reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3119 - Premium Taxes

Current through Register Vol. 50, No. 6, June 20, 2024
A. Premium
				taxes required under
				R.S.
				22:842 shall be imposed on an authorized
				carrier.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  R.S.
				  22:2241-2247, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3121 - Guaranty Association

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				applicable assessments for the Louisiana Life and Health Insurance Guaranty
				Association shall be imposed on an authorized carrier in accordance with
				R.S.
				22:2081-2099.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  R.S.
				  22:2241-2247, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3123 - Health Insurance Producers

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				For purposes of serving a LA Health Plan policy or soliciting prospective
				insureds for such a policy, insurance producers licensed for the line of
				accident and health or sickness shall be deemed to be servicing and soliciting
				within the scope of their license, pursuant to
				R.S.
				22:15411547 and
				22:255 of the Louisiana Insurance
				Code.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  R.S.
				  22:2241-2247, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3125 - Eligibility

Current through Register Vol. 50, No. 6, June 20, 2024
A. Eligibility for
				coverage and the effective date for an insured shall be determined by the
				authorized carrier after an applicant has returned the application for coverage
				to the authorized carrier and has been approved by said carrier. Eligibility
				for the LA Health Plan is limited to Louisiana residents with income levels
				below 250 percent of the federal poverty level. Individuals with major medical
				accident and health insurance coverage, individuals who are eligible for
				coverage under the Medicaid or Medicare programs, and those who have
				voluntarily canceled their accident and health insurance coverage during the
				last six months are not eligible under the LA Health Plan. The only exception
				to this requirement is for those individual eligibles who are without coverage
				because their coverage furnished in accordance with
				R.S.
				22:1046, group health continuation coverage,
				has expired; or for those individual eligibles with significantly reduced
				coverage through benefit riders or limitations.
B. Eligible adults may choose to purchase
				coverage only for themselves or all their children, or the entire
				family.
C. Unmarried eligible
				dependent children are eligible for coverage to age 21. Those children who are
				full-time students (after high school) in an institution of higher learning may
				remain covered to age 24. Such children shall be dependents under federal
				income tax laws.
D. A newborn child
				or an adopted child is covered, subject to §3125 E, from the moment of birth
				or date of assumption of legal responsibility to age 21, unless married before
				age 21, in the case of a family enrolled. The child's coverage is no different
				than that of the primary insured adult. An additional premium payment is
				required.
E. A newborn child or an
				adopted child of an enrolled individual is automatically covered for 31 days
				only in the case of an individual enrolled. In order for a newborn child or an
				adopted child to receive coverage past the thirty-first day, the enrolled
				individual shall complete an application form and pay the necessary premium for
				plan coverage.
F. If an eligible
				individual does not apply for coverage under the plan for himself or any
				eligible dependent, then application may be made later. If such individual is
				approved for coverage, the effective date of coverage will be the next month
				following approval of the application and payment of the necessary
				coverage.
G. Insureds may reduce
				the number of individuals covered at any time by submitting a change of
				coverage form. Such changes become effective on the due date of the LA Health
				Plan contract.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  R.S.
				  22:2241-2247, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3127 - Benefits

Current through Register Vol. 50, No. 6, June 20, 2024
A. The LA Health
				Plan is a basic health insurance plan providing primary and preventive health
				care services. Health care services are to be furnished by participating
				hospitals, clinics, and health care providers who have agreed to provide
				services under the LA Health Plan. An authorized carrier shall supply insured
				individuals under the LA Health Plan with a list of participating
				providers.
B. No requirement of the
				Louisiana Insurance Code relating to minimum required policy benefits, other
				than the minimum standards contained in this regulation or in
				R.S.
				22:2241-2247, shall apply to the LA Health
				Plan, its insureds, or the authorized carrier.
C. The benefits provided by the LA Health
				Plan are payable for services provided by a participating provider only. LA
				Health Plan insureds shall receive care from a participating provider. No
				coverage is provided with any other providers. Insureds shall pay in full for
				care they receive if the provider they utilize is not a participating
				provider.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  R.S.
				  22:2241-2247, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3129 - Hospital Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The LA
				Health Plan provides for the following minimum or their actuarial equivalent
				inpatient hospital services:
1. 15 days of
				hospital inpatient care (hospital/medical) per calendar year. A $50 per day
				co-payment is required;
2. surgical
				procedures and related expenses are covered up to a maximum of $5,000 per
				insured per calendar year. A $50 per surgical procedure co-payment is
				required;
3. the LA Health Plan
				will pay for covered expenses incurred for services in a participating hospital
				for the following services based on the limitations above;
a. daily room, board, and general nursing
				care at the semiprivate rate charged by the participating hospital;
b. confinement in an intensive care or
				coronary care unit with such payment being in lieu of expenses covered under
				§3129. A.3 a;
c. services and
				supplies furnished by the participating hospital which are necessary for
				inpatient medical care and treatment, including diagnostic x-ray and lab
				services;
4. maternity
				care;
5. newborn nursery care from
				the moment of birth;
6. medical
				care and treatment by a participating provider while confined as an inpatient
				in a hospital;
7. radiological
				services by a licensed radiologist while confined as an inpatient in a
				hospital;
8. radiation
				therapy.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3131 - Emergency Room Benefits

Current through Register Vol. 50, No. 6, June 20, 2024
A. The LA
				Health Plan provides for the following emergency room benefits:
1. outpatient health care received in the
				emergency room of a participating hospital is covered, limited to a maximum of
				$1,500 per insured per calendar year. This benefit is subject to an $85
				co-payment per visit;
2. the
				co-payment of $85 per visit shall be waived if such a visit is followed by an
				admission to the participating hospital for the care of the illness or injury
				for which the person was treated in the emergency room.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3133 - Provider Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The LA
				Health Plan provides for the following minimum, or their actuarial equivalent,
				primary health care provider services.
1. The
				LA Health Plan will provide for health care provider services, with such care
				including the general treatment of illness and diagnostic studies used to
				diagnose the cause of an illness.
2. All care received by a LA Health insured
				shall be related to the cause or symptom of the insured's illness or injury.
				Payment will not be made for care and treatment which is not deemed medically
				necessary.
3. Participating
				provider office visits are subject to a $10 per visit co-payment. Covered
				services in the participating provider's office include:
a. laboratory and x-ray services;
b. immunizations for children under age
				19;
c. prenatal care visits. Only
				one co-payment for all visits shall be charged if the participating provider
				bills in one lump sum;
d. an annual
				physical exam.
4. Fees
				for X-ray and laboratory tests made on an outpatient basis for diagnosis or
				treatment of an illness are covered when ordered by a participating provider.
				This benefit has a $1,000 calendar year maximum and is subject to the insured
				paying either $5 co-payment or a maximum of 10 percent of the charge up to a
				maximum of $1,100 per calendar year. The authorized carrier shall specify which
				option is to be taken in applying to participate in the LA Health
				Plan.
5. Surgical and related
				expenses are covered under the LA Health Plan up to a maximum of $5,000 per
				insured per calendar year. A $50 per surgical procedure co-payment is
				required.
6. Maternity care is a
				covered service subject to the following co-payment requirements:
a. normal vaginal delivery-$50
				co-payment;
b. Cesarean
				delivery-$100 co-payment;
c. if
				hospitalization follows delivery, the $50 per day inpatient co-payment shall
				apply.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3135 - Limitations

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pre-Existing
				Conditions
1. Until coverage for an insured
				enrolled in the LA Health Plan has been in force for 12 consecutive months,
				benefits for services to be paid to an authorized carrier shall not be
				available for any illness, injury, or other condition for which:
a. the existence of symptoms which would
				cause an ordinarily prudent person to seek diagnosis, care, or treatment, or a
				condition for which medical advice or treatment was recommended by or received
				from a provider of health care services within six months preceding the
				effective date of coverage of an individual insured.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3139 - Outpatient Prescription Rider

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				An authorized carrier may offer as rider to the LA Health Plan coverage for
				outpatient prescription drugs that includes a minimal co-payment.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S. 22:244-247 of the Insurance
				  Code.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3141 - Premium Maximums, Method for Calculating

Current through Register Vol. 50, No. 6, June 20, 2024
A. Premiums charged for the LA Health pilot
				plans shall be based on the average standard rate charged by the five largest
				health and accident insurers offering individual coverage in the state, as
				identified by the Louisiana Health Insurance Association's annual survey in
				accordance to
				R.S.
				22:1213.E.3. Annual survey results may be
				obtained from the department. For the purpose of calculating the maximum
				premiums as established in
				§3141.B of this
				regulation, insurers shall use the premiums identified in the Louisiana Health
				Insurance Association's Plan "A" and shall use the strict average of male and
				female rates.
B. Premium rates
				shall be community rated within each service area, but may vary according to an
				enrolled individual's status, (i.e., adult or minor dependent and smoker or
				nonsmoker), as established in §3141. B 1-3 of this regulation.
1. Adult individual rates shall be based on a
				per unit basis. Each individual's premium rate enrolled in the plan shall be no
				more than 60 percent of the strict average of the average individual standard
				rate charges for adults as identified in §3141. A of this regulation.
2. For the purpose of establishing the
				premium rate for minor dependents, there shall be one rate regardless of the
				number of minor dependents enrolled under each plan policy. The premium rate
				for minor dependents shall be no more than 60 percent of the average individual
				standard charged for children as identified in §3141. A of this
				regulation.
3. Rates may vary
				according to an individual's status as either a smoker or nonsmoker. For those
				individuals enrolled in the plan as a smoker, premium rates identified in
				§3141 shall be based on the average
				individual standard rate charged for smokers as identified in §3141 For those
				individuals enrolled in the plan as a nonsmoker, premium rates identified in
				§3141 shall be based on the average
				individual standard rate charge for nonsmokers as identified in §3141. A of
				this regulation.
4. Where a sliding
				scale is utilized for setting an individual or family's premium payment amount
				(including any contribution which may be made by an employer), the maximum
				payment amount for the highest income level cannot exceed the upper limits
				established under §3141. B 1-3 of this regulation.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3143 - Payment of Benefits

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				insured under the LA Health Plan is entitled to benefits for covered services
				as specified in this regulation and in the contract between an authorized
				carrier and the insured.
B.
				Benefits will be provided only if covered services are prescribed by or
				performed by or under the direct supervision of a participating
				provider.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S. 22:244-247 of the Insurance
				  Code.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3145 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				premium payments for coverage are due in advance. Monthly premium payments are
				for a complete month of coverage. There are no refunds and any cancellations
				will be effective on the first day of the month for which a premium has not
				been paid.
B. Any insured under the
				LA Health Plan may be considered for reinstatement within six months of
				termination, no matter what the reason prior coverage was terminated.
C. If coverage is terminated due to lack of
				payments, the insured may reapply for coverage within 90 days and pay any
				premiums still due.
D. An insured
				under the LA Health Plan may renew coverage by payment of the necessary
				premiums to the authorized carrier by the due date.
E. An authorized carrier may change the
				amount of monthly premium for the LA Health Plan in compliance with the
				Louisiana Insurance Code. Payment by the insured of the new rate is sufficient
				to indicate acceptance of the new rate.
F. The LA Health Plan shall be governed by
				the laws and regulations of the state of Louisiana and specifically those of
				the LA Health Plan.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  R.S.
				  22:2241-2247, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program › Section XIII-3147 - Termination of Coverage

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				insured's spouse who would otherwise lose coverage due to a divorce or death is
				automatically eligible for coverage in his or her name.
B. Coverage for any child terminates the last
				day of the month during which such child is no longer eligible for coverage
				under the LA Health Plan.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S. 22:244-247 of the Insurance
				  Code.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 33 - Regulation 55-Life Insurance Illustrations › Section XIII-3301 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is to provide rules for life insurance policy illustrations
				that will protect consumers and foster consumer education. The regulation
				provides illustration formats, prescribes standards to be followed when
				illustrations are used, and specifies the disclosures that are required in
				connection with illustrations for policies not excluded herein. The goals of
				this regulation are to ensure that illustrations do not mislead purchasers of
				life insurance and to make illustrations more understandable. Insurers will, as
				far as possible, eliminate the use of footnotes and caveats and define terms
				used in the illustration in language that would be understood by a typical
				person within the segment of the public to which the illustration is
				directed.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 33 - Regulation 55-Life Insurance Illustrations › Section XIII-3303 - Applicability and Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				regulation applies to all group and individual life insurance policies and
				certificates except:
1. variable life
				insurance;
2. individual and group
				annuity contracts;
3. credit life
				insurance; or
4. life insurance
				policies with no illustrated death benefits on any individual exceeding
				$10,000.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 33 - Regulation 55-Life Insurance Illustrations › Section XIII-3307 - Policies to Be Illustrated

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Each insurer marketing policies to which this regulation is applicable shall
				notify the department whether a policy form is to be marketed with or without
				an illustration. For all policy forms being actively marketed on the effective
				date of this regulation, the insurer shall identify, in writing, those forms
				and whether or not an illustration will be used with them. For policy forms
				filed after the effective date of this regulation, the identification shall be
				made at the time of filing. Any previous identification may be changed by
				notice to the department.
B. If the
				insurer identifies a policy form as one to be marketed without an illustration,
				any use of an illustration for any policy using that form prior to the first
				policy anniversary is prohibited.
C. If a policy form is identified by the
				insurer as one to be marketed with an illustration, a basic illustration
				prepared and delivered in accordance with this regulation is required, except
				that a basic illustration need not be provided to individual members of a group
				or to individuals insured under multiple lives coverage issued to a single
				applicant unless the coverage is marketed to these individuals. The
				illustration furnished an applicant for a group life insurance policy or
				policies issued to a single applicant on multiple lives may be either an
				individual or composite illustration representative of the coverage on the
				lives of members of the group or the multiple lives covered.
D. Potential enrollees of non-term group life
				subject to this regulation shall be furnished a quotation with the enrollment
				materials. The quotation shall show potential policy values for sample ages and
				policy years on a guaranteed and non-guaranteed basis appropriate to the group
				and the coverage. This quotation shall not be considered an illustration for
				purposes of this regulation, but all information provided shall be consistent
				with the illustrated scale. A basic illustration shall be provided at delivery
				of the certificate to enrollees for non-term group life who enroll for more
				than the minimum premium necessary to provide pure death benefit protection. In
				addition, the insurer shall make a basic illustration available to any non-term
				group life enrollee who requests it.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 33 - Regulation 55-Life Insurance Illustrations › Section XIII-3309 - General Rules and Prohibitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. An illustration used in the sale of a life
				insurance policy shall satisfy the applicable requirements of this regulation,
				be clearly labeled "life insurance illustration" and contain the following
				basic information:
1. name of
				insurer;
2. name and business
				address of producer or insurer's authorized representative, if any;
3. name, age, and sex of proposed insured,
				except where a composite illustration is permitted under this
				regulation;
4. underwriting or
				rating classification upon which the illustration is based;
5. generic name of policy, the company
				product name, if different, and form number;
6. initial death benefit; and
7. dividend option election or application of
				non-guaranteed elements, if applicable.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 33 - Regulation 55-Life Insurance Illustrations › Section XIII-3313 - Standards for Supplemental Illustrations

Current through Register Vol. 50, No. 6, June 20, 2024
A. A supplemental illustration may be
				provided so long as:
1. it is appended to,
				accompanied by, or preceded by a basic illustration that complies with this
				regulation;
2. the non-guaranteed
				elements shown are not more favorable to the policy owner than the
				corresponding elements, based on the scale used in the basic
				illustration;
3. it contains the
				same statement required of a basic illustration that non-guaranteed elements
				are not guaranteed; and
4. for a
				policy that has a contract premium, the contract premium underlying the
				supplemental illustration is equal to the contract premium shown in the basic
				illustration. For policies that do not require a contract premium, the premium
				outlay underlying the supplemental illustration shall be equal to the premium
				outlay shown in the basic illustration.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 33 - Regulation 55-Life Insurance Illustrations › Section XIII-3315 - Delivery of Illustrations and Record Retention

Current through Register Vol. 50, No. 6, June 20, 2024
A.
1. If a
				basic illustration is used by an insurance producer or other authorized
				representative of the insurer in the sale of a life insurance policy and the
				policy is applied for as illustrated, a copy of that illustration, signed in
				accordance with this regulation, shall be submitted to the insurer at the time
				of policy application. A copy shall also be provided to the
				applicant.
2. If the policy is
				issued other than as applied for, a revised basic illustration, conforming to
				the policy as issued, shall be sent with the policy. The revised illustration
				shall conform to the requirements of this regulation, shall be labeled "Revised
				Illustration" and shall be signed and dated by the applicant or policy owner
				and producer or other authorized representative of the insurer no later than
				the time the policy is delivered. A copy shall be provided to the insurer and
				the policy owner.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 33 - Regulation 55-Life Insurance Illustrations › Section XIII-3317 - Annual Report; Notice to Policy Owners

Current through Register Vol. 50, No. 6, June 20, 2024
A. In the case of a policy designated as one
				for which illustrations will be used, the insurer shall provide each policy
				owner with an annual report on the status of the policy that shall contain at
				least the following information.
1. For
				universal life policies, the report shall include the following:
a. the beginning and ending date of the
				current report period;
b. the
				policy value at the end of the previous report period and at the end of the
				current report period;
c. the total
				amounts that have been credited or debited to the policy value during the
				current report period, identifying each by type (e.g., interest, mortality,
				expense and riders);
d. the current
				death benefit at the end of the current report period on each life covered by
				the policy;
e. the net cash
				surrender value of the policy as of the end of the current report
				period;
f. the amount of
				outstanding loans, if any, as of the end of the current report period;
				and
g. for fixed premium policies:
i. if, assuming guaranteed interest,
				mortality and expense loads, and continued scheduled premium payments, the
				policy's net cash surrender value is such that it would not maintain insurance
				in force until the end of the next reporting period, a notice to this effect
				shall be included in the report; or
h. for flexible premium policies:
i. if, assuming guaranteed interest,
				mortality and expense loads, the policy's net cash surrender value will not
				maintain insurance in force until the end of the next reporting period unless
				further premium payments are made, a notice to this effect shall be included in
				the report.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 33 - Regulation 55-Life Insurance Illustrations › Section XIII-3319 - Annual Certifications

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				board of directors of each insurer shall appoint one or more illustration
				actuaries.
B. The illustration
				actuary shall certify that the disciplined current scale used in illustrations
				is in conformity with the Actuarial Standard of Practice for Compliance with
				the NAIC Model Regulation on Life Insurance Illustrations promulgated by the
				Actuarial Standards Board, and that the illustrated scales used in
				insurer-authorized illustrations meet the requirements of this
				regulation.
C. The illustration
				actuary shall:
1. be a member in good standing
				of the American Academy of Actuaries;
2. be familiar with the standard of practice
				regarding life insurance policy illustrations;
3. not have been found by the department,
				following appropriate notice and hearing, to have:
a. violated any provision of, or any
				obligation imposed by, the insurance law or other law in the course of his or
				her dealings as an illustration actuary;
b. been found guilty of fraudulent or
				dishonest practices;
c.
				demonstrated his or her incompetence, lack of cooperation, or untrustworthiness
				to act as an illustration actuary; or
d. resigned or been removed as an
				illustration actuary within the past five years as a result of acts or
				omissions indicated in any adverse report on examination or as a result of a
				failure to adhere to generally acceptable actuarial standards;
4. promptly notify the department
				of any action taken by a department of another state similar to that under
				§3319. C 3;
5. disclose in the
				annual certification whether, since the last certification, a currently payable
				scale applicable for business issued within the previous five years and within
				the scope of the certification has been reduced for reasons other than changes
				in the experience factors underlying the disciplined current scale. If
				non-guaranteed elements illustrated for new policies are not consistent with
				those illustrated for similar in-force policies, this must be disclosed in the
				annual certification. If non-guaranteed elements illustrated for both new and
				in-force policies are not consistent with the nonguaranteed elements actually
				being paid, charged, or credited to the same or similar forms, this must be
				disclosed in the annual certification; and
6. disclose in the annual certification the
				method used to allocate overhead expenses for all illustrations:
a. fully allocated expenses;
b. marginal expenses; or
c. a generally recognized expense table based
				on fully allocated expenses representing a significant portion of insurance
				companies and approved by the department.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 33 - Regulation 55-Life Insurance Illustrations › Section XIII-3321 - Severability

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 by any court of law, the remainder of the
				regulation and its application to other persons or circumstances shall not be
				affected.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 33 - Regulation 55-Life Insurance Illustrations › Section XIII-3323 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				regulation shall become effective July 1, 1997 and shall apply to policies sold
				on or after the effective date.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 35 - Regulation 56-Credit for Reinsurance › Section XIII-3501 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is to set forth rules and procedural requirements that the
				commissioner deems necessary to carry out the provisions on credit for
				reinsurance,
				R.S.
				22:651 et seq. The actions and information
				required by this regulation are hereby declared to be necessary and appropriate
				in the public interest and for the protection of the ceding insurers in this
				state.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S. 22, Sections
				  2(E)
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 35 - Regulation 56-Credit for Reinsurance › Section XIII-3503 - Severability

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any provision
				or item of this regulation, or the application thereof, is held invalid, such
				invalidity shall not affect other provisions, items, or applications of the
				regulation which can be given effect without the invalid provision, item, or
				application.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S. 22, Sections
				  2(E)
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 35 - Regulation 56-Credit for Reinsurance › Section XIII-3505 - Credit for Reinsurance-Reinsurer Authorized in this State

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				R.S.
				22:651(B), the commissioner
				shall allow credit for reinsurance ceded by a domestic insurer to an assuming
				insurer that was authorized in this state as of any date on which statutory
				financial statement credit for reinsurance is claimed.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S. 22, Sections
				  2(E)
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 35 - Regulation 56-Credit for Reinsurance › Section XIII-3507 - Credit for Reinsurance-Accredited Reinsurers

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				R.S.
				22:651(C) the commissioner
				shall allow credit for reinsurance ceded by a domestic insurer to an assuming
				insurer that is accredited as a reinsurer in this state as of the date on which
				statutory financial statement credit for reinsurance is claimed. An accredited
				reinsurer shall:
1. file a properly executed
				Form AR-1 (§3527.B) as evidence of its submission to this state's jurisdiction
				and to the authority of the commissioner to examine its books and
				records;
2. file with the
				commissioner a certified copy of a certificate of authority or other acceptable
				evidence that it is licensed to transact insurance or reinsurance in at least
				one state, or, in the case of a United States branch of an alien-assuming
				insurer, is entered through and licensed to transact insurance or reinsurance
				in at least one state;
3. file
				annually with the commissioner a copy of its annual statement filed with the
				insurance department of its state of domicile or, in the case of an alien
				assuming insurer, with the state through which it is entered and in which it is
				licensed to transact insurance or reinsurance, and a copy of its most recent
				audited financial statement; and
4.
				maintain a surplus as regards policyholders in an amount not less than
				$20,000,000, or obtain the affirmative approval of the commissioner upon a
				finding that it has adequate financial capacity to meet its reinsurance
				obligations and is otherwise qualified to assume reinsurance from domestic
				insurers.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 35 - Regulation 56-Credit for Reinsurance › Section XIII-3513 - Credit for Reinsurance Required by Law [Formerly Section 3511]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				R.S.
				22:651(G), the commissioner
				shall allow credit for reinsurance ceded by a domestic insurer to an assuming
				insurer not meeting the requirements of
				R.S. 22:651(B),
				(C), (D), (E) or (F) but only as to the
				insurance of risks located in jurisdictions where the reinsurance is required
				by the applicable law or regulation of that jurisdiction. As used in §3513:
Jurisdiction
-state, district or territory of
				  the United States and any lawful national government.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S. 22, Sections 2(E) and
				  661.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 35 - Regulation 56-Credit for Reinsurance › Section XIII-3515 - Reduction from Liability for Reinsurance Ceded to an Unauthorized Assuming Insurer [Formerly Section 3513]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				R.S.
				22:652, the commissioner shall allow a
				reduction from liability for reinsurance ceded by a domestic insurer to an
				assuming insurer not meeting the requirements of
				R.S.
				22:651 in an amount not exceeding the
				liabilities carried by the ceding insurer. The reduction shall be in the amount
				of funds held by or on behalf of the ceding insurer, including funds held in
				trust for the exclusive benefit of the ceding insurer, under a reinsurance
				contract with such assuming insurer as security for the payment of obligations
				under the reinsurance contract. The security shall be held in the United States
				subject to withdrawal solely by, and under the exclusive control of, the ceding
				insurer or, in the case of a trust, held in a qualified United States financial
				institution as defined in
				R.S.
				22:653(B). This security may
				be in the form of any of the following:
1.
				cash;
2. securities listed by the
				Securities Valuation Office of the NAIC, including those deemed exempt from
				filing as defined by the purposes and procedures manual of the Securities and
				Valuation Office, and qualifying as admitted assets;
3. clean, irrevocable, unconditional and
				evergreen letters of credit issued or confirmed by a qualified United States
				financial institution, as defined in
				R.S.
				22:653(A), effective no
				later than December 31 of the year for which filing is being made, and in the
				possession of, or in trust for, the ceding insurer on or before the filing date
				of its annual statement. Letters of credit meeting applicable standards of
				issuer acceptability as of the dates of their issuance (or confirmation) shall,
				notwithstanding the issuing (or confirming) institution's subsequent failure to
				meet applicable standards of issuer acceptability, continue to be acceptable as
				security until their expiration, extension, renewal, modification or amendment,
				whichever first occurs; or
4. any
				other form of security acceptable to the commissioner.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 35 - Regulation 56-Credit for Reinsurance › Section XIII-3517 - Trust Agreements Qualified under Section 3515 [Formerly Section 3515]

Current through Register Vol. 50, No. 6, June 20, 2024
A. As used in
				§3517:
Beneficiary
-the entity for whose sole
				  benefit the trust has been established and any successor of the beneficiary by
				  operation of law. If a court of law appoints a successor in interest to the
				  named
beneficiary
, then the named
beneficiary
includes, and is limited to, the court appointed domiciliary receiver
				  (including conservator, rehabilitator, or liquidator).
Grantor
-the entity that has established a
				  trust for the sole benefit of the beneficiary. When established in conjunction
				  with a reinsurance agreement, the
grantor
is the unlicensed,
				  unaccredited assuming insurer.
Obligations
-as used in §3517.B 11,
				  means:
a. reinsured losses and
				allocated loss expenses paid by the ceding company, but not recovered from the
				assuming insurer;
b. reserves for
				reinsured losses reported and outstanding;
c. reserves for reinsured losses incurred but
				not reported; and
d. reserves for
				allocated reinsured loss expenses and unearned premiums.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 35 - Regulation 56-Credit for Reinsurance › Section XIII-3521 - Other Security [Formerly Section 3519]

Current through Register Vol. 50, No. 6, June 20, 2024
A. A ceding insurer may take credit for
				unencumbered funds withheld by the ceding insurer in the United States subject
				to withdrawal solely by the ceding insurer and under its exclusive
				control.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S. 22, Sections 2(E) and
				  661.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 35 - Regulation 56-Credit for Reinsurance › Section XIII-3523 - Reinsurance Contract [Formerly Section 3521]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Credit will not be granted, nor an asset
				or reduction from liability allowed, to a ceding insurer for reinsurance
				effected with assuming insurers meeting the requirements of §§3505, 3507, 3509,
				3510, or 3513 or otherwise in compliance with
				R.S.
				22:651 after the adoption of this regulation
				unless the reinsurance agreement includes:
1.
				a proper insolvency clause, which stipulates that reinsurance is payable
				directly to the liquidator or successor without diminution regardless of the
				status of the ceding company, pursuant to
				R.S.
				22:651(I)(2);
2. a provision pursuant to
				R.S.
				22:651(H)(1)(a)(i) whereby
				the assuming insurer, if an unauthorized assuming insurer, has submitted to the
				jurisdiction of the alternative dispute resolution panel or court of competent
				jurisdiction within the United States, has agreed to comply with all
				requirements necessary to give the court or panel jurisdiction, has designated
				an agent upon whom service of process may be effected, and has agreed to abide
				by the final decision of the court or panel; and
3. a proper reinsurance intermediary clause,
				if applicable, which stipulates that the credit risk for the intermediary is
				carried by the assuming insurer.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 35 - Regulation 56-Credit for Reinsurance › Section XIII-3525 - Agreements Requiring Approval [Formerly Section 3523]

Current through Register Vol. 50, No. 6, June 20, 2024
A. The following kinds of reinsurance
				agreements shall not be entered into by any domestic insurer unless they are
				first submitted to the commissioner of insurance for his written approval, who
				shall approve the same if the terms thereof do not injuriously affect the
				rights of policyholders of any of the insurers parties thereto:
1. agreements of reinsurance of any life
				insurer other than agreements made in the ordinary course of business covering
				reinsurance of individual lives or joint lives under reinsurance agreements
				relating to current business; or
2.
				agreements whereby any insurer, other than a life insurer, cedes any existing
				outstanding reserves to an insurer not authorized to transact business in this
				state, or cedes to any insurer or insurers at one time, or during a period of
				six consecutive months more than 20 percent of the total amount of its
				outstanding reserves, not including in either case premiums ceded by agreements
				made in the ordinary course of business covering the reinsurance of individual
				risks under reinsurance relating to current business.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 35 - Regulation 56-Credit for Reinsurance › Section XIII-3527 - Contracts Affected [Formerly Section 3525]

Current through Register Vol. 50, No. 6, June 20, 2024
A. All new and renewal reinsurance
				transactions entered into after December 31, 2013 shall conform to the
				requirements of the Act and this regulation if credit is to be given to the
				ceding insurer for such reinsurance.
B. Form AR-1
FORM AR-1
CERTIFICATE OF ASSUMING INSURER
I______________________________,
				  _____________________________
(name of officer) (title of officer)
of
______________________________,
				  _____________________________
("Assuming Insurer"), the (name of assuming insurer)
assuming insurer under a reinsurance agreement with one or
				  more insurers domiciled in Louisiana, hereby certify that Assuming
				  Insurer:
1. Submits to the
				jurisdiction of any court of competent jurisdiction in Louisiana for the
				adjudication of any issues arising out of the reinsurance agreement, agrees to
				comply with all requirements necessary to give such court jurisdiction, and
				will abide by the final decision of such court or any appellate court in the
				event of an appeal. Nothing in this paragraph constitutes or should be
				understood to constitute a waiver of Assuming Insurer's rights to commence an
				action in any court of competent jurisdiction in the United States, to remove
				an action to a United States District Court, or to seek a transfer of a case to
				another court as permitted by the laws of the United States or of any state in
				the United States. This paragraph is not intended to conflict with or override
				the obligation of the parties to the reinsurance agreement to arbitrate their
				disputes if such an obligation is created in the agreement.
2. Designates the Commissioner of Insurance
				of Louisiana as its lawful attorney upon whom may be served any lawful process
				in any action, suit or proceeding arising out of the reinsurance agreement
				instituted by or on behalf of the ceding insurer.
3. Submits to the authority of the
				Commissioner of Insurance of Louisiana to examine its books and records and
				agrees to bear the expense of any such examination.
4. Submits with this form a current list of
				insurers domiciled in Louisiana reinsured by Assuming Insurer and undertakes to
				submit additions to or deletions from the list to the Insurance Commissioner at
				least once per calendar quarter.
Dated: ________________
				  _____________________________________
(name of assuming insurer)
BY: ________________________
				  ______________________________
(name of officer) (title of officer)
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 37 - Regulation 57-Life and Health Reinsurance Agreements › Section XIII-3701 - Preamble

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Department
				of Insurance recognizes that insurers possessing a certificate of authority
				routinely enter into reinsurance agreements that yield legitimate relief to the
				ceding insurer from strain to surplus.
B. However, it is improper for an insurer
				possessing a certificate of authority in the capacity of ceding insurer, to
				enter into reinsurance agreements for the principal purpose of producing
				significant surplus aid for the ceding insurer, typically on a temporary basis,
				while not transferring all of the significant risks inherent in the business
				being reinsured. In substance or effect, the expected potential liability to
				the ceding insurer remains basically unchanged by the reinsurance transaction,
				notwithstanding certain risk elements in the reinsurance agreement, such as
				catastrophic mortality or extraordinary survival.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S. 22, Section
				  2(H)
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 37 - Regulation 57-Life and Health Reinsurance Agreements › Section XIII-3703 - Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. This regulation
				shall apply to all domestic life and accident and health insurers and to all
				other life and accident and health insurers which possess a certificate of
				authority and which are not subject to a substantially similar regulation in
				their domiciliary state. This regulation shall also similarly apply to property
				and casualty insurers which possess a certificate of authority with respect to
				their accident and health business. This regulation shall not apply to
				assumption reinsurance, yearly renewable term reinsurance or certain
				nonproportional reinsurance such as stop loss or catastrophe
				reinsurance.
AUTHORITY NOTE:
				  Promulgated in accordance with R.S. 22, Section
				  2(H)