Title 22, Insurance
0 chapters · 2,651 sections in this title.
La. Rev. Stat. § 22:1241 Creation of the Louisiana Safety Net Health Insurance Program
0.8K chars
§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. § 22:1241.1 Redesignated as R.S
0.1K chars
§1241.1. Redesignated as R.S. 22:1922 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1242 Definitions
5.1K chars
§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
1.3K chars
§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
4.3K chars
§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
3.1K chars
§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
0.7K chars
§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
4.0K chars
§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. § 22:1247.1 Redesignated as R.S
0.1K chars
§1247.1. Redesignated as R.S. 22:1929 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1248 File and use of policy forms
0.8K chars
§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
3.9K chars
§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. § 22:1249.1 Redesignated as R.S
0.1K chars
§1249.1. Redesignated as R.S. 22:1903 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:125 Redesignated as R.S
0.1K chars
§125. Redesignated as R.S. 22:117 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1250 Construction of policy
0.6K chars
§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
0.5K chars
§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
1.0K chars
§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…
La. Rev. Stat. § 22:1253 Redesignated as R.S
0.1K chars
§1253. Redesignated as R.S. 22:1907 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1254 Redesignated as R.S
0.1K chars
§1254. Redesignated as R.S. 22:1908 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1255 Redesignated as R.S
0.1K chars
§1255. Redesignated as R.S. 22:1909 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1256 Redesignated as R.S
0.1K chars
§1256. Redesignated as R.S. 22:1910 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1257 Redesignated as R.S
0.1K chars
§1257. Redesignated as R.S. 22:432 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1258 Redesignated as R.S
0.1K chars
§1258. Redesignated as R.S. 22:433 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1259 Redesignated as R.S
0.1K chars
§1259. Redesignated as R.S. 22:434 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:126 Redesignated as R.S
0.1K chars
§126. Redesignated as R.S. 22:118 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
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…