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0 chapters · 1,747 sections in this title.
La. Rev. Stat. § 22:1060.16 Coverage for outpatient cancer treatments
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§1060.16. Coverage for outpatient cancer treatments A. All health coverage plans renewed, delivered, or issued for delivery in this state shall, in addition to providing coverage for an insured admitted on an inpatient basis to a licensed hospital providing rehabilitation, long-t…
La. Rev. Stat. § 22:1060.17 Enforcement provisions
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§1060.17. Enforcement provisions A. Whenever the commissioner has reason to believe that any health insurance issuer is not in compliance with any of the provisions of this Subpart, the commissioner shall notify the health insurance issuer. The commissioner may, in addition to th…
La. Rev. Stat. § 22:1060.18 Required coverage for proton therapy treatment for cancer
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§1060.18. Required coverage for proton therapy treatment for cancer A. No health insurance issuer shall deny coverage of proton therapy or proton beam therapy for the treatment of cancer as recommended by the American Society for Radiation Oncology practice guidelines. B. The cov…
La. Rev. Stat. § 22:1060.2 Notice and disclosure of certain information required
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§1060.2. Notice and disclosure of certain information required A health insurance issuer of a health benefit plan that covers prescription drugs and uses one or more drug formularies to specify the prescription drugs covered under the plan shall do all of the following: (1) Provi…
La. Rev. Stat. § 22:1060.3 Continuation of coverage required; other drugs not precluded
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§1060.3. Continuation of coverage required; other drugs not precluded A. A health insurance issuer of a health benefit plan that covers prescription drugs shall offer to each enrollee at the contracted benefit level and until the enrollee's plan renewal date any prescription drug…
La. Rev. Stat. § 22:1060.4 Adverse determination
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§1060.4. Adverse determination A. The refusal of a health insurance issuer to provide benefits to an enrollee for a prescription drug is an adverse determination for purposes of the Internal Claims and Appeals Process and External Review Act, R.S. 22:2391 et seq., if each of the …
La. Rev. Stat. § 22:1060.5 Specialty drug tiers; prohibitions; limits on copayments
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§1060.5. Specialty drug tiers; prohibitions; limits on copayments A. A health insurance issuer of a health benefit plan that covers prescription drugs, as defined in R.S. 22:1060.1(8), and utilizes a formulary tier that is higher than a preferred or non-preferred brand drug tier,…
La. Rev. Stat. § 22:1060.6 Limitation; patient payment
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§1060.6. Limitation; patient payment A. An individual shall not be required to make a payment for pharmacists' services in an amount greater than the pharmacist or pharmacy providing the pharmacists' services may retain from all payment sources. B. No pharmacy benefit manager, in…
La. Rev. Stat. § 22:1060.7 Prescription medication for pain
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§1060.7. Prescription medication for pain A. Notwithstanding any provision of law to the contrary, when a licensed physician prescribes a nonopioid medication for the treatment of chronic pain, it shall be unlawful for a health insurance issuer to deny coverage of the nonopioid p…
La. Rev. Stat. § 22:1060.8 Coverage of drugs approved by the United States Food and Drug Administration;
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§1060.8. Coverage of drugs approved by the United States Food and Drug Administration; exclusions; definitions A. No health coverage plan delivered or issued for delivery in this state shall limit or exclude coverage involving a minor for a drug on the basis that the drug is pres…
La. Rev. Stat. § 22:1061 Definitions
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§1061. Definitions As used in R.S. 22:984 and 1061 through 1079, the following terms shall have the following meanings: (1)(a) "Group health plan" means an employee welfare benefit plan as defined in Section 3(1) of the Employee Retirement Income Security Act of 1974 to the exten…
La. Rev. Stat. § 22:1062 Increased portability through limitation on preexisting condition exclusions
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§1062. Increased portability through limitation on preexisting condition exclusions A. Limitation on preexisting condition exclusion period; crediting for periods of previous coverage. Subject to the provisions of Subsection D of this Section, a group health plan, and a health in…
La. Rev. Stat. § 22:1062.1 Special enrollment period
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§1062.1. Special enrollment period A. Every group health plan issued by a health insurer or a health maintenance organization shall provide for a special enrollment period for employees or dependents if either of the following apply: (1) The employee or dependent loses eligibilit…
La. Rev. Stat. § 22:1063 Prohibiting discrimination against individual participants and beneficiaries based on
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§1063. Prohibiting discrimination against individual participants and beneficiaries based on health status A.(1) Subject to Paragraph (2) of this Subsection, a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group hea…
La. Rev. Stat. § 22:1064 Certification of coverage
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§1064. Certification of coverage The provisions of R.S. 22:1062(D) shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in connecti…
La. Rev. Stat. § 22:1065 Standards relating to benefits for mothers and newborns
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§1065. Standards relating to benefits for mothers and newborns A.(1) A group health plan, and a health insurance issuer offering group health insurance coverage, and Medical Assistance coverage provided under 42 U.S.C. 1396 et seq., may not, except as provided in Paragraph (2) of…
La. Rev. Stat. § 22:1066 Parity in the application of certain limits to mental health benefits
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§1066. Parity in the application of certain limits to mental health benefits A.(1) In the case of a group health plan, or health insurance coverage offered in connection with such a plan, that provides both medical and surgical benefits and mental health benefits: (a) If the plan…
La. Rev. Stat. § 22:1066.1 Benefit limits; lifetime; annual
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§1066.1. Benefit limits; lifetime; annual A. Except as provided for in Subsection C of this Section, any health coverage plan issued for delivery, delivered, renewed, or otherwise contracted for in this state on or after January 1, 2020, shall provide coverage without any lifetim…
La. Rev. Stat. § 22:1066.2 Psychiatric Collaborative Care Model; service delivery method requirements
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§1066.2. Psychiatric Collaborative Care Model; service delivery method requirements A. A health coverage plan which is delivered or issued for delivery in this state that provides mental health and substance abuse benefits shall provide coverage for mental health and substance ab…
La. Rev. Stat. § 22:1067 Guaranteed availability of coverage for employers in the group market
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§1067. Guaranteed availability of coverage for employers in the group market A.(1) Except as provided in Subsections B through E of this Section, each health insurance issuer that offers health insurance coverage in the small group market shall do the following: (a) Accept every …
La. Rev. Stat. § 22:1068 Guaranteed renewability of coverage for employers in the group market
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§1068. Guaranteed renewability of coverage for employers in the group market A. Except as provided in this Section, if a health insurance issuer offers health insurance coverage in the small or large group market in connection with a group health plan, the issuer must renew or co…
La. Rev. Stat. § 22:1069 Disclosure of information
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§1069. Disclosure of information A. In connection with the offering of any health insurance coverage to a small employer, a health insurance issuer shall make a reasonable disclosure to such employer, as part of its solicitation and sales materials, of the availability of informa…
La. Rev. Stat. § 22:1070 Exclusion of certain plans
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§1070. Exclusion of certain plans A. The requirements of this Subpart shall not apply to any group health plan, and health insurance coverage offered in connection with a group health plan, for any plan year if, on the first day of such plan year, such plan has less than two part…
La. Rev. Stat. § 22:1071 Enforcement provisions
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§1071. Enforcement provisions A. Health insurance issuers that issue, sell, renew, or offer health insurance coverage in this state in the small or large group markets shall meet the requirements of this Subpart with respect to such issuers. B. The commissioner of insurance shall…
La. Rev. Stat. § 22:1072 Individual health insurance coverage portability and limitation on preexisting condition exclusions; newborn coverage; coordination of benefits
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§1072. Individual health insurance coverage portability and limitation on preexisting condition exclusions; newborn coverage; coordination of benefits A. The coverage for an insured under individual health insurance coverage shall be subject to the provisions of this Section. B. …
La. Rev. Stat. § 22:1073 Guaranteed availability of individual health insurance coverage to certain individuals with prior group or individual coverage
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§1073. Guaranteed availability of individual health insurance coverage to certain individuals with prior group or individual coverage A.(1) Except as otherwise provided for in this Section, each health insurance issuer that offers health insurance coverage, as defined in R.S. 22:…
La. Rev. Stat. § 22:1074 Guaranteed renewability of individual health insurance coverage
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§1074. Guaranteed renewability of individual health insurance coverage A. Except as provided in this Section, a health insurance issuer that provides individual health insurance coverage to an individual shall renew or continue in force such coverage at the option of the individu…
La. Rev. Stat. § 22:1075 Standards relating to benefits for mothers and newborns
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§1075. Standards relating to benefits for mothers and newborns A.(1) The provisions of R.S. 22:1065(A), (B), and (C) shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverag…
La. Rev. Stat. § 22:1076 General exceptions
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§1076. General exceptions A. The requirements of this Subpart shall not apply to any health insurance coverage in relation to its provision of excepted benefits described in R.S. 22:1061(3)(a). B. The requirements of this Subpart shall not apply to any health insurance coverage i…
La. Rev. Stat. § 22:1076.1 Advisory board; composition; recommendations for treatment of rare cancers;
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§1076.1. Advisory board; composition; recommendations for treatment of rare cancers; meetings; rulemaking A. There is hereby created within the department an advisory board that shall review and provide medical recommendations to approve new treatments for rare cancers. The advis…
La. Rev. Stat. § 22:1077 Required coverage for mastectomies and reconstructive surgery following
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§1077. Required coverage for mastectomies and reconstructive surgery following mastectomies A. The legislature hereby finds that approximately three thousand women will be diagnosed with breast cancer each year in Louisiana. Studies documenting breast cancer statistics indicate t…
La. Rev. Stat. § 22:1077.1 Required coverage for preventive cancer screening following a bilateral
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§1077.1. Required coverage for preventive cancer screening following a bilateral mastectomy A. The legislature hereby finds that after women who are diagnosed with breast cancer finish active treatment, they may transition into a different system for long-term survivorship care. …
La. Rev. Stat. § 22:1077.2 Required coverage for a patient's choice of medical and surgical treatment
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§1077.2. Required coverage for a patient's choice of medical and surgical treatment following a diagnosis of breast cancer A. The legislature hereby finds all of the following: (1) Breast cancer was the most common cancer in Louisiana women from 2010 to 2014. (2) Between 2010 and…
La. Rev. Stat. § 22:1077.3 Required coverage for a patient's choice of medical and surgical treatments
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§1077.3. Required coverage for a patient's choice of medical and surgical treatments following a diagnosis and treatment of cancer A. The purpose of this Section is to stress that decisions regarding the treatment procedures to be performed following a diagnosis of cancer shall b…
La. Rev. Stat. § 22:1077.4 Inpatient treatment following a perinatal psychiatric diagnosis; commercial
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§1077.4. Inpatient treatment following a perinatal psychiatric diagnosis; commercial insurance A. Any health benefit plan offered by a health insurance issuer that provides mental health benefits with respect to treatment for perinatal psychiatric diagnoses shall provide coverage…
La. Rev. Stat. § 22:1077.5 Required coverage for integrative cancer treatments; acupuncture; cooling systems;
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§1077.5. Required coverage for integrative cancer treatments; acupuncture; cooling systems; cryotherapy A. A health insurance issuer offering health coverage plans in this state that provide hospital, medical, or surgical benefits for individuals covered under a respective plan s…
La. Rev. Stat. § 22:1078 Protections required for victims of the crime of domestic violence
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§1078. Protections required for victims of the crime of domestic violence A. As used in this Section, the following terms shall be defined as follows: (1) "Abuse" means bodily injury as a result of battery or any offense against the person as defined in the Louisiana Criminal Cod…
La. Rev. Stat. § 22:1079 Compliance of health insurance issuer with Gramm-Leach-Bliley Act
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§1079. Compliance of health insurance issuer with Gramm-Leach-Bliley Act A health insurance issuer who is in compliance with the privacy requirements of the federal Health Insurance Portability and Accountability Act of 1996 (42 USC 1320d) shall be deemed to be in compliance with…
La. Rev. Stat. § 22:1080 Third-party premium payments; refusal of acceptance
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§1080. Third-party premium payments; refusal of acceptance A. No health insurance issuer or health maintenance organization shall refuse the receipt of a premium payment when such payment is made by a third party to the insurance contract, provided that the payment is made from o…
La. Rev. Stat. § 22:1091 Health insurance plans subject to rate review
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§1091. Health insurance plans subject to rate review A. The provisions of this Subpart shall apply to any health benefit plan which provides coverage in the small group market or individual market, including any policy or subscriber agreement covering residents of this state. The…
La. Rev. Stat. § 22:1092 Health insurance issuers; rate filings and rate increases
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§1092. Health insurance issuers; rate filings and rate increases A. Every health insurance issuer shall file with the department every proposed rate to be used in connection with all of its particular products. Every such filing shall clearly state the date of the filing, the pro…
La. Rev. Stat. § 22:1092.1 Grandfathered health coverage; rating practices
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§1092.1. Grandfathered health coverage; rating practices The rating practices and rating methods and the rating restrictions imposed by law upon grandfathered health coverage in the individual market and small group market that are in effect on the day that this Section takes eff…
La. Rev. Stat. § 22:1093 Disclosure of rating practices and renewability provisions for insureds
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§1093. Disclosure of rating practices and renewability provisions for insureds A. Each health insurance issuer shall make reasonable disclosure in solicitation and sales materials provided to insureds of the provisions relating to renewability of coverage. B. Each health insuranc…
La. Rev. Stat. § 22:1094 Maintenance of records for the department
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§1094. Maintenance of records for the department A. Each health insurance issuer shall maintain at its principal place of business a complete and detailed description of its rating practices, including information and documentation which demonstrate that its rating methods and pr…
La. Rev. Stat. § 22:1095 Rating factors; risk pools; individual market plan and calendar year requirement
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§1095. Rating factors; risk pools; individual market plan and calendar year requirement A. Health insurance issuers may vary premiums from the plan-adjusted index rate in the individual or small group market due only to one or more of the following factors: (1) The number of pers…
La. Rev. Stat. § 22:1096 Regulations; preemption
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§1096. Regulations; preemption A. The commissioner may promulgate such rules and regulations as may be necessary and proper to carry out the provisions of this Subpart and Section 2794 of the Public Health Service Act. Such rules and regulations shall be promulgated and adopted i…
La. Rev. Stat. § 22:1097 Discrimination in rates or failure to provide coverage because of severe disability or sickle cell trait prohibited
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§1097. Discrimination in rates or failure to provide coverage because of severe disability or sickle cell trait prohibited A. No insurance company shall charge unfair discriminatory premiums, policy fees, or rates for, or refuse to provide any policy or contract of life insurance…
La. Rev. Stat. § 22:1098 Frequency of rate increases; limitations
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§1098. Frequency of rate increases; limitations A. The following rate increase limitations shall apply to all health benefit plans, limited benefits, and excepted benefits: (1) Health insurance issuers of limited benefits and excepted benefits policies shall not increase rates du…
La. Rev. Stat. § 22:1099 Enforcement
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§1099. Enforcement A. Whenever the commissioner has reason to believe that any health insurance issuer is not in compliance with any of the provisions of this Subpart, he shall notify such health insurance issuer. Upon such notice, the commissioner may, in addition to the penalti…
La. Rev. Stat. § 22:11 Rules and regulations by commissioner
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§11. Rules and regulations by commissioner A. The commissioner of insurance may promulgate rules and regulations that the commissioner determines are necessary for implementation of this Title. Such implementation shall be subject to the legislative oversight of the House of Repr…
