™Your Policy Risk Impact Agent
0 chapters · 1,747 sections in this title.
La. Rev. Stat. § 22:1260.1 Purpose
0.4K chars
§1260.1. Purpose The purpose of this Subpart shall be to protect the public from inappropriate, unfair, and deceptive marketing, sales or enrollment practices and to facilitate consumer understanding of the role and function of discount medical plan organizations in providing acc…
La. Rev. Stat. § 22:1260.10 Injunctions
0.8K chars
§1260.10. Injunctions A. In addition to the penalties and other enforcement provisions of this Subpart, the commissioner may seek both temporary and permanent injunctive relief when any of the following occur: (1) A discount medical plan is being operated by a person or entity th…
La. Rev. Stat. § 22:1260.11 Regulations
0.4K chars
§1260.11. Regulations The commissioner may promulgate such rules and regulations as may be necessary or proper to carry out the provisions of this Subpart. The rules and regulations shall be promulgated and adopted in accordance with the Administrative Procedure Act, R.S. 49:950 …
La. Rev. Stat. § 22:1260.2 Definitions
4.3K chars
§1260.2. Definitions As used in this Subpart, unless the context clearly indicates otherwise, the following definitions shall apply: (1) "Affiliate" shall mean a person that, directly or indirectly through one or more intermediaries, controls or is controlled by or is under commo…
La. Rev. Stat. § 22:1260.3 Registration
0.2K chars
§1260.3. Registration No discount medical plan organization shall conduct business or otherwise operate in this state unless it is registered with the commissioner. Acts 2008, No. 442, §1, eff. Jan. 1, 2009; Redesignated by Acts 2009, No. 503, §3.
La. Rev. Stat. § 22:1260.31 Short title
0.2K chars
§1260.31. Short title This Subpart shall be known and may be cited as the "Physician and Provider Notification of Patients in Health Insurance Exchange Grace Period Act". Acts 2014, No. 174, §1.
La. Rev. Stat. § 22:1260.32 Definitions
1.7K chars
§1260.32. Definitions As used in this Subpart, the following words shall have the following meanings, unless the context clearly indicates otherwise: (1) "Enrollee" means a qualified individual or qualified employee enrolled in a qualified health plan. An enrollee is generally a …
La. Rev. Stat. § 22:1260.33 Notice requirements
3.2K chars
§1260.33. Notice requirements A. Timing of notice to physician or provider of grace period status. (1) When a physician or other healthcare provider or his representative requests information regarding an enrollee from a qualified health plan issuer about eligibility, coverage, o…
La. Rev. Stat. § 22:1260.34 Strict compliance required
0.3K chars
§1260.34. Strict compliance required A qualified health plan issuer shall be obligated to pay for any covered claims for services rendered during a grace period if he has failed to strictly comply with the provisions of this Subpart. Such payment shall be in accordance with the t…
La. Rev. Stat. § 22:1260.35 Deadline for overpayment recoveries
0.6K chars
§1260.35. Deadline for overpayment recoveries If the qualified health plan issuer seeks to recoup or otherwise recover payments made to the physician or other healthcare provider for services furnished to an enrollee during the grace period and that enrollee's coverage is subsequ…
La. Rev. Stat. § 22:1260.36 Waiver prohibited
0.3K chars
§1260.36. Waiver prohibited The provisions of this Subpart cannot be waived by contract. Any contractual arrangements in conflict with the provisions of this Subpart or that purport to waive any requirements of this Subpart are null and void. Acts 2014, No. 174, §1.
La. Rev. Stat. § 22:1260.37 Injunction
0.2K chars
§1260.37. Injunction Any physician or other healthcare provider may request a court of appropriate jurisdiction to issue an injunction to enforce any provision of this Subpart. Acts 2014, No. 174, §1.
La. Rev. Stat. § 22:1260.38 Rules and regulations
0.3K chars
§1260.38. Rules and regulations The commissioner of insurance shall promulgate all rules and regulations which are necessary and proper to carry out the provisions of this Subpart. All rules and regulations promulgated pursuant to this Subpart shall be in accordance with the Admi…
La. Rev. Stat. § 22:1260.4 Procedure for registration
5.5K chars
§1260.4. Procedure for registration A. An applicant for registration shall submit an application to the commissioner and pay the application fee of two hundred fifty dollars. B. The application shall be on a form prescribed by the commissioner, accompanied by any supporting docum…
La. Rev. Stat. § 22:1260.41 Definitions
4.7K chars
§1260.41. Definitions For purposes of this Subpart, the following terms have the following meanings unless the context clearly indicates otherwise: (1) "Adverse determination" means a determination by a health insurance issuer or utilization review entity that an admission, avail…
La. Rev. Stat. § 22:1260.42 Documented prior authorization program; requirements
3.4K chars
§1260.42. Documented prior authorization program; requirements A. A health insurance issuer that requires the satisfaction of a utilization review as a condition of payment of a claim submitted by a healthcare provider shall maintain a documented prior authorization program that …
La. Rev. Stat. § 22:1260.43 Single utilization review per episode of care
0.7K chars
§1260.43. Single utilization review per episode of care A health insurance issuer shall not impose any additional utilization review requirement with respect to any surgical procedure or otherwise invasive procedure, nor any item furnished as part of the surgical or invasive proc…
La. Rev. Stat. § 22:1260.44 Timeframes for determinations; concurrent review; retrospective review; adverse
5.3K chars
§1260.44. Timeframes for determinations; concurrent review; retrospective review; adverse determination A.(1) A health insurance issuer or utilization review entity shall maintain written procedures for making utilization review determinations and for notifying enrollees and prov…
La. Rev. Stat. § 22:1260.45 Documentation
0.8K chars
§1260.45. Documentation When conducting a utilization review, a health insurance issuer shall do all of the following: (1) Accept any evidence-based information from a provider that will assist in the utilization review. (2) Collect only the information necessary to authorize the…
La. Rev. Stat. § 22:1260.46 Utilization review; determinations; appeals
1.9K chars
§1260.46. Utilization review; determinations; appeals A. When a healthcare provider makes a request for a utilization review, the health insurance issuer shall state if its response to the request is to certify or deny the request. If the request is denied, the health insurance i…
La. Rev. Stat. § 22:1260.47 Prior authorization; denial of claims
2.3K chars
§1260.47. Prior authorization; denial of claims A. A health insurance issuer shall not deny any claim subsequently submitted for healthcare services specifically included in a prior authorization unless at least one of the following circumstances applies for each healthcare servi…
La. Rev. Stat. § 22:1260.48 Reviews for fraud, waste, or abuse
0.3K chars
§1260.48. Reviews for fraud, waste, or abuse Nothing in this Subpart shall preclude a health insurance issuer from conducting investigations of possible fraud, waste, or abuse or taking appropriate actions based upon the results of the investigations. Acts 2023, No. 312, §1, eff.…
La. Rev. Stat. § 22:1260.5 Charges and fees; refund requirements; bundling of services
1.6K chars
§1260.5. Charges and fees; refund requirements; bundling of services A. A discount medical plan organization may charge a periodic charge as well as a reasonable one-time processing fee for a discount medical plan. B.(1) If a member cancels his membership in the discount medical …
La. Rev. Stat. § 22:1260.6 Provider listing requirements
0.6K chars
§1260.6. Provider listing requirements Each discount medical plan organization shall maintain an up-to-date list of the names and addresses of the providers with which it has contracted directly or through a provider network. This Section applies to those providers with which the…
La. Rev. Stat. § 22:1260.7 Marketing restrictions and disclosure requirements
6.2K chars
§1260.7. Marketing restrictions and disclosure requirements A.(1) The name of the discount medical plan and the address shall be prominently displayed on all of its advertisements, marketing materials and brochures. (2) All advertisements, marketing materials, brochures, discount…
La. Rev. Stat. § 22:1260.8 Notice of change in name or address
0.4K chars
§1260.8. Notice of change in name or address Each discount medical plan organization shall provide the commissioner at least thirty days advance notice of any change in the discount medical plan organization's name, address, principal business address, mailing address or Internet…
La. Rev. Stat. § 22:1260.9 Penalties
1.8K chars
§1260.9. Penalties A. In addition to the penalties and other enforcement provisions of this Subpart, any person who willfully violates the provisions of this Subpart shall be subject to civil penalties of up to two thousand five hundred dollars per violation. B. A person that wil…
La. Rev. Stat. § 22:1261 Renewal of policy; increase in premiums prohibited
0.9K chars
§1261. Renewal of policy; increase in premiums prohibited A. Any insurance policy terminating by its terms at a specified expiration date and not otherwise renewable may be renewed or extended at the option of the insurer. Such renewal shall be made upon a currently authorized re…
La. Rev. Stat. § 22:1262 Annulment of liability policies
0.7K chars
§1262. Annulment of liability policies No insurance contract insuring against loss or damage through legal liability for the bodily injury or death by accident of any individual, or for damage to the property of any person, shall be retroactively annulled by any agreement between…
La. Rev. Stat. § 22:1263 Premises used as polling places; prohibited provisions excluding or limiting coverage
0.7K chars
§1263. Premises used as polling places; prohibited provisions excluding or limiting coverage A. A provision in a liability or other insurance policy which excludes or limits coverage solely because premises are being used as a polling place in an election shall be null and void a…
La. Rev. Stat. § 22:1264 Presumption of coverage
1.5K chars
§1264. Presumption of coverage A. For losses that arose due to a catastrophic event for which a state of disaster or emergency was declared pursuant to law by civil officials, for those areas within the declaration, no damages to covered property shall be automatically denied by …
La. Rev. Stat. § 22:1265 Property, casualty, and liability insurance policies; cancellation and nonrenewal
7.8K chars
§1265. Property, casualty, and liability insurance policies; cancellation and nonrenewal provisions; nonrenewal for rate inadequacy; certain prohibitions A.(1) Any insurer cancelling or refusing to renew a policy providing property, casualty, or liability insurance on any propert…
La. Rev. Stat. § 22:1266 Automobile, property, casualty, and liability insurance policies; cancellations
19.9K chars
§1266. Automobile, property, casualty, and liability insurance policies; cancellations A. As used in this Part: (1) "Automobile collision coverage" includes all coverage of loss or damage to an automobile insured under the policy resulting from collision or upset. (2) "Automobile…
La. Rev. Stat. § 22:1267 Commercial insurance; cancellation and renewal
11.3K chars
§1267. Commercial insurance; cancellation and renewal A. This Section shall apply to commercial property insurance policies, commercial automobile insurance policies, commercial multi-peril insurance policies, workers' compensation insurance, professional errors and omissions pol…
La. Rev. Stat. § 22:1267.1 Commercial insurance deductibles applied to named storm, hurricane, and wind and
2.6K chars
§1267.1. Commercial insurance deductibles applied to named storm, hurricane, and wind and hail deductibles A. For purposes of this Section: (1) "Hurricane" means a storm system that has been declared a hurricane by the National Hurricane Center of the National Weather Service. (2…
La. Rev. Stat. § 22:1268 Interest on refund; exception
1.8K chars
§1268. Interest on refund; exception A. Any refund due an insured by an insurer writing or delivering insurance policies excluding health insurance, life insurance, and annuities in the state because of either cancellation, elimination, or reduction of coverage by the insurer or …
La. Rev. Stat. § 22:1269 Liability policy; insolvency or bankruptcy of insured and inability to effect service
7.7K chars
§1269. Liability policy; insolvency or bankruptcy of insured and inability to effect service of citation or other process; direct action against insurer A. No policy or contract of liability insurance shall be issued or delivered in this state, unless it contains provisions to th…
La. Rev. Stat. § 22:1270 Personal property; specific coverage; valuation; exemptions
1.6K chars
§1270. Personal property; specific coverage; valuation; exemptions A. In any case in which a policy includes coverage for loss of or damage to personal property of the insured, from whatever cause, if the insurer places a valuation upon the specific item of covered property and u…
La. Rev. Stat. § 22:1271 Identification of property upon which premium is due
0.9K chars
§1271. Identification of property upon which premium is due A. Any bill or other notice requiring payment of a premium for a policy of property or casualty insurance which is sent by an insurer to its policyholder shall identify the insured property sufficiently to allow the poli…
La. Rev. Stat. § 22:1272 Defense costs; prohibition; waiver
2.3K chars
§1272. Defense costs; prohibition; waiver A. The liability limits contained in a policy or contract of insurance issued by an authorized insurer shall not be reduced by the expenses of defense in a suit under the policy unless waived by the commissioner as provided in Paragraph (…
La. Rev. Stat. § 22:1273 Presumption of coverage; civil authority prohibited use
0.7K chars
§1273. Presumption of coverage; civil authority prohibited use A. For losses that arise due to a catastrophic event in which a state of disaster or emergency is declared by civil officials, for those areas within the declaration, if a civil authority prohibits the insured from us…
La. Rev. Stat. § 22:1274 Prohibited policy provision
0.4K chars
§1274. Prohibited policy provision A. An insurer shall not include a provision in any policy of property insurance that prohibits an insured from hiring a public adjuster for services provided pursuant to the provisions of this Title. B. Subsection A of this Section does not appl…
La. Rev. Stat. § 22:1275 Assignment of benefits; prohibited
1.8K chars
§1275. Assignment of benefits; prohibited A. For the purposes of this Section, "assignment agreement" means any instrument by which post-loss benefits under a residential or commercial property insurance policy, including but not limited to any right of action against the insurer…
La. Rev. Stat. § 22:1276 Notification to commissioner; market activity
1.7K chars
§1276. Notification to commissioner; market activity A. An insurer authorized to transact the business of automobile or property insurance in this state shall, within ten days of providing notice to its agents or other representatives of any decision to cease, pause, or resume th…
La. Rev. Stat. § 22:1281 Standard automobile insurance form
0.5K chars
§1281. Standard automobile insurance form The commissioner of insurance may promulgate such rules and regulations as necessary to establish reasonable standard provisions to be included in all policies of automobile insurance delivered or issued for delivery in this state. All su…
La. Rev. Stat. § 22:1282 Standard motor vehicle insurance form; prohibited provisions
1.0K chars
§1282. Standard motor vehicle insurance form; prohibited provisions No motor vehicle liability insurance policy nor any uninsured motorist coverage for bodily injury shall limit the coverage of, or the amount that can be recovered by, the named insured, or the spouse or other fam…
La. Rev. Stat. § 22:1283 Proof of motorcycle endorsement
1.0K chars
§1283. Proof of motorcycle endorsement A. Each person who makes an application for issuance of a policy of insurance covering a motorcycle shall provide proof of the appropriate license endorsement required by R.S. 32:408(C). Such proof shall be provided to the insurer or its pro…
La. Rev. Stat. § 22:1284 Motor vehicle insurance; consideration of nonfault incidents prohibited
1.7K chars
§1284. Motor vehicle insurance; consideration of nonfault incidents prohibited A. No insurer shall increase the rate, increase or add a surcharge, cancel, or fail to renew any policy of motor vehicle insurance when such action is based on consideration of one or more nonfault inc…
La. Rev. Stat. § 22:1284.1 Motor vehicle insurance; consideration of lapse in coverage
1.8K chars
§1284.1. Motor vehicle insurance; consideration of lapse in coverage A (1)(a) An insurer shall not increase the premium rate or increase or add a surcharge on any policy of motor vehicle insurance based on an insured's first lapse in coverage, provided the lapse does not exceed n…
La. Rev. Stat. § 22:1285 Automobile insurance policies; refusal to issue or renew; age discrimination
0.6K chars
§1285. Automobile insurance policies; refusal to issue or renew; age discrimination No insurer shall refuse to issue or renew an automobile insurance policy to any person over the age of sixty-five based upon the age of the insured provided the insured is mentally and physically …
