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0 chapters · 1,747 sections in this title.
La. Rev. Stat. § 22:1186 Disclosure and performance standards for long-term care insurance
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§1186. Disclosure and performance standards for long-term care insurance A. The commissioner may adopt rules and regulations that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long-term care insurance po…
La. Rev. Stat. § 22:1187 Incontestability period
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§1187. Incontestability period A. For a policy or certificate that has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation tha…
La. Rev. Stat. § 22:1188 Nonforfeiture benefits
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§1188. Nonforfeiture benefits A. Except as provided in Subsection B of this Section, a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or cer…
La. Rev. Stat. § 22:1188.1 Prompt payment of clean claims
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§1188.1. Prompt payment of clean claims A. For purposes of this Section: (1) "Claim" means a request for payment of benefits under an in-force policy, regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met. (2)…
La. Rev. Stat. § 22:1189 Authority to promulgate regulations
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§1189. Authority to promulgate regulations The commissioner shall issue reasonable regulations to promote premium adequacy and to protect the policyholder in the event of substantial rate increases and to establish minimum standards for marketing practices, producer compensation,…
La. Rev. Stat. § 22:119 Policyholders' meetings; voting rights; proxies
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§119. Policyholders' meetings; voting rights; proxies A. Domestic mutual insurers shall hold at least one policyholders' meeting annually at a time and place, including by remote means, specified in the charter or bylaws of the insurer. B. Each policyholder shall be entitled to v…
La. Rev. Stat. § 22:1190 Administrative procedure
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§1190. Administrative procedure Regulations adopted pursuant to this Subpart shall be adopted in accordance with the provisions of the Administrative Procedure Act. Acts 2004, No. 780, §1, eff. Jan. 1, 2005; Redesignated from R.S. 22:1740 by Acts 2008, No. 415, §1, eff. Jan. 1, 2…
La. Rev. Stat. § 22:1191 Penalties
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§1191. Penalties In addition to any other penalties provided by law, any insurer and any producer found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to thr…
La. Rev. Stat. § 22:12 Insurer; qualification required; compliance with Code required
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§12. Insurer; qualification required; compliance with Code required No person shall act as an insurer in this state unless properly qualified as an insurer of a type permitted under the provisions of this Code. No person shall be authorized to transact or shall transact a busines…
La. Rev. Stat. § 22:12.1 Maintenance of information in applications for licensure
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§12.1. Maintenance of information in applications for licensure All persons applying for any form of license or certificate of authority pursuant to this Title shall notify the commissioner of changes to the content of the application. Acts 2019, No. 66, §1, eff. July 1, 2019.
La. Rev. Stat. § 22:120 Elections of officers and directors
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§120. Elections of officers and directors Election of officers and directors shall be made in the manner specified in the charter or bylaws of the insurer, provided that: (1) Each policyholder shall be entitled to one vote in accordance with the provisions of R.S. 22:119; (2) At …
La. Rev. Stat. § 22:1201 Legislative findings; purpose; short title
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§1201. Legislative findings; purpose; short title A. Existing law does not establish a health coverage program to provide health insurance to Louisiana domiciliaries who are not otherwise able to obtain health insurance meeting prescribed criteria. B. Uninsurable Louisianians, le…
La. Rev. Stat. § 22:1202 Definitions
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§1202. Definitions As used in this Subpart: (1) "Ambulatory surgical center" means an establishment in this state as defined in and licensed under the provisions of R.S. 40:2131 et seq., as may be from time to time amended. (2) "Benefits plan" means the coverages offered by the p…
La. Rev. Stat. § 22:1203 Creation of the plan
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§1203. Creation of the plan A. There is hereby created a nonprofit entity to be known as the "Louisiana Health Plan" whose legal domicile shall be in the parish of East Baton Rouge. The plan shall perform its functions under the plan of operation established and approved pursuant…
La. Rev. Stat. § 22:1204 Board of directors
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§1204. Board of directors A. The board of directors shall be composed of the commissioner of insurance or his designee, who shall serve as an ex officio, nonvoting member of the board, and twelve members to be selected from the groups and in the manner as follows: (1) A represent…
La. Rev. Stat. § 22:1205 Plan of operation
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§1205. Plan of operation A. The board shall submit to the commissioner a plan of operation for the plan and any amendments thereto necessary or suitable to assure the fair, reasonable, and equitable administration of the plan. The commissioner shall approve the plan of operation …
La. Rev. Stat. § 22:1206 Powers and duties of the plan
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§1206. Powers and duties of the plan The plan shall have the general powers and authority granted under the laws of this state to insurance companies licensed to provide health and accident insurance and, in addition thereto, the specific authority to: (1) Contract with an outsid…
La. Rev. Stat. § 22:1207 Eligibility
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§1207. Eligibility A. Any natural person who has been domiciled in this state for six consecutive months shall be eligible for coverage as a nonfederally defined individual as provided in this Subpart, except the following: (1) Any person who, on the effective date of coverage by…
La. Rev. Stat. § 22:1208 Administration
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§1208. Administration A. The board shall select an administrator or administrators, which may consist of an insurer or insurers, a third-party administrator or administrators, medical or pharmaceutical providers, or a combination thereof, through a competitive bidding process to …
La. Rev. Stat. § 22:1209 Service charges
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§1209. Service charges A.(1) Each patient who is not a private-pay patient, is not covered by Medicare or any other public program, is not covered by the Office of Group Benefits program, and is not covered by an insolvent insurer who is admitted to a hospital for treatment, othe…
La. Rev. Stat. § 22:121 Duties of officers
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§121. Duties of officers The president or, in his absence, the one so designated to act for him, shall preside at all meetings of the directors and of the policyholders, unless otherwise provided in the charter or bylaws. The secretary shall keep a record of the votes and proceed…
La. Rev. Stat. § 22:1210 Fees assessed to participating health insurers for plan losses attributable to federally
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§1210. Fees assessed to participating health insurers for plan losses attributable to federally defined eligible individuals A.(1) For the purposes of this Section, "participating insurer" includes any insurer providing insurance, as defined by R.S. 22:1209(F), to citizens of thi…
La. Rev. Stat. § 22:1211 Powers and duties of the commissioner
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§1211. Powers and duties of the commissioner A. In addition to the duties and powers enumerated elsewhere in this Subpart, and in other provisions of law, the commissioner shall upon request of the board of directors, and notwithstanding any provision of law to the contrary, prov…
La. Rev. Stat. § 22:1212 Miscellaneous provisions
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§1212. Miscellaneous provisions A. Nothing in this Subpart shall be construed to reduce or offset the liability for unpaid fees assessed to an impaired or insolvent insurer operating a plan with liability for fees assessed under this Subpart. B. For purposes of carrying out its o…
La. Rev. Stat. § 22:1213 Benefits; availability
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§1213. Benefits; availability A. The plan shall offer comprehensive coverage to every eligible person who is not eligible for Medicare and public programs as defined in this Subpart. Comprehensive coverage offered by the plan shall pay an eligible person's covered expenses, subje…
La. Rev. Stat. § 22:1214 Mandated benefits
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§1214. Mandated benefits Service charges assessed to any patient pursuant to R.S. 22:1209 shall be a mandated benefit of any insurance policy, insurance certificate, insurance arrangement or self-insurance which provides coverage to such patient, except that such charges shall no…
La. Rev. Stat. § 22:1215 Exemptions; relation to other laws
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§1215. Exemptions; relation to other laws A. The plan established pursuant to this Subpart shall be exempt from any and all state and local taxes. B. The plan and any administrator selected by the board to administer the benefits plan shall be exempt from the provisions of R.S. 2…
La. Rev. Stat. § 22:1215.1 Peremption
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§1215.1. Peremption Dissolution of the operations of the Louisiana Health Plan requires the expeditious determination of its outstanding liabilities. As such, each of the following provisions shall apply: (1) Any action against the plan, the board, the employees of the plan, or a…
La. Rev. Stat. § 22:1216 Health and accident policy provisions; service charges; penalties
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§1216. Health and accident policy provisions; service charges; penalties A. Any health and accident insurance policy issued under this Subpart or Subpart J of Part III of Chapter 4 of this Title, and any health and accident insurance policy having effect in this state, shall prov…
La. Rev. Stat. § 22:1217 Health insurance rejections; Louisiana Health Insurance Plan information
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§1217. Health insurance rejections; Louisiana Health Insurance Plan information A. Each rejection for individual health and accident insurance shall contain information stating that health insurance may be available through the Louisiana Health Insurance Plan. Each rejection shal…
La. Rev. Stat. § 22:122 Non-assessable policies; authority to issue
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§122. Non-assessable policies; authority to issue Except as provided in R.S. 22:114, any domestic mutual insurer not organized under the legal reserve plan for the writing of life insurance, as defined under R.S. 22:47(1), authorized so to do by its charter may issue policies wit…
La. Rev. Stat. § 22:1221 Definitions
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§1221. Definitions For purposes of this Subpart, the following definitions shall apply: (1) "Carve-out agreement" means a written agreement between a health insurance issuer and another entity to provide health care services other than medical, surgical, or physician services, in…
La. Rev. Stat. § 22:1222 Assignment of obligations limited
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§1222. Assignment of obligations limited A. When a health insurance issuer contracts or subcontracts with another entity for the provision of services, the health insurance issuer shall be ultimately responsible for compliance with the laws and regulations governing risk-based ca…
La. Rev. Stat. § 22:123 Policyholders' liability
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§123. Policyholders' liability A. Except as to non-assessable policies, any contract of insurance issued by a mutual insurer shall provide for the contingent liability of the subscriber for payment of actual losses and expenses incurred while such contract was in force. Such cont…
La. Rev. Stat. § 22:1231 Organ transplant centers
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§1231. Organ transplant centers No health insurance issuer authorized to transact business in this state shall refuse to consider an application to provide solid organ transplantation in any preferred or exclusive provider network by any transplant center located in the state pro…
La. Rev. Stat. § 22:1232 Hematopoietic transplant centers
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§1232. Hematopoietic transplant centers No health insurance issuer authorized to transact business in this state shall refuse to consider an application to provide hematopoietic cell transplantation in any preferred or exclusive provider network by any transplant center located i…
La. Rev. Stat. § 22:1233 Documentation
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§1233. Documentation A. The provisions of this Subpart shall not apply to a health insurance issuer who has documented to the satisfaction of the commissioner of insurance that inclusion of the Louisiana based transplant center will result in higher costs to the insurer and insur…
La. Rev. Stat. § 22:124 Domestic nonprofit mutual associations; insurer
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§124. Domestic nonprofit mutual associations; insurer Notwithstanding any law, regulation, or definition to the contrary, a domestic nonprofit mutual association, as defined in this Section, is deemed to be an insurer for the purposes of all surplus requirements, policy reserve r…
La. Rev. Stat. § 22:1241 Creation of the Louisiana Safety Net Health Insurance Program
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§1241. Creation of the Louisiana Safety Net Health Insurance Program A. There is hereby established the "Louisiana Safety Net Health Insurance Program". The program shall provide for minimal benefit hospital and medical policies, which may be insured by the Office of Group Benefi…
La. Rev. Stat. § 22:1242 Definitions
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§1242. Definitions As used in this Subpart: (1) "Commissioner" means the commissioner of insurance. (2) "Contracted health care provider" means a health care provider that has entered into a contract or agreement directly with a health insurance issuer or through a network of pro…
La. Rev. Stat. § 22:1243 Eligibility
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§1243. Eligibility The following are eligible for the program: (1) Employees of the state of Louisiana, and political subdivisions thereof, who have not been covered by health insurance for at least one year and are eligible for coverage through the Office of Group Benefits. (2) …
La. Rev. Stat. § 22:1244 Participation and requirements
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§1244. Participation and requirements A. Participating health insurance issuers shall offer minimal benefit hospital and medical insurance policies that allow enrollees or insureds access to at least one Prime Network. The Prime Network shall be specifically established for the m…
La. Rev. Stat. § 22:1245 Plan of operation
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§1245. Plan of operation A. A health insurance issuer shall submit a plan of operation to the commissioner for review and approval whereby the health insurance issuer establishes policies and procedures: (1) For the determination of program eligibility of employers, as set forth …
La. Rev. Stat. § 22:1246 Producer requirements
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§1246. Producer requirements No producer fees or other compensation or consideration shall be payable for coverage offered through the plan unless: (1) The producer is duly licensed by the commissioner. (2) The producer certifies to the health insurance issuer in writing, that to…
La. Rev. Stat. § 22:1247 Form of policy; delivery; cancellation
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§1247. Form of policy; delivery; cancellation A. No minimal benefit hospital and medical policy shall be delivered or issued for delivery on risks in this state unless: (1) The entire money and other consideration therefor are expressed therein. (2) The time at which the insuranc…
La. Rev. Stat. § 22:1248 File and use of policy forms
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§1248. File and use of policy forms Health insurance issuers shall file with the commissioner minimal benefit hospital and medical plans delivered or issued for delivery in this state. Such forms shall be considered approved, unless notified by the commissioner of insurance withi…
La. Rev. Stat. § 22:1249 Minimal benefit hospital and medical policy provisions
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§1249. Minimal benefit hospital and medical policy provisions A. No minimal benefit hospital and medical policy shall be delivered or issued in this state without the following notice: "THIS IS A MINIMAL BENEFIT HOSPITAL AND MEDICAL POLICY. THIS IS NOT A COMPREHENSIVE MAJOR MEDIC…
La. Rev. Stat. § 22:1250 Construction of policy
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§1250. Construction of policy A policy issued in violation of this Subpart shall be held valid and shall be construed as provided herein. When any provision in such a policy is in conflict with any provisions of this Subpart, the rights, duties, and obligations of the health insu…
La. Rev. Stat. § 22:1251 Statutory construction; relationship to other laws
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§1251. Statutory construction; relationship to other laws Except as otherwise provided in this Subpart, provisions of the insurance law and provisions of this Title shall not be applicable to minimal benefit hospital and medical policies, unless as provided in this Subpart. Acts …
La. Rev. Stat. § 22:1252 Scope and limitation
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§1252. Scope and limitation A. It is not the purpose of this Subpart to alter or diminish any right, privilege, or authority granted to any health insurance issuer to write hospital insurance under any other Chapter, Part, or Section of this Title. B. All health insurance insurer…
