Title 22, Insurance
0 chapters · 2,651 sections in this title.
La. Rev. Stat. § 22:1059.4 Required coverage for pregnancy-related nutrition counseling services;
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§1059.4. Required coverage for pregnancy-related nutrition counseling services; reimbursement discrimination prohibited; definitions A. The legislature hereby finds and affirms all of the following: (1) Louisiana has one of the highest maternal and infant mortality rates in the U…
La. Rev. Stat. § 22:1059.5 Required coverage for lactation support services; reimbursement discrimination
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§1059.5. Required coverage for lactation support services; reimbursement discrimination prohibited; definitions A. The legislature hereby finds and affirms all of the following: (1) Louisiana has one of the highest maternal and infant mortality rates in the United States and has …
La. Rev. Stat. § 22:1059.6 Required coverage for home visiting services; newborns and young children;
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§1059.6. Required coverage for home visiting services; newborns and young children; legislative findings; reimbursement methods; definitions A. The legislature hereby finds and affirms all of the following: (1) Home visiting services are evidence-based deliveries of services to f…
La. Rev. Stat. § 22:1059.7 Required coverage for amino acid-based elemental formulas
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§1059.7. Required coverage for amino acid-based elemental formulas A. A health insurance issuer offering health coverage plans in this state that provides benefits for maternity services shall provide coverage for amino acid-based elemental formulas, regardless of the formula del…
La. Rev. Stat. § 22:1060.1 Definitions
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§1060.1. Definitions As used in this Subpart, the following definitions shall apply: (1) "Authorized prescriber" means a person licensed, registered, or otherwise authorized by the appropriate licensing board to prescribe prescription drugs in the course of professional practice.…
La. Rev. Stat. § 22:1060.11 Short title
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§1060.11. Short title This Subpart shall be known and may be cited as the "Cancer Patient's Right to Prompt Coverage Act". Acts 2023, No. 254, §1.
La. Rev. Stat. § 22:1060.12 Definitions
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§1060.12. Definitions As used in this Subpart, the following definitions apply unless the context indicates otherwise: (1) "Consensus statements" means statements developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting str…
La. Rev. Stat. § 22:1060.13 Prior authorization; time periods
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§1060.13. Prior authorization; time periods A. For any services typically covered under the plan and related to the diagnosis or treatment of cancer for which prior authorization is required under a health coverage plan, the health insurance issuer shall offer an expedited review…
La. Rev. Stat. § 22:1060.14 Requirement to cover services consistent with nationally recognized clinical
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§1060.14. Requirement to cover services consistent with nationally recognized clinical practice guidelines or consensus statements A. No health coverage plan that is renewed, delivered, or issued for delivery in this state that provides coverage for cancer in accordance with this…
La. Rev. Stat. § 22:1060.15 Required coverage for positron emission tomography or other recommended
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§1060.15. Required coverage for positron emission tomography or other recommended imaging for cancer A. No health insurance issuer shall deny coverage of a positron emission tomography or other recommended imaging for the purpose of diagnosis, treatment, appropriate management, r…
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. § 22:1065.1 Redesignated as R.S
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§1065.1. Redesignated as R.S. 22:822 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
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…