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0 chapters · 1,747 sections in this title.
La. Rev. Stat. § 22:11.1 Rules and regulations; essential health benefits package
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§11.1. Rules and regulations; essential health benefits package The commissioner shall promulgate rules pursuant to the Administrative Procedure Act to define "essential health benefits", to establish annual limitations on cost sharing and deductibles, and to define required leve…
La. Rev. Stat. § 22:111 Surplus requirements; applicants prior to September 1, 1989
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§111. Surplus requirements; applicants prior to September 1, 1989 A. Domestic mutual insurers who apply for a certificate of authority prior to September 1, 1989, may transact the following kinds of insurance in this state upon qualifying therefor and by having an initial minimum…
La. Rev. Stat. § 22:1111 Medicare supplement minimum standards
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§1111. Medicare supplement minimum standards A.(1) Except as otherwise specifically provided, this Section shall apply to: (a) All Medicare supplement policies and subscriber contracts delivered or issued for delivery in this state on or after the effective date hereof, and (b) A…
La. Rev. Stat. § 22:1112 Medicare supplement guaranteed issue; open enrollment periods; prohibited
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§1112. Medicare supplement guaranteed issue; open enrollment periods; prohibited conditioning of coverage; notice to policyholders A.(1) If, at the time of an individual's birthday each year, that individual has an existing Medicare supplement policy, the individual shall have an…
La. Rev. Stat. § 22:112 Surplus requirements; applicants on and after September 1, 1989
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§112. Surplus requirements; applicants on and after September 1, 1989 A. Domestic mutual insurers who apply for a certificate of authority on or after September 1, 1989, may transact the following kinds of insurance in this state upon qualifying therefor and by having an initial …
La. Rev. Stat. § 22:1121 Short title
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§1121. Short title This Subpart shall be known and may be cited as the "Healthcare Coverage for Louisiana Families Protection Act". Acts 2019, No. 412, §1, eff. June 11, 2019.
La. Rev. Stat. § 22:1122 Effectiveness
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§1122. Effectiveness If a court of competent jurisdiction rules that the Patient Protection and Affordable Care Act, P.L. 111-148, is unconstitutional and the judgment of that court becomes final and definitive, the attorney general shall give written notification of the final an…
La. Rev. Stat. § 22:1123 Preexisting condition exclusions prohibited
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§1123. Preexisting condition exclusions prohibited A health insurance policy or contract issued or issued for delivery in this state after the effective date of this Subpart shall not impose a preexisting condition exclusion. This Section shall not limit an insurer's ability to r…
La. Rev. Stat. § 22:1124 Annual and lifetime limits prohibited
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§1124. Annual and lifetime limits prohibited A health insurance policy or contract issued or issued for delivery in this state after the effective date of this Subpart shall not do either of the following: (1) Establish lifetime limits on the dollar value of benefits for any part…
La. Rev. Stat. § 22:1125 Coverage for dependent children
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§1125. Coverage for dependent children A health insurance policy or contract issued or issued for delivery in this state after the effective date of this Subpart that offers coverage for a dependent child shall offer dependent coverage, at the option of the policyholder, until th…
La. Rev. Stat. § 22:1126 Rate setting
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§1126. Rate setting For all health insurance policies, contracts, or certificates that are executed, delivered, issued for delivery, continued, or renewed in this state after the effective date of this Subpart the maximum rate differential due to age filed by the carrier as deter…
La. Rev. Stat. § 22:1127 Open enrollment
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§1127. Open enrollment A health insurance policy or contract issued or issued for delivery in this state after the effective date of this Subpart may restrict enrollment in individual health plans to open enrollment periods and special enrollment periods to the extent not inconsi…
La. Rev. Stat. § 22:1128 Comprehensive health coverage
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§1128. Comprehensive health coverage A. Notwithstanding any other provision of law to the contrary, a health insurance policy or contract issued or issued for delivery in this state thirty days or more after rules promulgated pursuant to Subsection G of this Section become effect…
La. Rev. Stat. § 22:1129 Conflict of laws
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§1129. Conflict of laws In case of any conflict between the provisions of this Subpart and any other provision of law, the provisions of this Subpart shall control unless application of this Subpart results in a reduction in coverage for any insured. Acts 2019, No. 412, §1, eff. …
La. Rev. Stat. § 22:113 Additional surplus
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§113. Additional surplus The commissioner may require a domestic mutual insurer to have and maintain a greater amount of surplus than prescribed in R.S. 22:111 or 112, based upon the type, volume, and nature of insurance business transacted. The commissioner is authorized to prom…
La. Rev. Stat. § 22:1130 Applicability
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§1130. Applicability A. The provisions of this Subpart shall be effective or enforceable only in the event that the tax credit authorized in Section 1401 of the Patient Protection and Affordable Care Act of 2010, P. L. 111-148, as amended by the Healthcare and Education Reconcili…
La. Rev. Stat. § 22:1131 Short title
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§1131. Short title This Subpart shall be known and may be cited as the "Louisiana Guaranteed Benefits Pool Act". Acts 2019, No. 412, §1, eff. June 11, 2019.
La. Rev. Stat. § 22:1132 Definitions
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§1132. Definitions As used in this Subpart, the following definitions apply: (1) "Commissioner" means the commissioner of insurance. (2) "Program" means the Louisiana Guaranteed Benefits Pool. Acts 2019, No. 412, §1, eff. June 11, 2019.
La. Rev. Stat. § 22:1133 Louisiana Guaranteed Benefits Pool; establishment
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§1133. Louisiana Guaranteed Benefits Pool; establishment A. The commissioner shall establish the Louisiana Guaranteed Benefits Pool which shall be a risk-sharing program to provide payment to health insurance issuers for claims for healthcare services provided to eligible individ…
La. Rev. Stat. § 22:1134 Operation of program
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§1134. Operation of program A. The commissioner shall establish the Louisiana Guaranteed Benefits Pool with a framework and operation similar to other state best practices. B. The program may be administered by either the commissioner or by an independent nonprofit organization. …
La. Rev. Stat. § 22:1135 Actuarial analysis
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§1135. Actuarial analysis In establishing the program, the commissioner shall commission an actuarial analysis to do all of the following: (1) Inform the development and parameters of the program. (2) Evaluate how funds that may currently be utilized to pay the Health Insurance P…
La. Rev. Stat. § 22:1136 Program parameters
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§1136. Program parameters In establishing the program, the commissioner shall provide for all of the following: (1) The criteria for individuals to be eligible for participation in the program. (2) The development and use of health status statements with respect to eligible indiv…
La. Rev. Stat. § 22:1137 Approval by legislature
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§1137. Approval by legislature A. The commissioner shall submit the actuarial analysis required by R.S. 22:1135 to the Joint Legislative Committee on the Budget. B. The Joint Legislative Committee on the Budget shall meet to review and approve the actuarial analysis, the details …
La. Rev. Stat. § 22:1138 Enrollment or participation limitation
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§1138. Enrollment or participation limitation The commissioner shall not enroll an individual or permit any individual to participate as an eligible individual in the program unless the commissioner has received written notification from the attorney general of a final and defini…
La. Rev. Stat. § 22:114 Hull insurance
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§114. Hull insurance A. For the purposes of this Section, "hull insurance" is that part of marine and transportation insurance limited to the total or partial loss of a commercial fishing vessel and any tackle, fittings, equipment, stores, boats, furniture, machinery, and appurte…
La. Rev. Stat. § 22:115 Surplus to be paid in cash
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§115. Surplus to be paid in cash The initial minimum surplus of any insurer shall be paid in cash within twelve months from the date of its charter and no policies shall be issued by it until the total amount required by law and specified in the charter is paid-in. A majority of …
La. Rev. Stat. § 22:1151 Definitions
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§1151. Definitions For the purposes of this Subpart, the following words and phrases shall be defined as follows: (1) "Commissioner" means the commissioner of insurance of the state of Louisiana. (2) "Dental service contractor" means any person who accepts a prepayment from or fo…
La. Rev. Stat. § 22:1152 Qualification and regulation of dental service contractors
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§1152. Qualification and regulation of dental service contractors A. No person shall act as or hold himself out to be a dental service contractor in this state unless that person has qualified and has been issued a certificate of authority as a domestic insurer or has been admitt…
La. Rev. Stat. § 22:1153 Additional regulations
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§1153. Additional regulations A. Each contract between a dental service contractor and its subscribers shall be nonassessable, shall have a minimum term of six months, and shall guarantee unconditionally to the subscriber the performance of all dental services covered by the cont…
La. Rev. Stat. § 22:1154 Freedom of choice of dentist in health plans
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§1154. Freedom of choice of dentist in health plans A. As used in this Section: (1) "Dental care services" means any services furnished to any person for the purpose of preventing, alleviating, curing or healing human dental abnormalities, accidents, or diseases. (2) "Dentist" me…
La. Rev. Stat. § 22:1155 Denial of claims; appeal; prior authorization; preexisting conditions
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§1155. Denial of claims; appeal; prior authorization; preexisting conditions A.(1) A dental service contractor or a contract of dental insurance shall establish and maintain appeal procedures for any claim by a dentist or a subscriber that is denied based upon lack of medical nec…
La. Rev. Stat. § 22:1156 Dental reimbursement or payments
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§1156. Dental reimbursement or payments A. Every company that issues, delivers, amends, or renews a policy of dental insurance in this state providing coverage for dental health care treatment which provides that the payment of benefits under the policy shall be based upon the us…
La. Rev. Stat. § 22:1157 Dental reimbursement or payments
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§1157. Dental reimbursement or payments A. As used in this Section, the following definitions shall apply: (1) "Covered person" means any subscriber, enrollee, member, or participant in a dental plan, or his dependent, for whom benefits are payable when that person receives denta…
La. Rev. Stat. § 22:1157.1 Dental reimbursement or payments; procedure codes; downcoding; prohibitions
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§1157.1. Dental reimbursement or payments; procedure codes; downcoding; prohibitions A.(1) A dental service contractor shall not systematically downcode with the intent to deny reimbursement otherwise due to a dentist or other healthcare provider. (2) A violation of Paragraph (1)…
La. Rev. Stat. § 22:116 Methods of acquiring surplus
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§116. Methods of acquiring surplus The initial minimum sum required may be raised by the insurer in either of the following manners: (1) By payment in advance of premiums by persons who desire to become policyholders and members of the mutual insurer. Such payments must be made i…
La. Rev. Stat. § 22:1161 Short title
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§1161. Short title This Subpart shall be cited as the "Louisiana Dental Loss Ratios for Dental Healthcare Services Plans Act". Acts 2024, No. 357, §1, eff. Jan. 1, 2025.
La. Rev. Stat. § 22:1162 Purpose
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§1162. Purpose The purpose of this Subpart is to provide for transparency of the expenditures of dental healthcare service plan premiums and to require annual reports. Acts 2024, No. 357, §1, eff. Jan. 1, 2025.
La. Rev. Stat. § 22:1163 Definitions
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§1163. Definitions As used in this Subpart, the following definitions apply: (1) "Dental carrier" or "carrier" means a dental insurance company, dental service corporation, dental plan organization authorized to provide dental benefits, or a health insurance plan that includes co…
La. Rev. Stat. § 22:1164 Dental loss ratio calculations
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§1164. Dental loss ratio calculations The dental loss ratio is calculated by dividing the numerator by the denominator as follows: (1)(a) The numerator is the sum of the amount incurred for clinical dental services provided to enrollees, the amount incurred on activities that imp…
La. Rev. Stat. § 22:1165 Transparency of patient premium expenditures; dental loss ratio annual report
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§1165. Transparency of patient premium expenditures; dental loss ratio annual report A. In order to provide transparency of patient premium expenditures for dental healthcare services, all carriers that renew, deliver, or issue a dental healthcare service plan in this state shall…
La. Rev. Stat. § 22:1166 Rulemaking
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§1166. Rulemaking The commissioner shall promulgate rules and regulations in accordance with the Administrative Procedure Act as necessary to implement the provisions of this Subpart, including but not limited to definitions of eligible clinical dental services, activities to imp…
La. Rev. Stat. § 22:117 Dividends
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§117. Dividends No domestic mutual insurer shall pay any dividends to its policyholders unless it has a surplus beyond the initial minimum surplus required and all other liabilities, except a liability created under R.S. 22:116(2), equal to fifteen percent of such initial minimum…
La. Rev. Stat. § 22:1171 Short title; definitions
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§1171. Short title; definitions A. This Subpart may be cited as the "Network Leasing Act". B. As used in this Subpart, the following definitions apply: (1) "Contracting entity" means any person or entity, including a third-party administrator and a dental carrier, that enters int…
La. Rev. Stat. § 22:1172 Fair and transparent network contracting; responsible leasing requirements;
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§1172. Fair and transparent network contracting; responsible leasing requirements; applicability; penalties; enforcement; waiver of contractual regulations prohibited; rules and regulations A. A contracting entity may grant a third party access to a provider network contract or a…
La. Rev. Stat. § 22:118 Impairment of surplus; how made good
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§118. Impairment of surplus; how made good Any impairment in the initial minimum surplus required of a mutual insurer may be made good by funds obtained in accordance with R.S. 22:116(2), provided the transaction is submitted to and approved by the commissioner of insurance. Acts…
La. Rev. Stat. § 22:1181 Purpose
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§1181. Purpose The purposes of this Subpart are: to promote the public interest; to promote the availability of long-term care insurance policies, or certificate if a group; to protect applicants for long-term care insurance, as defined, from unfair or deceptive sales or enrollme…
La. Rev. Stat. § 22:1182 Scope
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§1182. Scope The requirements of this Subpart shall apply to policies delivered or issued for delivery in this state on or after September 1, 1989. Renewal policies shall comply with this Subpart, as amended. This Subpart is not intended to supersede the obligations of entities s…
La. Rev. Stat. § 22:1183 Short title
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§1183. Short title This Subpart may be known and cited as the "Long-Term Care Insurance Act". Acts 1989, No. 448, §1, eff. Sept. 1, 1989; Redesignated from R.S. 22:1733 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1184 Definitions
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§1184. Definitions Unless the context requires otherwise, the following definitions in this Section shall apply for purposes of this Subpart: (1) "Applicant" means: (a) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits, an…
La. Rev. Stat. § 22:1185 Extraterritorial jurisdiction; group long-term care insurance
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§1185. Extraterritorial jurisdiction; group long-term care insurance No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in R.S. 22:1184(4)(d), unless this state has made a determi…
