Health benefit plans; process further specified for making coverage determinations with enforcement and oversight given to the Department of Insurance.

HB 557 shifts oversight of health insurance "utilization review" (the process insurers use to approve or deny coverage) from the Alabama Department of Public Health to the Alabama Department of Insurance. It requires health insurers to: report annual denial rates to the Department, make coverage criteria publicly available, make coverage decisions within 72 hours for non-urgent care (24 hours for urgent care), and have those decisions reviewed by a licensed healthcare professional. The bill also mandates the Department establish an ombudsman to handle complaints and grants the Department authority to impose civil fines for violations, while allowing enrollees to pursue civil damages for denied care. This directly affects health insurers, enrollees, and healthcare providers in Alabama by increasing transparency, speeding up decisions, and strengthening accountability for coverage denials.