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SB170 ENROLLED
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SB170
RBRKINM-2
By Senators Roberts, Shelnutt
RFD: Banking and Insurance
First Read: 15-Jan-26
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First Read: 15-Jan-26
Enrolled, An Act,
Relating to health insurance; to create the Health
Savings Account State-Federal Regulatory Coordination Act; to
add Article 5 to Chapter 19, Title 27, Code of Alabama 1975,
to limit application of a federal cost-sharing requirement to
instances where the minimum deductible under federal law has
been applied to an enrollee's plan; to ensure the enrollee's
health savings account continues to qualify as a
high-deductible plan under federal law; and to amend Sections
10A-20-6.16 and 27-21A-23, Code of Alabama 1975, relating to
certain health care service corporations and health
maintenance organizations, to reference the new Article 5,
Chapter 9, Title 27, Code of Alabama 1975, created by the new
article.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Article 5 is added to Chapter 19, Title 27
of the Code of Alabama 1975, to read as follows:
Article 5. The Health Savings Account State-Federal
Regulatory Coordination Act.
§27-19-180
(a) This article shall be known and may be cited as the
Health Savings Account State-Federal Regulatory Coordination
Act.
(b) The purpose of this article is to protect the
efficacy of Health Savings Account (HSA) qualified plans via a
legislative exception or safe harbor from any state benefit
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legislative exception or safe harbor from any state benefit
mandate or copay accumulator adjustment law due to federal
law, regulations, rules, or guidance regarding high deductible
health plans.
(c) For purposes of this article, the following terms
have the following meanings:
(1) ENROLLEE. An individual who is enrolled in a health
insurance plan, whether on an individual or group basis,
including any covered dependent.
(2) HEALTH SAVINGS ACCOUNT QUALIFIED INSURANCE PLAN or
HSA. A high deductible health plan that meets the specific
requirements of 26 U.S.C. § 223, as interpreted and
administered by the federal Internal Revenue Service.
Individuals covered by such a plan may contribute to a Health
Savings Account (HSA), a trust, or a custodial account for
qualified medical expenses. An individual may not contribute
to an HSA unless he or she is covered by an HSA-qualified
insurance plan and has no other disqualifying coverage.
(3) HIGH DEDUCTIBLE HEALTH PLAN. A health insurance
plan, as defined in 26 U.S.C. § 223(c)(2).
(4) PREVENTIVE CARE. Those services defined as such by
the U.S. Department of the Treasury and the Internal Revenue
Service, including preventive services recognized under the
Affordable Care Act, pursuant to regulation or guidance issued
under the authority of Title 26 of the United States Code. In
general, the term does not include services that provide
treatment for known illnesses, diseases, or conditions.
However, under IRS Notice 2019-45, the term also includes
specified products and services provided to individuals with
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specified products and services provided to individuals with
certain defined chronic conditions including, but not limited
to, diabetes, asthma, and heart disease.
(5) ZERO COST-SHARING or COST-SHARING RESTRICTIONS.
Prohibition outright of any deductible, copayment, or
coinsurance on the part of the enrollee or certain limitations
on the amount of the deductible, copayment, or coinsurance.
(d) If under federal law, the application of any
cost-sharing requirement of the Insurance Code would cause the
enrollee's health savings account plan to no longer qualify as
a high-deductible health plan under 26 U.S.C. § 223, then the
cost-sharing requirement shall only apply to the enrollee's
plan once the minimum deductible under 26 U.S.C. § 223 has
been applied.
(e) The Commissioner of Insurance may adopt rules as
necessary to implement this section.
Section 2. Sections 10A-20-6.16 and 27-21A-23 of the
Code of Alabama 1975, are amended to read as follows:
"§10A-20-6.16
(a) No statute of this state applying to insurance
companies shall be applicable to any corporation organized
under this article and amendments thereto or to any contract
made by the corporation ;, except the corporation shall be
subject to the following:
(1) The provisions regarding annual premium tax to be
paid by insurers on insurance premiums.
(2) Chapter 55 of Title 27.
(3) Article 2 and Article 3 of Chapter 19 of Title 27.
(4) Section 27-1-17.
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(4) Section 27-1-17.
(5) Chapter 56 of Title 27.
(6) Rules adopted by the Commissioner of Insurance
pursuant to Sections 27-7-43 and 27-7-44.
(7) Chapter 54 of Title 27.
(8) Chapter 57 of Title 27.
(9) Chapter 58 of Title 27.
(10) Chapter 59 of Title 27.
(11) Chapter 54A of Title 27.
(12) Chapter 12A of Title 27.
(13) Chapter 2B of Title 27.
(14) Chapter 29 of Title 27.
(15) Chapter 62 of Title 27.
(16) Chapter 63 of Title 27.
(17) Chapter 45A of Title 27.
(18) Article 5 of Chapter 19 of Title 27.
(b) The provisions in subsection (a) that require
specific types of coverage to be offered or provided shall not
apply when the corporation is administering a self-funded
benefit plan or similar plan, fund, or program that it does
not insure."
"§27-21A-23
(a) Except as otherwise provided in this chapter,
provisions of the insurance law and provisions of health care
service plan laws shall not be applicable to any health
maintenance organization granted a certificate of authority
under this chapter. This provision subsection shall not apply
to an insurer or health care service plan licensed and
regulated pursuant to the insurance law or the health care
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regulated pursuant to the insurance law or the health care
service plan laws of this state except with respect to its
health maintenance organization activities authorized and
regulated pursuant to this chapter.
(b) Solicitation of enrollees by a health maintenance
organization granted a certificate of authority shall not be
construed to violate any provision of law relating to
solicitation or advertising by health professionals.
(c) Any health maintenance organization authorized
under this chapter shall not be deemed to be practicing
medicine and shall be exempt from the provisions of Section
34-24-310, et seq., relating to the practice of medicine.
(d) No person participating in the arrangements of a
health maintenance organization other than the actual provider
of health care services or supplies directly to enrollees and
their families shall be liable for negligence, misfeasance,
nonfeasance, or malpractice in connection with the furnishing
of such services and supplies.
(e) Nothing in this chapter shall be construed in any
way to repeal or conflict with any provision of the
certificate of need law.
(f) Notwithstanding the provisions of subsection (a), a
health maintenance organization shall be subject to all of the
following:
(1) Section 27-1-17.
(2) Chapter 56.
(3) Chapter 54.
(4) Chapter 57.
(5) Chapter 58.
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(5) Chapter 58.
(6) Chapter 59.
(7) Rules adopted by the Commissioner of Insurance
pursuant to Sections 27-7-43 and 27-7-44.
(8) Chapter 12A.
(9) Chapter 54A.
(10) Chapter 2B.
(11) Chapter 29.
(12) Chapter 62.
(13) Chapter 63.
(14) Chapter 45A.
(15) Article 5 of Chapter 19. "
Section 3. This act shall become effective on June 1,
2026.
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2026.
________________________________________________
President and Presiding Officer of the Senate
________________________________________________
Speaker of the House of Representatives
SB170
Senate 17-Feb-26
I hereby certify that the within Act originated in and passed
the Senate.
Patrick Harris,
Secretary.
House of Representatives
Amended and passed: 11-Mar-26
Senate concurred in House amendment 11-Mar-26
By: Senator Roberts
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