reglab/statecodes huggingface dataset:
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1019.3. Enforcement provisions; penalties; regulations

RS 22:1019.3 - Enforcement provisions; penalties; regulations
A. If the commissioner determines that a health insurance issuer has not contracted with enough participating providers to ensure that covered persons have accessible health care services in a geographic area, that a health insurance issuer's access plan does not ensure reasonable access to covered health care services, or that a health insurance issuer has entered into a contract that does not comply with this Subpart, the commissioner may do either or both of the following:
(1) Institute a corrective action plan that shall be followed by the health insurance issuer within thirty days of notice of noncompliance from the commissioner.
(2) Use his other enforcement powers to obtain the health insurance issuer's compliance with this Subpart, including but not limited to disapproval or withdrawal of his approval.
B. The commissioner shall not act to arbitrate, mediate, or settle disputes regarding a decision not to include a health care provider in a health benefit plan or in a provider network if the health insurance issuer has an adequate network as determined by the commissioner pursuant to the requirements contained in this Subpart.
C. The commissioner may promulgate such rules and regulations as may be necessary or proper to carry out the provisions of this Subpart. Such rules and regulations shall be promulgated and adopted in accordance with the Administrative Procedure Act, R.S. 49:950 et seq.
D.(1) The commissioner may issue, and cause to be served upon the health insurance issuer violating this Subpart, an order requiring such health insurance issuer to cease and desist from such act or omission for the whole state or any geographic area.
(2) The commissioner may refuse to renew, suspend, or revoke the certificate of authority of any health insurance issuer violating any of the provisions of this Subpart, or in lieu of suspension or revocation of a license duly issued, the commissioner may levy a fine not to exceed one thousand dollars for each violation per health insurance issuer, up to one hundred thousand dollars aggregate for all violations in a calendar year per health insurance issuer, when such violations, in his opinion, after a proper hearing, warrant the refusal, suspension, or revocation of such certificate, or the imposition of a fine. The commissioner of insurance is authorized to withhold fines imposed under this Subpart. Such hearing shall be held in the manner provided in Chapter 12 of this Title, R.S. 22:2191 et seq. Additionally, the commissioner may take any other administrative action, including imposing those fines and penalties enumerated in R.S. 22:18.
Acts 2013, No. 205, §1, eff. June 10, 2013.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1020.1. Short title; purpose; scope; definitions

RS 22:1020.1 - Short title; purpose; scope; definitions
A. This Subpart shall be known and may be cited as the "Network Provider Directory Accessibility and Accuracy Act".
B. The purpose and intent of this Subpart is to establish standards for the creation and maintenance by a health insurance issuer of a directory of the issuer's network of healthcare providers and to ensure the accessibility and accuracy of the directory.
C. This Subpart shall apply to all health insurance issuers that offer health benefit plans in this state but shall not include excepted benefits policies as defined in R.S. 22:1061(3).
D. As used in this Subpart:
(1) "Commissioner" means the commissioner of insurance.
(2) "Covered person" means a policyholder, subscriber, enrollee, insured, or other individual participating in a health benefit plan.
(3) "Department" means the Department of Insurance.
(4) "Health benefit plan" means a policy, contract, certificate, or subscriber agreement entered into, offered, or issued by a health insurance issuer to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services.
(5) "Healthcare facility" means an institution providing healthcare services or a healthcare setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, diagnostic, laboratory, and imaging centers, and rehabilitation and other therapeutic health settings.
(6) "Healthcare professional" means a physician or other healthcare practitioner licensed, certified, or registered to perform specified healthcare services consistent with state law.
(7) "Healthcare provider" or "provider" means a healthcare professional or a healthcare facility.
(8) "Healthcare services" means services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.
(9) "Health insurance issuer" means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including a sickness and accident insurance company, a health maintenance organization, a preferred provider organization or any similar entity, or any other entity providing a plan of health insurance or health benefits.
(10) "Network of providers" or "network" means an entity, including a health insurance issuer, that, through contracts or agreements with healthcare providers, provides or arranges for access by groups of covered persons to healthcare services by healthcare providers who are not otherwise or individually contracted directly with a health insurance issuer.
Acts 2018, No. 290, §1, eff. Jan. 1, 2019.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1020.2. Provider directory; content; accessibility

RS 22:1020.2 - Provider directory; content; accessibility
A. A health insurance issuer shall maintain a directory of the issuer's network of providers on the internet.
B. The directory shall include the name, specialty, if any, street address, and telephone number of each healthcare provider and indicate whether the provider is accepting new patients.
C. The directory shall be all of the following:
(1) Electronically searchable by healthcare provider name, specialty, if any, and location.
(2) Publicly accessible without necessity of providing a password, a user name, or personally identifiable information.
Acts 2018, No. 290, §1, eff. Jan. 1, 2019.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1020.3. Continuous review required

RS 22:1020.3 - Continuous review required
A. A health insurance issuer shall conduct an ongoing review of the issuer's provider directory and correct or update the information as necessary. Except as provided in Subsections B and C of this Section, corrections and updates, if any, shall be made not less than once every twenty business days.
B. The health insurance issuer shall update the directory to list a healthcare provider not later than ten business days after the effective date of the provider's credentialing with the health insurance issuer.
C. The health insurance issuer shall update the directory to remove a healthcare provider not later than ten business days after the effective date of the termination of the provider's credentialing with the health insurance issuer.
Acts 2018, No. 290, §1, eff. Jan. 1, 2019.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1020.4. Reporting of inaccurate information

RS 22:1020.4 - Reporting of inaccurate information
A. A health insurance issuer shall conspicuously display in the issuer's provider directory an email address, a toll-free telephone number, or another mechanism that is easily accessible to any individual by which the individual may report any inaccuracy in the directory.
B. If the health insurance issuer receives a report from any person that specifically identified directory information may be inaccurate, the issuer shall investigate the report and correct the information, as necessary, in accordance with the following schedule:
(1) Not later than the second business day after the date the report is received if the report concerns the health insurance issuer's representation of the network participation status of a healthcare provider.
(2) Not later than the fifth business day after the date the report is received if the report concerns any other type of information in the directory.
Acts 2018, No. 290, §1, eff. Jan. 1, 2019.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1020.5. Investigation by the commissioner; assessment; penalties; applicability

RS 22:1020.5 - Investigation by the commissioner; assessment; penalties; applicability
A. If, in any thirty-day period, a health insurance issuer receives three or more reports that allege the issuer's directory inaccurately represents a healthcare provider's network participation status and that are confirmed by the issuer's investigation, the health insurance issuer shall immediately report that occurrence to the commissioner.
B. On receipt of a report pursuant to Subsection A of this Section, the commissioner shall investigate the health insurance issuer's compliance with the provisions of this Subpart.
C. The department may collect an assessment in an amount determined by the commissioner from the health insurance issuer at the time of the investigation to cover all expenses attributable directly to the investigation, including but not limited to the salaries and expenses of department employees and all reasonable expenses of the department necessary for the administration of this Subpart.
D. Except as otherwise provided in Subsection F of this Section, the Department of Insurance may promulgate rules and regulations to provide for civil fines payable by a health insurance issuer not to exceed five hundred dollars for each act of violation of the requirements of this Subpart, not to exceed an aggregate fine of fifty thousand dollars. For purposes of this Subsection, "act of violation" is limited to an intentional act or an act of gross negligence.
E.(1) A health insurance issuer shall not be responsible for information that is inaccurately submitted or not submitted by healthcare providers as stated in their contract.
(2) The penalties provided for in this Section shall be the exclusive remedy for any violations and there shall be no independent cause of action by any person based upon a violation or other information reported.
F. The provisions of this Subpart shall apply to the Office of Group Benefits; however, the commissioner of insurance shall not levy an assessment or fine against the Office of Group Benefits. If the commissioner of insurance concludes that the Office of Group Benefits has violated this Subpart, the commissioner of insurance shall notify the commissioner of administration in writing within thirty days of the violation.
Acts 2018, No. 290, §1, eff. Jan. 1, 2019.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1020.6. Printed form available upon request

RS 22:1020.6 - Printed form available upon request
The directory of network providers required pursuant to this Subpart shall be furnished in printed form to any covered person upon request.
Acts 2018, No. 290, §1, eff. Jan. 1, 2019.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1020.51. Purpose and intent

RS 22:1020.51 - Purpose and intent
The purpose and intent of this Subpart is to ensure patient access to physician-administered drugs and related services furnished to persons covered under a health insurance contract. This Subpart shall ensure that health insurance issuers do not interfere with patients' freedom of choice with respect to providers furnishing physician-administered drugs and ensure that patients receive safe and effective drug therapies.
Acts 2021, No. 50, §1, eff. June 1, 2021.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1020.52. Definitions

RS 22:1020.52 - Definitions
For purposes of this Subpart, the following words shall have the following meanings:
(1) "Covered person" shall have the same meaning as provided in R.S. 22:1019.1.
(2) "Health insurance issuer" shall have the same meaning as provided in R.S. 22:1019.1.
(3) "Participating provider" shall have the same meaning as provided in R.S. 22:1019.1. For purposes of this Subpart, "participating provider" shall include any clinic, hospital outpatient department, or pharmacy under the common ownership or control of the participating provider.
(4) "Physician-administered drug" means any prescription drug, as defined in R.S. 22:1060.1, other than a vaccine, that requires administration by a provider and is not approved as a self-administered drug.
Acts 2021, No. 50, §1, eff. June 1, 2021.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1020.53. Physician-administered drugs; access; payment

RS 22:1020.53 - Physician-administered drugs; access; payment
A.(1) A health insurance issuer, pharmacy benefit manager, or their agent shall not refuse to authorize, approve, or pay a participating provider for providing covered physician-administered drugs and related services to covered persons. A health insurance issuer shall not condition, deny, restrict, refuse to authorize or approve, or reduce payment to a participating provider for a physician-administered drug when all criteria for medical necessity are met, because the participating provider obtains physician-administered drugs from a pharmacy that is not a participating provider in the health insurance issuer's network. The drug supplied shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act, Pub. L. 113-54, as amended. The payment shall be at the rate set forth in the health insurance issuer's agreement with the participating provider applicable to such drugs, or if no such rate is included in the agreement, then at the wholesale acquisition cost. A health insurance issuer, pharmacy benefit manager, or their agent, shall not require a covered person to pay an additional fee, or any other increased cost-sharing amount in addition to applicable cost-sharing amounts payable by the covered person as designated within the benefit plan to obtain the physician-administered drug when provided by a participating provider. However, nothing in this Subpart shall prohibit a health insurance issuer or its agent from establishing differing copayments or other cost-sharing amounts within the benefit plan for covered persons who acquire physician-administered drugs from other providers. Nothing in this Subpart shall prohibit a health insurance issuer or its agent from refusing to authorize or approve, or from denying coverage of a physician-administered drug based upon failure to satisfy medical necessity criteria. For purposes of this Section, the location of receiving the physician-administered drug shall not be included in the medical necessity criteria.
(2) Nothing in this Section shall prohibit a health insurance issuer from establishing specialty care centers of excellence based on nationally established, objective quality measures, to be utilized by covered persons focused on specific drugs or types of drugs to impact the safety, quality, affordability, and expertise of treatment.
B. The commission of any act prohibited by this Subpart shall be considered an unfair method of competition and unfair practice or act which shall subject the violator to any and all actions, including investigative demands, private actions, remedies, and penalties, provided for in the Unfair Trade Practices and Consumer Protection Law.
C. Any provision of a contract that is contrary to any provision of this Subpart shall be null, void, and unenforceable in this state.
Acts 2021, No. 50, §1, eff. June 1, 2021.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1020.61. Selective application of prior authorization

RS 22:1020.61 - Selective application of prior authorization
A.(1) Every health insurance issuer authorized to do business in this state shall implement and maintain a program that allows for the selective application of reducing prior authorization requirements that are based on the stratification of healthcare providers' performance and adherence to evidence-based medicine. The program shall promote quality, affordable health care and reduce unnecessary administrative burdens for both the health insurance issuer and the healthcare provider. Criteria for participation by healthcare providers and the healthcare services included in the program excluding pharmacy services shall be at the sole discretion of the health insurance issuer. A health insurance issuer shall submit to the Department of Insurance a filing, in accordance with Subsection B of this Section, concerning the program that includes a full narrative description, the criteria for participation, a listing of the procedures and services subject to selective application of prior authorization, and the number of healthcare providers participating in the program.
(2) For the purposes of this Section, "health insurance issuer" has the same meaning as provided for in R.S. 22:1019.1.
B. The filing shall be in a form and manner provided for by the Department of Insurance, promulgated in accordance with the Administrative Procedure Act, and shall be submitted initially by July 1, 2023, and each time the health insurance issuer makes a filing in accordance with R.S. 22:571 thereafter.
Acts 2022, No. 432, §1, eff. June 16, 2022.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1021. Prohibition of discrimination against dental care services

RS 22:1021 - Prohibition of discrimination against dental care services
A. Whenever the terms "physician", "surgeon", "medical doctor", or any other terms which refer to licensed practitioners of the healing arts are used in any health and accident insurance policy, group health and accident insurance policy, certificate of insurance, contract providing coverage for hospital service, medical or surgical benefits as set out in R.S. 22:839, miscellaneous insurance contract authorized by R.S. 22:47(14) which provides benefits for hospital and medical care, public employee group benefit program document, subscriber contract providing health care treatment coverage, or any other policy, contract, or document providing for the payment of health care treatment procedures which are specified in the policy, contract, or document and are within the scope of a dentist's professional license, such terms shall be construed to include a dentist, licensed under the laws of the state of Louisiana governing the practice of dentistry under Chapter 9, Title 37, Louisiana Revised Statutes of 1950, who performs such specified treatment procedures.
B. Payment shall not be denied for a service provided by a person licensed to engage in the practice of dentistry if that service would be a covered service if provided by a person licensed to engage in the practice of medicine and surgery, if the service can be lawfully performed within the scope of a person's license to practice dentistry.
C. The provisions of this Section shall be applicable only with respect to policies, contracts, or other documents delivered, issued for delivery, promulgated, or renewed in this state on or after January 1, 1990.
D. This Section shall not be construed to mandate that any benefit or health care treatment be authorized and included in a policy, contract, or other document.
Added by Acts 1974, No. 544, §1; Acts 1989, No. 817, §1; Redesignated from R.S. 22:213.1 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
NOTE: Former R.S. 22:1321 redesignated as R.S. 22:801 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1022. Prohibited discrimination; prenatal test results

RS 22:1022 - Prohibited discrimination; prenatal test results
A. No hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan, or any policy of group, family group, blanket, or association health and accident insurance, a self-insurance plan, health maintenance organization, and preferred provider organization, which delivers or issues for delivery in this state an insurance policy or plan shall, on the basis of any prenatal test result:
(1) Terminate, restrict, limit, or otherwise apply conditions to the coverage under the policy or plan, or restrict the sale of the policy or plan in force.
(2) Cancel or refuse to renew the coverage under the policy or plan in force.
(3) Deny coverage or exclude an individual or family member from coverage under the policy or plan in force.
(4) Impose a rider that excludes coverage for certain benefits or services under the policy or plan in force.
(5) Establish differentials in premium rates or cost sharing for coverage under the policy or plan in force.
(6) Otherwise discriminate against an individual or family member in the provision of insurance.
B. The provisions of this Section shall not apply to tests conducted to determine pregnancy.
Acts 1997, No. 1418, §1; Acts 2003, No. 129, §1, eff. May 28, 2003; Redesignated from R.S. 22:213.6 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
NOTE: Former R.S. 22:1022 redesignated as R.S. 22:802 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1023.2. Coverage of a living donor; prohibitions

RS 22:1023.2 - Coverage of a living donor; prohibitions
A. As used in this Section, the following terms apply:
(1) "Insurance coverage" means coverage under a disability income, life, or long-term care insurance policy.
(2) "Living donor" means an individual for which both of the following apply:
(a) Has donated all or part of an organ or bone marrow.
(b) Is not deceased.
B. Notwithstanding any other provision of law to the contrary, an insurer or issuer of a disability income, life, or long-term care insurance policy shall not deny, cancel, or refuse to issue insurance coverage, determine the price or premium for, or otherwise vary any term or condition of the policy solely on the basis of the individual's status as a living donor and without any unique and material actuarial risks in accordance with sound actuarial principles or actual and reasonably anticipated and expected experience of the individual based on the individual's status as a living donor.
Acts 2022, No. 146, §1.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1024. Group, family group, blanket, and association health and accident insurance; mandatory coverage

RS 22:1024 - Group, family group, blanket, and association health and accident insurance; mandatory coverage
A. Any policy issued under this Section, which in addition to covering the insured also covers members of the insured's immediate family, shall provide coverage for illnesses and injuries of unmarried dependent children of the insured and unmarried grandchildren in the legal custody of the grandparent from the date of birth to the attainment of the limiting age. Such coverage shall include coverage for illness, injury, congenital defects, and premature birth, but need not include routine well baby care.
B.(1) All policies issued more than ninety days following September 1, 1979, which in addition to covering the insured also cover members of the insured's immediate family, shall offer coverage for the transportation by professional ambulance services, including air or surface transport, of all the newly born to the nearest available hospital or neonatal special care unit for treatment of illnesses, injuries, congenital defects, and complications of premature birth but the coverage need not include transportation services for the purpose of obtaining routine well baby care.
(2) Such policies shall also provide coverage for transportation by professional ambulance services of the temporarily medically disabled mother of the ill newly born when accompanying the ill newly born to the nearest available hospital or neonatal special care unit. The mother's need for professional ambulance service must be certified by her attending physician.
C. For the purpose of this Section the following definitions shall apply:
(1) "Newly born" means infants from the time of birth until age one month or until such time as the infant is well enough to be discharged from a hospital or neonatal special care unit to his home, whichever period is longer.
(2) "Temporarily medically disabled mother" means a woman who has recently given birth and whose physician has advised that normal travel would be hazardous to her health.
D. The provisions of this Section shall not apply to limited benefit health insurance policies or contracts authorized to be issued in this state.
Added by Acts 1973, No. 98, §§1, 2. Amended by Acts 1979, No. 470, §1; Acts 1992, No. 637, §1, eff. July 2, 1992; Acts 1997, No. 1268, §1; Acts 2003, No. 129, §3, eff. May 28, 2003; Redesignated from R.S. 22:215.5 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011.
NOTE: Former R.S. 22:1024 redesignated as R.S. 22:804 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1025. Group, blanket, and association health insurance, treatment for alcoholism and drug abuse

RS 22:1025 - Group, blanket, and association health insurance, treatment for alcoholism and drug abuse
A. Any group, blanket, or association health insurance policy issued under R.S. 22:1000 shall include as an option to be exercised by the policyholder, as defined therein, covered benefits for the treatment of alcoholism and for the treatment of drug abuse, rendered or prescribed by a physician licensed in this state, received in any licensed hospital or in any other public or private facility, or portion thereof duly authorized by the appropriate state authority to provide alcoholism or drug abuse treatment and rehabilitation services, including freestanding, nonhospital chemical dependency units.
B. Any insurer who, on October 1, 1982, has group, blanket, or association health insurance policies in force shall convert such existing policies to conform to the provisions of this Section on or before the renewal dates.
Added by Acts 1974, No. 252, §1. Amended by Acts 1979, No. 58, §1; Acts 1982, No. 849, §1; Acts 2003, No. 129, §1, eff. May 28, 2003; Redesignated from R.S. 22:215.5 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011.
NOTE: Former R.S. 22:1025 repealed by Acts 2008, No. 504, §2, eff. Jan.1, 2009, and redesignated as R.S. 22:805 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1025.1. Health insurance policies; mandated offering for treatment of lymphedema

RS 22:1025.1 - Health insurance policies; mandated offering for treatment of lymphedema
A. Any health insurance policy issued or issued for delivery in this state shall include as an option to be exercised by the policyholder, as defined therein, covered benefits for the treatment of lymphedema, rendered or prescribed by a physician licensed in this state or received in any licensed hospital or in any other public or private facility authorized to provide lymphedema treatment, including multilayer compression bandaging systems and custom or standard-fit gradient compression garments.
B. Any insurer who, on August 1, 2014, has health insurance policies in force in this state shall convert such existing policies to conform to the provisions of this Section on or before the renewal dates.
C. The provisions of this Section shall not apply to limited benefit health insurance policies or contracts authorized to be issued in this state.
Acts 2014, No. 445, §1.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1026. Group, family group, blanket, and association health and accident insurance; cleft lip and cleft palate coverage; mandatory coverage

RS 22:1026 - Group, family group, blanket, and association health and accident insurance; cleft lip and cleft palate coverage; mandatory coverage
A. Any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan, and a self-insurance plan that provides medical and surgical benefits which is delivered, issued for delivery or renewed in this state on or after January 1, 1998, shall include coverage for the treatment and correction of cleft lip and cleft palate. Such coverage shall also include benefits for secondary conditions and treatment attributable to that primary medical condition. Benefits shall include but not be limited to the following:
(1) Oral and facial surgery, surgical management, and follow-up care.
(2) Prosthetic treatment such as obturators, speech appliances, and feeding appliances.
(3) Orthodontic treatment and management.
(4) Preventive and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management or therapy.
(5) Speech-language evaluation and therapy.
(6) Audiological assessments and amplification devices.
(7) Otolaryngology treatment and management.
(8) Psychological assessment and counseling.
(9) Genetic assessment and counseling for patient and parents.
B. The provisions of this Section shall not apply to limited benefit health insurance policies or contracts authorized to be issued in this state.
Acts 1989, No. 409, §1; Acts 1997, No. 1355, §1; Acts 2003, No. 129, §3, eff. May 28, 2003; Redesignated from R.S. 22:215.8 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011.
NOTE: Former R.S. 22:1026 repealed by Acts 2008, No. 504, §2, eff. Jan.1, 2009, and redesignated as R.S. 22:806 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1027. Interpreter services for the deaf and hard of hearing; expenses

RS 22:1027 - Interpreter services for the deaf and hard of hearing; expenses
A. Any hospital or medical expense insurance policy delivered or issued for delivery in this state on or after December 1, 1991, shall contain a provision or endorsement requiring payment for expenses incurred by the insured for services performed by a qualified interpreter/transliterator, other than a family member of the insured, when such services are used by the insured in connection with medical treatment or diagnostic consultations performed by a physician, dentist, chiropractor, or podiatrist, provided such medical treatment or consultation is covered under said insurance policy and provided the services are required because of hearing loss of the insured or a failure of the insured to understand or otherwise communicate in spoken language.
B. The provisions of this Section shall not apply to limited benefit health insurance policies or contracts.
Acts 1991, No. 609, §1; Acts 1995, No. 593, §1; Redesignated from R.S. 22:215.10 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011; Acts 2017, No. 146, §5.
NOTE: Former R.S. 22:1027 redesignated as R.S. 22:807 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1028.1. Required coverage for breast and ovarian cancer susceptibility screening

RS 22:1028.1 - Required coverage for breast and ovarian cancer susceptibility screening
A. The legislature hereby finds that a woman's lifetime risk of developing breast or ovarian cancer is greatly increased if she inherits a harmful mutation in the BRCA1 or BRCA2 genes. Testing for the presence of BRCA1 or BRCA2 gene mutations may allow for interventions to reduce the risk for cancer or cancer-related death in women who are BRCA mutation carriers.
B.(1) Any health coverage plan delivered or issued for delivery in this state shall include coverage for the cost of the genetic testing of the BRCA1 and BRCA2 genes to detect an increased risk for breast and ovarian cancer when recommended by a healthcare provider in accordance with the United States Preventive Services Task Force recommendations for testing.
(2) The coverage provided in this Section may be subject to annual deductibles, coinsurance, and copayment provisions as are consistent with those established under the health coverage plan.
C. For purposes of this Section, "health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs. "Health coverage plan" shall not include a plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, and short-term policies that have a term of less than twelve months.
Acts 2019, No. 118, §1, eff. Jan. 1, 2020.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1028.2. Required coverage for diagnostic imaging

RS 22:1028.2 - Required coverage for diagnostic imaging
A.(1) Any health coverage plan delivered or issued for delivery in this state shall include coverage for diagnostic imaging at the same level of coverage provided for the minimum mammography examination pursuant to R.S. 22:1028.
(2) The health coverage plan may require a referral by the treating physician based on medical necessity for the diagnostic imaging to be eligible for the coverage required pursuant to Paragraph (1) of this Subsection.
(3) Any coverage required pursuant to the provisions of this Section shall not be subject to any policy or health coverage plan deductible amount.
B. For purposes of this Section:
(1) "Diagnostic imaging" means a diagnostic mammogram or breast ultrasound screening for breast cancer designed to evaluate an abnormality in the breast that is any of the following:
(a) Seen or suspected from a screening examination for breast cancer.
(b) Detected by another means of examination.
(c) Suspected based on the medical history or family medical history of the individual.
(2) "Health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs. "Health coverage plan" shall not include a plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, and short-term policies that have a term of less than twelve months.
C. Any provision in a health insurance policy, benefit program, or health coverage plan delivered, renewed, issued for delivery, or otherwise contracted for in this state which is contrary to the provisions of this Section shall, to the extent of the conflict, be void.
Acts 2019, No. 119, §1, eff. Jan, 1, 2021.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1029. Requirement for coverage of colorectal cancer screening

RS 22:1029 - Requirement for coverage of colorectal cancer screening
A. Any health coverage plan specified in Subsection C of this Section which is issued for delivery, delivered, renewed, or otherwise contracted for in this state on or after January 1, 2006, shall provide coverage for routine colorectal cancer screening.
B. As used in this Section, "routine colorectal cancer screening" shall mean a fecal occult blood test, flexible sigmoidoscopy, or colonoscopy provided in accordance with the most recently published recommendations established by the American College of Gastroenterology, in consultation with the American Cancer Society, for the ages, family histories, and frequencies referenced in such recommendations. "Routine colorectal cancer screening" shall not mean services otherwise excluded from coverage because they are deemed by a health coverage plan to be experimental or investigational.
C. As used in this Section, "health coverage plan" shall mean any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract or agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs.
D. The provisions of this Section shall not apply to limited benefit health insurance policies or contracts.
Acts 2005, No. 505, §1; Redesignated from R.S. 22:215.12 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011.
NOTE: Former R.S. 22:1029 redesignated as R.S. 22:809 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1030. Immunizations; coverage

RS 22:1030 - Immunizations; coverage
A. Any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan and a self-insurance plan, which is delivered or issued for delivery in this state on or after January 1, 1993, shall include benefits payable for immunizations for dependent children from birth to age six. These benefits shall be payable under the same circumstances and conditions as benefits are paid under those policies, contracts, benefit plans, agreements, or programs for all other diagnoses, treatments, illnesses, or accidents.
B. The immunizations covered shall include the complete basic immunization series for children up to age six as defined by the state health officer and required for school entry.
C. This Section shall apply to any new policy, contract, program, or plan issued on or after January 1, 1993. Any policy, contract, or plan in effect prior to January 1, 1993, shall convert to conform to the provisions of this Section on or before the renewal date thereof but in no event later than January 1, 1994. Any policy affected by this Section shall only be required to provide coverage for children born after August 21, 1992.
D. The provisions of this Section shall not apply to limited benefit health insurance policies or contracts.
E. Any coverage required under the provisions of this Section shall not be subject to any policy or health coverage plan deductible amount. The provision in this Subsection shall apply to any new policy, contract, program, or plan issued on or after January 1, 2005. Any policy, contract, or plan in effect prior to January 1, 2005, shall convert to conform to the provision of this Subsection on or before the renewal date thereof but in no event later than January 1, 2006.
Acts 1992, No. 756, §1; Acts 1993, No. 185, §1; Acts 1995, No. 593, §1; Acts 2001, No. 1178, §2, eff. June 29, 2001; Acts 2004, No. 431, §1; Redesignated from R.S. 22:215.14 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1031. Attention deficit/hyperactivity disorder; coverage; diagnosis

RS 22:1031 - Attention deficit/hyperactivity disorder; coverage; diagnosis
A. Any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan, or any policy of group, family group, blanket, or association health and accident insurance, and a self-insurance plan, which is delivered or issued for delivery in this state on or after January 1, 1994, shall include benefits payable for diagnosis and treatment of attention deficit/hyperactivity disorder as provided in this Section. These benefits shall be payable under the same circumstances and conditions as benefits are paid under those policies, contracts, benefit plans, agreements, or programs for all other diagnoses, illnesses, or accidents.
B. The diagnosis and treatment for attention deficit/hyperactivity disorder shall be covered when rendered or prescribed by a physician or other appropriate health care provider licensed in this state and received in any physician's or other appropriate health care provider's office, any licensed hospital, or in any other licensed public or private facility, or portion thereof, including but not limited to clinics and mobile screening units. However, benefits for attention deficit/hyperactivity disorder provided for an initial diagnosis shall not exceed six hundred dollars. Services rendered on an outpatient basis shall not exceed fifty dollars per visit with a physician or other appropriate health care provider and total benefits shall be limited to ten thousand dollars during a person's lifetime, and shall not exceed twenty-five hundred dollars in any given year. The limitation on benefits payable for attention deficit/hyperactivity disorder shall be minimum levels of coverage and nothing in this Section shall prohibit insurers from offering benefits in excess of the coverage provided for in this Subsection.
C. This Section shall apply to any new policy, contract, program, or plan issued on or after January 1, 1994. Any policy, contract, or plan in effect prior to January 1, 1994, shall convert to conform to the provisions of this Section on or before the renewal date but in no event later than January 1, 1995.
D. The provisions of this Section shall not apply to limited benefit health insurance policies or contracts.
Acts 1993, No. 376, §1; Acts 1995, No. 593, §1; Acts 2003, No. 129, §1, eff. May 28, 2003; Redesignated from R.S. 22:215.15 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1032. Osteoporosis; bone mass measurement; mandatory coverage

RS 22:1032 - Osteoporosis; bone mass measurement; mandatory coverage
A. Any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan, and a self-insurance plan that provides medical and surgical benefits for accident and health services, which is delivered or issued for delivery in this state on or after January 1, 2000, shall include coverage for a qualified individual for scientifically proven bone mass measurement for the diagnosis and treatment of osteoporosis.
B. As used in this Section, the following definitions shall apply:
(1) "Bone mass measurement" means a radiologic or radioisotopic procedure or other scientifically proven technologies performed on an individual for the purpose of identifying bone mass or detecting bone loss.
(2) "Qualified individual" means:
(a) An estrogen-deficient woman at clinical risk of osteoporosis who is considering treatment.
(b) An individual receiving long-term steroid therapy.
(c) An individual being monitored to assess the response to or efficacy of approved osteoporosis drug therapies.
C. Nothing in this Section shall apply to limited benefit health insurance policies or contracts.
Acts 1999, No. 64, §1; Redesignated from R.S. 22:215.16 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1033. Obstetrician or gynecological examination; coverage

RS 22:1033 - Obstetrician or gynecological examination; coverage
A.(1) Every hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan, or any policy of group, family group, blanket, or association health and accident insurance, a self-insurance plan, health maintenance organization, and preferred provider organization, which is delivered or issued for delivery in this state shall not prevent any individual who is an insured, enrollee, or beneficiary of any such policy or benefit plan from receiving direct access to an obstetrician or gynecologist or in-network obstetrician or gynecologist for routine gynecological care. For those enrollees in a plan that has made agreements with providers for the provision of health care or related services, the provisions of this Subsection may limit direct access to any in-network obstetrician or gynecologist for routine gynecological care.
(2) Routine gynecological care as used in this Section shall mean a minimum of two routine annual visits, provided that the second visit shall be permitted based upon medical need only, and follow-up treatment within sixty days following either visit if related to a condition diagnosed or treated during the visits, and any care related to a pregnancy. Nothing in this Section shall prevent a policy, program, or plan from requiring that an obstetrician-gynecologist treating a covered patient coordinate that care with the patient's primary care physician, if applicable.
B. Any provision in a health insurance policy or benefit program which is delivered, renewed, issued for delivery, or otherwise contracted for in this state which is contrary to this Section shall, to the extent of such conflict, be void.
Acts 1995, No. 637, §1; Acts 2003, No. 129, §1, eff. May 28, 2003; Redesignated from R.S. 22:1033 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1034.1. Health insurance coverage for insulin; limit on cost-sharing requirement

RS 22:1034.1 - Health insurance coverage for insulin; limit on cost-sharing requirement
A. As used in this Section, the following terms apply:
(1) "Formulary" has the same meaning as the term is defined in R.S. 22:1060.1.
(2) "Health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs. "Health coverage plan" does not include a plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, short-term policies that have a term of less than twelve months, and plans that do not provide prescription drug coverage.
(3) "Insulin" means a prescription drug that contains insulin and is used to treat diabetes. The term does not include an insulin drug that is administered to a patient intravenously.
B.(1) A health coverage plan shall not impose a cost-sharing provision for insulin in the health coverage plan's formulary as prescribed in Subsection C of this Section if the total amount the enrollee is required to pay exceeds seventy-five dollars per prescription for a thirty-day supply, regardless of the amount or type of insulin needed to fill the enrollee's prescription.
(2) On January first of each year, the limit on the amount that an insured is required to pay for a thirty-day supply of a covered prescription of insulin as provided for in this Subsection shall increase by a percentage equal to the percentage change from the preceding year in the prescription drug component of the Consumer Price Index of the United States Department of Labor, Bureau of Labor Statistics.
C. A health coverage plan shall include at least one insulin from each therapeutic class in the plan's formulary that complies with the provisions of this Section.
Acts 2022, No. 724, §1.