reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-540 - Standards for Claims Payment

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				issuer shall comply with Section 1882(c)(3) of the Social Security Act (as
				enacted by Section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of
				1987 (OBRA) 1987, Pub. L. No. 100-203) by:
1.
				accepting a notice from a Medicare carrier on dually assigned claims submitted
				by participating physicians and suppliers as a claim for benefits in place of
				any other claim form otherwise required and making a payment determination on
				the basis of the information contained in that notice;
2. notifying the participating physician or
				supplier and the beneficiary of the payment determination;
3. paying the participating physician or
				supplier directly;
4. furnishing,
				at the time of enrollment, each enrollee with a card listing the policy name,
				number, and a central mailing address to which notices from a Medicare carrier
				may be sent;
5. paying user fees
				for claim notices that are transmitted electronically or otherwise;
				and
6. providing to the Secretary
				of Health and Human Services, at least annually, a central mailing address to
				which all claims may be sent by Medicare carriers.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-545 - Loss Ratio Standards and Refund or Credit of Premium

Current through Register Vol. 50, No. 6, June 20, 2024
A. Loss Ratio Standards
1.
a. A
				Medicare supplement policy form or certificate form shall not be delivered or
				issued for delivery unless the policy form or certificate form can be expected,
				as estimated for the entire period for which rates are computed to provide
				coverage, to return to policyholders and certificateholders in the form of
				aggregate benefits (not including anticipated refunds or credits) provided
				under the policy form or certificate form:
i.
				at least 75 percent of the aggregate amount of premiums earned in the case of
				group policies; or
ii. at least 65
				percent of the aggregate amount of premiums earned in the case of individual
				policies.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-550 - Filing and Approval of Policies and Certificates and Premium Rates

Current through Register Vol. 50, No. 6, June 20, 2024
A. An issuer shall
				not deliver or issue for delivery a policy or certificate to a resident of this
				state unless the policy form or certificate form has been filed with and
				approved by the commissioner in accordance with filing requirements and
				procedures prescribed by the commissioner.
B. An issuer shall file any riders or
				amendments to policy or certificate forms to delete outpatient prescription
				drug benefits as required by the Medicare Prescription Drug, Improvement, and
				Modernization Act of 2003 only with the commissioner in the state in which the
				policy or certificate was issued.
C. An issuer shall not use or change premium
				rates for a Medicare supplement policy or certificate unless the rates, rating
				schedule and supporting documentation have been filed with and approved by the
				commissioner in accordance with the filing requirements and procedures
				prescribed by the commissioner.
D.
1. Except as provided in Paragraph D.2 of
				this Section, an issuer shall not file for approval more than one form of a
				policy or certificate of each type for each standard Medicare supplement
				benefit plan.
2. An issuer may
				offer, with the approval of the commissioner, up to four additional policy
				forms or certificate forms of the same type for the same standard Medicare
				supplement benefit plan, one for each of the following cases:
a. the inclusion of new or innovative
				benefits;
b. the addition of either
				direct response or agent marketing methods;
c. the addition of either guaranteed issue or
				underwritten coverage;
d. the
				offering of coverage to individuals eligible for Medicare by reason of
				disability.
3. For the
				purposes of this Section, a
type
means an individual policy, a
				group policy, an individual Medicare select policy, or a group Medicare select
				policy.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-555 - Permitted Compensation Arrangements

Current through Register Vol. 50, No. 6, June 20, 2024
A. An issuer or other entity may provide
				commission or other compensation to an agent or other representative for the
				sale of a Medicare supplement policy or certificate only if the first year
				commission or other first year compensation is no more than 200 percent of the
				commission or other compensation paid for selling or servicing the policy or
				certificate in the second year or period.
B. The commission or other compensation
				provided in subsequent (renewal) years must be the same as that provided in the
				second year or period and must be provided for no fewer than five renewal
				years.
C. No issuer or other entity
				shall provide compensation to its agents or other producers, and no agent or
				producer shall receive compensation greater than the renewal compensation
				payable by the replacing issuer on renewal policies or certificates if an
				existing policy or certificate is replaced.
D. For purposes of this Section,
compensation
includes pecuniary or non-pecuniary remuneration
				of any kind relating to the sale or renewal of the policy or certificate
				including, but not limited to, bonuses, gifts, prizes, awards and finders
				fees.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:224 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-570 - Filing Requirements for Advertising

Current through Register Vol. 50, No. 6, June 20, 2024
A. An issuer shall provide a copy of any
				Medicare supplement advertisement intended for use in this state whether
				through written, radio or television medium to the commissioner of insurance of
				this state for review and approval by the commissioner to the extent permitted
				under the Insurance Code, particularly under
				R.S.
				22:1215.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:224 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-575 - Standards for Marketing

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				issuer, directly or through its producers, shall:
1. establish marketing procedures to assure
				that any comparison of policies by its agents or other producers will be fair
				and accurate;
2. establish
				marketing procedures to assure excessive insurance is not sold or
				issued;
3. display prominently by
				type, stamp or other appropriate means, on the first page of the policy the
				following:
"Notice to buyer: This policy may not cover all of your
				  medical expenses;"
4.
				inquire and otherwise make every reasonable effort to identify whether a
				prospective applicant or enrollee for Medicare supplement insurance already has
				accident and sickness insurance and the types and amounts of any such
				insurance;
5. establish auditable
				procedures for verifying compliance with this Subsection A.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-580 - Appropriateness of Recommended Purchase and Excessive Insurance

Current through Register Vol. 50, No. 6, June 20, 2024
A. In recommending
				the purchase or replacement of any Medicare supplement policy or certificate an
				agent shall make reasonable efforts to determine the appropriateness of a
				recommended purchase or replacement.
B. Any sale of a Medicare supplement policy
				or certificate that will provide an individual more than one Medicare
				supplement policy or certificate is prohibited.
C. An issuer shall not issue a Medicare
				supplement policy or certificate to an individual enrolled in Medicare Part C
				(Medicare Advantage) unless the effective date of the coverage is after the
				termination date of the individual's Part C coverage.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:224 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-585 - Reporting of Multiple Policies

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				On or before March 1 of each year, an issuer shall report the following
				information for every individual resident of this state for which the issuer
				has in force more than one Medicare supplement policy or certificate:
1. policy and certificate number;
				and
2. date of issuance.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-590 - Prohibition against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies or Certificates

Current through Register Vol. 50, No. 6, June 20, 2024
A. If a Medicare
				supplement policy or certificate replaces another Medicare supplement policy or
				certificate, the replacing issuer shall waive any time periods applicable to
				preexisting conditions, waiting periods, elimination periods and probationary
				periods in the new Medicare supplement policy or certificate to the extent such
				time was spent under the original policy.
B. If a Medicare supplement policy or
				certificate replaces another Medicare supplement policy or certificate which
				has been in effect for at least six months, the replacing policy shall not
				provide any time period applicable to preexisting conditions, waiting periods,
				elimination periods and probationary periods.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:224 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-591 - Prohibition Against Use of Genetic Information and Requests for Genetic Testing

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				Section applies to all policies with policy years beginning on or after May 21,
				2009.
1. An issuer of a Medicare supplement
				policy or certificate;
a. shall not deny or
				condition the issuance or effectiveness of the policy or certificate (including
				the imposition of any exclusion of benefits under the policy based on a
				pre-existing condition) on the basis of the genetic information with respect to
				such individual; and
b. shall not
				discriminate in the pricing of the policy or certificate (including the
				adjustment of premium rates) of an individual on the basis of the genetic
				information with respect to such individual.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-595 - Severability

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any Sect on
				or provision of this regulation, or the application to any person or
				circumstance, is held invalid, such invalidity or determination shall not
				affect other provisions or applications of this regulation which can be given
				effect without the invalid section or provision or application, and for these
				purposes the Sections and provisions or this regulation, and the applications,
				are severable.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:224 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-596 - Appendix A-Calculation Forms

Current through Register Vol. 50, No. 6, June 20, 2024
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AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:224 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-597 - Appendix B-Medicare Supplement Policies Reporting Form

Current through Register Vol. 50, No. 6, June 20, 2024
FORM FOR REPORTING
MEDICARE SUPPLEMENT POLICIES
Company Name: _____________________________
Address: ____________________________________
Phone Number: ______________________________
Due: March 1, annually
The purpose of this form is to report the following
				  information on each resident of this state who has in force more than one
				  Medicare supplement policy or certificate. The information is to be grouped by
				  individual policyholder.
Policy and Certificate #
Date of Issuance
________________________________________
Signature
________________________________________
Name and Title (please type)
________________________________________
Date
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:224 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-599 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				regulation shall become effective upon final publication in the
Louisiana Register.
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 7 - Regulation 39-Statement of Actuarial Opinion › Section XIII-701 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is to implement Act 103 of the 1990 Regular Legislative
				Session. It is further intended to protect the public from the risk of
				insolvent insurance companies by requiring companies issuing certain types of
				policies to provide actuarial statement of opinion of loss and loss adjustment
				expense reserves. This will assist the agency in ensuring that adequate
				reserves are retained by insurers so that claims can be paid and minimize the
				necessity of putting companies into conservation and/or liquidation.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:904.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 7 - Regulation 39-Statement of Actuarial Opinion › Section XIII-703 - Applicability and Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				regulation shall apply to all companies which issue policies of personal injury
				liability insurance, policies of employer's liability insurance, and policies
				of worker's compensation insurance. Companies which issue these types of
				policies shall attach to page 1 of the annual statement the statement of a
				qualified actuary, entitled "Statement of Actuarial Opinion," setting forth his
				or her opinion relating to loss and loss adjustment expense reserves.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:904.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 7 - Regulation 39-Statement of Actuarial Opinion › Section XIII-705 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
Annual Statement
- the annual financial
				  statement required to be filed by insurers with the commissioner.
Insurer
- an insurer authorized to write
				  property and/or casualty insurance under the laws of any state and includes,
				  but is not limited to, fire and marine companies, general casualty companies,
				  local mutual aid societies, statewide mutual assessment companies, mutual
				  insurance companies other than life, farm mutual insurance companies, county
				  mutual insurance companies, Lloyd's plans, reciprocal and interinsurance
				  exchanges, captive insurance companies, risk retention groups, stipulated
				  premium insurance companies, and non-profit legal service corporations.
Qualified Actuary
-a person who:
a. meets the basic education, experience and continuing
				  education requirements of the Specific Qualification Standard for Statements of
				  Actuarial Opinion, NAIC Property and Casualty Annual Statement, as set forth in
				  the Qualification Standards for Actuaries Issuing Statements of Actuarial
				  Opinion in the United States (U.S. Qualifications Standards), promulgated by
				  the American Academy of Actuaries (Academy) and as adopted in Chapter 161 of
				  this Part;
b. has obtained and maintains an Accepted Actuarial
				  Designation; and
c. is a member of a professional actuarial association that
				  requires adherence to the same Code of Professional Conduct promulgated by the
				  Academy, requires adherence to the U.S. Qualification Standards, and
				  participates in the Actuarial Board for Counseling and Discipline when its
				  members are practicing in the U.S.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:904.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 7 - Regulation 39-Statement of Actuarial Opinion › Section XIII-707 - Content

Current through Register Vol. 50, No. 6, June 20, 2024
A. The "Statement
				of Actuarial Opinion" shall be in the format of and contain the information
				required by §12 of the Annual Statement Instructions: Property and
				Casualty.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:904.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 7 - Regulation 39-Statement of Actuarial Opinion › Section XIII-709 - Exemptions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Companies
				subject to this regulation may apply for an exemption. If an exemption is
				granted, a certified copy of the approved exemption must be filed with the
				annual statement in all jurisdictions in which the company is authorized to do
				business. An exemption may be applied for solely on the following grounds.
1. Automatic Exemption
a. An insurer, otherwise subject to this
				regulation, that has less than $1,000,000 total direct plus assumed written
				premiums during a calendar year or that has less than a total of 1,000
				policyholders and certificate holders at the end of a calendar year, in lieu of
				the certification required for the calendar year, may submit an affidavit,
				under oath of an officer of the insurer, that specifies that amount of direct,
				plus assumed, premiums written and the total number of policyholders and
				certificate holders.
b. An insurer
				who intends to file for an exemption under
				§709 must submit a letter of intent to
				its domiciliary commissioner no later than December 1 of the calendar year for
				which the exemption is to be claimed. The commissioner may deny the exemption
				prior to December 31 of the same year if he deems the exemption inappropriate.
				If an insurer intends to file for an exemption for calendar year 1991, it must
				do so no later than January 31, 1992.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 9 - Regulation 40-Summary Document and Disclaimer and Notice of Noncoverage › Section XIII-901 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				Regulation 40 is to implement the Louisiana Life and Health Insurance Guaranty
				Association Law as set forth in
				R.S.
				22:2081 et seq., which is designed to protect
				covered persons against the risk of insurer insolvencies under certain life,
				health, or annuity policies or contracts.
B. The purpose of the documents, designated
				in §903 as exhibit A
				and exhibit B, is to give notice to the insurance-buying consumer that the
				Louisiana Life and Health Insurance Guaranty Association Law includes
				restrictions as to coverage, and in some instances excludes coverage for
				certain types of policies or contracts, and includes substantial limitations as
				to the amounts which may be reimbursed in the event of the insolvency of the
				insurer
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2, 11, and
				  2098.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 9 - Regulation 40-Summary Document and Disclaimer and Notice of Noncoverage › Section XIII-903 - Applicability and Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Regulation 40 applies to the Louisiana Life and Health Insurance Guaranty
				Association (LLHIGA) as created by
				R.S.
				22:2085 and its member insurers as defined by
				R.S.
				22:2084.
B. Exhibit A, which follows hereto and is
				made a part hereof, sets forth the form and content of the summary document, as
				approved by the commissioner of insurance, summarizes the coverage provided by
				the Louisiana Life and Health Insurance Guaranty Association Law, and includes
				a disclaimer statement which is to be placed conspicuously on the front of the
				summary document. Pursuant to
				R.S.
				22:2098(B), the summary
				document with the disclaimer is to be delivered with each life, health, or
				annuity policy or contract, described in
				R.S.
				22:2083(B)(1), issued or
				delivered in Louisiana.
C. Exhibit
				B, which follows hereto and is made a part hereof, sets forth the notice of
				noncoverage required by
				R.S.
				22:2098(D). It is required
				to be delivered with each life, health, or annuity policy or contract described
				in
				R.S.
				22:2083(B)(1) and excluded
				from coverage under
				R.S.
				22:2083(B)(2).
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2, 11, and
				  2098.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 9 - Regulation 40-Summary Document and Disclaimer and Notice of Noncoverage › Section XIII-905 - Form and Content

Current through Register Vol. 50, No. 6, June 20, 2024
A. The summary
				document and disclaimer shall be in a form which complies with §907, exhibit A,
				which follows hereto and forms a part of Regulation 40.
B. The notice of noncoverage shall be in a
				form which complies with §909, exhibit B, which follows hereto and forms a part
				of Regulation 40.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2, 11 and
				  2098.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 9 - Regulation 40-Summary Document and Disclaimer and Notice of Noncoverage › Section XIII-909 - Exhibit B-Notice of Noncoverage

Current through Register Vol. 50, No. 6, June 20, 2024
A. When an insurer or agent delivers a policy
				or contract described in
				R.S.
				22:2083(B)(1) that is
				excluded from coverage by
				R.S.
				22:2083(B)(2), then prior to
				or at the time of such delivery, the following notice shall be given separately
				to the policy or contract holder:
The Policy Or Contract You Are Purchasing Is Not Covered By
				  The Louisiana Life And Health Insurance Guaranty Association.
Coverage is specifically excluded by law for the type of
				  policy or contract you are purchasing.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2, 11 and
				  2098.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 9 - Regulation 40-Summary Document and Disclaimer and Notice of Noncoverage › Section XIII-911 - Severability

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any Section
				or provision of Regulation 40 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 40 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 40 and the application to any persons or circumstances are
				severable.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2, 11 and
				  2098.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1105 - Conditions for Retaining the Self-Insurance Privilege

Current through Register Vol. 50, No. 6, June 20, 2024
A. The certificate of authority shall be
				continuous until revoked or suspended by the department, or until it is
				voluntarily surrendered by the fund.
B. All funds shall be required to submit the
				following documents and reports:
1. annual
				financial statements certified by an independent certified public accountant
				pursuant to §1107. B hereof;
2.
				estimated breakdown of policy year expenses pursuant to §1107. D hereof;
3. annual actuarial reports
				prepared by a qualified actuary;
4.
				changes in items required to be furnished under
				§1103.D 1, 2, 3, 4, 6,
				10, 11, and 12 within 10 days of the effective date of such change;
5. any other documents permitted or required
				by regulation or statute.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1107 - Financial and Actuarial Reports for Group Self-Insurance Funds

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each fund shall
				submit a current financial statement, audited by an independent certified
				public accountant, of at least two members showing, at the inception of the
				fund, a combined net worth of a minimum of $1,000,000, current financial
				statements of all other members, a combined ratio of current assets to current
				liabilities of more than one to one, a combined working capital of an amount
				establishing financial strength and liquidity of the members to pay normal
				compensation claims promptly, and showing evidence of the financial ability of
				the group to meet its obligations. An annual financial statement audited by an
				independent certified public accountant or a financial statement properly
				certified by an officer, owner, or partner for all members joining the fund
				after the inception date shall be submitted to the commissioner until such time
				as an annual financial statement audited by an independent certified public
				accountant is available for the fund as a whole. Thereafter, the filing of
				member financial statements with the department is no longer required. In no
				event shall the cumulative net worth or ratio of the current assets to current
				liabilities of all members be less than that required in this
				Subsection
B. An annual financial
				statement audited by an independent certified public accountant shall be due
				annually within six months of the close of the fiscal year of the fund, unless
				an extension is granted by the commissioner, on a form acceptable to the
				commissioner.
C. Actuarial reviews
				shall be made by a qualified actuary. Actuarial reports shall be due and filed
				at the same time as the fund's annual financial statement, except as otherwise
				provided by the commissioner.
D.
				Repealed.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1200.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1109 - Excess Insurance Requirements for Group Self-Insurance Funds

Current through Register Vol. 50, No. 6, June 20, 2024
A. All funds shall
				maintain specific excess insurance or reinsurance in the amount of at least
				$2,000,000 per occurrence and aggregate excess insurance or reinsurance of at
				least $2,000,000.
B. For the
				purposes of §1109, no loss fund shall be less than 70 percent of earned normal
				premium without the approval of the commissioner.
C. - E. Repealed.
F. The commissioner shall deny the use of a
				retention requested by a fund if he finds:
1.
				that the higher retention will have a significant adverse effect on the
				financial condition of the fund; or
2. that the fund is unable to establish
				reserves using monies from:
a. premium earned
				during the year the loss was incurred; or
b. investment earnings from the year in which
				the loss was incurred; or
c. from
				future investment earnings on the specific loss reserve.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1111 - Indemnity Agreement

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each
				self-insurance fund member shall enter into an indemnity agreement jointly and
				severally binding the self-insurance fund and each member thereof to comply
				with the provisions of the applicable Louisiana Revised Statutes and rules,
				regulations, and directives of the Department of Insurance.
B. Repealed.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1200.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1113 - Rates and Reporting of Rates

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Each fund shall file rates on an actuarially justified class code basis with
				the department and may use the rates 90 days after filing, unless the
				department disapproves the use of such rates within the 90-day
				period.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1200.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1115 - Authorized Investments for Group Self-Insurance Funds

Current through Register Vol. 50, No. 6, June 20, 2024
A. Amounts not needed for current obligations
				may be invested by the board of trustees in deposits in federally insured banks
				or savings and loan associations or in direct obligations of the United States
				government or direct obligations of the state of Louisiana, or in any other
				investments permissible under
				R.S.
				23:1196.1.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1200.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1117 - Premium Audit

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				self-insurance funds shall determine the normal premium due from each member in
				each policy year based on actual audited payroll. Audits shall consist of
				physical onsite audits, mail self-audits, telephone audits, or virtual audits.
				The requirements set forth herein shall apply to the fund and its present or
				former members. Funds shall be responsible for compliance with this Subsection
				by either an independent payroll audit firm or by the fund.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1200.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1119 - Board of Trustees

Current through Register Vol. 50, No. 6, June 20, 2024
A. Except
				upon approval of the commissioner, the fund's administrator, service company,
				or any owner, officer, employee of, or any other person affiliated with, such
				administrator or service company shall not serve on the board of trustees of
				the fund.
B. All trustees shall be
				residents of this state or officers of corporations authorized to do business
				in this state.
C. The board of
				trustees of each group shall ensure that all claims are paid promptly and take
				all necessary precautions to safeguard the assets of the group, including all
				of the following:
1. maintain responsibility
				for all monies collected or disbursed from the group and segregate all monies
				into a claims fund account and an administrative fund account. At least 70
				percent of the premium, as determined by the commissioner, shall be designated
				for the sole purpose of paying claims, allocated claims expenses, and special
				fund contributions, including second injury and other loss related funds. This
				shall be called the claims fund account. The remaining net premium shall be
				designated for the payment of taxes, general regulatory fees, assessments, and
				administrative costs. This shall be called the administrative fund account. The
				commissioner may approve an administrative fund account of more than 30 percent
				and a claims fund account of less than 70 percent only if the group shows to
				the commissioner's satisfaction that:
a. more
				than 30 percent is needed for an effective safety and loss control program;
				or
b. the group's aggregate excess
				insurance attaches at less than 70 percent;
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1121 - Group Membership; Termination, Liability

Current through Register Vol. 50, No. 6, June 20, 2024
A. An employer joining a fund after the group
				has been issued a certificate of approval shall:
1. submit an application for membership to
				the board of trustees or its administrator; and
2. enter into the indemnity agreement
				required by §1103. C.l hereof. Membership shall take effect no earlier than
				each member's date of approval. The application for membership and its approval
				shall be maintained as permanent records of the board of trustees.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1123 - Service Companies

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				service companies must file a request for approval by the commissioner and have
				a letter or certificate of approval from the commissioner prior to engaging in
				any service to a fund. All service companies performing services for group
				self-insurance funds on the effective date of this regulation shall file the
				request for approval and receive the letter or certificate of approval from the
				commissioner not later than March 1, 1993. The commissioner may request any
				information deemed necessary to establish the ability and financial strength of
				the service company to perform the required functions.
B. Except upon approval of the commissioner:
1. no service company or its employees,
				officers, or directors shall be an employee, officer, or director of, or have
				either a direct or indirect financial interest in, an administrator;
				and
2. no administrator or its
				employees, officers, or directors shall be an employee, officer, or director
				of, or have either a direct or indirect financial interest in, a service
				company.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1125 - Licensing of Agents

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any person
				soliciting membership for a fund must be licensed by the commissioner as a
				property and casualty agent; provided, however, that employees of a bona fide
				trade or professional association which has established a fund shall not be
				required to be so licensed if such solicitation is not the primary duty of such
				employees.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1193.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1127 - Deficits and Insolvencies

Current through Register Vol. 50, No. 6, June 20, 2024
A. In the
				event that a fund is insolvent, the fund shall file a written plan within 60
				days, signed by the board of trustees, detailing the means by which the fund
				intends to eliminate the insolvency. The means of eliminating the insolvency
				may include an assessment of the members of the fund. The fund shall also
				include the timetable for implementation and requirements for reporting to the
				department. Within 30 days of receiving the plan, the department shall review
				the plan and notify the fund of the approval or disapproval of the
				plan.
B. If the department
				disapproves a plan submitted by the fund or determines that a fund is not
				implementing a plan in accordance with the plan terms, the department shall
				notify the fund in writing of such decision or determination.
C. If the fund fails to file a plan to
				eliminate an insolvency, or should the department notify a fund that a plan has
				been disapproved or that the fund is not implementing the plan according to the
				plan, the department shall have the following powers and authority in addition
				to any other powers and authority granted under law:
1. The department may order the fund to
				immediately levy an assessment upon its members that will eliminate the
				insolvency.
2. If the fund fails or
				refuses to assess its members, the department may levy an assessment upon fund
				members in the name of the fund.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1129 - Review of Rate Determination

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Funds shall provide reasonable means whereby any member aggrieved by the
				application of the fund's rating system may, in writing, request a review of
				the manner in which such rating system has been applied in connection with the
				coverage afforded. The fund shall have 30 days from receipt to grant or deny
				the request, in writing. If the fund rejects such request or fails to grant or
				reject such request within such 30-day period, the member may, within 30 days
				following the expiration of such 30-day period, appeal to the commissioner,
				who, after a hearing held upon not less than 10 days' written notice to the
				member and to the fund, may affirm, modify, or reverse such action.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1200.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1131 - Cease and Desist Orders and Other Penalties

Current through Register Vol. 50, No. 6, June 20, 2024
A.
1. The
				department shall have authority to issue cease and desist orders and suspend or
				revoke the certificate of authority of any fund which the department determines
				is not in compliance.
2. Upon
				finding, after notice and opportunity for a hearing, that any person or group
				has violated any cease and desist order, the commissioner may revoke the
				group's certificate of authority.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1133 - Revocation of Certificate of Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A. After notice and opportunity for a
				hearing, the commissioner may revoke a group's certificate of authority if:
1. the group is found to be
				insolvent;
2. the group fails to
				pay any premium tax, regulatory fee, or assessment, or special fund
				contribution imposed upon it;
3.
				the group fails to comply with any of the provisions of this regulation, or
				with any lawful order of the commissioner within the time prescribed;
4. the certificate of authority issued to the
				group was obtained by fraud;
5.
				there was a material misrepresentation in the application for the certificate
				of authority; or
6. the group or
				its administrator has misappropriated, converted, illegally withheld, or
				refused to pay over upon proper demand any monies held in a fiduciary capacity
				that belong to a member, an employee of a member, or another person.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 11 - Regulation Number 42-Group Self-Insurance Funds › Section XIII-1135 - Examinations

Current through Register Vol. 50, No. 6, June 20, 2024
A. The commissioner
				shall examine, not less frequently than once every five years, and at any other
				time when an examination is necessary in the opinion of the commissioner, all
				group self-insurance funds established pursuant to
				R.S.
				23:1191 et seq. The expenses of such
				examinations shall be paid by the fund being examined.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1200.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 13 - Regulation 43-Companies in Hazardous Financial Condition › Section XIII-1301 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				Regulation 43 is to set forth the standards which the commissioner of insurance
				("commissioner") may use for identifying insurers found to be in such condition
				as to render the continuance of their business hazardous to their
				policyholders, creditors, or the general public.
B. Regulation 43 shall not be interpreted to
				limit the powers granted the commissioner by any laws or parts of laws of this
				state, nor shall Regulation 43 be interpreted to supersede any laws or parts of
				laws of this state.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11 and
				  22:2001 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 13 - Regulation 43-Companies in Hazardous Financial Condition › Section XIII-1303 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. As used in
				Regulation 43, the following terms shall have the respective meaning
				hereinafter set forth.
Control
-
as defined in
				  R.S.
				  22:691.2(3).
Person
-
as defined in
				  R.S.
				  22:691.2(7).
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11 and
				  22:2001 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 13 - Regulation 43-Companies in Hazardous Financial Condition › Section XIII-1307 - Commissioner's Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A. For
				the purposes of making a determination of an insurer's financial condition
				under this regulation, the commissioner may:
1. disregard any credit or amount receivable
				resulting from transactions with a reinsurer which is insolvent, impaired, or
				otherwise subject to a delinquency proceeding;
2. make appropriate adjustments including
				disallowance to asset values attributable to investments in or transactions
				with parents, subsidiaries or affiliates consistent with the NAIC Accounting
				Practices And Procedures Manual, state laws and regulations;
3. refuse to recognize the stated value of
				accounts receivable if the ability to collect receivables is highly speculative
				in view of the age of the account or the financial condition of the debtor;
				or
4. increase the insurer's
				liability in an amount equal to any contingent liability, pledge, or guarantee
				not otherwise included if there is a substantial risk that the insurer will be
				called upon to meet the obligation undertaken within the next 12 month
				period.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 13 - Regulation 43-Companies in Hazardous Financial Condition › Section XIII-1309 - Administrative Review

Current through Register Vol. 50, No. 6, June 20, 2024
A. An insurer
				subject to an order under Subsection 1307. B may request an administrative
				hearing to review that order pursuant to
				R.S.
				22:2191.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2(H).
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 13 - Regulation 43-Companies in Hazardous Financial Condition › Section XIII-1311 - Judicial Review

Current through Register Vol. 50, No. 6, June 20, 2024
A. An insurer
				aggrieved by a final decision pursuant to an administrative hearing under
				R.S.22:2191
				shall be entitled to judicial review in accordance with the applicable
				provisions of the Louisiana Administrative Procedure Act,
				R.S.
				49:950 et seq.
B. Notwithstanding the provisions of
				Subsections 1309. A and 1311.A, nothing shall preclude the commissioner from
				initiating judicial proceedings in conservation, rehabilitation, or liquidation
				proceedings or any other delinquency proceedings, however designated under the
				laws of the state, regardless of whether the commissioner has previously
				initiated any regulatory action against the insurer.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2(H).
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 13 - Regulation 43-Companies in Hazardous Financial Condition › Section XIII-1313 - Severability

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any Section
				or provision of Regulation 43 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 43 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 43 and the application to any persons or circumstances are
				severable.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2(H).
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 13 - Regulation 43-Companies in Hazardous Financial Condition › Section XIII-1315 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. Regulation
				43 shall become effective upon final publication in the
Louisiana
				Register
.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2(H).
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1501 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is to regulate accelerated benefit provisions of individual and
				group life insurance policies and to provide required standards of disclosure.
				This regulation shall apply to all accelerated benefits provisions of
				individual and group life insurance policies except those subject to the
				Long-Term Care Insurance Model Act, issued or delivered in this state, on or
				after the effective date of this regulation.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:644.