Title 22, Insurance
0 chapters · 2,651 sections in this title.
La. Rev. Stat. § 22:1807.21 Additional obligations for commissioner-selected umpires
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§1807.21. Additional obligations for commissioner-selected umpires All of the following obligations apply to an umpire selected by the commissioner: (1) No later than seven days after receiving notice of selection for an appraisal, the umpire shall send a written notice to the pa…
La. Rev. Stat. § 22:1807.22 Prohibited communications
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§1807.22. Prohibited communications A. All of the following provisions apply after an umpire's selection and before the appraisal process ends: (1) The umpire shall not communicate separately with either party or either party's appraiser regarding the pending appraisal unless the…
La. Rev. Stat. § 22:1807.23 Costs
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§1807.23. Costs A. Each party is responsible for and shall pay the following: (1) His own appraiser fees and expenses. (2) Half of the reasonable and necessary costs incurred for an umpire's fee and expenses. (3) Half of any reasonable and necessary costs incurred to conduct the …
La. Rev. Stat. § 22:1807.24 Extensions of deadlines
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§1807.24. Extensions of deadlines A. The commissioner may extend any deadline provided in this Subpart for reasonable cause, except the deadline for the umpire to notify the parties that the umpire is insured by the insurer. B. To request the commissioner to extend a deadline, a …
La. Rev. Stat. § 22:1807.25 Requests and submissions to the commissioner
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§1807.25. Requests and submissions to the commissioner A. A party, appraiser, or umpire submitting notices, requests, or other items to the commissioner pursuant to this Subpart shall hand deliver, mail, or send in a manner that is otherwise acceptable to the commissioner. B. For…
La. Rev. Stat. § 22:1807.26 Objections
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§1807.26. Objections A.(1) A party or appraiser may object to an umpire for good cause no later than ten days after the party or appraiser receives the selection panel. (2) A party or appraiser may object to an umpire for good cause, no later than thirty days after the appraisal …
La. Rev. Stat. § 22:1807.27 Payment of an appraisal award
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§1807.27. Payment of an appraisal award A. If an appraisal award made pursuant to the provisions of this Subpart is not paid by the insurer within thirty days of the award amount being submitted to the insurer in a signed writing, the award amount may be considered as evidence bu…
La. Rev. Stat. § 22:1807.3 Enforcement
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§1807.3. Enforcement A. The commissioner may take any actions necessary or appropriate to enforce the provisions of this Part and the commissioner's regulations. The commissioner may order a person to cease and desist from committing violations of this Part or the commissioner's …
La. Rev. Stat. § 22:1808 Redesignated as R.S
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§1808. Redesignated as R.S. 22:369 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1808.1 License required
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§1808.1. License required A. No person shall act as, or hold himself out to be, an insurance consultant unless licensed by the Department of Insurance. B.(1) "Insurance consultant" means any person or entity which offers for a fee or other valuable consideration any advice, couns…
La. Rev. Stat. § 22:1808.10 Reciprocity; non-reciprocal states or other jurisdictions
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§1808.10. Reciprocity; non-reciprocal states or other jurisdictions A. The commissioner of insurance shall waive any requirements for a nonresident license applicant with a valid license from his home state, except the requirements imposed by R.S. 22:1808.5, if the applicant's ho…
La. Rev. Stat. § 22:1808.11 Disclosure agreement and compensation
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§1808.11. Disclosure agreement and compensation A. Prior to providing consulting services, a person licensed as a consultant pursuant to this Part shall disclose all of the following in a written contract signed by the party receiving the consulting services: (1) The services to …
La. Rev. Stat. § 22:1808.12 Prohibited acts
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§1808.12. Prohibited acts A.(1) No person licensed and acting as an insurance consultant under a written agreement pursuant to R.S. 22:1808.11, shall sell, solicit, make an application for, procure, negotiate for, or place for others, any policies for any lines of insurance. (2) …
La. Rev. Stat. § 22:1808.13 Reporting of actions
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§1808.13. Reporting of actions A. An insurance consultant shall report to the commissioner of insurance any administrative action taken against the consultant in another jurisdiction or by another governmental agency in this state within thirty days of the final disposition of th…
La. Rev. Stat. § 22:1808.2 Examination
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§1808.2. Examination A. A resident individual applying for an insurance consultant license shall pass an examination unless exempt pursuant to R.S. 22:1808.6. The examination shall test the knowledge of the individual concerning the lines of authority for which application is mad…
La. Rev. Stat. § 22:1808.3 Application for license
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§1808.3. Application for license A. A person applying for a resident insurance consultant license shall apply to the commissioner of insurance on the application promulgated by the Department of Insurance and declare under penalty of refusal, suspension, or revocation of the lice…
La. Rev. Stat. § 22:1808.4 License
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§1808.4. License A. Unless denied licensure pursuant to R.S. 22:1808.8, persons who have met the requirements of this Part shall be issued an insurance consultant license. An insurance consultant may receive qualification for a license in one or more of the following lines of aut…
La. Rev. Stat. § 22:1808.5 Nonresident licensing
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§1808.5. Nonresident licensing A. Unless denied licensure pursuant to R.S. 22:1808.8, a nonresident person shall receive a nonresident consultant license if: (1) The person is currently licensed as a resident for an equivalent license and in good standing in his home state. (2) T…
La. Rev. Stat. § 22:1808.6 Exemption from examination
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§1808.6. Exemption from examination A. An individual who applies for an insurance consultant license in this state who was previously licensed as a resident insurance consultant for the same lines of authority in another state shall not be required to complete an examination. Thi…
La. Rev. Stat. § 22:1808.7 Assumed names
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§1808.7. Assumed names A. An insurance consultant doing business under any name other than the consultant's legal name is required to notify the commissioner of insurance prior to using the assumed name. Prior to the use of or changes to any trade name or names, an insurance cons…
La. Rev. Stat. § 22:1808.8 License denial, suspension, nonrenewal, or revocation
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§1808.8. License denial, suspension, nonrenewal, or revocation A. The commissioner of insurance may place on probation, suspend, revoke, or refuse to issue, renew, or reinstate an insurance consultant license, or may levy a fine not to exceed five hundred dollars for each violati…
La. Rev. Stat. § 22:1808.9 Commissions
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§1808.9. Commissions A. No person or business entity licensed and acting as an insurance consultant under a written agreement pursuant to R.S. 22:1808.11, shall accept any commission, service fee, brokerage, or other valuable consideration for selling, soliciting, or negotiating …
La. Rev. Stat. § 22:1809 Redesignated as R.S
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§1809. Redesignated as R.S. 22:370 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:181 Reserves
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§181. Reserves Each reciprocal insurer subject to this Subpart shall maintain the same reserves, calculated in the same manner and upon the same basis as the reserves required to be maintained by stock and mutual insurers transacting the same kind or kinds of insurance. Acts 1958…
La. Rev. Stat. § 22:1810 Redesignated as R.S
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§1810. Redesignated as R.S. 22:371 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1811 Payment of claims; life policies; penalty
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§1811. Payment of claims; life policies; penalty All death claims arising under policies of insurance issued or delivered within this state shall be settled by the insurer within sixty days after the date of receipt of due proof of death, and if the insurer fails to do so without…
La. Rev. Stat. § 22:1812 Redesignated as R.S
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§1812. Redesignated as R.S. 22:373 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:182 Amendment of declaration of organization
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§182. Amendment of declaration of organization The attorney-in-fact of any domestic reciprocal insurer upon written approval of at least a majority of the subscribers, may amend the declaration of organization of such insurer in any respect not in violation of law, but the declar…
La. Rev. Stat. § 22:1821 Payment of claims; health and accident policies; prospective review; penalties;
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§1821. Payment of claims; health and accident policies; prospective review; penalties; self-insurers; telehealth reimbursement by insurers; prohibitions A. All claims arising under the terms of health and accident contracts issued in this state, except as provided in Subsection B…
La. Rev. Stat. § 22:1822 Proceeds from health care payments; notice to patient, creditor
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§1822. Proceeds from health care payments; notice to patient, creditor A. Any entity, including a health care provider as defined by R.S. 40:1231.1, receiving health insurance payments from a health insurer or other payor of health care benefits shall provide written notice to th…
La. Rev. Stat. § 22:1823 Hospitalization insurance, exclusion of payments to medical facilities owned or operated by state or for services reimbursed by medical assistance
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§1823. Hospitalization insurance, exclusion of payments to medical facilities owned or operated by state or for services reimbursed by medical assistance A. No policy of hospitalization insurance shall be issued after August 31, 1968, by any insurer doing business in this state w…
La. Rev. Stat. § 22:1824 Uniform claim forms; promulgation, implementation
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§1824. Uniform claim forms; promulgation, implementation A. The Department of Insurance shall promulgate rules and regulations for the establishment of uniform claim forms, in both written form and by electronic means, for all hospital, health, or medical expense insurance polici…
La. Rev. Stat. § 22:1825 Billing audit guidelines, rules, and regulations
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§1825. Billing audit guidelines, rules, and regulations A. The commissioner shall, with the consent of the Louisiana Department of Health and in compliance with the Louisiana Administrative Procedure Act, issue such rules, regulations, and orders as shall be necessary to implemen…
La. Rev. Stat. § 22:1826 Payment of claims for emergency services provided by noncontracted health care providers
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§1826. Payment of claims for emergency services provided by noncontracted health care providers A. If a health care provider that does not contract with a health insurance issuer files a claim with a health insurance issuer for emergency services rendered, the health insurance is…
La. Rev. Stat. § 22:1827 Submission of health insurance claims
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§1827. Submission of health insurance claims A. No healthcare provider that accepts a patient's health insurance coverage shall require an enrollee or insured to consent to payment for healthcare services as a condition for verification of health insurance coverage for such healt…
La. Rev. Stat. § 22:1828 Provider claim payment and information protection
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§1828. Provider claim payment and information protection A. As used in this Section: (1) "Electronic funds transfer" means an electronic funds transfer through the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended, standard automated cl…
La. Rev. Stat. § 22:183 Application for receiver
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§183. Application for receiver No proceedings for the dissolution of, or the appointment of a receiver for, any domestic reciprocal insurer shall be entertained by any court in this state unless the same is made by the commissioner of insurance in accordance with R.S. 22:73, 96, …
La. Rev. Stat. § 22:1831 Definitions
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§1831. Definitions As used in this Subpart, the following terms shall be defined as follows: (1) "Accepted claim" means either of the following: (a) A nonelectronic claim on a HCFA 1500 form or Uniform Billing Form 92 (UB92), properly completed according to Medicare guidelines. (…
La. Rev. Stat. § 22:1832 Standards for receipt and processing of nonelectronic claims
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§1832. Standards for receipt and processing of nonelectronic claims A.(1) Any nonelectronic claim by a health care provider under a contract with a health insurance issuer, for provision of health care services, submitted by the provider or its agent within forty-five days of the…
La. Rev. Stat. § 22:1833 Standards for receipt and processing of electronic claims
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§1833. Standards for receipt and processing of electronic claims A.(1) A health insurance issuer shall allow a health care provider access to information in the issuer's Payer's Companion Guide, or its successor, listing issuer-specific data requirements for accepted electronic c…
La. Rev. Stat. § 22:1834 Remittance advice; thirty-day payment standard; limitations on claim filing and audits
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§1834. Remittance advice; thirty-day payment standard; limitations on claim filing and audits A. Each remittance advice generated by a health insurance issuer or its agent to a health care provider or its agent shall include the following information, if known at that time, clear…
La. Rev. Stat. § 22:1835 Regulations; applicability
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§1835. Regulations; applicability A. The commissioner may promulgate such rules and regulations as may be necessary or proper to carry out the provisions of this Subpart. Such rules and regulations shall be promulgated and adopted in accordance with the Administrative Procedure A…
La. Rev. Stat. § 22:1836 Coordination of benefits
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§1836. Coordination of benefits A. Coordination of benefits requirements adopted by health insurance issuers shall, at a minimum, adhere to the following requirements: (1) No plan shall contain a provision that its benefits are "always excess" or "always secondary" except in acco…
La. Rev. Stat. § 22:1837 Violations; cease and desist orders; penalties
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§1837. Violations; cease and desist orders; penalties A. Whenever the commissioner has reason to believe that any health insurance issuer is not in full compliance with the requirements of this Subpart, the commissioner shall notify such issuer in accordance and compliance with R…
La. Rev. Stat. § 22:1838 Recoupment of health insurance claims payments
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§1838. Recoupment of health insurance claims payments A. As used in this Section, "recoupment" shall mean a reduction, offset, adjustment, or other act to lower or lessen the payment of a claim or any other amount owed to a health care provider for any reason unrelated to that cl…
La. Rev. Stat. § 22:184 Penalties
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§184. Penalties No person shall act as attorney-in-fact for a reciprocal insurer except in accordance with the provisions of this Subpart and any person who violates any of the provisions of this Section or who knowingly participates in or abets such violation shall be guilty of …
La. Rev. Stat. § 22:1841 Definitions
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§1841. Definitions For purposes of this Subpart, the following definitions apply: (1) "Health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a h…
La. Rev. Stat. § 22:1842 Telehealth healthcare services statement
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§1842. Telehealth healthcare services statement A.(1) Each issuer of a health coverage plan shall display in a conspicuous manner on the health coverage plan issuer's website information regarding how to receive covered telehealth healthcare services and remote patient monitoring…
La. Rev. Stat. § 22:1843 Remote patient monitoring services
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§1843. Remote patient monitoring services A. The legislature hereby finds all of the following: (1) Remote patient monitoring services aim to allow more people to remain at home or in other nontraditional clinical settings and to improve the quality and cost of their care, includ…
La. Rev. Stat. § 22:1844 Exclusions
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§1844. Exclusions The provisions of this Subpart shall not apply to any plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, and short-term policies that have a term of less than twelve months. Acts 2020, No. 276, §1, e…