reglab/statecodes huggingface dataset:
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1060.14. Requirement to cover services consistent with nationally recognized clinical practice guidelines

RS 22:1060.14 - Requirement to cover services consistent with nationally recognized clinical practice guidelines
A. No health coverage plan that is renewed, delivered, or issued for delivery in this state that provides coverage for cancer in accordance with the Louisiana Insurance Code shall deny a request for prior authorization or the payment of a claim for any procedure, pharmaceutical, or diagnostic test typically covered under the plan to be provided or performed for the diagnosis and treatment of cancer if the procedure, pharmaceutical, or diagnostic test is recommended by nationally recognized clinical practice guidelines for use in the diagnosis or treatment for the insured's particular type of cancer and clinical state.
B. The provisions of this Section shall not prohibit a health insurance issuer from requiring utilization review to assess the effectiveness of the procedure, pharmaceutical, or test for the insured's condition, but if the procedure, pharmaceutical, or test is what is recommended by nationally recognized clinical practice guidelines for use in the diagnosis or treatment for the insured's particular type of cancer and clinical state, then any associated prior authorization shall be approved within the time limit specified in R.S. 22:1060.13.
Acts 2023, No. 254, §1.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1060.15. Required coverage for positron emission tomography or other recommended imaging for cancer

RS 22:1060.15 - Required coverage for positron emission tomography or other recommended imaging for cancer
A. No health insurance issuer shall deny coverage of a positron emission tomography or other recommended imaging for the purpose of diagnosis, treatment, appropriate management, restaging, or ongoing monitoring of an individual's disease or condition if the imaging is being requested for the diagnosis, treatment, or ongoing surveillance of cancer and is recommended by nationally recognized clinical practice guidelines.
B. No health coverage plan that is renewed, delivered, or issued for delivery in this state shall require an insured to undergo any imaging test for the purpose of diagnosis, treatment, appropriate management, restaging, or ongoing monitoring of an insured's disease or condition of cancer that is not recommended by nationally recognized clinical practice guidelines, as a condition precedent to receiving a positron emission tomography or other recommended imaging, when the positron emission tomography or other recommended imaging is recommended by the guidelines provided by this Subpart.
C. 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.
Acts 2023, No. 254, §1.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1060.16. Coverage for outpatient cancer treatments

RS 22:1060.16 - Coverage for outpatient cancer treatments
A. All health coverage plans renewed, delivered, or issued for delivery in this state shall, in addition to providing coverage for an insured admitted on an inpatient basis to a licensed hospital providing rehabilitation, long-term acute care, or skilled nursing services, provide coverage for claims for any otherwise covered and authorized outpatient services provided to the patient for the treatment of cancer.
B. 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.
Acts 2023, No. 254, §1.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1062.1. Special enrollment period

RS 22:1062.1 - Special enrollment period
A. Every group health plan issued by a health insurer or a health maintenance organization shall provide for a special enrollment period for employees or dependents if either of the following apply:
(1) The employee or dependent loses eligibility for Medicaid or coverage under the Louisiana Children's Health Insurance Program and the employee requests, not later than sixty days after the date of termination of such coverage, coverage under a group health plan for which the employee or dependent is eligible.
(2) The employee or dependent becomes eligible to participate in a premium assistance program under Medicaid or the Louisiana Children's Health Insurance Program and the employee requests, not later than sixty days after the date of determination of eligibility, coverage under a group health plan for which the employee or dependent is eligible. In the event of such eligibility, the Louisiana Department of Health shall ensure that each eligible enrollee, or, in the case of an enrollee in the Louisiana Children's Health Insurance Program, the child's parent or guardian, receives information regarding the special enrollment period. The department shall provide consistent communication and facilitation for everyone eligible to enroll in a group health plan during the special enrollment period.
B. The Department of Insurance may promulgate rules and regulations, pursuant to the Administrative Procedure Act, as necessary to assure compliance with the provisions of this Section and Section 311 of the Children's Health Insurance Program Reauthorization Act of 2009.
Acts 2009, No. 243, §1.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1064. Certification of coverage

RS 22:1064 - Certification of coverage
The provisions of R.S. 22:1062(D) shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market.
Acts 1997, No. 1138, §1, eff. July 14, 1997; Redesignated from R.S. 22:250.14 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1065.1. Redesignated as R.S. 22:822 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1065.1 - Redesignated as R.S. 22:822 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1066.1. Benefit limits; lifetime; annual

RS 22:1066.1 - Benefit limits; lifetime; annual
A. Except as provided for in Subsection C of this Section, any health coverage plan issued for delivery, delivered, renewed, or otherwise contracted for in this state on or after January 1, 2020, shall provide coverage without any lifetime limit on the dollar amount of benefits for any individual.
B. Except as provided for in Subsections C and D of this Section, any health coverage plan newly issued for delivery, delivered, renewed, or otherwise contracted for in this state on or after January 1, 2020, shall provide coverage without any annual limit on the dollar amount of benefits for any individual.
C. This Section shall apply only to covered benefits that are either of the following:
(1) Included among the covered benefits of the base-benchmark plan selected for the state of Louisiana for calendar year 2019 pursuant to 45 CFR Part 156.
(2) Required as a state-mandated health benefit pursuant to Title 22 of the Louisiana Revised Statutes of 1950.
D. Subsection B of this Section shall not apply to a health coverage plan that meets all of the following criteria:
(1) Is health insurance coverage offered only to individuals in the individual market.
(2) Covers only individuals who have been continuously covered by the health coverage plan since March 23, 2010.
(3) Is qualified as a grandfathered health plan coverage pursuant to 29 CFR Section 2590.715-1251 as of calendar year 2019.
E. No provision of this Section shall be interpreted to require any health coverage plan issued for delivery, delivered, renewed, or otherwise contracted for in this state to include particular covered benefits.
F. 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 and the Office of Group Benefits plans.
G. The provisions of this Section shall not apply to limited benefit health insurance policies or contracts, as defined by R.S. 22:47.
Acts 2019, No. 212, §1.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1066.2. Psychiatric Collaborative Care Model; service delivery method requirements

RS 22:1066.2 - Psychiatric Collaborative Care Model; service delivery method requirements
A. A health coverage plan which is delivered or issued for delivery in this state that provides mental health and substance abuse benefits shall provide coverage for mental health and substance abuse services that are delivered through evidence-based, integrated behavioral healthcare models, such as the Psychiatric Collaborative Care Model.
B. Any medical necessity determination made by a health coverage plan shall be in compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and its related regulations, and in accordance with the Internal Claims and Appeals Process and External Review Act, R.S. 22:2391 et seq.
C. As used in this Section, the following terms apply:
(1) "Health coverage plan" means 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 and the Office of Group Benefits programs.
(2) "Mental health or substance abuse benefits" means benefits for the treatment of any condition or disorder that involves a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental disorders section of the current edition of the International Classification of Diseases or that is listed in the mental disorders section of the most recent version of the Diagnostic and Statistical Manual of Mental Disorders.
(3) "Psychiatric Collaborative Care Model" means the evidence-based, integrated behavioral health service delivery method that is typically provided by a primary care team consisting of a primary care provider and a care manager who works in collaboration with a psychiatric consultant, such as a psychiatrist. Care is directed by the primary care team and includes structured care management with regular assessments of clinical status using validated tools and modification of treatment as appropriate. The psychiatric consultant provides regular consultations to the primary care team to review the clinical status and care of patients and to make recommendations.
Acts 2022, No. 457, §1.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1069. Disclosure of information

RS 22:1069 - Disclosure of information
A. In connection with the offering of any health insurance coverage to a small employer, a health insurance issuer shall make a reasonable disclosure to such employer, as part of its solicitation and sales materials, of the availability of information described in Subsection B of this Section, and upon request of such a small employer, provide such information.
B.(1) Subject to the provisions of Subsection C of this Section, information described in this Section is information concerning:
(a) The provisions of such coverage concerning the issuer's right to change premium rates and the factors that may affect changes in premium rates.
(b) The provisions of such coverage relating to renewability of coverage.
(c) The provisions of such coverage relating to any preexisting condition exclusion.
(d) The benefits and premiums available under all health insurance coverage for which the employer is qualified.
(2) Information under this Subsection shall be provided to small employers in a manner determined to be understandable by the average small employer, and shall be sufficient to reasonably inform small employers of their rights and obligations under the health insurance coverage.
C. An issuer is not required under this Section to disclose any information that is proprietary and trade secret information under applicable law.
Acts 1997, No. 1138, §1, eff. July 14, 1997; Redesignated from R.S. 22:250.8 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
NOTE: Former R.S. 22:1069 redesignated as R.S. 22:791 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1076. General exceptions

RS 22:1076 - General exceptions
A. The requirements of this Subpart shall not apply to any health insurance coverage in relation to its provision of excepted benefits described in R.S. 22:1061(3)(a).
B. The requirements of this Subpart shall not apply to any health insurance coverage in relation to its provision of excepted benefits described in R.S. 22:1061(3)(b), (c), or (d) if the benefits are provided under a separate policy, certificate, or contract of insurance.
Acts 1997, No. 1138, §1, eff. July 14, 1997; Redesignated from R.S. 22:250.16 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
NOTE: Former R.S. 22:1076 redesignated as R.S. 22:833 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1076.1. Redesignated as R.S. 22:834 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1076.1 - Redesignated as R.S. 22:834 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1079. Compliance of health insurance issuer with Gramm-Leach-Bliley Act

RS 22:1079 - Compliance of health insurance issuer with Gramm-Leach-Bliley Act
A health insurance issuer who is in compliance with the privacy requirements of the federal Health Insurance Portability and Accountability Act of 1996 (42 USC 1320d) shall be deemed to be in compliance with state law intended to implement requirements of Title V of the federal Gramm-Leach-Bliley Act.
Acts 2003, No. 659, §1; Redesignated from R.S. 22:250.20 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
NOTE: Former R.S. 22:1079 redesignated as R.S. 22:836 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1080. Third-party premium payments; refusal of acceptance

RS 22:1080 - Third-party premium payments; refusal of acceptance
A. No health insurance issuer or health maintenance organization shall refuse the receipt of a premium payment when such payment is made by a third party to the insurance contract, provided that the payment is made from or pursuant to a fund or grant established by any one of the following:
(1) The Ryan White HIV/AIDS Program pursuant to Title XXVI of the Public Health Service Act.
(2) Indian tribes, tribal organizations, or urban Indian organizations.
(3) State or federal government programs.
(4) The American Kidney Fund.
B. This Section shall not be construed to require a health insurance issuer or health maintenance organization to accept a third-party premium payment from a health care provider.
Redesignated as R.S. 22:837 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
Acts 2014, No. 491, §1
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1081. Redesignated as R.S. 22:796 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1081 - Redesignated as R.S. 22:796 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1092.1. Grandfathered health coverage; rating practices

RS 22:1092.1 - Grandfathered health coverage; rating practices
The rating practices and rating methods and the rating restrictions imposed by law upon grandfathered health coverage in the individual market and small group market that are in effect on the day that this Section takes effect, including the restrictions on rate increases and required notices for such increases, shall remain binding upon such grandfathered health coverage. Such grandfathered coverage is exempt from the provisions of this Subpart, unless specifically provided for otherwise.
Acts 2014, No. 718, §1, eff. June 18, 2014.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1093. Disclosure of rating practices and renewability provisions for insureds

RS 22:1093 - Disclosure of rating practices and renewability provisions for insureds
A. Each health insurance issuer shall make reasonable disclosure in solicitation and sales materials provided to insureds of the provisions relating to renewability of coverage.
B. Each health insurance issuer shall provide its insureds with a written notice and reasonable explanation and justification, including the contributing factors for the rate increase, for any rate increase no less than forty-five days prior to the effective date of such increase.
Acts 1991, No. 777, §2, eff. Sept. 30, 1992; Acts 2001, No. 272, §1, eff. Jan. 1, 2002; Redesignated from R.S. 22:228.4 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2014, No. 718, §1, eff. June 18, 2014.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1094. Maintenance of records for the department

RS 22:1094 - Maintenance of records for the department
A. Each health insurance issuer shall maintain at its principal place of business a complete and detailed description of its rating practices, including information and documentation which demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles and the rules and regulations of the department.
B. Each health insurance issuer shall file once per calendar year with the department an actuarial certification that the health insurance issuer is in compliance with this Subpart and that the rating methods of the health insurance issuer are actuarially sound. A copy of such certification shall be retained by the health insurance issuer at its principal place of business.
C. A health insurance issuer shall make the information and documentation described in Subsection A of this Section available to the department for inspection.
Acts 1991, No. 777, §2, eff. Sept. 30, 1992; Redesignated from R.S. 22:228.5 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2014, No. 718, §1, eff. June 18, 2014.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1095. Rating factors; risk pools; individual market plan and calendar year requirement

RS 22:1095 - Rating factors; risk pools; individual market plan and calendar year requirement
A. Health insurance issuers may vary premiums from the plan-adjusted index rate in the individual or small group market due only to one or more of the following factors:
(1) The number of persons such product or coverage covers, whether an individual or family.
(2) Geographic rating area, as established in accordance with this Section.
(3) Age, except that such variation shall be no more than three-to-one for adults.
(4) Tobacco use as defined in 45 C.F.R. 147.102 or any subsequent federal law, except that such rate shall not vary by more than one- and one-half-to-one.
B. Every health insurance issuer in this state shall maintain a single, separate, and distinct risk pool for the individual market and a single, separate, and distinct risk pool for the small group market. Health insurance issuers of student health plans shall maintain a single, separate, and distinct risk pool for student health plans.
C. To the extent that they are applied to coverage issued to members within a family under a small group plan, the ratings variations permitted under Paragraphs (A)(3) and (4) of this Section shall be attributed to each member to whom those factors apply and the factors may be applied only as permitted by federal law.
D. Consistent with the single risk pool requirement, as of January 1, 2015, all nongrandfathered coverage in the individual market shall be offered on a calendar year basis. For purposes of new enrollment effective on any date other than January first, the first policy year following such enrollment may comprise a prorated policy year, ending on December thirty-first. Any exceptions or modifications to the calendar year requirement by federal law or rule shall also apply to health insurance issuers under this Section.
E. The department shall determine the geographic rating area or areas in this state by rule, regulation, bulletin, or any other mechanism made available by law.
F. Any rate proposed to be used by a health insurance issuer shall be submitted and controlled by this Subpart. However, the commissioner shall have the authority to grant transitional relief from the provisions of this Subpart.
Acts 1993, No. 655, §1; Acts 1995, No. 593, §1; Acts 1995, No. 1173, §1; Acts 1997, No. 1165, §1; Acts 2001, No. 272, §1, eff. Jan. 1, 2002; Acts 2004, No. 426, §1; Redesignated from R.S. 22:228.6 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011; Acts 2014, No. 718, §1, eff. June 18, 2014.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1096. Regulations; preemption

RS 22:1096 - Regulations; preemption
A. The commissioner may promulgate such rules and regulations as may be necessary and proper to carry out the provisions of this Subpart and Section 2794 of the Public Health Service Act. Such rules and regulations shall be promulgated and adopted in accordance with the Administrative Procedure Act.
B. If at any time a provision of this Subpart is in conflict with federal law or with regulations promulgated pursuant to federal law, such provision shall be preempted only to the extent necessary to avoid direct conflict with federal law or regulations. The commissioner shall subsequently administer and enforce the provisions of this Subpart in a manner that conforms to federal law or regulations. If necessary to preserve the department's regulatory authority or if necessary to effectively enforce the provisions of this Subpart, the commissioner may promulgate rules or regulations to that effect and may issue directives or bulletins on a provisional basis before such rules or regulations take effect. Such provisional basis for the issuance of directives or bulletins under this Section shall not exceed a period of one year.
Acts 1990, No. 636, §1; Acts 1991, No. 848, §1; Acts 1993, No. 297, §1; Acts 1995, No. 418, §1; Redesignated from R.S. 22:229 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 595, §1; Acts 2014, No. 718, §1, eff. June 18, 2014.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1097. Discrimination in rates or failure to provide coverage because of severe disability or sickle cell trait prohibited

RS 22:1097 - Discrimination in rates or failure to provide coverage because of severe disability or sickle cell trait prohibited
A. No insurance company shall charge unfair discriminatory premiums, policy fees, or rates for, or refuse to provide any policy or contract of life insurance, life annuity, or policy containing disability coverage for a person solely because the applicant therefor has a severe disability, unless the rate differential is based on sound actuarial principles or is related to actual experience. No insurance company shall unfairly discriminate in the payments of dividends, other benefits payable under a policy, or in any of the terms and conditions of such policy or contract solely because the owner of the policy or contract has a severe disability.
B. As used in this Section, "severe disability" means any disease of, or injury to, the spinal cord resulting in permanent and total disability, amputation of any extremity that requires prosthesis, permanent visual acuity of twenty/two hundred or worse in the better eye with the best correction, a peripheral field so contracted that the widest diameter of such field subtends an angular distance no greater than twenty degrees, total deafness, inability to hear a normal conversation or use a telephone without the aid of an assistive device, or any developmental disability, including but not limited to autism, cerebral palsy, epilepsy, intellectual disabilities, and other neurological impairments.
C. No insurance company shall charge unfair discriminatory premiums, policy fees, or rates for, or refuse to provide any policy, subscriber agreement, or contract of life insurance, life annuity, or policy containing disability coverage for a person solely because the applicant therefor has sickle cell trait. No insurance company shall unfairly discriminate in the payments of dividends, other benefits payable under a policy, or in any of the terms and conditions of such policy or contract solely because the insured of the policy or contract has sickle cell trait. Nothing in this Subsection shall prohibit waiting periods, pre-existing conditions, or dreaded disease rider exclusions, or any combination thereof, as may be permitted by federal law.
Added by Acts 1981, No. 766, §1. Amended by Acts 1982, No. 643, §1; Redesignated from R.S. 22:652.1 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2014, No. 718, §1, eff. June 18, 2014; Acts 2014, No. 811, §11, eff. June 23, 2014.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1098. Frequency of rate increases; limitations

RS 22:1098 - Frequency of rate increases; limitations
A. The following rate increase limitations shall apply to all health benefit plans, limited benefits, and excepted benefits:
(1) Health insurance issuers of limited benefits and excepted benefits policies shall not increase rates during the initial twelve months of coverage, and may not do so more than once in any six-month period following the initial twelve-month period.
(2) Health insurance issuers shall not increase rates for policies or plans in the individual market during the plan year. Rate increases for policies or plans in the individual market may occur only upon renewal or upon commencement of the policy or plan year.
(3) Rates for policies or plans in the small group market shall not increase during the initial twelve months of coverage.
B. No health insurance issuer issuing policies or subscriber agreements shall increase its rates or reduce the covered benefits under the policy or subscriber agreement after the commencement of the minimum one-hundred-eighty-day period following the notice of the discontinuation of offering all health insurance coverage as described in R.S. 22:1068(C)(2)(a)(i) or 1074(C)(2)(a)(i).
C. This Section shall not affect increases in the premium amount due to any change required for compliance with the addition of a newly covered person or policy benefit level, or such changes necessary to comply with R.S. 22:1095 or other state or federal law, regulation, or rule.
Acts 2014, No. 718, §1, eff. June 18, 2014.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1099. Enforcement

RS 22:1099 - Enforcement
A. Whenever the commissioner has reason to believe that any health insurance issuer is not in compliance with any of the provisions of this Subpart, he shall notify such health insurance issuer. Upon such notice, the commissioner may, in addition to the penalties in Subsection C of this Section, issue and cause to be served upon such health insurance issuer an order requiring the health insurance issuer to cease and desist from any violation.
B. Any health insurance issuer who violates a cease and desist order issued by the commissioner pursuant to this Subpart while such order is in effect shall be subject to one or more of the following at the commissioner's discretion:
(1) A monetary penalty of not more than twenty-five thousand dollars for each act or violation and every day the health insurance issuer is not in compliance with the cease and desist order, not to exceed an aggregate of two hundred fifty thousand dollars for any six-month period.
(2) Suspension or revocation of the health insurance issuer's certificate of authority to operate in this state.
(3) Injunctive relief from the district court of the district in which the violation may have occurred or in the Nineteenth Judicial District Court.
C. As a penalty for violating this Subpart, the commissioner may refuse to renew, or may suspend or revoke the certificate of authority of any health insurance issuer, or in lieu of suspension or revocation of a certificate of authority, the commissioner may levy a monetary penalty of not more than one thousand dollars for each act or violation, not to exceed an aggregate of two hundred fifty thousand dollars.
D. An aggrieved party affected by the commissioner's decision, act, or order may demand a hearing in accordance with Chapter 12 of this Title, R.S. 22:2191 et seq., except as otherwise provided by this Subpart. If a health insurance issuer has demanded a timely hearing, the penalty, fine, or order by the commissioner shall not be imposed until such time as the division of administrative law makes a finding that the penalty, fine, or order is warranted in a hearing held in the manner provided in Chapter 12 of this Title.
Acts 2014, No. 718, §1, eff. June 18, 2014.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1112. Medicare supplement guaranteed issue; open enrollment periods; prohibited conditioning of coverage; notice to policyholders

RS 22:1112 - Medicare supplement guaranteed issue; open enrollment periods; prohibited conditioning of coverage; notice to policyholders
A.(1) If, at the time of an individual's birthday each year, that individual has an existing Medicare supplement policy, the individual shall have an annual open enrollment period commencing with the individual's birthday and lasting for a period of sixty-three calendar days, during which the individual may purchase any Medicare supplement policy offered by the same issuer or any affiliate authorized to transact business in this state.
(2) If, during the annual open enrollment period, the individual seeks to purchase a Medicare supplement policy that is a standardized policy identified by a plan letter indicating benefits that are equal to or less than the benefits indicated by the plan letter of the individual's previous Medicare supplement policy, the issuer of the chosen Medicare supplement policy shall not deny or condition the issuance or effectiveness of the coverage, nor discriminate in the pricing of the coverage, due to health status, claims experience, receipt of health care, or a medical condition of the individual.
B.(1)(a) If an individual is eligible for Medicare coverage and does not have an existing Medicare supplement policy but maintained health insurance coverage through the individual's employer at the time the individual became eligible for Medicare coverage, the individual shall have an open enrollment period commencing on any of the following:
(i) The termination date of the individual's employer-based plan.
(ii) The date the employer-based plan ceases to provide some or all health benefits to the individual.
(iii) The date the individual leaves the employer-based plan.
(b) An open enrollment period prescribed in this Subsection shall last for a period of sixty-three calendar days, during which the individual may purchase any Medicare supplement policy offered in this state.
(2) If, during the open enrollment period, the individual seeks to purchase a Medicare supplement policy that is a standardized policy identified by a plan letter for which federal law currently provides a guaranteed issue right at the time of the individual's initial eligibility for Medicare coverage, the issuer of the chosen Medicare supplement policy shall not deny or condition the issuance or effectiveness of the coverage, nor discriminate in the pricing of the coverage, due to health status, claims experience, receipt of health care, or a medical condition of the individual.
C. A Medicare supplement policy issuer shall provide notice of the annual open enrollment period for eligible Medicare supplement policyholders at the time the application is made for a Medicare supplement policy or certificate. The notice shall be in a form prescribed by the commissioner.
Acts 2022, No. 459, §1; Acts 2023, No. 71, §1.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1122. Effectiveness

RS 22:1122 - Effectiveness
If a court of competent jurisdiction rules that the Patient Protection and Affordable Care Act, P.L. 111-148, is unconstitutional and the judgment of that court becomes final and definitive, the attorney general shall give written notification of the final and definitive ruling to the commissioner, the legislature, and the Louisiana State Law Institute. The provisions of this Subpart shall become effective ninety days after receipt by the commissioner of the written notification. However, no provision of this Subpart shall abridge or affect the provisions of insurance policies or contracts already in effect until such policies or contracts are renewed.
Acts 2019, No. 412, §1, eff. June 11, 2019.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1123. Preexisting condition exclusions prohibited

RS 22:1123 - Preexisting condition exclusions prohibited
A health insurance policy or contract issued or issued for delivery in this state after the effective date of this Subpart shall not impose a preexisting condition exclusion. This Section shall not limit an insurer's ability to restrict enrollment in an individual contract to open enrollment and special enrollment periods in accordance with other provisions of this Title.
Acts 2019, No. 412, §1, eff. June 11, 2019.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1124. Annual and lifetime limits prohibited

RS 22:1124 - Annual and lifetime limits prohibited
A health insurance policy or contract issued or issued for delivery in this state after the effective date of this Subpart shall not do either of the following:
(1) Establish lifetime limits on the dollar value of benefits for any participant or beneficiary.
(2) Establish annual limits on the dollar value of essential benefits, as determined by the commissioner, to the extent not inconsistent with applicable federal law.
Acts 2019, No. 412, §1, eff. June 11, 2019.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1125. Coverage for dependent children

RS 22:1125 - Coverage for dependent children
A health insurance policy or contract issued or issued for delivery in this state after the effective date of this Subpart that offers coverage for a dependent child shall offer dependent coverage, at the option of the policyholder, until the dependent child attains the age of twenty-six. An insurer may require, as a condition of eligibility for coverage in accordance with this Section, that a person seeking coverage for a dependent child provide written documentation on an annual basis that the dependent child satisfies the requirements applicable to dependent children in this Title.
Acts 2019, No. 412, §1, eff. June 11, 2019.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1126. Rate setting

RS 22:1126 - 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.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1127. Open enrollment

RS 22:1127 - 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.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1129. Conflict of laws

RS 22:1129 - 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.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1130. Applicability

RS 22:1130 - 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.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1132. Definitions

RS 22:1132 - 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.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1133. Louisiana Guaranteed Benefits Pool; establishment

RS 22:1133 - 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.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1134. Operation of program

RS 22:1134 - 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.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1135. Actuarial analysis

RS 22:1135 - 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.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1136. Program parameters

RS 22:1136 - 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.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1137. Approval by legislature

RS 22:1137 - 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.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1138. Enrollment or participation limitation

RS 22:1138 - 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.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1138.1. Redesignated as R.S. 22:1549 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1138.1 - Redesignated as R.S. 22:1549 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1138.2. Redesignated as R.S. 22:1550 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1138.2 - Redesignated as R.S. 22:1550 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1142.1. Redesignated as R.S. 22:1556 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1142.1 - Redesignated as R.S. 22:1556 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1145. Redesignated as R.S. 22:1559 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1145 - Redesignated as R.S. 22:1559 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1146. Redesignated as R.S. 22:1560 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1146 - Redesignated as R.S. 22:1560 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1147. Redesignated as R.S. 22:1561 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1147 - Redesignated as R.S. 22:1561 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1148. Redesignated as R.S. 22:1562 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1148 - Redesignated as R.S. 22:1562 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1149. Redesignated as R.S. 22:1563 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1149 - Redesignated as R.S. 22:1563 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1150. Redesignated as R.S. 22:1564 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 22:1150 - Redesignated as R.S. 22:1564 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1151. Definitions

RS 22:1151 - 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.