reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 1 - Regulation Number 31-Holding Company › Section XIII-121 - Alternative and Consolidated Registrations

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any authorized insurer may file a
				registration statement on behalf of any affiliated insurer or insurers which
				are required to register under
				R.S.
				22:691.6. A registration statement may
				include information not required by the Act regarding any insurer in the
				insurance holding company system, even if such insurer is not authorized to do
				business in this state. In lieu of filing a registration statement on form B,
				the authorized insurer may file a copy of the registration statement or similar
				report which it is required to file in its state of domicile, provided:
1. the statement or report contains
				substantially similar information required to be furnished on form B;
				and
2. the filing insurer is the
				principal insurance company in the insurance holding company system.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 1 - Regulation Number 31-Holding Company › Section XIII-123 - Disclaimers and Termination of Registration

Current through Register Vol. 50, No. 6, June 20, 2024
A. A disclaimer of affiliation or a request
				for termination of registration claiming that a person does not, or will not
				upon the taking of some proposed action, control another person (hereinafter
				referred to as the "subject") shall contain the following information:
1. the number of authorized, issued, and
				outstanding voting securities of the subject;
2. with respect to the person whose control
				is denied and all affiliates of such person, the number and percentage of
				shares of the subject's voting securities which are held of record or known to
				be beneficially owned, and the number of such shares concerning which there is
				a right to acquire, directly or indirectly;
3. all material relationships and bases for
				affiliation between the subject and the person whose control is denied and all
				affiliates of such person;
4. a
				statement explaining why such person should not be considered to control the
				subject.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 1 - Regulation Number 31-Holding Company › Section XIII-125 - Extraordinary Dividends and Other Distributions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Requests for approval of extraordinary
				dividends or any other extraordinary distribution to shareholders shall include
				the following:
1. the amount of the proposed
				dividend;
2. the date established
				for payment of the dividend;
3. a
				statement as to whether the dividend is to be in cash or other property, and if
				in property, a description thereof, its cost, and its fair market value
				together with an explanation of the basis for evaluation;
4. a copy of the calculations determining
				that the proposed dividend is extraordinary. The work paper shall include the
				following information:
a. the amounts, dates,
				and form of payment of all dividends or distributions (including regular
				dividends but excluding distributions of the insurers own securities) paid
				within the period of 12 consecutive months ending on the date fixed for payment
				of the proposed dividend for which approval is sought and commencing on the day
				after the same day of the same month in the last preceding year;
b. surplus as regards policyholders (total
				capital and surplus) as of the thirty-first day of December next
				preceding;
c. if the insurer is a
				life insurer, the net gain from operations for the 12-month period ending the
				thirty-first day of December next preceding;
d. if the insurer is not a life insurer, the
				net income less realized capitalized gains for the 12-month period ending the
				thirty-first day of December next preceding and the two preceding 12-month
				periods; and
e. if the insurer is
				not a life insurer, the dividends paid to stockholders, excluding distributions
				of the insurers own securities in the preceding two calendar years;
5. a balance sheet and statement
				of income for the period intervening from the last annual statement filed with
				the commissioner and the end of the month preceding the month in which the
				request for dividend approval is submitted; and
6. a brief statement as to the effect of the
				proposed dividend upon the insurers surplus and the reasonableness of surplus
				in relation to the insurer's outstanding liabilities and the adequacy of
				surplus relative to the insurer's financial needs.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 1 - Regulation Number 31-Holding Company › Section XIII-126 - Enterprise Risk Report

Current through Register Vol. 50, No. 6, June 20, 2024
A. The ultimate
				controlling person of an insurer required to file an enterprise risk report
				pursuant to
				R.S.
				22:691.6(L) shall furnish the
				required information on form F, hereby made a part of this
				regulation.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:691.1-691.27.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 1 - Regulation Number 31-Holding Company › Section XIII-127 - Adequacy of Surplus

Current through Register Vol. 50, No. 6, June 20, 2024
A. The factors
				set forth in
				R.S.
				22:691.7(D) are not intended
				to be an exhaustive list. In determining the adequacy and the reasonableness of
				an insurers surplus, no single factor is necessarily controlling. The
				commissioner will instead consider the net effect of all of these factors plus
				other factors bearing on the financial condition of the insurer. In comparing
				the surplus maintained by other insurers, the commissioner will consider the
				extent to which each of these factors varies from company to company, and in
				determining the quality and liquidity of investments in subsidiaries, the
				commissioner will consider the individual subsidiary and may discount or
				disallow its valuation to the extent that the individual investments so
				warrant.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:691.1-691.27.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 1 - Regulation Number 31-Holding Company › Section XIII-128 - Group Capital Calculation

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				lead state commissioner has the discretion to exempt the ultimate controlling
				person from filing the annual group capital calculation if the lead state
				commissioner makes a determination based upon that filing that the insurance
				holding company system meets all of the following criteria:
1. has annual direct written and unaffiliated
				assumed premium (including international direct and assumed premium), but
				excluding premiums reinsured with the Federal Crop Insurance Corporation and
				Federal Flood Program, of less than $1,000,000,000;
2. has no insurers within its holding company
				structure that are domiciled outside of the United States or one of its
				territories;
3. has no banking,
				depository or other financial entity that is subject to an identified
				regulatory capital framework within its holding company structure;
4. the holding company system attests that
				there are no material changes in the transactions between insurers and
				non-insurers in the group that have occurred since the last filing of the
				annual group capital; and
5. the
				non-insurers within the holding company system do not pose a material financial
				risk to the insurer's ability to honor policyholder obligations.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 1 - Regulation Number 31-Holding Company › Section XIII-131 - Instructions for Forms A, B, C, D, E and F

Current through Register Vol. 50, No. 6, June 20, 2024
A. General Requirements
1. Forms A, B, C, D, E and F are intended to
				be guides in the preparation of the statements required by
				R.S.
				22:691.4, 691.5, 691.6, and 691.7. They are
				not intended to be blank forms which are to be filled in. These statements
				filed shall contain the numbers and captions of all items, but the text of the
				items may be omitted provided the answers thereto are prepared in such a manner
				as to indicate clearly the scope and coverage of the items. All instructions,
				whether appearing under the items of the form or elsewhere therein, are to be
				omitted. Unless expressly provided otherwise, if any item is inapplicable or
				the answer thereto is in the negative, an appropriate statement to that effect
				shall be made.
2. A complete copy
				of each statement, including exhibits and all other papers and documents filed
				as a part thereof, shall be filed with commissioner by U.S. Mail, or as
				provided by LAC 37:XI.Chapter 9, addressed to: Insurance Commissioner of the
				State of Louisiana, P.O. Box 94214, Baton Rouge, LA 70804-9214, Attention:
				(Chief Examiner). The statement shall be manually signed in the manner
				prescribed on the form. Unsigned copies shall be conformed. If the signature of
				any person is affixed pursuant to a power of attorney or other similar
				authority, a copy of such power of attorney or other authority shall also be
				filed with the statement.
3.
				Statements should be prepared on paper 8 1/2" x 11" in size and preferably
				bound at the top or the top left corner. Exhibits and financial statements,
				unless specifically prepared for the filing, may be submitted in their original
				size. All copies of any statement, financial statements, or exhibits shall be
				clear, easily readable, and suitable for photocopying. Debits in credit
				categories and credits in debit categories shall be designated so as to be
				clearly distinguishable as such on photocopies. Statements shall be in the
				English language and monetary values shall be stated in United States currency.
				If any exhibit or other paper or document filed with the statement is in a
				foreign language, it shall be accompanied by a translation into the English
				language and any monetary value shown in a foreign currency normally shall be
				converted into United States currency.
4. If an applicant requests a hearing on a
				consolidated basis under
				R.S.
				22:691.4(E)(3), in addition
				to filing the form A with the commissioner, the applicant shall file a copy of
				form A with the National Association of Insurance Commissioners in electronic
				form.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 1 - Regulation Number 31-Holding Company › Section XIII-133 - Form A-Acquisition of Control or Merger with a Domestic Insurer

Current through Register Vol. 50, No. 6, June 20, 2024
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AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:691.6 and
				  22:691.11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 1 - Regulation Number 31-Holding Company › Section XIII-135 - Form B-Annual Registration Statement

Current through Register Vol. 50, No. 6, June 20, 2024
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AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:691.6 and
				  22:691.11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 1 - Regulation Number 31-Holding Company › Section XIII-141 - Form E-Pre-Acquisition Notification Form Regarding the Potential Competitive Impact of a Proposed Merger or Acquisition by a Non-Domiciliary Insurer Doing Business in this State or by a Domestic Insurer

Current through Register Vol. 50, No. 6, June 20, 2024
________________________________
(Name of Applicant)
________________________________
(Name of Other Person Involved in Merger or Acquisition
				)
Filed with the Insurance Department of ______________
Dated: __________________________, 20 ________.
Name, Title, Address and Telephone Number of person
				  Completing This Statement:
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
ITEM 1. NAME AND ADDRESS
State the names and addresses of the persons who hereby
				  provide notice of their involvement in a pending acquisition or change in
				  corporate control.
ITEM 2. NAME AND ADDRESSES OF AFFILIATED COMPANIES
State the names and addresses of the persons affiliated with
				  those listed in Item 1. Describe their affiliations.
ITEM 3. NATURE AND PURPOSE OF THE PROPOSED MERGER OR
				  ACQUISITION
State the nature and purpose of the proposed merger or
				  acquisition.
ITEM 4. NATURE OF BUSINESS
State the nature of the business performed by each of the
				  persons identified in response to Item 1 and Item 2.
ITEM 5. MARKET AND MARKET SHARE
State specifically what market and market share in each
				  relevant insurance market the persons identified in Item 1 and Item 2 currently
				  enjoy in this state. Provide historical market and market share data for each
				  person identified in Item 1 and Item 2 for the past five years and identify the
				  source of such data. Provide a determination as to whether the proposed
				  acquisition or merger, if consummated, would violate the competitive standards
				  of the state as stated in
				  R.S.
				  22:691.5(D). If the proposed
				  acquisition or merger would violate competitive standards, provide
				  justification of why the acquisition or merger would not substantially lessen
				  competition or create a monopoly in the state.
For purposes of this question, market means direct written
				  insurance premium in this state for a line of business as contained in the
				  annual statement required to be filed by insurers licensed to do business in
				  this state.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:691.5 and
				  22:691.11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 2 - Regulation 104-Corporate Governance Annual Disclosure › Section XIII-201 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is to set forth rules and procedural requirements which the
				commissioner deems necessary to carry out the provisions of
				R.S.
				22:691.51-691.58 of the Insurance Code. The
				information called for by this regulation is hereby declared to be necessary
				and appropriate in the public interest and for the protection of the
				policyholders in this state.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11 and
				  22:691.51-691.58.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 2 - Regulation 104-Corporate Governance Annual Disclosure › Section XIII-203 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
Commissioner
-commissioner of insurance for
				  the state of Louisiana.
Corporate Governance Annual Disclosure
or
CGAD
-a confidential report filed by the insurer or insurance
				  group compiled in accordance with the requirements of
				  R.S.
				  22:691.51-691.58 and Regulation 104.
Insurance Group
-those insurers and
				  affiliates included within an insurance holding company system as defined in
				  R.S.
				  22:691.2(8).
Insurer
-shall have the same meaning as set
				  forth in R.S. 22:46(14).
				  For the purposes of this Subpart, a health maintenance organization as defined
				  R.S.
				  22:242(6) shall also be
				  considered an insurer. The term "insurer" shall not include agencies,
				  authorities, or instrumentalities of the United States, its possessions and
				  territories, the Commonwealth of Puerto Rico, the District of Columbia, or a
				  state or political subdivision of a state.
Senior Management
-any corporate officer
				  responsible for reporting information to the board of directors at regular
				  intervals or providing this information to shareholders or regulators and shall
				  include, for example and without limitation, the chief executive officer (CEO),
				  chief financial officer (CFO), chief operations officer (COO), chief
				  procurement officer (CPO), Chief Legal Officer (CFO), chief information officer
				  (CIO), chief technology officer (CTO), chief revenue officer (CRO), chief
				  visionary officer (CVO), or any other "C" level executive.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11 and
				  22:691.51-691.58.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 2 - Regulation 104-Corporate Governance Annual Disclosure › Section XIII-207 - Contents of Corporate Governance Annual Disclosure

Current through Register Vol. 50, No. 6, June 20, 2024
A. The insurer or insurance group shall be as
				descriptive as possible in completing the CGAD, with inclusion of attachments
				or example documents that are used in the governance process, since these may
				provide a means to demonstrate the strengths of their governance framework and
				practices.
B. The CGAD shall
				describe the insurers or insurance groups corporate governance framework and
				structure including consideration of the following.
1. The board and various committees thereof
				ultimately responsible for overseeing the insurer or insurance group and the
				level(s) at which that oversight occurs (e.g., ultimate control level,
				intermediate holding company, legal entity, etc.). The insurer or insurance
				group shall describe and discuss the rationale for the current board size and
				structure; and
2. The duties of the
				board and each of its significant committees and how they are governed (e.g.,
				bylaws, charters, informal mandates, etc.), as well as how the boards
				leadership is structured, including a discussion of the roles of chief
				executive officer (CEO) and chairman of the board within the
				organization.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 2 - Regulation 104-Corporate Governance Annual Disclosure › Section XIII-209 - Severability Clause

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any
				Section or provision of Regulation 104 or the application to any person or
				circumstance is held invalid, such invalidity or determination shall not affect
				other Sections or provisions or the application of Regulation 104 to any
				persons or circumstances that can be given effect without the invalid section
				or provision or application, and for these purposes the Sections and provisions
				of Regulation 104 and the application to any persons or circumstances are
				severable.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11 and
				  22:691.31-691.38.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 3 - Regulation 32-Coordination of Benefits › Section XIII-301 - Purpose and Applicability

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				purpose of this regulation is to:
1. establish
				a uniform order of benefit determination under which plans pay
				claims;
2. reduce duplication of
				benefits by permitting a reduction of the benefits to be paid by plans that,
				pursuant to rules established by this regulation, do not have to pay their
				benefits first; and
3. provide
				greater efficiency in the processing of claims when a person is covered under
				more than one plan.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 3 - Regulation 32-Coordination of Benefits › Section XIII-305 - Use of Model COB Contract Provision

Current through Register Vol. 50, No. 6, June 20, 2024
A. Appendix A and Appendix B contain model
				COB provisions that shall be used in group and individual contracts or
				subscriber agreements. That use is subject to the provisions of Subsections B,
				C, and D of this Section and to the provisions of §307
B. Appendix B is a plain language description
				of the COB process that explains to the covered person how insurers will
				implement coordination of benefits. It is not intended to replace or change the
				provisions that are set forth in the contract. Its purpose is to explain the
				process by which the two (or more) plans will pay for or provide benefits, how
				the benefit reserve is accrued and how the covered person may use the benefit
				reserve.
C. The COB provision
				contained in Appendix A and the plain language explanation in Appendix B do not
				have to use the specific words and format shown in §321, Appendix A, or §323,
				Appendix B. Changes may be made to fit the language and style of the rest of
				the group contract or to reflect differences among plans that provide services,
				that pay benefits for expenses incurred and that indemnify. No substantive
				changes are permitted.
D. A COB
				provision may not be used that permits a plan to reduce its benefits on the
				basis that:
1. another plan exists and the
				covered person did not enroll in that plan;
2. a person is or could have been covered
				under another plan, except with respect to part B of Medicare; or
3. a person has elected an option under
				another plan providing a lower level of benefits than another option that could
				have been elected.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 3 - Regulation 32-Coordination of Benefits › Section XIII-307 - Rules for Coordination of Benefits

Current through Register Vol. 50, No. 6, June 20, 2024
A. When a person is covered by two or more
				plans, the rules for determining the order of benefit payments are as follows.
1. The primary plan shall pay or provide its
				benefits as if the secondary plan or plans did not exist.
2. If the primary plan is a closed panel plan
				and the secondary plan is not a closed panel plan, the secondary plan shall pay
				or provide benefits as if it were the primary plan when a covered person uses a
				non-panel provider, except for emergency services or authorized referrals that
				are paid or provided by the primary plan.
3. When multiple contracts providing
				coordinated coverage are treated as a single plan under this regulation, this
				section applies only to the plan as a whole, and coordination among the
				component contracts is governed by the terms of the contracts. if more than one
				carrier pays or provides benefits under the plan, the carrier designated as
				primary within the plan shall be responsible for the plans compliance with this
				regulation.
4. If a person is
				covered by more than one secondary plan, the order of benefit determination
				rules of this regulation decide the order in which secondary plans benefits are
				determined in relation to each other. Each secondary plan shall take into
				consideration the benefits of the primary plan or plans and the benefits of any
				other plan, which, under the rules of this regulation, has its benefits
				determined before those of that secondary plan.
5. Except as provided in Paragraph 2 of this
				Subsection, a plan that does not contain order of benefit determination
				provisions that are consistent with this regulation is always the primary plan
				unless the provisions of both plans, regardless of the provisions of this
				Paragraph, state that the complying plan is primary.
6. Coverage that is obtained by virtue of
				membership in a group and designed to supplement a part of a basic package of
				benefits may provide that the supplementary coverage shall be excess to any
				other parts of the plan provided by the contract holder. Examples of these
				types of situations are major medical coverages that are superimposed over base
				plan hospital and surgical benefits, and insurance type coverages that are
				written in connection with a closed panel plan to provide out-of-network
				benefits.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 3 - Regulation 32-Coordination of Benefits › Section XIII-309 - Procedure to be Followed by Secondary Plan

Current through Register Vol. 50, No. 6, June 20, 2024
A. When a plan is secondary, it shall reduce
				its benefits so that the total benefits paid or provided by all plans during a
				claim determination period or plan year are not more than 100 percent of total
				allowable expenses as provided for in §303 A,
Allowable
				Expense,
a-e. The secondary plan shall calculate its savings by
				subtracting the allowable expense amount as provided for in §303 A,
Allowable Expense,
a-e that it paid as a secondary plan from
				the allowable expense amount provided for §303 A,
Allowable
				Expense,
a-e that it would have paid had it been primary. These
				savings shall be recorded as a benefit reserve for the covered person and shall
				be used by the secondary plan to pay any allowable expenses, not otherwise
				paid, that are incurred by the covered person during the claim determination
				period. (See Appendix C, Explanation for Secondary Plans on the Purpose and Use
				of the Benefit Reserve.) As each claim is submitted, the secondary plan must:
1. determine its obligation, pursuant to its
				contract;
2. determine whether a
				benefit reserve has been recorded for the covered person; and
3. determine whether there are any unpaid
				allowable expenses during that claims determination period.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 3 - Regulation 32-Coordination of Benefits › Section XIII-311 - Notice to Covered Persons

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Plan shall in its explanation of benefits provided to covered persons, include
				the following language. "If you are covered by more than one health benefit
				plan, you should file all your claims with each plan." Additionally, notice to
				obtain a copy of Appendix C, as provided for in LAC 37:XIII.305.G, shall be
				added as part of the coordination of benefit section or provision found in an
				insurance contract or subscriber agreement. Appendix C will also be available
				on the Louisiana Department of Insurances website.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 3 - Regulation 32-Coordination of Benefits › Section XIII-313 - Miscellaneous Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. A
				secondary plan that provides benefits in the form of services may recover the
				reasonable cash value of the services from the primary plan, to the extent that
				benefits for the services are covered by the primary plan and have not already
				been paid or provided by the primary plan. Nothing in this provision shall be
				interpreted to require a plan to reimburse a covered person in cash for the
				value of services provided by a plan that provides benefits in the form of
				services.
B.
1. A plan with order of benefit determination
				rules that comply with this regulation (complying plan) may coordinate its
				benefits with a plan that is "excess" or "always secondary" or that uses order
				of benefit determination rules that are inconsistent with those contained in
				this regulation (noncomplying plan) on the following basis:
a. if the complying plan is the primary plan,
				it shall pay or provide its benefits first;
b. if the complying plan is the secondary
				plan, it shall, nevertheless, pay or provide its benefits first, but the amount
				of the. benefits payable shall be determined as if the complying plan were the
				secondary plan. In such a situation, the payment shall be the limit of the
				complying plan's liability; and
c.
				if the noncomplying plan does not provide the information needed by the
				complying plan to determine its benefits within a reasonable time after it is
				requested to do so, the complying plan shall assume that the benefits of the
				noncomplying plan are identical to its own, and shall pay its benefits
				accordingly. If, within two years of payment, the complying plan receives
				information as to the actual benefits of the noncomplying plan, it shall adjust
				payments accordingly.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 3 - Regulation 32-Coordination of Benefits › Section XIII-315 - Miscellaneous Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. A
				secondary plan that provides benefits in the form of services may recover the
				reasonable cash value of the services from the primary plan, to the extent that
				benefits for the services are covered by the primary plan and have not already
				been paid or provided by the primary plan. Nothing in this provision shall be
				interpreted to require a plan to reimburse a covered person in cash for the
				value of services provided by a plan that provides benefits in the form of
				services.
1. A plan with order of benefit
				determination rules that comply with this regulation (complying plan) may
				coordinate its benefits with a plan that is "excess" or "always secondary" or
				that uses order of benefit determination rules that are inconsistent with those
				contained in this regulation (non-complying plan) on the following basis:
a. if the complying plan is the primary plan,
				it shall pay or provide its benefits first;
b. if the complying plan is the secondary
				plan, it shall pay or provide its benefits first, but the amount of the
				benefits payable shall be determined as if the complying plan were the
				secondary plan. In such a situation, the payment shall be the limit of the
				complying plans liability; and
c.
				if the non-complying plan does not provide the information needed by the
				complying plan to determine its benefits within a reasonable time after it is
				requested to do so, the complying plan shall assume that the benefits of the
				non-complying plan are identical to its own, and shall pay its benefits
				accordingly. If, within two years of payment, the complying plan receives
				information as to the actual benefits of the non-complying plan, it shall
				adjust payments accordingly.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 3 - Regulation 32-Coordination of Benefits › Section XIII-317 - Severability Provision

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any
				Section or provision of Regulation 32 or the application to any person or
				circumstance is held invalid, such invalidity or determination shall not affect
				other Sections or provisions or the application of Regulation 32 to any persons
				or circumstances that can be given effect without the invalid section or
				provisions or application, and for these purposes the Sections and provisions
				of Regulation 32 and the applications to any persons or circumstances are
				severable.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 3 - Regulation 32-Coordination of Benefits › Section XIII-319 - Effective Date for Existing Contracts (Formerly section 315)

Current through Register Vol. 50, No. 6, June 20, 2024
A. A contract that
				provides health care benefits and that was issued before the effective date of
				this regulation shall be brought into compliance with this regulation, by
				January 2019.
B. This amended
				regulation is applicable to every group and individual contract or subscriber
				agreement that provides health care benefits and that is issued on or after the
				effective date of this regulation. The effective date of this regulation shall
				be upon final publication and all contracts that provide healthcare benefits
				issued after the effective date shall be brought into compliance by January
				2019.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S. 22:3.2014.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 3 - Regulation 32-Coordination of Benefits › Section XIII-321 - Appendix A-Model COB Contract Provisions (Formerly section 317)

Current through Register Vol. 50, No. 6, June 20, 2024
A. Model COB
				Contract Provisions
COORDINATION OF THIS CONTRACTS BENEFITS WITH OTHER
				  BENEFITS
The Coordination of Benefits (COB) provision applies when a
				  person has health care coverage under more than one Plan. Plan is defined
				  below.
The order of benefit determination rules govern the order in
				  which each Plan will pay a claim for benefits. The Plan that pays first is
				  called the Primary plan. The Primary plan must pay benefits in accordance with
				  its policy terms without regard to the possibility that another Plan may cover
				  some expenses. The Plan that pays after the Primary plan is the Secondary plan.
				  The Secondary plan may reduce the benefits it pays so that payments from all
				  Plans do not exceed 100% of the total Allowable expense as provided for in
				  §303A.(a.-e.) of Regulation 32.
DEFINITIONS
A. A Plan is any of the following that
				provides benefits or services for medical or dental care or treatment. If
				separate contracts are used to provide coordinated coverage for members of a
				group, the separate contracts are considered parts of the same plan and there
				is no COB among those separate contracts.
(1)
				Plan includes: group and nongroup insurance contracts, health maintenance
				organization (HMO) contracts, closed panel plans or other forms of group or
				group-type coverage (whether insured or uninsured); medical care components of
				long-term care contracts, such as skilled nursing care; medical benefits under
				group or individual automobile contracts; and Medicare or any other federal
				governmental plan, as permitted by law.
(2) Plan does not include: hospital indemnity
				coverage or other fixed indemnity coverage; accident only coverage; specified
				disease or specified accident coverage; limited benefit health coverage, as
				defined by state law; school accident type coverage except those enumerated in
				LSA-R.S.
				22:1000 A.3C; benefits for non-medical
				components of long-term care policies; Medicare supplement policies; Medicaid
				policies; or coverage under other federal governmental plans, unless permitted
				by law.
Each contract for coverage under (1) or (2) is a separate
				  Plan. If a Plan has two parts and COB rules apply only to one of the two, each
				  of the parts is treated as a separate Plan.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-501 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is:
1. to provide for the
				reasonable standardization of coverage and simplification of terms and benefits
				of Medicare supplement policies;
2.
				to facilitate public understanding and comparison of such policies;
3. to eliminate provisions contained in such
				policies which may be misleading or confusing in connection with the purchase
				of such policies or with the settlement of claims; and
4. to provide for full disclosures in the
				sale of accident and sickness insurance coverages to persons eligible for
				Medicare.
5. to incorporated Medigap
				policies that cover Part B deductibles to "newly eligible" Medicare
				beneficiaries defined as those individuals who:
a. have attained age 65 on or after January
				1, 2020; or
b. first become
				eligible for Medicare due to age, disability or end-stage renal disease, on or
				after January 1, 2020.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-502 - Applicability and Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. Except
				as otherwise specifically provided in
				§510 and 585, this regulation shall
				apply to:
1. all Medicare supplement policies
				delivered or issued for delivery in this state on or after the effective date
				of this regulation; and
2. all
				certificates issued under group Medicare supplement policies which certificates
				have been delivered or issued for delivery in this state.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-505 - Policy Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Except
				for permitted preexisting condition clauses as described in §510. A.1 a, §515.
				A.1 a, and §516. A.1.a of this regulation, no policy or certificate may be
				advertised, solicited or issued for delivery in this state as a Medicare
				supplement policy if the policy or certificate contains limitations or
				exclusions on coverage that are more restrictive than those of
				Medicare.
B. No Medicare supplement
				policy or certificate may use waivers to exclude, limit or reduce coverage or
				benefits for specifically named or described preexisting diseases or physical
				conditions.
C. No Medicare
				supplement policy or certificate in force in the state shall contain benefits,
				which duplicate benefits provided by Medicare.
D.
1.
				Subject to §510. A 1(d), (e), and (g), and 515.A.1(d) and (e) of this
				regulation, a Medicare supplement policy with benefits for outpatient
				prescription drugs in existence prior to January 1, 2006 shall be renewed for
				current policyholders who do not enroll in Part D at the option of the
				policyholder.
2. A Medicare
				supplement policy with benefits for outpatient prescription drugs shall not be
				issued after December 31, 2005.
3.
				After December 31, 2005, a Medicare supplement policy with benefits for
				outpatient prescription drugs may not be renewed after the policyholder enrolls
				in Medicare Part D unless:
a. the policy is
				modified to eliminate outpatient prescription coverage for expenses of
				outpatient prescription drugs incurred after the effective date of the
				individual's coverage under a Part D plan; and
b. premiums are adjusted to reflect the
				elimination of outpatient prescription drug coverage at the time of Medicare
				Part D enrollment, accounting for any claims paid, if applicable.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-506 - Premium Increase Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. Every insurer issuing or renewing a
				Medicare supplement policy shall notify the policyholder and each member of an
				association in writing at least 45 days before any premium increase.
B. Medicare supplement policies and
				certificates shall have a notice prominently printed on the first page of the
				policy or certificate stating in substance that the policyholder or
				certificateholder will be notified at least 45 days before any premium
				increase.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:1111 (re-designated from LSA-R.S. 22:224 pursuant
				  to Acts 2008, No. 415, effective January 1, 2009) and
				  42 U.S.C.
				  1395 et seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-521 - Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or After June 1, 2010

Current through Register Vol. 50, No. 6, June 20, 2024
A. The following standards are applicable to
				all Medicare supplement policies or certificates delivered or issued for
				delivery in this state with an effective date for coverage on or after June 1,
				2010. No policy or certificate may be advertised, solicited, delivered or
				issued for delivery in this state as a Medicare supplement policy or
				certificate unless it complies with these benefit plan standards. Benefit plan
				standards applicable to Medicare supplement policies and certificates issued
				with an effective date for coverage before June 1, 2010 remain subject to the
				requirements of §510, §515, §520, and §525
1.
a. An
				issuer shall make available to each prospective policyholder and
				certificateholder a policy form or certificate form containing only the basic
				(core) benefits, as defined in §516. A.2 of this regulation.
b. If an issuer makes available any of the
				additional benefits described in §516. A 3, or offers standardized benefit
				Plans K or L (as described §521. A.5.h and i of this regulation), then the
				issuer shall make available to each prospective policyholder and
				certificateholder, in addition to a policy form or certificate form with only
				the basic (core) benefits as described in Subsection A.1.a. above, a policy
				form or certificate form containing either standardized benefit Plan C (as
				described in §521. A.5.c of this regulation) or standardized benefit Plan F
				(as described in §521. A.5.e of this regulation).
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-522 - Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or After January 1, 2020.

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Medicare
				Access and CHIP Reauthorization Act of 2015 (MACRA) requires the following
				standards are applicable to all Medicare supplement policies or certificates
				delivered or issued for delivery in this state to individuals newly eligible
				for Medicare on or after January 1, 2020. No policy or certificate that
				provides coverage of the Medicare Part B deductible may be advertised,
				solicited, delivered or issued for delivery in this state as a Medicare
				supplement policy or certificate to individuals newly eligible for Medicare on
				or after January 1, 2020. All policies must comply with the following benefit
				standards. Benefit plan standards applicable to Medicare supplement policies
				and certificates issued to individuals eligible for Medicare before January 1,
				2020, remain subject to the requirements of Regulation 33.
1. Benefit Requirements. The standards and
				requirements of
				§521 shall apply to all Medicare
				supplement policies or certificates delivered or issued for delivery to
				individuals newly eligible for Medicare on or after January 1, 2020, with the
				following exceptions:
a. standardized
				Medicare supplement benefit Plan C is redesignated as Plan D and shall provide
				the benefits contained in
				§521.A.5.c of this
				regulation but shall not provide coverage for 100 percent or any portion of the
				Medicare Part B deductible.
b.
				standardized Medicare supplement benefit Plan F is redesignated as Plan G and
				shall provide the benefits contained in
				§521.A.5.e of this
				regulation but shall not provide coverage for 100 percent or any portion of the
				Medicare Part B deductible.
c.
				standardized Medicare supplement benefit plans C, F, and F with high deductible
				may not be offered to individuals newly eligible for Medicare on or after
				January 1, 2020.
d. standardized
				Medicare supplement benefit Plan F with high deductible is redesignated as Plan
				G with high deductible and shall provide the benefits contained in
				§521.A.5.f of this
				regulation but shall not provide coverage for 100 percent or any portion of the
				Medicare Part B deductible; provided further that, the Medicare Part B
				deductible paid by the beneficiary shall be considered an out-of-pocket expense
				in meeting the annual high deductible.
e. the reference to Plans C or F contained in
				§521.A.1.b is deemed a
				reference to Plans D or G for purposes of this section.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-525 - Medicare Select Policies and Certificates

Current through Register Vol. 50, No. 6, June 20, 2024
A.
1. This
				Section shall apply to Medicare select policies and certificates, as defined in
				this Section.
2. No policy or
				certificate may be advertised as a Medicare select policy or certificate unless
				it meets the requirements of this Section.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-530 - Open Enrollment

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				issuer shall not deny or condition the issuance or effectiveness of any
				Medicare supplement policy or certificate available for sale in this state, nor
				discriminate in the pricing of a policy or certificate because of the health
				status, claims experience, receipt of health care, or medical condition of an
				applicant in the case of an application for a policy or certificate that is
				submitted prior to or during the six month period beginning with the first day
				of the first month in which an individual is enrolled for benefits under
				Medicare Part B. Each Medicare supplement policy and certificate currently
				available from an insurer shall be made available to all applicants who qualify
				under this Subsection without regard to age.
B.
1. If an
				applicant qualifies under Subsection A and submits an application during the
				time period referenced in Subsection A and, as of the date of application, has
				had a continuous period of creditable coverage of at least six months, the
				issuer shall not exclude benefits based on a preexisting condition.
2. If the applicant qualifies under
				Subsection A and submits an application during the time period referenced in
				Subsection A and, as of the date of application, has had a continuous period of
				creditable coverage that is less than six months, the issuer shall reduce the
				period of any preexisting condition exclusion by the aggregate of the period of
				creditable coverage applicable to the applicant as of the enrollment date. The
				secretary shall specify the manner of the reduction under this
				Subsection.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-535 - Guaranteed Issue for Eligible Persons

Current through Register Vol. 50, No. 6, June 20, 2024
A. Guaranteed Issue
1. Eligible persons are those individuals
				described in Subsection B who seek to enroll under the policy during the period
				specified in Subsection C, and who submit evidence of the date of termination
				disenrollment, or Medicare Part D enrollment with the application for a
				Medicare supplement policy.
2. With
				respect to eligible persons, an issuer shall not deny or condition the issuance
				or effectiveness of a Medicare supplement policy described in Subsection E that
				is offered and is available for issuance to new enrollees by the issuer, shall
				not discriminate in the pricing of such a Medicare supplement policy because of
				health status, claims experience, receipt of health care, or medical condition,
				and shall not impose an exclusion of benefits based on a preexisting condition
				under such a Medicare supplement policy.