reglab/housing_qa huggingface dataset:
LA Rev Stat § 22:1126 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1126. Rate setting

RS 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 determined by ratio shall be five to one. The limitation does not apply for determining rates for an attained age of less than nineteen years or more than sixty-five years.  Acts 2019, No. 412, §1, eff. June 11, 2019.
LA Rev Stat § 22:1127 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1127. Open enrollment

RS 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 inconsistent with applicable federal law. The commissioner may adopt rules establishing minimum open enrollment dates and minimum criteria for special enrollment periods for all individual health plans offered in this state.  Acts 2019, No. 412, §1, eff. June 11, 2019.
LA Rev Stat § 22:1129 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1129. Conflict of laws

RS 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. June 11, 2019.
LA Rev Stat § 22:1130 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1130. Applicability

RS 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 Reconciliation Act of 2010, P. L. 111-152, and codified in Section 36B of the Internal Revenue Code, is held to be valid by a court of competent jurisdiction or is otherwise enforceable at law, or unless adequate appropriations are timely made by the federal or state government in an amount that is calculated in a similar manner as the tax credit in Section 1401 of the Patient Protection and Affordable Care Act.  B. The provisions of this Subpart shall not apply to grandfathered coverage as defined in R.S. 22:1091(B).  C. The provisions of this Subpart shall not apply to health benefit plans in the large groups as defined in R.S. 22:1091(B) or to the large group market as defined in R.S. 22:1091(B).  D. The provisions of this Subpart shall not apply to limited or excepted benefits policies as defined in this Title.  Acts 2019, No. 412, §1, eff. June 11, 2019.
LA Rev Stat § 22:1131 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1131. Short title

RS 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 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1132. Definitions

RS 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 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1133. Louisiana Guaranteed Benefits Pool; establishment

RS 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 individuals with expected high healthcare costs for the purpose of lowering premiums for health insurance coverage offered in the individual market.  B. In establishing the program, the commissioner shall do all of the following:  (1) Examine Louisiana's historical experience with the Louisiana Health Plan high risk pool, R.S. 22:1201 et seq.  (2) Consult with healthcare consumers, health insurance issuers, and other interested stakeholders.  (3) Take into consideration high-cost health conditions and other health trends that generate a high cost.  Acts 2019, No. 412, §1, eff. June 11, 2019.
LA Rev Stat § 22:1134 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1134. Operation of program

RS 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.  Acts 2019, No. 412, §1, eff. June 11, 2019.
LA Rev Stat § 22:1135 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1135. Actuarial analysis

RS 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 Provider Fee (HIPF) or may be recovered pursuant to litigation related to the HIPF may be used to contribute to the funding of the guaranteed benefits pool.  (3) Estimate the necessary funding required to reach the premium reduction goals of the program, taking into consideration all of the above-listed sources.  Acts 2019, No. 412, §1, eff. June 11, 2019.
LA Rev Stat § 22:1136 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1136. Program parameters

RS 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 individuals.  (3) The standards for qualification, including but not limited to all of the following:  (a) The identification of health conditions that automatically qualify individuals as eligible individuals at the time of application for health insurance coverage.  (b) A process pursuant to which health insurance issuers may voluntarily qualify individuals who do not automatically qualify as eligible individuals at the time of application for coverage.  (4) The percentage of the premiums paid to health insurance issuers for health insurance coverage by eligible individuals that shall be collected and deposited to the credit and available for the use of the program.  (5) The threshold dollar amount of claims for eligible individuals after which the program will provide payments to health insurance issuers and the proportion of the claims above the threshold dollar amount that the program will pay.  Acts 2019, No. 412, §1, eff. June 11, 2019.
LA Rev Stat § 22:1137 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1137. Approval by legislature

RS 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 of the program as determined by the commissioner, and any required funding. The committee may also take any other action with respect to the program deemed necessary by the committee.  Acts 2019, No. 412, §1, eff. June 11, 2019.
LA Rev Stat § 22:1138 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1138. Enrollment or participation limitation

RS 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 definitive ruling by a court of competent jurisdiction that the federal Patient Protection and Affordable Care Act, P.L. 111-148, is unconstitutional pursuant to R.S. 22:1122.  Acts 2019, No. 412, §1, eff. June 11, 2019.
LA Rev Stat § 22:1138.1 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1138.1. Redesignated as R.S. 22:1549 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 1138.1 - Redesignated as R.S. 22:1549 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1138.2 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1138.2. Redesignated as R.S. 22:1550 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 1138.2 - Redesignated as R.S. 22:1550 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1139 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1139. Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.

RS 1139 - Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.
LA Rev Stat § 22:1140 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1140. Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.

RS 1140 - Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.
LA Rev Stat § 22:1141 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1141. Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.

RS 1141 - Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.
LA Rev Stat § 22:1142 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1142. Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.

RS 1142 - Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.
LA Rev Stat § 22:1142.1 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1142.1. Redesignated as R.S. 22:1556 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 1142.1 - Redesignated as R.S. 22:1556 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1143 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1143. Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.

RS 1143 - Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.
LA Rev Stat § 22:1144 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1144. Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.

RS 1144 - Repealed by Acts 2013, No. 326, §2, eff. Jan. 1, 2015.
LA Rev Stat § 22:1145 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1145. Redesignated as R.S. 22:1559 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 1145 - Redesignated as R.S. 22:1559 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1146 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1146. Redesignated as R.S. 22:1560 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 1146 - Redesignated as R.S. 22:1560 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1147 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1147. Redesignated as R.S. 22:1561 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 1147 - Redesignated as R.S. 22:1561 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1148 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1148. Redesignated as R.S. 22:1562 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 1148 - Redesignated as R.S. 22:1562 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1149 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1149. Redesignated as R.S. 22:1563 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 1149 - Redesignated as R.S. 22:1563 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1150 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1150. Redesignated as R.S. 22:1564 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 1150 - Redesignated as R.S. 22:1564 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1151 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1151. Definitions

RS 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 for the benefit of any other person or group of persons as consideration for providing to such person or group of persons the opportunity to receive dental services at such times in the future as such services may be appropriate or required, but shall not be construed to include a dentist or professional dental corporation that accepts prepayment on a fee-for-service basis for providing specific dental services to individual patients for whom such services have been prediagnosed. Nothing in Paragraph 2 of this Section shall apply to a funded or self-funded trust qualified with the United States Department of Labor in accordance with Public Law 93-406.  (3) "Dentist" means any person lawfully licensed by the Louisiana State Board of Dentistry to practice dentistry in Louisiana.  (4) "Downcode" or "downcoding" means the alteration by a dental service contractor, insurer, or other third-party payer of a service code submitted with a claim for reimbursement by a dentist or other healthcare provider to one of lesser complexity, resulting in decreased reimbursement.  (5) "Participant" means a dentist who has contracted with a dental service contractor to accept from and to look solely to such contractor for payment for any health care services rendered to a subscriber, subject to any co-payment obligations included in the contract of the subscriber with the dental service contractor.  (6) "Person" means an individual, insurer, association, organization, partnership, business, trust, except E.R.I.S.A. trusts qualified with the United States Department of Labor under Public Law 93-406, corporation, or other legal entity.  (7) "Regular fee" means the fee a dentist or other healthcare provider would normally charge for a procedure before any discounts applicable by a preferred provider organization network, dental benefit plan, dental referral plan, direct primary care agreement, or similar contracts.   (8) "Subscriber" means any person by or for whom a dental service contractor is paid a periodic premium as prepayment for dental services to be rendered to him by a participant.  Added by Acts 1981, No. 461, §1; Redesignated from R.S. 22:1510 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2020, No. 187, §1. NOTE: Former R.S. 22:1151 redesignated as R.S. 22:1565 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1152 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1152. Qualification and regulation of dental service contractors

RS 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 admitted to transact business in this state and issued a certificate of authority as a foreign or alien insurer under this Title. B. Except as provided in this Subpart, every dental service contractor operating in this state shall be regulated by the commissioner as a domestic or foreign health and accident insurer and shall meet all of the requirements established by this Title applicable to health and accident insurers, including all capital, surplus, and deposit requirements. For purposes of regulation, a contract between a dental service contractor and a subscriber shall be considered a health and accident insurance policy, and the subscriber shall be considered a policyholder. Any insurer not authorized to transact any health and accident insurance business in this state which seeks authority to act also as a dental service contractor, shall be required to satisfy the capital, surplus, and deposit requirements referred to above in addition to those required to transact the business of insurance, and no cash or its equivalence and no bond used by an insurer to meet the capital, surplus, or deposit requirements of this Title to transact insurance shall be considered by the commissioner in determining whether that insurer is also qualified to act as a dental service contractor. Added by Acts 1981, No. 461, §1; Redesignated from R.S. 22:1511 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1153 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1153. Additional regulations

RS 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 contract and that those services shall be available and conveniently accessible, promptly as appropriate, and in a manner which assures continuity. The premium to be paid by the subscriber to the dental service contractor shall be set in the contract and shall not vary during the term of the contract. B. Each contract between a dental service contractor and any of its participants for the rendition of services to subscribers shall provide that the contract may be cancelled by either the participant or the dental service contractor upon thirty days' written notice to the other party, and such cancellation shall be fully effective as to subscribers as well as to the other party to the contract. Added by Acts 1981, No. 461, §1; Redesignated from R.S. 22:1512 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1156 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1156. Dental reimbursement or payments

RS 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 usual and customary fee charged by licensed dentists shall contain all of the following disclosure requirements:  (1) The frequency of the determination of the usual and customary fee. (2) A specific and detailed description of the methodology used to determine the usual and customary fee. (3) The percentile that determines the maximum benefit that the company will pay for each dental procedure, if the usual and customary fee is determined by taking a sample of fees submitted on actual claims from licensed dentists and then determining the benefit by selecting a percentile of those fees. B. Each insurer providing dental health coverage shall, upon request, provide a complete copy of the dental health coverage provisions, including the information enumerated in Subsection A of this Section, to each insured. Every employee benefit explanation or description and any proposal for dental insurance coverage shall also contain such information regarding the determination of the usual and customary fee. C. As used in this Section, the following definitions shall apply:  (1) "Usual fee" is the fee which an individual dentist most frequently charges for a specific dental procedure. (2) "Customary fee" is the fee level determined by the administrator of the dental benefit plan from actual submitted fees for a specific dental procedure to establish the maximum benefit payable under a given plan for that specific procedure. D. The disclosure must be provided upon request to all group and individual policyholders and group certificate holders. All proposals for dental insurance must notify the prospective policyholder that information regarding usual and customary fee determinations are available from the insurer. The employee benefit descriptions or supplemental documents must notify the employee that information regarding dental reimbursements rates are available from the employer. Acts 1992, No. 329, §1; Redesignated from R.S. 22:213.5 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1157.1 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1157.1. Dental reimbursement or payments; procedure codes; downcoding; prohibitions

RS 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) of this Subsection shall be considered an unfair or deceptive practice pursuant to Part IV of Chapter 7 of this Title and shall be subject to the penalties contained in that Part.  B. No dental service contractor shall change a procedure code submitted by a dentist or other healthcare provider unless both of the following conditions are met:  (1) The change is consistent with the dental service contractor's policies.  (2) The dental service contractor has sufficient information to make the change.  C.(1) If a procedure code change is made pursuant to Subsection B of this Section, the explanation of benefits provided to the subscriber shall include the reason for the downcoding and citation of the dental service contractor's applicable policy.  (2) The explanation of benefits shall not state or infer that the code billed by the dentist or other healthcare provider was inappropriate unless there is clear evidence the code listed on the claim by the dentist or provider in no way related to the procedure actually performed.  (3) The explanation of benefits shall not state or infer that the dentist or other healthcare provider's charge was excessive unless there is clear evidence the charge was substantially higher than the dentist's or provider's regular fees.  D. The dental service contractor shall disclose in its provider contracts, on its website, or both, the specific downcoding policies that the dental service contractor reasonably expects to be applied to the provider or provider's services on a routine basis as a matter of policy.  E. Notwithstanding any provision of this Section to the contrary, a dental service contractor, insurer, or other third-party payer shall not downcode the installation service of a fixed bridge to a removable bridge.  Acts 2020, No. 187, §1.
LA Rev Stat § 22:1161 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1161. Repealed by Acts 2021, No. 86, §1.

RS 1161 - Repealed by Acts 2021, No. 86, §1.
LA Rev Stat § 22:1162 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1162. Repealed by Acts 2021, No. 86, §1.

RS 1162 - Repealed by Acts 2021, No. 86, §1.
LA Rev Stat § 22:1163 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1163. Repealed by Acts 2021, No. 86, §1.

RS 1163 - Repealed by Acts 2021, No. 86, §1.
LA Rev Stat § 22:1164 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1164. Repealed by Acts 2021, No. 86, §1.

RS 1164 - Repealed by Acts 2021, No. 86, §1.
LA Rev Stat § 22:1165 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1165. Repealed by Acts 2021, No. 86, §1.

RS 1165 - Repealed by Acts 2021, No. 86, §1.
LA Rev Stat § 22:1166 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1166. Repealed by Acts 2021, No. 86, §1.

RS 1166 - Repealed by Acts 2021, No. 86, §1.
LA Rev Stat § 22:1167 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1167. Repealed by Acts 2021, No. 86, §1.

RS 1167 - Repealed by Acts 2021, No. 86, §1.