Ala. Admin. Code r. 482-1-115-.09

Current through Register Vol. 43, No. 1, October 31, 2024

Section 482-1-115-.09 - Benefits

(1) The Plan shall make available health care coverage consistent with the requirements of the Act and the federal Health Insurance Portability and Accountability Act of 1996. In particular, the Plan will make available two or more policy forms, at least one of which provides coverage comparable to comprehensive major medical coverage offered in the individual health insurance market in the state of Alabama.

(2) The policy forms to be issued by the Plan, along with the schedule of benefits, exclusions and other limitations, shall be established by the Board, subject to the approval of the Commissioner. The Plan benefits shall be inclusive of the provisions of Sections 27-1-10 and 27-19-39, Code of Ala. 1975.

(3) Coverage under all policy forms will be available to all individuals eligible for the Plan, as defined in Rule 482-1-115-.05, on a "guaranteed issue" basis, with no exclusions of coverage for pre-existing medical conditions, and on a "guaranteed renewable" basis.

Author: Elizabeth Bookwalter, Associate Counsel

Ala. Admin. Code r. 482-1-115-.09

New Rule: July 23, 1997; effective August 30, 1997. Revised: November 13, 2002; effective December 29, 2002. Filed with LRS December 19, 2002. Rule is not subject to the Alabama Administrative Procedure Act.

Statutory Authority:Code of Ala. 1975, §§ 27-2-17, 27-52-1, etseq.