Alabama insurance laws

What it would do: Requires health benefit plans offered in Alabama that cover supplemental or diagnostic breast examinations to provide such coverage without imposing any deductible, copayment, coinsurance, or similar cost-sharing requirement on enrollees.

What it would do: Requires health insurance plans to cover prostate cancer screening without cost-sharing for African American men over 40, men over 40 with a family history of prostate cancer, and all men over 50.

What it would do: Requires health insurers to reimburse in-network ground ambulance providers at least 200 percent of Medicare rates and out-of-network providers at most 180 percent of Medicare rates, prohibits balance billing beyond in-network cost-sharing amounts, and requires ambulance providers to report operational and financial data annually.

What it would do: Requires health care insurers to contract with willing emergency medical service providers and pay minimum reimbursement rates of 200 percent of Medicare Ambulance Fee Schedule for in-network providers and 180 percent for out-of-network providers, prohibits balance billing to enrollees, and requires reporting by providers and insurers to the Alabama Department of Public Health.

What it would do: Authorizes nonprofit health care service corporations to reorganize by creating a nonprofit holding company as their ultimate controlling person, exempting such reorganizations from change-of-control requirements and allowing limited asset transfers not exceeding 25 percent of admitted assets.

What it would do: Requires health benefit plans, including those covering public employees and Medicaid, to cover breast reconstruction surgery with enrollee choice of surgeon and modality, in-network cost-sharing for out-of-network providers, and expedited prior authorization, effective January 1, 2027.

What it would do: Requires private health benefit plans and Alabama Medicaid to cover influenza vaccinations administered by licensed health care providers, including vaccine and administration costs at any location, while preserving individual and parental choice to accept or decline vaccination.

What it would do: Requires health insurance plans to cover prostate cancer screening without cost-sharing for men over 50 and men at high risk (African American men or those with family history of prostate cancer) over 40, effective January 1, 2027.

What it would do: Requires dental insurers to spend at least 75 percent of premiums on individual plans and 83 percent on group plans for dental claims, and mandates rebates to policyholders if the ratio falls short. Requires insurers to report financial information to the Commissioner of Insurance by April 30 annually.

What it would do: Requires health insurance plans to cover prostate cancer screening without cost-sharing for men over 50 and men over 40 at high risk, defined as African American men or those with family history of prostate cancer or associated genetic markers.

What it would do: Prohibits out-of-network ground ambulance providers from balance billing enrollees by establishing a minimum reimbursement rate of 325 percent of Medicare rates and requiring health insurers to pay providers directly, with enrollees liable only for in-network cost-sharing amounts.

What it would do: Amends Section 16-25A-7 of the Code of Alabama 1975 to require the Public Education Employees' Health Insurance Board to renegotiate contracts for Medicare retiree health benefit plans every five years instead of every three years, while maintaining the three-year renegotiation requirement for other health benefit plans.

What it would do: Transfers regulation of health insurance utilization review from the Department of Public Health to the Department of Insurance, requires coverage determinations within 72 hours for nonurgent and 24 hours for urgent care requests, mandates annual reporting of coverage denials, and establishes an ombudsman program with enforcement authority including civil fines up to $10,000.

What it would do: Requires health insurers using artificial intelligence in coverage determinations to base decisions on individual patient circumstances and clinical information, with final determinations made by licensed health care professionals. Mandates disclosure of AI use and allows civil actions for injuries from violations.

What it would do: Establishes time limits for health insurers to make prior authorization decisions (72 hours for non-urgent, 24 hours for urgent requests), requires physicians to make all coverage determinations, and grants "gold card" status waiving prior authorization to health care professionals with 90 percent approval rates on at least seven claims annually.

What it would do: Requires insurers issuing dental benefit plans or health benefit plans in Alabama to allow beneficiaries to carry over unused annual benefit maximum dollars into the succeeding year, with carryover capped at two times the annual benefit maximum, effective January 1, 2026.

What it would do: Requires dental insurers to spend at least 85 percent of premiums on claims and refund excess premiums to policyholders if they fall short. Requires annual financial reporting to the Commissioner of Insurance and prohibits premium rate increases exceeding the dental services consumer price index.

What it would do: Prohibits financial institutions with over $20 billion in assets and insurers from using social credit scores or non-quantitative factors to deny services based on religion, speech, firearms ownership, fossil fuel involvement, or diversity policies. Establishes enforcement by state banking and insurance departments with penalties up to $10,000 or treble damages.

What it would do: Requires Alabama Medicaid to ensure FDA-approved nonopioid pain medications receive coverage terms no less restrictive than opioid pain medications on the preferred drug list, effective October 1, 2025.

What it would do: Expands regulation of pharmacy benefits managers by requiring minimum reimbursement rates, prohibiting steering practices and spread pricing, mandating rebate pass-through, and allowing civil actions by pharmacies, insurers, and beneficiaries for violations.