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0 chapters · 1,747 sections in this title.
La. Rev. Stat. § 22:237.13 Directors and officers of the reorganized company
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§237.13. Directors and officers of the reorganized company The directors and officers of the reorganizing mutual, unless otherwise specified in the plan of reorganization, shall serve as the directors and officers of the reorganized company until new directors and officers are du…
La. Rev. Stat. § 22:237.2 Definitions
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§237.2. Definitions As used in this Subpart, the following terms shall have the respective meanings hereinafter set forth, unless the context shall otherwise require: (1) "Adoption date" means the date as of which the board of directors of the reorganizing mutual initially approv…
La. Rev. Stat. § 22:237.3 Conversion of mutual insurers and mutual insurance holding companies authorized
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§237.3. Conversion of mutual insurers and mutual insurance holding companies authorized A. A mutual insurer may, pursuant to R.S. 22:71 and 72 and the provisions of this Subpart, reorganize into a stock insurance company that may be or become a subsidiary of a parent corporation …
La. Rev. Stat. § 22:237.4 Plan of reorganization
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§237.4. Plan of reorganization A. A reorganizing mutual seeking to reorganize pursuant to the provisions of this Subpart shall submit a proposed plan of reorganization to the commissioner. The plan of reorganization shall include the following: (1) A statement analyzing the benef…
La. Rev. Stat. § 22:237.5 Consideration and dividend protections
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§237.5. Consideration and dividend protections A. In effecting a conversion of a reorganizing mutual, each eligible member shall be entitled to consideration in an amount equal to his or its equitable share of the value of the reorganizing mutual as provided for in the plan of re…
La. Rev. Stat. § 22:237.6 Approval by commissioner after public hearing
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§237.6. Approval by commissioner after public hearing A. The commissioner shall hold a public hearing upon notice as set forth in this Section to hear evidence upon whether the plan of reorganization properly protects the interests of the policyholders as such and as members, ser…
La. Rev. Stat. § 22:237.7 Approval by qualified voters
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§237.7. Approval by qualified voters A. The plan of reorganization shall be approved at a meeting convened for that purpose by a vote of not less than two-thirds of the qualified voters of the reorganizing mutual entitled to vote on matters and present or represented by special b…
La. Rev. Stat. § 22:237.8 Limitations on acquisition of beneficial ownership
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§237.8. Limitations on acquisition of beneficial ownership A. Except as otherwise specifically provided in the plan of reorganization, prior to and for a period of five years following the effective date of the reorganization, no person or persons acting in concert, other than th…
La. Rev. Stat. § 22:237.9 Limitations on compensation of directors, officers, agents, and employees
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§237.9. Limitations on compensation of directors, officers, agents, and employees Except as set forth in the plan of reorganization approved by the qualified voters and the commissioner or in a stock-based compensation program or arrangement using options or other securities prev…
La. Rev. Stat. § 22:2370 Earned capital
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§2370. Earned capital A. An insurer who receives a matching capital fund grant under the provisions of this Chapter shall earn the grant at the rate of twenty percent per year for each year in which the insurer maintains the net written premiums in compliance with the requirement…
La. Rev. Stat. § 22:2371 Insure Louisiana Incentive Fund
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§2371. Insure Louisiana Incentive Fund There is hereby created in the state treasury as a special fund the Insure Louisiana Incentive Fund, referred to in this Chapter as the "fund". Monies appropriated or transferred to the fund shall be deposited by the state treasurer after co…
La. Rev. Stat. § 22:2381 Interstate Insurance Product Regulation Compact; Louisiana's participation
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§2381. Interstate Insurance Product Regulation Compact; Louisiana's participation The Interstate Insurance Product Regulation Compact, the full text of which is set forth and confirmed by the Louisiana Legislature, is hereby entered into on behalf of the state of Louisiana. The c…
La. Rev. Stat. § 22:2382 Louisiana compact commission official
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§2382. Louisiana compact commission official Pursuant to the terms and conditions of this Part, the state of Louisiana seeks to join with other states and establish the Interstate Insurance Product Regulation Compact, and thus become a member of the Interstate Insurance Product R…
La. Rev. Stat. § 22:2391 Purpose; short title
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§2391. Purpose; short title A. This Chapter shall be known and may be cited as the "Internal Claims and Appeals Process and External Review Act". B. The purpose of this Chapter is the following: (1) To establish standards and criteria for the structure and operation of utilizatio…
La. Rev. Stat. § 22:2392 Definitions
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§2392. Definitions As used in this Chapter: (1) "Adverse determination" means any of the following: (a) A determination by a health insurance issuer or its designee utilization review organization that, based upon the information provided, a request for a benefit under the health…
La. Rev. Stat. § 22:2393 Applicability and scope
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§2393. Applicability and scope A. This Chapter shall apply to any health insurance issuer that offers a health benefit plan as defined in this Chapter. B. For purposes of claims related to a dental insurance policy, this Chapter shall apply only to external review or adverse dete…
La. Rev. Stat. § 22:2394 Licensure as a utilization review organization
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§2394. Licensure as a utilization review organization A. No health insurance issuer, or entity acting on behalf of, or agent of a health insurance issuer shall act as a utilization review organization unless authorized as such by the commissioner as provided in this Chapter. B. A…
La. Rev. Stat. § 22:2395 Procedure for application to act as a utilization review organization
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§2395. Procedure for application to act as a utilization review organization A. Any applicant for licensure as a utilization review organization, other than a health insurance issuer, shall submit an application to the commissioner and pay the application fee specified in R.S. 22…
La. Rev. Stat. § 22:24 Life and health sales quotas; prohibitions
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§24. Life and health sales quotas; prohibitions No existing contract between an insurer and a producer may be amended to add any provision that may require, as a quota, a producer to sell a specific number of life or health policies or a specific dollar amount of life or health i…
La. Rev. Stat. § 22:2401 Requirements of federal laws and regulations; minimum requirements
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§2401. Requirements of federal laws and regulations; minimum requirements Health insurance issuers shall implement effective processes for appeals of coverage determinations and claims. The processes shall comply with any applicable federal law or regulation. Under such processes…
La. Rev. Stat. § 22:241 Short title
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§241. Short title This Subpart may be cited as the Health Maintenance Organization Act. Acts 1986, No. 1065, §1; Redesignated from R.S. 22:2001 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009. NOTE: Former R.S. 22:241 redesignated as R.S. 22:1214 by Acts 2008, No. 415, §1, eff. Jan.…
La. Rev. Stat. § 22:242 Definitions
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§242. Definitions As used in this Subpart: (1) "Basic health care services" means emergency care, inpatient hospital and physician care, outpatient medical and chiropractic services, and laboratory and x-ray services. The term shall include optional coverage for mental health ser…
La. Rev. Stat. § 22:243 Incorporation
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§243. Incorporation A. Three or more artificial or natural persons capable of contracting, who are citizens of the United States and a majority of whom are residents of this state, may act as incorporators to form a corporation for the purpose of transacting business as a health …
La. Rev. Stat. § 22:2431 Short title
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§2431. Short title This Part shall be known and may be cited as the "Health Insurance Issuer External Review Act". Acts 2013, No. 326, §1, eff. Jan. 1, 2015.
La. Rev. Stat. § 22:2432 Purpose and intent
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§2432. Purpose and intent The purpose of this Part is to provide uniform standards for the establishment and maintenance of external review procedures to assure that covered persons have the opportunity for an independent review of an adverse determination or final adverse determ…
La. Rev. Stat. § 22:2433 Notice of right to external review
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§2433. Notice of right to external review A.(1) For matters involving an issue of medical necessity, appropriateness, health care setting, level of care, effectiveness, or a rescission, a health insurance issuer shall notify the covered person in writing of the covered person's r…
La. Rev. Stat. § 22:2434 Request for external review
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§2434. Request for external review A.(1) Except for a request for an expedited external review, all requests for external review shall be made in writing to the health insurance issuer. (2) The commissioner may prescribe by regulation the form and content of external review reque…
La. Rev. Stat. § 22:2435 Exhaustion of internal claims and appeals process
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§2435. Exhaustion of internal claims and appeals process A.(1) Except as provided in Subsection B of this Section, a request for an external review pursuant to R.S. 22:2436 through 2438 shall not be made until the covered person has exhausted the health insurance issuer's interna…
La. Rev. Stat. § 22:2436 Standard external review
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§2436. Standard external review A. Within four months after the date of receipt of a notice of an adverse determination or final adverse determination pursuant to R.S. 22:2433, a covered person or his authorized representative may file a request for an external review with the he…
La. Rev. Stat. § 22:2437 Expedited external review
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§2437. Expedited external review A. Except as provided in Subsection F of this Section, a covered person or his authorized representative may make a request regardless of the claim amount for an expedited external review with the health insurance issuer at the time that the cover…
La. Rev. Stat. § 22:2438 External review of experimental or investigational treatment adverse determinations
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§2438. External review of experimental or investigational treatment adverse determinations A.(1) Within four months after the date of receipt of a notice of an adverse determination or final adverse determination pursuant to R.S. 22:2433 that involves a denial of coverage based o…
La. Rev. Stat. § 22:2439 Binding nature of external review decision
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§2439. Binding nature of external review decision A. A standard or an expedited external review decision shall be binding on the health insurance issuer except to the extent the health insurance issuer has other remedies available under applicable federal or state law. B. A stand…
La. Rev. Stat. § 22:244 Application for certificate of authority to do business as a health maintenance organization in this state
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§244. Application for certificate of authority to do business as a health maintenance organization in this state A. Notwithstanding any other provision of law to the contrary, an application for a certificate of authority shall be made by the corporation to the commissioner in co…
La. Rev. Stat. § 22:2440 Approval of independent review organizations
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§2440. Approval of independent review organizations A. The commissioner shall approve independent review organizations eligible to be assigned to conduct external reviews under this Part. B. In order to be eligible for approval by the commissioner under this Section to conduct ex…
La. Rev. Stat. § 22:2441 Minimum qualifications for independent review organizations
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§2441. Minimum qualifications for independent review organizations A. To be approved under R.S. 22:2440 to conduct external reviews, an independent review organization shall not be a health insurance issuer and shall have and maintain written policies and procedures that govern a…
La. Rev. Stat. § 22:2442 Hold harmless for external review procedures
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§2442. Hold harmless for external review procedures No independent review organization or clinical peer working on behalf of an independent review organization or an employee, agent, or contractor of an independent review organization shall be liable in damages to any person for …
La. Rev. Stat. § 22:2443 External review reporting requirements
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§2443. External review reporting requirements A. An independent review organization assigned pursuant to R.S. 22:2436 through 2438 to conduct an external review shall maintain written records in the aggregate, by state, and by health insurance issuer on all requests for external …
La. Rev. Stat. § 22:2444 Funding of external review
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§2444. Funding of external review A. The health insurance issuer against which a request for a standard external review or an expedited external review is filed shall pay the cost of the independent review organization for conducting the external review, and no fee or other charg…
La. Rev. Stat. § 22:2445 Disclosure requirements
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§2445. Disclosure requirements A.(1) Each health insurance issuer shall include a description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage that it provides to covered persons. (…
La. Rev. Stat. § 22:245 Interpreter services for the deaf and hard of hearing; expenses; requirement
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§245. Interpreter services for the deaf and hard of hearing; expenses; requirement As a requirement for authorization to do business in this state pursuant to R.S. 22:244, all health maintenance organizations shall provide coverage for expenses incurred by any enrollee who is dea…
La. Rev. Stat. § 22:2452 Regulations; preemption
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§2452. Regulations; preemption A. The commissioner may promulgate such rules and regulations as may be necessary or proper to carry out the provisions of this Chapter. Such rules and regulations shall be promulgated and adopted in accordance with the Administrative Procedure Act,…
La. Rev. Stat. § 22:2453 Penalties; fines; cease and desist orders; grounds for suspension or revocation of licensure or certificate of authority
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§2453. Penalties; fines; cease and desist orders; grounds for suspension or revocation of licensure or certificate of authority A. Whenever the commissioner has reason to believe that any health insurance issuer, utilization review organization, or independent review organization…
La. Rev. Stat. § 22:246 Inherited metabolic diseases; coverage for food products
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§246. Inherited metabolic diseases; coverage for food products A. Every health maintenance organization granted a certificate of authority under this Subpart and every insurer licensed under the provisions of Subpart C of Part I of Chapter 2 of this Title that engages in health m…
La. Rev. Stat. § 22:2461 Definitions
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§2461. Definitions As used in this Chapter, the following definitions apply: (1) "Delivered by electronic means" means either of the following: (a) Delivery to an electronic mail address at which a party has consented to receive notices or documents. (b) Posting on an electronic …
La. Rev. Stat. § 22:2462 Electronic delivery of insurance documents and notices
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§2462. Electronic delivery of insurance documents and notices A. Subject to the requirements of this Section, any notice to a party or any other document required by law in an insurance transaction or that is to serve as evidence of insurance coverage may be delivered, stored, an…
La. Rev. Stat. § 22:2463 Change in hardware or software requirements
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§2463. Change in hardware or software requirements After the consent of a party is given, in the event a change in the hardware or software requirements needed to access or retain a notice or document delivered by electronic means creates a material risk that the party will not b…
La. Rev. Stat. § 22:2464 Applicability
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§2464. Applicability A. The provisions of this Section shall not be construed to affect requirements related to content or timing of any notice or document required by any other provision of law. B. If a provision of this Title or other applicable law requiring a notice or docume…
La. Rev. Stat. § 22:2465 Contracts and policies not affected
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§2465. Contracts and policies not affected The legal effectiveness, validity, or enforceability of any contract or policy of insurance executed by a party shall not be denied solely because of the failure of the insurer to obtain electronic consent or confirmation of consent of t…
La. Rev. Stat. § 22:2466 Withdrawal of consent
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§2466. Withdrawal of consent A. A withdrawal of consent by a party shall not affect the legal effectiveness, validity, or enforceability of a notice or document delivered by electronic means to the party before the withdrawal of consent is effective. B. A withdrawal of consent by…
La. Rev. Stat. § 22:2467 Prior consent to receive notices or documents in an electronic form
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§2467. Prior consent to receive notices or documents in an electronic form If the consent of a party to receive certain notices or documents in an electronic form is on file with an insurer before August 1, 2018, and an insurer intends to deliver additional notices or documents t…
