reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 107 - Regulation 84-Recognition and Selection of Applicable CSO Mortality Table in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits › Section XIII-10705 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
2001 CSO Mortality Table
- that mortality
				  table, consisting of separate rates of mortality for male and female lives,
				  developed by the American Academy of Actuaries CSO Task Force from the
				  Valuation Basic Mortality Table developed by the Society of Actuaries
				  Individual Life Insurance Valuation Mortality Task Force, and adopted by the
				  NAIC in December 2002. The 2001 CSO Mortality Table is included in the
Proceedings of the NAIC (2nd Quarter 2002)
. Unless the context
				  indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate
				  form of that table and the select and ultimate form of that table and includes
				  both the smoker and nonsmoker mortality tables and the composite mortality
				  tables. It also includes both the age-nearest-birthday and age-last-birthday
				  bases of the mortality tables.
2001 CSO Mortality Table (F)
- that mortality
				  table consisting of the rates of mortality for female lives from the 2001 CSO
				  Mortality Table.
2001 CSO Mortality Table (M)
- that mortality
				  table consisting of the rates of mortality for male lives from the 2001 CSO
				  Mortality Table.
Composite Mortality Tables
- mortality tables
				  with rates of mortality that do not distinguish between smokers and
				  nonsmokers.
Smoker and Nonsmoker Mortality Tables
-
				  mortality tables with separate rates of mortality for smokers and
				  nonsmokers.
Valuation Manual-
manual of valuation
				  instructions as adopted by NAIC that sets forth the minimum reserve and related
				  requirements for jurisdictions where the Standard Valuation Law or legislation
				  including substantially similar terms and provisions has been enacted. The
				  purpose of the VM-20 is to assign the appropriate CSO mortality table and
				  interest rate for use in determining the minimum nonforfeiture standard for
				  life insurance policies issued on or after the operative date of the applicable
Valuation Manual
as authorized and superseded by applicable
				  state requirements.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.22:11,
				  22:753,
				  22:936
				  and the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 107 - Regulation 84-Recognition and Selection of Applicable CSO Mortality Table in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits › Section XIII-10707 - CSO Mortality Tables

Current through Register Vol. 50, No. 6, June 20, 2024
A. At
				the election of the company for any one or more specified plans of insurance
				and subject to the conditions stated in this regulation, the 2001 CSO Mortality
				Table may be used as the minimum standard for policies issued on or after
				January 1, 2005 and before the date specified in Subsection B to which
				R.S.
				22:753,
				R.S.
				22:936 and
				Sections
				10909. A
				and B of Regulation 85 are applicable. If the company elects to use the 2001
				CSO Mortality Table, it shall do so for both valuation and nonforfeiture
				purposes. Notwithstanding the preceding, the commissioner may specify
				restrictions on the use of this table for certain categories of life insurance
				for which the use of this table's mortality assumption is not representative of
				the business' underlying mortality experience.
B. Subject to the conditions stated in this
				regulation, the 2001 CSO Mortality Table shall be used in determining minimum
				standards for policies issued January 1, 2009 through December 31, 2016, to
				which
				R.S.
				22:753,
				R.S.
				22:936 and
				Sections
				10909.A and
				B of Regulation 85 are applicable.
C. Subject to the conditions stated in this
				regulation, either the 2001 CSO Mortality Table or the 2017 CSO Mortality Table
				may be used in determining the minimum standards for policies issued January 1,
				2017 through December 31, 2019, to which
				R.S.
				22:753,
				R.S.
				22:936 and
				Sections
				10909.A and
				B of Regulation 85 are applicable.
D. Subject to the conditions stated in this
				regulation, minimum standards for policies issued on or after January 1, 2020
				shall be determined using the mortality table in the Valuation Manual adopted
				by the NAIC at the time of issuance of the policy.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.22:11,
				  22:753,
				  22:936
				  and the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 107 - Regulation 84-Recognition and Selection of Applicable CSO Mortality Table in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits › Section XIII-10709 - Conditions

Current through Register Vol. 50, No. 6, June 20, 2024
A. For each plan of
				insurance with separate rates for smokers and nonsmokers an insurer may use:
1. composite mortality tables to determine
				minimum reserve liabilities and minimum cash surrender values and amounts of
				paid-up nonforfeiture benefits;
2.
				smoker and nonsmoker mortality tables to determine the valuation net premiums
				and additional minimum reserves, if any, required by
				R.S.
				22:753 and use composite mortality tables to
				determine the basic minimum reserves, minimum cash surrender values and amounts
				of paid-up nonforfeiture benefits; or
3. smoker and nonsmoker mortality to
				determine minimum reserve liabilities and minimum cash surrender values and
				amounts of paid-up nonforfeiture benefits.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 107 - Regulation 84-Recognition and Selection of Applicable CSO Mortality Table in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits › Section XIII-10715 - Separability

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any provision
				of this regulation or its application to any person or circumstance is for any
				reason held to be invalid, the remainder of the regulation and the application
				of the provision to other persons or circumstances shall not be
				affected.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.22:3,
				  22:163,
				  22:168 and
				  the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 107 - Regulation 84-Recognition and Selection of Applicable CSO Mortality Table in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits › Section XIII-10717 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				regulation shall take effect upon final publication in the
Louisiana
				Register
.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.22:11,
				  22:753,
				  22:936
				  and the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 109 - Regulation Number 85-Valuation of Life Insurance Policies › Section XIII-10901 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is to provide:
1. tables of
				select mortality factors and rules for their use;
2. rules concerning a minimum standard for
				the valuation of plans with nonlevel premiums or benefits; and
3. rules concerning a minimum standard for
				the valuation of plans with secondary guarantees.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 109 - Regulation Number 85-Valuation of Life Insurance Policies › Section XIII-10903 - Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A. This regulation
				is promulgated by the commissioner of insurance pursuant to authority granted
				under the Louisiana Insurance Code, Title 22, Section 22:1 et seq.,
				particularly the Standard Valuation Law, see Title 22, §163. B.1.a and the
				Standard Nonforfeiture Law for Life Insurance, see Title 22 §168.
				G.(8)(f).
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.22:3,
				  22:163,
				  22:168 and
				  the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 109 - Regulation Number 85-Valuation of Life Insurance Policies › Section XIII-10905 - Applicability

Current through Register Vol. 50, No. 6, June 20, 2024
A. This regulation
				shall apply to all life insurance policies, with or without nonforfeiture
				values, issued on or after the effective date of this regulation, subject to
				the following exceptions and conditions.
1.
				Exceptions
a. This regulation shall not apply
				to any individual life insurance policy issued on or after the effective date
				of this regulation if the policy is issued in accordance with and as a result
				of the exercise of a reentry provision contained in the original life insurance
				policy of the same or greater face amount, issued before the effective date of
				this regulation, that guarantees the premium rates of the new policy. This
				regulation also shall not apply to subsequent policies issued as a result of
				the exercise of such a provision, or a derivation of the provision, in the new
				policy.
b. This regulation shall
				not apply to any universal life policy that meets all the following
				requirements:
i. secondary guarantee period,
				if any, is five years or less;
ii.
				specified premium for the secondary guarantee period is not less than the net
				level reserve premium for the secondary guarantee period based on the
CSO valuation tables
as defined in
				§10907 and the applicable valuation
				interest rate; and
iii. the initial
				surrender charge is not less than 100 percent of the first year annualized
				specified premium for the secondary guarantee period.
c. This regulation shall not apply to any
				variable life insurance policy that provides for life insurance, the amount or
				duration of which varies according to the investment experience of any separate
				account or accounts.
d. This
				regulation shall not apply to any variable universal life insurance policy that
				provides for life insurance, the amount or duration of which varies according
				to the investment experience of any separate account or accounts.
e. This regulation shall not apply to a group
				life insurance certificate unless the certificate provides for a stated or
				implied schedule of maximum gross premiums required in order to continue
				coverage in force for a period in excess of one year.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 109 - Regulation Number 85-Valuation of Life Insurance Policies › Section XIII-10909 - General Calculation Requirements for Basic Reserves and Premium Deficiency Reserves

Current through Register Vol. 50, No. 6, June 20, 2024
A. At the
				election of the company for any one or more specified plans of life insurance,
				the minimum mortality standard for basic reserves may be calculated using the
				1980 CSO valuation tables with select mortality factors (or any other valuation
				mortality table adopted by the NAIC after the effective date of this regulation
				and promulgated by regulation by the commissioner for this purpose). If select
				mortality factors are elected, they may be:
1. the 10-year select mortality factors
				incorporated into the 1980 amendments to the NAIC Standard Valuation
				Law;
2. the select mortality
				factors in §10915; or
3. any other
				table of select mortality factors adopted by the NAIC after the effective date
				of this regulation and promulgated by regulation by the commissioner for the
				purpose of calculating basic reserves.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 109 - Regulation Number 85-Valuation of Life Insurance Policies › Section XIII-10911 - Calculation of Minimum Valuation Standard for Policies with Guaranteed Nonlevel Gross Premiums or Guaranteed Nonlevel Benefits (Other than Universal Life Policies)

Current through Register Vol. 50, No. 6, June 20, 2024
A. Basic
				Reserves. Basic reserves shall be calculated as the greater of the segmented
				reserves and the unitary reserves. Both the segmented reserves and the unitary
				reserves for any policy shall use the same valuation mortality table and
				selection factors. At the option of the insurer, in calculating segmented
				reserves and net premiums, either of the adjustments described in Paragraph 1
				or 2 below may be made.
1. Treat the unitary
				reserve, if greater than zero, applicable at the end of each segment as a pure
				endowment and subtract the unitary reserve, if greater than zero, applicable at
				the beginning of each segment from the present value of guaranteed life
				insurance and endowment benefits for each segment.
2. Treat the guaranteed cash surrender value,
				if greater than zero, applicable at the end of each segment as a pure
				endowment; and subtract the guaranteed cash surrender value, if greater than
				zero, applicable at the beginning of each segment from the present value of
				guaranteed life insurance and endowment benefits for each segment.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 109 - Regulation Number 85-Valuation of Life Insurance Policies › Section XIII-10913 - Calculation of Minimum Valuation Standard for Flexible Premium and Fixed Premium Universal Life Insurance Policies that Contain Provisions Resulting in the Ability of a Policy Owner to Keep a Policy in Force over a Secondary Guarantee Period

Current through Register Vol. 50, No. 6, June 20, 2024
A. General
1. Policies with a secondary guarantee
				include:
a. a policy with a guarantee that the
				policy will remain in force at the original schedule of benefits, subject only
				to the payment of specified premiums;
b. a policy in which the minimum premium at
				any duration is less than the corresponding one year valuation premium,
				calculated using the maximum valuation interest rate and the 1980 CSO valuation
				tables with or without 10-year select mortality factors, or any other table
				adopted after the effective date of this regulation by the NAIC and promulgated
				by regulation by the commissioner for this purpose; or
c. a policy with any combination of
				Subparagraph a and b.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 109 - Regulation Number 85-Valuation of Life Insurance Policies › Section XIII-10915 - Select Mortality Factors-Appendix

Current through Register Vol. 50, No. 6, June 20, 2024
A. This appendix contains tables of select
				mortality factors that are the bases to which the respective percentage of
				§10909 A2, 10909.B.2 and 10909.B.3 are applied.
B. The six tables of select mortality factors
				contained herein include:
1. male
				aggregate;
2. male
				nonsmoker;
3. male
				smoker;
4. female
				aggregate;
5. female nonsmoker;
				and
6. female smoker.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 109 - Regulation Number 85-Valuation of Life Insurance Policies › Section XIII-10917 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. The proposed
				effective date for this regulation is November 1, 2005.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.22:3,
				  22:163,
				  22:168 and
				  the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 111 - Regulation 86-Dependent Coverage of Newborn Children in the Group and Individual Market › Section XIII-11101 - Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A. This regulation
				is issued pursuant to the authority vested in the commissioner under the
				provisions of
				R.S.
				49:953 of the Administrative Procedure Act,
				R.S.
				22:3 and
				22:250.2(E)(2)(b) and
				(c), and
				R.S.
				22:250.4.F, and 22:250.11.E and 22:250.15.A,
				regarding the coverage of a newborn child as a dependent in the group and
				individual health insurance market and to provide for related
				matters.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 to implement and enforce the provisions
				  of
				  R.S.
				  22:250.2.E.(2)(b) and (c), and 22:250.4.F,
				  and 22:250.11.E, and 22:250.15.A of Part VI-C of Chapter 1 of Title 22 of the
				  Louisiana Revised Statutes of 1950, as
				  amended.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 111 - Regulation 86-Dependent Coverage of Newborn Children in the Group and Individual Market › Section XIII-11103 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is to establish reasonable requirements and standards for the
				processing of such coverage by health insurance issuers that assures compliance
				with state requirements under Title 22 of the Louisiana Revised Statutes of
				1950, as amended. More specifically, this regulation is necessary to implement
				and enforce the provisions of
				R.S.
				22:250.2.E.(2)(b) and (c), and
				R.S.
				22:250.4.F, and 22:250.11.E and 22:250.15.A
				of Part VI-C of Chapter 1 of Title 22.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 to implement and enforce the provisions
				  of
				  R.S.
				  22:250.2.E.(2)(b) and (c), and 22:250.4.F,
				  and 22:250.11.E, and 22:250.15.A of Part VI-C of Chapter 1 of Title 22 of the
				  Louisiana Revised Statutes of 1950, as
				  amended.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 111 - Regulation 86-Dependent Coverage of Newborn Children in the Group and Individual Market › Section XIII-11105 - Applicability and Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. Except
				as otherwise specifically provided, the requirements of this regulation shall
				apply to health insurance issuers, including health maintenance organizations,
				as required pursuant to
				R.S.
				22:2001 et seq., of the Louisiana Revised
				Statutes of 1950, as amended.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 to implement and enforce the provisions
				  of
				  R.S.
				  22:250.2.E.(2)(b) and (c), and 22:250.4.F,
				  and 22:250.11.E, and 22:250.15.A of Part VI-C of Chapter 1 of Title 22 of the
				  Louisiana Revised Statutes of 1950, as
				  amended.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 111 - Regulation 86-Dependent Coverage of Newborn Children in the Group and Individual Market › Section XIII-11109 - Enrollment Notification Procedures for a Qualifying Newborn Child

Current through Register Vol. 50, No. 6, June 20, 2024
A. Upon
				notification of the birth of a newborn child who is potentially eligible under
				Title XIX of the Social Security Act, the health insurance issuer shall be
				required to:
1. verify that dependant
				coverage is available for the newborn child or make a determination that no
				coverage is available for the newborn child;
2. make a determination of the benefit limits
				with regard to the newborn child;
3. make a determination of any additional
				premium, if applicable, that may be due in order to provide dependent coverage
				for the newborn child; and
4.
				designate a point of contact (which may be a specific position), with telephone
				number and physical address, to represent the health insurance issuer to
				facilitate all matters relative to the newborn child.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 111 - Regulation 86-Dependent Coverage of Newborn Children in the Group and Individual Market › Section XIII-11111 - Procedures for a Non-Qualifying Newborn Child

Current through Register Vol. 50, No. 6, June 20, 2024
A. The health insurance issuer shall be
				required to comply with the provisions of the Health Insurance Portability and
				Accountability Act of 1996 with regard to the enrollment procedures relative to
				dependent coverage for a non-qualifying newborn child.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 to implement and enforce the provisions
				  of
				  R.S.
				  22:250.2.E.(2)(b) and (c), and 22:250.4.F,
				  and 22:250.11.E, and 22:250.15.A of Part VI-C of Chapter 1 of Title 22 of the
				  Louisiana Revised Statutes of 1950, as
				  amended.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 111 - Regulation 86-Dependent Coverage of Newborn Children in the Group and Individual Market › Section XIII-11113 - Timely Payment of Claims

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				In cases where the time for the payment of a claim may be effected by the
				requirements of
				R.S.
				22:250.4 et seq., such requirements shall be
				considered "just and reasonable grounds" for a health insurance issuer to delay
				in the payment of a claim pursuant to
				R.S.
				22:250.31 et seq.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 to implement and enforce the provisions
				  of
				  R.S.
				  22:250.2.E.(2)(b) and (c), and 22:250.4.F,
				  and 22:250.11.E, and 22:250.15.A of Part VI-C of Chapter 1 of Title 22 of the
				  Louisiana Revised Statutes of 1950, as
				  amended.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 111 - Regulation 86-Dependent Coverage of Newborn Children in the Group and Individual Market › Section XIII-11115 - Sanctions

Current through Register Vol. 50, No. 6, June 20, 2024
A. A health
				insurance issuer that does not comply with any of the time limits for action or
				notice set forth in this regulation, or who does not provide all of the
				information required in this regulation, shall be subject to the sanctions set
				forth in
				R.S.
				22:1457.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 to implement and enforce the provisions
				  of
				  R.S.
				  22:250.2.E.(2)(b) and (c), and 22:250.4.F,
				  and 22:250.11.E, and 22:250.15.A of Part VI-C of Chapter 1 of Title 22 of the
				  Louisiana Revised Statutes of 1950, as
				  amended.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 111 - Regulation 86-Dependent Coverage of Newborn Children in the Group and Individual Market › Section XIII-11117 - Severability

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any Section
				or provision of this regulation 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 this regulation 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 this regulation and the application to any persons or circumstances are
				severable.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 to implement and enforce the provisions
				  of
				  R.S.
				  22:250.2.E.(2)(b) and (c), and 22:250.4.F,
				  and 22:250.11.E, and 22:250.15.A of Part VI-C of Chapter 1 of Title 22 of the
				  Louisiana Revised Statutes of 1950, as
				  amended.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 111 - Regulation 86-Dependent Coverage of Newborn Children in the Group and Individual Market › Section XIII-11119 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				regulation shall be effective upon final publication in the
Louisiana
				Register
.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 to implement and enforce the provisions
				  of
				  R.S.
				  22:250.2.E.(2)(b) and (c), and 22:250.4.F,
				  and 22:250.11.E, and 22:250.15.A of Part VI-C of Chapter 1 of Title 22 of the
				  Louisiana Revised Statutes of 1950, as
				  amended.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 113 - Regulation 88-Standardization of Health Benefits and Compliance Requirements for LaChoice › Section XIII-11301 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is:
1. to implement the
				statutory requirements in establishing pilot health insurance programs to
				increase access to affordable health insurance for small employers and for
				individuals pursuant to
				R.S.
				22:244 et seq., of the Louisiana Revised
				Statutes of 1950; and
2. to carry
				out the intent of the Legislature and assure full compliance with the
				applicable statutory provisions by establishing procedures for the
				standardization of health benefits and compliance requirements. This program
				and the applicable statutory authority relating thereto shall be referred to
				hereinafter as "LaChoice."
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 113 - Regulation 88-Standardization of Health Benefits and Compliance Requirements for LaChoice › Section XIII-11303 - Applicability and Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. Except
				as otherwise specifically provided, the requirements of this regulation shall
				apply to health insurance issuers that choose to offer health insurance under
				the provisions of LaChoice as required pursuant to
				R.S.
				22:244 et seq., of the Louisiana Revised
				Statutes of 1950.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:245(C)(3)
				  to implement and enforce the following provisions:
				  R.S.
				  22:244,
				  22:245,
				  and
				  22:246,
				  Part VI-B. of Chapter One of Title 22 of the Louisiana Revised Statutes of
				  1950.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 113 - Regulation 88-Standardization of Health Benefits and Compliance Requirements for LaChoice › Section XIII-11305 - Eligibility, Benefits and Underwriting Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order to participate in LaChoice,
				employers must not have provided group health insurance coverage to their
				employees for at least six months from the date the last policy of insurance
				was terminated or nonrenewed.
B.
				The commissioner of insurance shall have the authority via regulation to alter
				the above time period in accordance with
				R.S.
				22:246(1).
C. In order to participate in LaChoice, a
				health insurance issuer shall be required to file all proposed health insurance
				policy forms with the Department of Insurance for review and approval. Such
				policies shall be in compliance with Regulation 78. A statement of compliance
				is not required.
D. Policies issued
				pursuant to the provisions of LaChoice shall be exempted from all state benefit
				mandates, including but not limited to those mandates contained in
				R.S.
				22:213.2.A,
				R.S.22:215.1.B,
				R.S.22:215.8,
				R.S.
				22:215.10,
				R.S.
				22:215.11.A,
				R.S.
				22:215.11.B,
				R.S.
				22:215.14,
				R.S.
				22:215.15,
				R.S.
				22:215.16,
				R.S.
				22:215.20,
				R.S.
				22:215.21,
				R.S.
				22:215.22,
				R.S.
				22:215.24,
				R.S.
				22:228.7,
				R.S.
				22:230.4,
				R.S.
				22:669,
				R.S.
				22:2004.1 and
				R.S.
				22:2004.2.
E. All such health insurance coverage shall
				meet the requirements of Part VI-C of Title 22 except as specifically
				enumerated by statute or regulation. Any waiting period imposed shall be in
				compliance with Part VI-C of Title 22.
F. Policies issued pursuant to the provisions
				of LaChoice shall be exempted from
				R.S. 22:250.4(F)(1), (2)
				and (3), and
				R.S. 22:250.15(A)(2), (3),
				(4) and (5) unless dependent coverage is
				offered pursuant to LaChoice policies. If dependent coverage is offered, the
				provisions of
				R.S. 22:250.4(F)(1), (2)
				and (3), and
				R.S. 22:250.15(A)(2), (3),
				(4) and (5) shall apply to LaChoice
				policies.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:245(C)(3)
				  to implement and enforce the following provisions:
				  R.S.
				  22:244,
				  22:245,
				  and
				  22:246,
				  Part VI-B. of Chapter One of Title 22 of the Louisiana Revised Statutes of
				  1950.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 113 - Regulation 88-Standardization of Health Benefits and Compliance Requirements for LaChoice › Section XIII-11307 - Participation Requirement

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				health insurance issuer shall provide to the Department of Health and Hospitals
				through electronic means via a current ANSI X12N 834 transaction format
				pursuant to the HIPAA transactions and code sets requirements, an initial
				enrollment roster for each employer group listing employees who are to be
				covered by the health insurance issuer.
B. The initial enrollment roster for each
				employer group will include all employees who are to be covered by the health
				insurance issuer regardless of whether or not the employee is eligible for the
				LaChoice premium subsidy pursuant to §11311
C. The health insurance issuer shall provide
				monthly employee update transactions to the Department of Health and Hospitals
				using the 834 transaction format to indicate changes in insurance coverage for
				employees eligible for the LaChoice premium subsidy pursuant to §11311 Such
				changes shall include but not be limited to: changes in coverage, terminations
				from coverage and changes to employee demographics.
D. If an employee is to be covered in an
				employer group by the health insurance issuer and the employee was not included
				in the initial enrollment roster, the health insurance issuer shall include the
				employee in a monthly employee update transaction regardless of whether or not
				the employee is eligible for the LaChoice premium subsidy pursuant to §11311
E. The health insurance issuer
				shall provide a monthly report to the Department of Insurance indicating the
				count of all insured or members covered under LaChoice for each employer group.
				Such list shall include the following categories:
1. a list of current employers enrolled in
				the program;
2. the number of
				insured or members who are receiving the subsidy pursuant to §11311;
3. the number of insured or members who are
				not receiving the subsidy pursuant to §11311
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 113 - Regulation 88-Standardization of Health Benefits and Compliance Requirements for LaChoice › Section XIII-11309 - Underwriting Criteria for Health Insurance Issuer

Current through Register Vol. 50, No. 6, June 20, 2024
A. Underwriting criteria shall comply with
				the provisions in Title 22 and shall be subject to actuarial review and
				approval by the Department of Insurance, pursuant to
				R.S.
				22:246(6).
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:245(C)(3)
				  to implement and enforce the following provisions:
				  R.S.
				  22:244,
				  22:245,
				  and
				  22:246,
				  Part VI-B. of Chapter One of Title 22 of the Louisiana Revised Statutes of
				  1950.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 113 - Regulation 88-Standardization of Health Benefits and Compliance Requirements for LaChoice › Section XIII-11311 - Criteria for Public Subsidy

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				To be eligible for the LaChoice premium subsidy, an employee of a qualified
				employer that opts to provide LaChoice must make application and have household
				income levels at or below 200 percent of the federal poverty level as
				established by the Department of Health and Hospitals Medicaid Health Insurance
				Flexibility and Accountability (HIFA) Demonstration Project. Eligibility for
				the subsidy shall be determined by the Medicaid agency. Implementation of this
				provision shall be contingent upon the approval of the HIFA demonstration
				project by the U.S. Department of Health and Human Services, Centers for
				Medicare and Medicaid Services.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:245(C)(3)
				  to implement and enforce the following provisions:
				  R.S.
				  22:244,
				  22:245,
				  and
				  22:246,
				  Part VI-B. of Chapter One of Title 22 of the Louisiana Revised Statutes of
				  1950.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 113 - Regulation 88-Standardization of Health Benefits and Compliance Requirements for LaChoice › Section XIII-11313 - Enforcement Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				commissioner of insurance shall have the authority to disapprove a policy
				submitted pursuant to LaChoice in accordance with
				R.S.
				22:621 that fails to comply with the
				provisions of any statute or regulation.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:245(C)(3)
				  to implement and enforce the following provisions:
				  R.S.
				  22:244,
				  22:245,
				  and
				  22:246,
				  Part VI-B. of Chapter One of Title 22 of the Louisiana Revised Statutes of
				  1950.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 113 - Regulation 88-Standardization of Health Benefits and Compliance Requirements for LaChoice › Section XIII-11315 - Financial Statement Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. The following requirement is applicable
				only to health insurance issuers that offer LaChoice policies. Such health
				insurance issuers shall be required to report LaChoice business in a
				supplemental worksheet to the annual statement in a format to be provided by
				the Louisiana Department of Insurance.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:245(C)(3)
				  to implement and enforce the following provisions:
				  R.S.
				  22:244,
				  22:245,
				  and
				  22:246,
				  Part VI-B. of Chapter One of Title 22 of the Louisiana Revised Statutes of
				  1950.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 113 - Regulation 88-Standardization of Health Benefits and Compliance Requirements for LaChoice › Section XIII-11317 - Discontinuation of Product Type

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				When a health insurer issuer decides to discontinue offering policies pursuant
				to the LaChoice program,
				R.S.
				22:250.7(C)(1)(a),(b),(c) and
				(d) shall be applicable in the
				discontinuation of such product.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:245(C)(3)
				  to implement and enforce the following provisions:
				  R.S.
				  22:244,
				  22:245,
				  and
				  22:246,
				  Part VI-B. of Chapter One of Title 22 of the Louisiana Revised Statutes of
				  1950.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 113 - Regulation 88-Standardization of Health Benefits and Compliance Requirements for LaChoice › Section XIII-11319 - Severability

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any Section
				or provision of this regulation 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 this regulation 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 this regulation and the application to any persons or circumstance are
				severable.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:245(C)(3)
				  to implement and enforce the following provisions:
				  R.S.
				  22:244,
				  22:245,
				  and
				  22:246,
				  Part VI-B. of Chapter One of Title 22 of the Louisiana Revised Statutes of
				  1950.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 115 - Regulation 90-Payment of Pharmacy and Pharmacist Claims › Section XIII-11501 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				Regulation 90 is to implement
				R.S.
				22:250.51-62 relative to the making of the
				prompt and correct payment for prescription drugs, other products and supplies,
				and pharmacist services covered under insurance or other contracts that provide
				for pharmacy benefits. It is the intent of the legislature that payments for
				covered prescription drugs, other products and supplies, and pharmacist
				services provided by pharmacists and pharmacies are paid timely. It is also the
				intent of the legislature that the provisions of this Part shall be interpreted
				to achieve these ends. Additionally, these statutory provisions establish the
				intent of the legislature to assure that pharmacists and pharmacies who submit
				claims for covered prescription drugs, other products and supplies, and
				pharmacist services are paid timely and payments are based on calculations that
				reflect nationally recognized pricing references such as average wholesale
				price and maximum allowable cost.
B. To carry out the intent of the legislature
				and assure full compliance with the applicable statutory provisions, this
				regulation sets forth the standards for payment of claims for prescription
				drugs, pharmaceutical products and pharmacists services on behalf of health
				insurance issuers including, health maintenance organizations, to pharmacies
				and pharmacists and supersedes current regulations on uniform claim
				forms.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:250.61.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 115 - Regulation 90-Payment of Pharmacy and Pharmacist Claims › Section XIII-11503 - Scope and Applicability

Current through Register Vol. 50, No. 6, June 20, 2024
A. Except
				as otherwise specifically provided, the requirements of Regulation 90 apply to
				all health insurance issuers including health maintenance organizations that
				offer coverage in their insurance contracts for pharmacy services in accordance
				with the statutory requirements of Part VI-F of Chapter One of Title 22 of the
				Louisiana Revised Statutes of 1950,
				R.S.
				22:250.51 et seq. Additionally, Regulation 90
				applies to all contracts between a pharmacist and/or, pharmacy and/or a health
				insurance issuer, its agent, or any other party responsible for reimbursement
				for prescription drugs, other products and supplies, and pharmacist services.
				Any and all contracts entered into after July 1, 2005 shall be required to be
				in compliance with
				R.S.
				22:250.51 et seq. Additionally, Regulation 90
				shall apply to all contracts in existence prior to July 1, 2005. Regulation 90
				shall include but not be limited to those contracts that contain any automatic
				renewal provisions, renewal provisions that renew if not otherwise notified by
				a party, any provision that allows a party the opportunity to opt out of the
				contract, evergreen contracts, or rollover contracts and therefore these
				contracts shall be required to come into compliance. Regulation 90 shall apply
				to all contracts as enumerated above as of the first renewal date, first opt
				out date, first rollover date or first annual anniversary on or after July 1,
				2005.
B. Notwithstanding any
				provision to the contrary in any contract, evergreen contract, rollover
				contract or any agreement or contract that contains any automatic renewal
				provision, renewal provision that renews if not otherwise notified by a party
				or any provision that allows a party the opportunity to opt out of the
				contract, any and all contracts shall comply with Regulation 90 as of January
				1, 2008.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:250.61.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 115 - Regulation 90-Payment of Pharmacy and Pharmacist Claims › Section XIII-11507 - Claim Handling Procedures for Non-Electronic Claims

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				R.S.
				22:250.53.B, health insurance issuers or
				health maintenance organizations are required to submit to the Department, for
				approval, a "Prompt Payment Procedures Plan for Non-Electronic Pharmacy Claims"
				detailing statutory compliance for the receipt, acceptance, processing, payment
				of non-electronic claims and procedures in place to ensure compliance with
				R.S.
				22:250.41 et seq. The Prompt Payment
				Procedures Plan for Non-Electronic Pharmacy Claims shall include, but not be
				limited to, the following:
1. a process for
				documenting the date of actual receipt of non-electronic claims; and
2. a process for reviewing non-electronic
				claims for accuracy and acceptability.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 115 - Regulation 90-Payment of Pharmacy and Pharmacist Claims › Section XIII-11509 - Claim Handling Procedures for Electronic Claims

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				R.S.
				22:250.54, health insurance issuers and
				health maintenance organizations are required to submit to the department, for
				approval, a "Prompt Payment Procedures Plan for Electronic Pharmacy Claims"
				detailing statutory compliance for the receipt, acceptance, processing, payment
				of electronic claims and procedures in place to ensure compliance with
				R.S.
				22:250.54 et seq. The "Prompt Payment
				Procedures Plan for Electronic Pharmacy Claims" shall include, but not be
				limited to, the following:
1. a process for
				electronically dating the time and date of actual receipt of electronic
				claims;
2. a process for reviewing
				electronic review of transmitted claims for accuracy and acceptability;
				and
3. a process for reporting all
				claims rejected during electronic transmission and the reason for the
				rejection.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 115 - Regulation 90-Payment of Pharmacy and Pharmacist Claims › Section XIII-11511 - State of Emergency

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Pursuant to any Executive Order issued by the governor transferring authority
				to the department on matters pertaining to insurance, and pursuant to the
				plenary authority vested in the commissioner under Title 22, the department
				shall be authorized to issue emergency regulations during a state of emergency
				that suspends and/or interrupts any of the provisions found in Title 22 or take
				any or all such action that the commissioner deems necessary in reference to
				provisions in Title 22.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:250.61.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 115 - Regulation 90-Payment of Pharmacy and Pharmacist Claims › Section XIII-11513 - Severability Clause

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any
				Section or provision of Regulation 90 or its application to any person or
				circumstance is held invalid, such invalidity or determination shall not affect
				other sections or provisions that can be given effect without the invalid
				sections or provisions or application, and for these purposes, the Sections or
				provisions of this regulation and the application to any person or circumstance
				shall be severable.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:250.61.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 115 - Regulation 90-Payment of Pharmacy and Pharmacist Claims › Section XIII-11515 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. Regulation
				90 shall become effective upon final publication in the
Louisiana
				Register.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 and
				  22:250.61.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 117 - Regulation Number 89-Suitability in Annuity Transactions › Section XIII-11701 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is to require insurers to establish a system to supervise
				recommendations and to set forth standards and procedures for recommendations
				to consumers that result in transactions involving annuity products so that the
				insurance needs and financial objectives of consumers at the time of the
				transaction are appropriately addressed.
B. Nothing herein shall be construed to
				create or imply a private cause of action for a violation of this
				regulation.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11 and the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 117 - Regulation Number 89-Suitability in Annuity Transactions › Section XIII-11703 - Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. This regulation
				shall apply to any recommendation to purchase, exchange, or replace an annuity
				made to a consumer by an insurance producer, or an insurer where no producer is
				involved, that results in the recommended purchase, exchange, or
				replacement.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11 and the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 117 - Regulation Number 89-Suitability in Annuity Transactions › Section XIII-11705 - Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A. This regulation
				is promulgated under the authority of
				R.S.
				22:11 and the auspices of
				R.S. 22:1961
				et seq., referred to as unfair trade practices.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11 and the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.