An insurer that takes an action which adversely affects a subject of abuse, or a related individual or entity, based on an abuse-related medical condition, abuse-related claim, abuse status, or association or relationship with a subject of abuse, pursuant to an individual or group insurance policy or health benefit plan, shall advise the applicant or the insured of the specific reasons for the action in writing. Reference to general underwriting practices or guidelines shall constitute a specific reason. The specific reason for the actions of the insurer shall be stated in writing. The actions of the health carrier or insurer, and any applicable policy provisions, shall be applied equally to all applicants or insureds with similar medical conditions or similar claim or claims history without regard to whether the condition or the claims are abuse related.

(Act 2000-595, p. 1185, §4.)

Terms Used In Alabama Code 27-55-4

  • abuse: The occurrence of one or more of the following acts by a family or household member, as defined by subdivision (3) of subsection (b) of Section 15-10-3:

    a. See Alabama Code 27-55-2

  • ABUSE STATUS: The fact that a person is or has been the subject of abuse and has sustained abuse-related medical conditions or has incurred abuse-related claims. See Alabama Code 27-55-2
  • ABUSE-RELATED CLAIM: A claim under an insurance policy or health benefit plan for a loss which resulted from an act of abuse as defined in this chapter. See Alabama Code 27-55-2
  • ABUSE-RELATED MEDICAL CONDITION: A medical condition sustained by a subject of abuse which arises in whole or in part out of an act or pattern of abuse as defined in this chapter. See Alabama Code 27-55-2
  • HEALTH BENEFIT PLAN: A policy, contract, certificate, or agreement offered by a health carrier to provide, deliver, arrange, pay for, or reimburse any of the costs of health care services or health care benefit. See Alabama Code 27-55-2
  • HEALTH CARRIER: A person or entity subject to regulation under this chapter who or which contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any costs of health care services including, without limitation, a sickness and accident insurance company, a health maintenance organization, mutual aid associations, a fraternal benefit society, a hospital service corporation, or any other entity providing a plan of health insurance, including entities created pursuant to Article 6 (commencing with Section 10A-20-6. See Alabama Code 27-55-2
  • insured: A party named on a policy or health benefit plan as the person with legal rights to the benefits provided by the policy or health benefit plan, except that for life insurance, insured means the person whose life is covered under the policy. See Alabama Code 27-55-2
  • insurer: A person or other legal entity engaged in the business of insurance in this state, including agents, brokers, adjusters, and third-party administrators. See Alabama Code 27-55-2
  • policy: A contract of insurance, certificate, indemnity, suretyship, or annuity issued, proposed for issuance, or intended for issuance by an insurer, including endorsements or riders to an insurance policy or contract. See Alabama Code 27-55-2
  • SUBJECT OF ABUSE: A person, including a minor child, against whom an act of abuse has been committed a. See Alabama Code 27-55-2
  • writing: includes typewriting and printing on paper. See Alabama Code 1-1-1