Code of Alabama
Chapter 14 - The Insurance Contract.
Section 27-14-11.1 - Contents of Policies - Denial or Reduction of Benefits Due to Medicaid Eligibility Void.

(a) For purposes of this section, "private insurer" is defined as any of the following:
(1) Any commercial insurance company offering health or casualty insurance to individuals or groups, including both experience-rated contracts and indemnity contracts.
(2) Any profit or nonprofit prepaid plan offering either medical services or full or partial payment for the diagnosis or treatment of an injury, disease, or disability.
(3) Any organization administering health or casualty insurance plans for professional associations, unions, fraternal groups, employer-employee benefit plans, and any similar organization offering these payments or services, including self-insured and self-funded plans.
(4) Any health insurer, including group health plans, as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974, self-insured plans, service benefit plans, managed care organizations, pharmacy benefit managers, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service.
(b) Any provision in an insurance contract issued or renewed after March 25, 1980, by a private insurer which denies or reduces benefits due to the eligibility of the insured to receive assistance under the Medicaid program is null and void.
(c) A private insurer may not deny enrollment to an individual because of Medicaid eligibility.
(d) As a condition of doing business in Alabama, a private insurer shall do all of the following:
(1) Provide, with respect to individuals who are eligible for, or are provided, medical assistance under the Alabama Title XIX plan, upon the request of the state, information to determine during what period the individuals or their spouses or their dependents may be, or may have been, covered by a health insurer and the nature of the coverage that is or was provided by the health insurer, including the name, address, and identifying number of the plan, in a manner prescribed by the state Medicaid Agency.
(2) Accept the state's right of recovery and the assignment to the state of any right of an individual or other entity to payment from the party for an item or service for which payment has been made under the Alabama Medicaid program.
(3) Respond to an inquiry by the state regarding a claim for payment for any health care item or service that is submitted not later than three years after the date of the provision of such health care item or service.
(4) Agree not to deny a claim submitted by the state solely on the basis of the date of submission of the claim, the type or format of the claim form, or a failure to present proper documentation at the point-of-sale that is the basis of the claim, if both of the following apply:
a. The claim is submitted by the state within the three-year period beginning on the date on which the item or service was furnished.
b. Any action by the state to enforce its rights with respect to the claim is commenced within six years of the state's submission of the claim.
(e) The provisions of this section shall not be effective if they are found by a court of competent jurisdiction to contravene federal laws or federal regulations applicable to the Medicaid program.

Structure Code of Alabama

Code of Alabama

Title 27 - Insurance.

Chapter 14 - The Insurance Contract.

Section 27-14-1 - Definitions.

Section 27-14-2 - Applicability of Chapter.

Section 27-14-3 - Insurable Interest - Personal Insurance; Preneed Contracts.

Section 27-14-4 - Insurable Interest - Property Insurance.

Section 27-14-5 - Power to Contract; Purchase of Insurance by or for Minors.

Section 27-14-6 - Application for Policy - Requirement; Reliance by Insurer; Admissibility Into Evidence; Alterations.

Section 27-14-7 - Application for Policy - Representations and Misrepresentations, Etc.

Section 27-14-8 - Forms - Filing and Approval or Disapproval.

Section 27-14-9 - Forms - Grounds for Disapproval or Withdrawal of Previous Approval.

Section 27-14-10 - Standard or Uniform Provisions; Waiver or Substitution Thereof.

Section 27-14-11 - Contents of Policies - Generally.

Section 27-14-11.1 - Contents of Policies - Denial or Reduction of Benefits Due to Medicaid Eligibility Void.

Section 27-14-12 - Contents of Policies - Additional Provisions.

Section 27-14-13 - Charter, Bylaws, etc., of Insurer as Part of Contract.

Section 27-14-14 - Execution of Policies.

Section 27-14-15 - Underwriters' and Combination Policies.

Section 27-14-16 - Noncomplying Policies, Riders, and Endorsements.

Section 27-14-17 - Construction of Policies.

Section 27-14-18 - Binders.

Section 27-14-19 - Delivery of Policies.

Section 27-14-19.1 - Electronic Delivery of Property or Casualty Insurance Policy.

Section 27-14-20 - Renewal or Extension of Policies.

Section 27-14-21 - Assignment of Policies.

Section 27-14-22 - Situs of Contracts.

Section 27-14-23 - Effect of War on Contracts of Foreign Insurer.

Section 27-14-24 - Effect of Payments.

Section 27-14-25 - Receipt and Giving of Acquittance and Discharge for Payment by Minors.

Section 27-14-26 - Forms for Proof of Loss.

Section 27-14-27 - Acts Not Deemed Waiver of Provisions or Defenses.

Section 27-14-28 - Effect of Misrepresentations in Proof of Loss.

Section 27-14-29 - Rights of Beneficiaries, etc., Under Life Insurance Policies Against Creditors, Etc.

Section 27-14-30 - Right to Proceeds When Same Retained by Life Insurer.

Section 27-14-31 - Exemption From Debt of Proceeds - Disability.

Section 27-14-32 - Exemption From Debt of Proceeds - Annuity Contracts.