reglab/statecodes huggingface dataset:
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-079 - HEALTH MAINTENANCE ORGANIZATIONS GENERALLY › Section 482-1-079-.11 - Fees

Current through Register Vol. 42, No. 9, June 28, 2024
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 Diem
				Subsistence and Compensation incurred in Examination of Domestic Insurance
				Companies and Others" shall apply to HMOs.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-079 - HEALTH MAINTENANCE ORGANIZATIONS GENERALLY › Section 482-1-079-.12 - Change Of Name

Current through Register Vol. 42, No. 9, June 28, 2024
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 licensed
				HMO shall not be used by the HMO.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-079 - HEALTH MAINTENANCE ORGANIZATIONS GENERALLY › Section 482-1-079-.14 - Insurance - General Liability, Medical Malpractice And Reinsurance

Current through Register Vol. 42, No. 9, June 28, 2024
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 section, the HMO shall secure insurance coverage or furnish evidence of
				acceptable self-insurance to provide:
(1) For payments or services required to be
			 made or furnished under the health care contract to those enrollees who are
			 injured or become ill outside the geographical limits served by the
			 HMO;
(2) Reinsurance protection to
			 the HMO in the event of catastrophic or unusual losses in excess of levels of
			 loss which the HMO assumes in the basis of its calculation of premium charges
			 (schedule of charges);
(3) That the
			 HMO has an agreement with an Alabama licensed insurer or nonprofit health
			 service plan under which the insurer or nonprofit health service plan agrees to
			 issue to enrollees in the HMO, a plan of hospital, medical and surgical
			 insurance at standard conversion premium rates without any underwriting or
			 other requirement, other than an application and payment of the first monthly
			 premium by the enrollee, in the event the HMO is unable to continue in
			 operation;
(4) For a general
			 liability and medical malpractice plan or an adequate plan for self-insurance
			 program approved by the Commissioner. Evidence of these plans must be submitted
			 at least 30 days prior to the expiration date of the policy and with each
			 annual report.
Author:
Commissioner of Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-079 - HEALTH MAINTENANCE ORGANIZATIONS GENERALLY › Section 482-1-079-.16 - Deposit Requirements

Current through Register Vol. 42, No. 9, June 28, 2024
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 securities, the market
				value of which is readily ascertainable, and, if negotiable by delivery or
				assignment, of the kinds described below:
(1) United States government
			 obligations;
(2) State, county,
			 municipal and school obligations;
(3) Public improvement obligations;
(4) Housing authority obligations;
(5) Obligations, stock of certain federal
			 agencies;
(6) Canadian governmental
			 obligations;
(7) International
			 banks;
(8) Corporate
			 obligations;
(9) Equipment trust
			 obligations;
(10) Railroad leased
			 lines, terminal obligations.
The market value of the deposit of any HMO shall at all times
				be equal to or greater than $100,000. If at any time the value of the
				securities held on deposit is less than $100,000, the HMO shall promptly
				deposit sufficient, acceptable securities to meet the deficiency in market
				value.
Author:
Commissioner of Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-079 - HEALTH MAINTENANCE ORGANIZATIONS GENERALLY › Section 482-1-079-.17 - Service Area

Current through Register Vol. 42, No. 9, June 28, 2024
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 the
				form of a drawn or printed map of the proposed expansion of geographic area
				detailed enough to easily determine the area, a description of the physical
				facilities to be used in providing health care services including a copy of any
				proposed lease or real estate purchase agreement; a list with their
				qualifications and licensed status of all contracted health care providers
				whether HMO employees or independent providers for the expanded service area;
				and any other information which the State Health Officer or Commissioner may
				require to evaluate the proposed expansion. The expanded service area will be
				approved within thirty (30) days after the filing of proposed expanded area, if
				adequate information is furnished to evaluate the proposal, unless in the
				opinion of the State Health Officer or Commissioner the expansion will
				detrimentally and substantially affect the solvency of the HMO or decrease the
				quality of health care services of the enrollees.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-079 - HEALTH MAINTENANCE ORGANIZATIONS GENERALLY › Section 482-1-079-.18 - Limitation Period For Payment Of Claims Under Health Maintenance Organization Contracts

Current through Register Vol. 42, No. 9, June 28, 2024
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 not
				supplied as to the entire claim, the amount supported by reasonable proof shall
				be considered overdue if not paid within forty-five (45) days after such proof
				is received by the HMO. Any part or all of the remainder of the claim that is
				later supported by reasonable proof shall be considered overdue if not paid
				within forty-five (45) days after such proof is received by the HMO. For the
				purposes of calculating the extent to which any benefits are overdue, payment
				shall be treated as made on the date a draft or other valid instrument was
				placed in the United States mail to the last known address of the claimant or
				provider in a properly addressed, postpaid envelope, or, if not so posted, on
				the date of delivery. When the claim is overdue or denied, the HMO must provide
				written justification within five days of the overdue or denial date to any
				providers involved and to the enrollee if the enrollee is financially liable
				for the denied claim.
The above required payment time period of forty-five (45) days
				is not applicable if the HMO has approved executed provider contracts in which
				the HMO and the provider have agreed to a different schedule of payment, in
				which case, all other provisions set out above will be applicable with the
				exception that the time payment will be in accordance with the approved
				contract between the HMO and the provider.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-079 - HEALTH MAINTENANCE ORGANIZATIONS GENERALLY › Section 482-1-079-.19 - Separability

Current through Register Vol. 42, No. 9, June 28, 2024
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:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-079 - HEALTH MAINTENANCE ORGANIZATIONS GENERALLY › Section 482-1-079-.20 - Effective Date

Current through Register Vol. 42, No. 9, June 28, 2024
The effective date of this chapter is May 8, 1987.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-080 - LIABILITIES OF HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-080-.01 - Purpose

Current through Register Vol. 42, No. 9, June 28, 2024
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
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-19,
				  27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-080 - LIABILITIES OF HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-080-.02 - Authority

Current through Register Vol. 42, No. 9, June 28, 2024
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
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-19,
				  27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-080 - LIABILITIES OF HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-080-.03 - Applicability And Scope

Current through Register Vol. 42, No. 9, June 28, 2024
Except as otherwise specifically provided, this chapter shall
				apply to Health Maintenance Organizations licensed in Alabama.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-19,
				  27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-080 - LIABILITIES OF HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-080-.06 - Separability

Current through Register Vol. 42, No. 9, June 28, 2024
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 of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-19,
				  27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-080 - LIABILITIES OF HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-080-.07 - Effective Date

Current through Register Vol. 42, No. 9, June 28, 2024
The effective date of this chapter is May 1, 1996.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-19 and
				  27-2-17
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-081 - LICENSING OF SALES AGENTS FOR HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-081-.01 - Purpose

Current through Register Vol. 42, No. 9, June 28, 2024
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
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-081 - LICENSING OF SALES AGENTS FOR HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-081-.02 - Authority

Current through Register Vol. 42, No. 9, June 28, 2024
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
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-081 - LICENSING OF SALES AGENTS FOR HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-081-.03 - Applicability And Scope

Current through Register Vol. 42, No. 9, June 28, 2024
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
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-081 - LICENSING OF SALES AGENTS FOR HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-081-.04 - Producer Defined

Current through Register Vol. 42, No. 9, June 28, 2024
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:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-081 - LICENSING OF SALES AGENTS FOR HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-081-.05 - Examination And Licensing Of Producers

Current through Register Vol. 42, No. 9, June 28, 2024
(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
			 HMO.
(2) The HMO must comply with
			 the provisions of Chapter 7 of Title 27 with regard to the obtaining a license
			 for each producer of the HMO, paying the appropriate fees for licensing the
			 producers and paying commissions only to licensed producers. (3) If the
			 applicant is a partnership or corporation, the examination shall be taken and
			 licensing requirements met by each individual who is to be designated in the
			 appointment as having authority to act for the applicant under the
			 license.
Author:
Commissioner of Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-081 - LICENSING OF SALES AGENTS FOR HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-081-.06 - Separability

Current through Register Vol. 42, No. 9, June 28, 2024
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 of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-081 - LICENSING OF SALES AGENTS FOR HEALTH MAINTENANCE ORGANIZATIONS › Section 482-1-081-.07 - Effective Date

Current through Register Vol. 42, No. 9, June 28, 2024
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
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-082 - HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-082-.01 - Purpose

Current through Register Vol. 42, No. 9, June 28, 2024
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:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-12(i),
				  27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-082 - HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-082-.02 - Authority

Current through Register Vol. 42, No. 9, June 28, 2024
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
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-12(i),
				  27-2-17,
				  27-21A-19
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-082 - HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-082-.03 - Applicability And Scope

Current through Register Vol. 42, No. 9, June 28, 2024
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 of the association as a condition of
				their authority to transact business as health maintenance organizations in
				this state. The association shall perform its functions under the plan of
				operation approved by the Commissioner and shall exercise its functions through
				a board of directors elected by the members. The association shall be subject
				to the provisions of the insurance laws of this state applicable to health
				maintenance organizations; except that the association shall be exempt from
				payment of all fees and taxes levied by this state or any of its subdivisions,
				excluding taxes on real or personal property.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-12(i),
				  27-2-17,
				  27-21A-19
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-082 - HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-082-.04 - Organization Of The Guaranty Association

Current through Register Vol. 42, No. 9, June 28, 2024
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 for an initial
				board of directors. Each licensed HMO shall have one vote in person or by
				proxy. If no directors are elected the Commissioner may appoint directors from
				the members for the guaranty association. These directors shall serve for one
				year terms until staggered terms of one to three years are established for the
				directors by the articles of association. Vacancies of the board shall be
				filled for the remaining period of the director's term by a majority vote of
				the remaining board members, subject to the approval of the commissioner. The
				reasonable expenses of the association and the directors shall be paid by
				assessment of the members of the association.
The board of directors shall within ninety days of their
				election meet and promulgate articles of association, bylaws and a plan of
				operation to govern their activities. These articles and bylaws shall be
				submitted to the Commissioner for consent and approval before they are
				effective. The organizational articles of the guaranty association shall be
				similar to the organizational requirements of the Life and Disability Guaranty
				Association as required by Section
				27-44-1
et
seq
.,
Code of
				Ala. 1975
.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-12(i),
				  27-2-17,
				  27-21A-19
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-082 - HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-082-.05 - Powers And Duties Of The Association

Current through Register Vol. 42, No. 9, June 28, 2024
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
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-12(i),
				  27-2-17,
				  27-21A-19
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-082 - HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-082-.06 - Separability

Current through Register Vol. 42, No. 9, June 28, 2024
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 of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-12(i),
				  27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-082 - HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-082-.07 - Effective Date

Current through Register Vol. 42, No. 9, June 28, 2024
The effective date of this chapter is May 8, 1987.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-21A-12(i),
				  27-2-17,
				  27-21A-19.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-083 - GOVERNING RULES OF THE ALABAMA HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-083-.01 - Authority

Current through Register Vol. 42, No. 9, June 28, 2024
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 that the Commissioner may promulgate
				regulations for the implementation of a Health Maintenance Organization
				Guaranty Association modeled on the Alabama Life and Disability Guaranty
				Association as established in Chapter 44 of Title 27,
Code of Ala.
				1975
.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19,
				  27-21A-12(i).
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-083 - GOVERNING RULES OF THE ALABAMA HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-083-.03 - Powers And Duties Of The Association

Current through Register Vol. 42, No. 9, June 28, 2024
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 Association and approved by the
			 Commissioner, either:
1.
(i) guarantee, assume, or reinsure, or cause
			 to be guaranteed, assumed or reinsured, any or all of the evidences of coverage
			 of such insolvent HMO; or
(ii)
			 assure payment of the contractual obligations of the insolvent HMO;
			 and
(iii) provide such moneys,
			 pledges, notes, guarantees, or other means as are reasonably necessary to
			 discharge such duties; or
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-083 - GOVERNING RULES OF THE ALABAMA HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-083-.05 - Immunity Under Regulation

Current through Register Vol. 42, No. 9, June 28, 2024
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 taken by
				them in the performance of their powers and duties granted to them under
				Section 27-21A-12(i) Code
				and this chapter.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19,
				  27-21A-12(i).
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-083 - GOVERNING RULES OF THE ALABAMA HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-083-.06 - Stay Of Proceedings; Reopening Default Judgments

Current through Register Vol. 42, No. 9, June 28, 2024
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 association on
				any matters germane to its powers or duties. As to judgment under any decision,
				order, verdict, or finding based on default the association may apply to have
				such judgment set aside by the same court that made such judgment and shall be
				permitted to defend against such suit on its merits.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19,
				  27-21A-12(i).
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-083 - GOVERNING RULES OF THE ALABAMA HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-083-.07 - General Provisions

Current through Register Vol. 42, No. 9, June 28, 2024
(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 insolvent HMO attributable to
			 covered contracts and all assets to which covered contract holders are given a
			 right of priority shall be used to continue all covered contracts and to pay
			 all contractual obligations of such HMO as required by the Act and this
			 chapter.
(2) Upon the issuance of a
			 proper court order placing a domestic HMO in receivership or placing a foreign
			 HMO in ancillary receivership for rehabilitation or liquidation, all enrollees,
			 unaffiliated health care providers for uncovered expenditures, beneficiaries
			 and insured of such insolvent HMO, with respect to claims arising from and
			 within the coverage of and not in excess of the applicable limits of evidences
			 of coverages and other health care contracts issued by the insolvent HMO and
			 the Alabama Health Maintenance Organization Guaranty Association shall be
			 preferred creditors of said HMO.
(3)
1.
			 Prior to the termination of any receivership, liquidation, or conservation
			 proceeding, the court may take into consideration the contributions of the
			 respective parties, including the Association, the shareholders and contract
			 holders of the insolvent HMO, and any other party with a bona fide interest in
			 making an equitable distribution of the ownership rights of such insolvent HMO.
			 In such a determination, consideration shall be given the welfare of the
			 contract holders of the continuing or successor HMO.
2. No distribution to stockholders, if any,
			 of an insolvent HMO shall be made until and unless the total amount of
			 assessments levied by the Association with respect to such HMO have been fully
			 recovered by the Association.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-083 - GOVERNING RULES OF THE ALABAMA HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-083-.08 - Assignment And Subrogation

Current through Register Vol. 42, No. 9, June 28, 2024
(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 Plan. The
			 Association may require an assignment to it of such rights by any payee,
			 contract owner, or beneficiary as a condition precedent to the receipt of any
			 rights or benefits conferred by the Act or the Plan upon such person. The
			 Association shall be subrogated to these rights against the assets of any
			 insolvent or impaired HMO.
(2) The
			 subrogation rights of the Association under this rule shall have the same
			 priority against the assets of the insolvent HMO as that possessed by the
			 person entitled to receive covered health care services under the Act or the
			 Plan.
(3) If the Association
			 provides medical benefits or payments to an enrollee who suffers injury,
			 disease or illness by virtue of the negligent act or omission of a third party
			 the Association is entitled to reimbursement from such third party for the
			 reasonable value of the benefits or payments provided, just as the insolvent
			 HMO would be entitled to such reimbursement pursuant to Section
			 27-21A-30(b).
Author:
Commissioner of Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19,
				  27-21A-12(i).
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-083 - GOVERNING RULES OF THE ALABAMA HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-083-.09 - Examination And Regulation Of Association; Annual Report

Current through Register Vol. 42, No. 9, June 28, 2024
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 of its
				activities during the preceding calendar year.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19,
				  27-21A-12(i).
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-083 - GOVERNING RULES OF THE ALABAMA HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-083-.10 - Membership

Current through Register Vol. 42, No. 9, June 28, 2024
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 certificate of authority from the
				Commissioner to transact the kinds of business covered by the Act shall
				automatically become, effective on the date of its admission, a member HMO of
				the Association. A member HMO which ceases to be authorized after said date
				shall automatically cease to be a member effective on the day following the
				termination or expiration of its certificate to transact the kinds of business
				covered by said Act; provided, however, such HMO shall remain liable for any
				assessment or assessments based on an insolvency or impairment occurring prior
				to the cessation of its status as a member HMO in the Association.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19,
				  27-21A-12(i).
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-083 - GOVERNING RULES OF THE ALABAMA HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-083-.11 - Effective Date

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter shall become effective October 20, 1988.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19,
				  27-21A-12(i).
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-083 - GOVERNING RULES OF THE ALABAMA HEALTH MAINTENANCE ORGANIZATION GUARANTY ASSOCIATION › Section 482-1-083-.12 - Separability

Current through Register Vol. 42, No. 9, June 28, 2024
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 of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-21A-19,
				  27-21A-12(i).
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-084 - [Repealed] › Section 482-1-084-.07 - Effective Date

Current through Register Vol. 42, No. 9, June 28, 2024
(Repealed 7/18/05).
Author:
Department of Insurance
Statutory Authority:
Code of Ala.
				  1975
, §
										27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-085 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 482-1-085-.01 - Authority

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter is promulgated by the Commissioner of Insurance
				pursuant to Section
				27-2-17,
Code of Ala.
				1975
.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §
										27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-085 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 482-1-085-.02 - Preamble

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The Alabama
			 Insurance Department recognizes that licensed insurers routinely enter into
			 reinsurance agreements that yield legitimate relief to the ceding insurer from
			 strain to surplus.
(2) However, it
			 is improper for a licensed insurer, in the capacity of ceding insurer, to enter
			 into reinsurance agreements for the principal purpose of producing significant
			 surplus aid for the ceding insurer, typically on a temporary basis, while not
			 transferring all of the significant risks inherent in the business being
			 reinsured. In substance or effect, the expected potential liability to the
			 ceding insurer remains basically unchanged by the reinsurance transaction,
			 notwithstanding certain risk elements in the reinsurance agreement, such as
			 catastrophic mortality or extraordinary survival. The terms of such agreements
			 referred to herein and described in Rule
			 482-1-085-.04 violate:
(a) Section
			 27-37-4 and
			 27-3-26,
Code of Ala.
			 1975
, as amended, relating to financial statements which do not
			 properly reflect the financial condition of the ceding insurer;
(b) Section
			 27-5-12 and
			 27-37-1(8),
Code of Ala. 1975
, as amended, relating to reinsurance
			 reserve credits, thus resulting in a ceding insurer improperly reducing
			 liabilities or establishing assets for reinsurance ceded; and
(c) Section
			 27-3-21,
Code of Ala.
			 1975
, as amended, relating to creating a situation that may be
			 hazardous to policyholders and the people of this State.
Author:
Commissioner of Insurance
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-085 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 482-1-085-.03 - Scope

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter shall apply to all domestic life and accident and
				health insurers and to all other licensed life and accident and health insurers
				which are not subject to a substantially similar regulation in their
				domiciliary state. This chapter shall also similarly apply to licensed property
				and casualty insurers with respect to their accident and health business. This
				chapter shall not apply to assumption reinsurance where the ceding company has
				been released of all liability or yearly renewable term reinsurance.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §
										27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-085 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 482-1-085-.05 - Written Agreements

Current through Register Vol. 42, No. 9, June 28, 2024
(1) No
			 reinsurance agreement or amendment to any agreement may be used to reduce any
			 liability or to establish any asset in any financial statement filed with the
			 Department, unless the agreement, amendment or a binding letter of intent has
			 been duly executed by both parties no later than the "as of date" of the
			 financial statement.
(2) In the
			 case of a letter of intent, a reinsurance agreement or an amendment to a
			 reinsurance agreement must be executed within a reasonable period of time, not
			 exceeding ninety (90) days from the execution date of the letter of intent, in
			 order for credit to be granted for the reinsurance ceded.
(3) The reinsurance agreement shall contain
			 provisions which provide that:
(a) The
			 agreement shall constitute the entire agreement between the parties with
			 respect to the business being reinsured thereunder and that there are no
			 understandings between the parties other than as expressed in the agreement;
			 and
(b) Any change or modification
			 to the agreement shall be null and void unless made by amendment to the
			 agreement and signed by both parties.
Author:
Commissioner of Insurance
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-085 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 482-1-085-.06 - Existing Agreements

Current through Register Vol. 42, No. 9, June 28, 2024
Insurers subject to this chapter shall reduce to zero by
				December 31, 1997, any reserve credits or assets established with respect to
				reinsurance agreements entered into prior to the effective date of this chapter
				which, under the provisions of this chapter would not be entitled to
				recognition of the reserve credits or assets; provided, however, that the
				reinsurance agreements shall have been in compliance with laws or regulations
				in existence immediately preceding the effective date of this chapter.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §
										27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-085 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 482-1-085-.07 - Effective Date

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter shall become effective ten (10) days from the date
				of certification that the properly executed chapter was delivered to the
				Secretary of the State.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §
										27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-088 - GUIDELINES TO ADVERTISERS REGARDING THE OFFERING OF FREE GIFTS, BENEFITS, ETC › Section 482-1-088-.01 - Authority

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter is adopted pursuant to Ala. Code §§
								27-2-17,
				27-12-12, and
				27-12-14.
Rule is not subject to the Alabama Administrative Procedure
				  Act.
Author:
Commissioner of Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-12-12, and
				  27-12-14.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-088 - GUIDELINES TO ADVERTISERS REGARDING THE OFFERING OF FREE GIFTS, BENEFITS, ETC › Section 482-1-088-.02 - Purpose

Current through Register Vol. 42, No. 9, June 28, 2024
The purpose of this chapter is to clarify questions raised by
				insurers regarding marketing practices that offer some form of free gifts,
				benefits, etc., and the amount of the free gifts, benefits, etc.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-088 - GUIDELINES TO ADVERTISERS REGARDING THE OFFERING OF FREE GIFTS, BENEFITS, ETC › Section 482-1-088-.03 - Scope

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter shall apply to all insurers, insurance agencies,
				and producers doing business in the State of Alabama.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-088 - GUIDELINES TO ADVERTISERS REGARDING THE OFFERING OF FREE GIFTS, BENEFITS, ETC › Section 482-1-088-.04 - Definitions

Current through Register Vol. 42, No. 9, June 28, 2024
(1) For the
			 purposes of this chapter, a free gift, benefit, etc. is defined as a gift,
			 benefit, etc., to invite an inquiry or quote from the insurance buying public.
			 It is not an inducement or invitation to enter into an insurance
			 contract.
(2) If necessary, a
			 "reasonableness" test will be used to determine whether the value of the gift
			 actually acts as an inducement to enter into an insurance contract regardless
			 of the semantics used in the advertisement.
Rule is not subject to the Alabama Administrative Procedure
				  Act.
Author:
Commissioner of Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-12-12,
				  27-12-14.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-088 - GUIDELINES TO ADVERTISERS REGARDING THE OFFERING OF FREE GIFTS, BENEFITS, ETC › Section 482-1-088-.05 - Allowable Amount

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The value
			 of the amount of the gift, benefit, etc. will be no more than $100.00 payable
			 to an individual or family (only one gift per family). This gift cannot be
			 cash.
(2) No rebate can be used as
			 a part of a gift.
Rule is not subject to the Alabama Administrative Procedure
				  Act.
Author:
Commissioner of Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-12-12,
				  27-12-14.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-088 - GUIDELINES TO ADVERTISERS REGARDING THE OFFERING OF FREE GIFTS, BENEFITS, ETC › Section 482-1-088-.06 - Severability

Current through Register Vol. 42, No. 9, June 28, 2024
If any paragraph or a portion of a paragraph of this chapter or
				its applicability to any person or circumstance is held invalid by a court, the
				remainder of the chapter or the applicability of the provision to other persons
				or circumstances shall not be affected.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-088 - GUIDELINES TO ADVERTISERS REGARDING THE OFFERING OF FREE GIFTS, BENEFITS, ETC › Section 482-1-088-.07 - Effective Date

Current through Register Vol. 42, No. 9, June 28, 2024
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
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-090 - EXAMINATION EXPENSES OF RULE, RATE OR FORM FILINGS BY RATE-MAKING ORGANIZATIONS › Section 482-1-090-.01 - Authority

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter is made and promulgated by the undersigned
				Commissioner of Insurance pursuant to the authority set forth in Section
				27-2-17,
Code of Ala.
				1975
.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-13-1,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-090 - EXAMINATION EXPENSES OF RULE, RATE OR FORM FILINGS BY RATE-MAKING ORGANIZATIONS › Section 482-1-090-.02 - Purpose

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter is intended to implement and augment the
				provisions of Sections
				27-13-1,
et
seq
.,
Code of
				Ala. 1975
.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-13-1,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-090 - EXAMINATION EXPENSES OF RULE, RATE OR FORM FILINGS BY RATE-MAKING ORGANIZATIONS › Section 482-1-090-.03 - Applicability And Scope

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter is to authorize the payment of examination
				expenses incurred by the consulting actuaries employed by the Department in the
				review of rule, rate or form filings by rate-making organizations. These
				expenses are to be paid by the rate-making organization in the same manner as
				if the organization was an insurance company.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-13-1,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-090 - EXAMINATION EXPENSES OF RULE, RATE OR FORM FILINGS BY RATE-MAKING ORGANIZATIONS › Section 482-1-090-.04 - Effective Date

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter shall become effective ten (10) days from the date
				of certification that the properly executed chapter was delivered to the
				Secretary of State.
Author:
Commissioner of
				Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-13-1,
et
seq
.