Alabama § 27-58-1 - Definitions.

§ 27-58-1. Definitions.

As used in this chapter, the following terms have the following meanings:

(1) COST-SHARING REQUIREMENTS. An annual deductible, coinsurance, copayment, or other out-of-pocket expense imposed on an insured as a condition for receiving a covered treatment or service.

(2) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit plan, policy, or contract for health care services issued, delivered, issued for delivery, or renewed in this state by a health care insurer, health maintenance organization, accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit medical service corporation, health care service plan, any plan or health benefits offered by a nonprofit agricultural organization, or any other person, firm, corporation, joint venture, or other similar business entity that pays for insureds or beneficiaries in this state. The term includes, but is not limited to, entities created pursuant to Article 6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates, pays, or denies claims for health care services submitted by or on behalf of patients, insureds, or beneficiaries who reside in Alabama. Provided, however, the term shall not include accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies.

(3) MEN AT HIGH RISK. Regardless of age, African American men and men who have a father, brother, or son to whom any of the following apply:

a. Received a diagnosis of prostate cancer.

b. Developed prostate cancer.

c. Died as a result of prostate cancer.

d. Received a diagnosis of a cancer that is known to be associated with a higher risk of prostate cancer.

e. Carries a genetic marker known to be associated with an increased risk of prostate cancer.

(4) SCREENING FOR THE EARLY DETECTION OF PROSTATE CANCER. At a minimum, a prostate-specific antigen blood test and a digital rectal examination.