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 and shall be conducted under the supervision of the commissioner pursuant to the law governing the rehabilitation, liquidation, or conservation of insurance companies. The commissioner may apply for an order directing him to rehabilitate, liquidate, or conserve a health maintenance organization upon any one or more grounds set out in Section 27-32-6, or when in his opinion the continued operation of the health maintenance organization would be hazardous either to the enrollees or to the people of this state. Enrollees shall have the same priority in the event of liquidation or rehabilitation as the law provides to policyholders of an insurer. (b) A claim by a health care provider for an uncovered expenditure has the same priority as a claim of an enrollee, provided such provider of services agrees not to assert such claim against any enrollee of the health maintenance organization. (c) The State Health Officer shall provide to the commissioner or receiver of any financially troubled health maintenance organization advice and support to facilitate the expeditious rehabilitation, liquidation, conservation, or dissolution of the health maintenance organization. (Acts 1986, No. 86-471, p. 854, §18.)
AL Code § 27-21A-19 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-19 - Regulations.

Section 27-21A-19Regulations. 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 accordance with the provisions of Sections 41-22-1, et seq. (Acts 1986, No. 86-471, p. 854, §19.)
AL Code § 27-21A-20 (2021)
2021 Code of Alabama|Title 27 - Insurance.|Chapter 21A - Health Maintenance Organizations.|Section 27-21A-20 - Administrative Procedures.

Section 27-21A-20Administrative 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 for the suspension or revocation of a certificate of authority exist, he shall notify the health maintenance organization and the State Health Officer in writing specifically stating the grounds for denial, suspension, or revocation. If so requested in writing by the health maintenance organization, the commissioner shall set a hearing on the matter within 30 days of the receipt of such request. (b) The State Health Officer, or his designated representative, shall be in attendance at the hearing and shall participate in the proceedings. The recommendation and findings of the State Health Officer with respect to matters relating to the quality of health care services provided in connection with any decision regarding denial, suspension, or revocation of a certificate of authority, shall be conclusive and binding upon the commissioner. Within 30 days after such hearing, or upon the failure of the health maintenance organization to appear at such hearing, the commissioner shall take action as is deemed advisable on written findings which shall be mailed to the health maintenance organization with a copy thereof to the State Health Officer. The health maintenance organization can appeal the action of the commissioner and the recommendation and findings of the State Health Officer to the Circuit Court of Montgomery County by filing an appeal to such court within 30 days of the receipt of such findings. The court may, in disposing of the issue before it, modify, affirm, or reverse the order of the commissioner in whole or in part. (c) Those provisions of this title, relating to the suspension, denial, or revocation of a certificate of authority, shall apply to proceedings under this section. (Acts 1986, No. 86-471, p. 854, §20.)