reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 5 - Uniform Provisions-Plan Administration › Section I-507 - Legal Limitations and Statement of Contractual Agreement

Current through Register Vol. 50, No. 6, June 20, 2024
A. A plan
				participant's rights and benefits under any OGB plan of benefits are personal
				to him/her.
B. The OGB self-funded
				plan, as amended, including the schedule of benefits, together with the
				application for coverage and any related documents executed by or on behalf of
				the enrollee, constitute the entire agreement between the parties.
C. In the event of any conflict between the
				written provisions of the OGB plan or any OGB plan of benefits with any
				information provided by OGB or its contractors or rules or regulations
				promulgated by OGB, the written provisions of the OGB plan or plan of benefits
				shall supersede and control.
D. A
				plan participant shall exhaust the administrative claims review procedure
				before filing a suit for benefits. No legal action shall be brought to recover
				benefits under an OGB plan or plan of benefits more than one year after the
				time a claim is required to be filed or more than 30 days after mailing of the
				notice of a final administrative decision, whichever is later, unless otherwise
				provided in the terms of the participant's plan. A decision is not final until
				all levels of the administrative appeals process are exhausted.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 5 - Uniform Provisions-Plan Administration › Section I-509 - Benefit Payments to Other Group Health Plans

Current through Register Vol. 50, No. 6, June 20, 2024
A. When payments that should have been made
				under an OGB plan of benefits, have been made by another group health plan, OGB
				may pay to the other plan the sum proper to satisfy the terms of the enrollee's
				OGB plan benefits.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 5 - Uniform Provisions-Plan Administration › Section I-511 - Recovery of Overpayments

Current through Register Vol. 50, No. 6, June 20, 2024
A. If an
				overpayment occurs, OGB retains the right to recover the overpayment. The plan
				participant, institution, or provider receiving the overpayment must return the
				overpayment. At OGB's discretion, the overpayment may be deducted from future
				claims. Should legal action be required as a result of fraudulent statements or
				deliberate omissions on the application for coverage or a claim for benefits,
				the defendant shall be responsible for attorney fees of 25 percent of the
				overpayment or $1,000, whichever is greater. The defendant shall also be
				responsible for court costs and legal interest from the date of judicial demand
				until paid.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 5 - Uniform Provisions-Plan Administration › Section I-513 - Subrogation and Reimbursement

Current through Register Vol. 50, No. 6, June 20, 2024
A. Upon
				payment of any eligible benefits covered under an OGB plan of benefits, OGB
				shall succeed and be subrogated to all rights of recovery of the plan
				participant or his/her heirs or assigns for whose benefit payment is made and
				he/she shall execute and deliver instruments and papers and do whatever is
				necessary to secure such rights and shall do nothing to prejudice such
				rights.
B. OGB has an automatic
				lien against and shall be entitled, to the extent of any payment made to a plan
				participant, to 100 percent of the proceeds of any settlement or judgment that
				may result from the exercise of any rights of recovery of a plan participant
				against any person or entity legally responsible for the disease, illness,
				accident, or injury for which said payment was made.
C. To this end, plan participants agree to
				immediately notify OGB or its agent of any action taken to attempt to collect
				any sums against any person or entity responsible for the disease, illness,
				accident, or injury.
D. These
				subrogation and reimbursement rights also apply, but are not limited to, when a
				plan participant recovers under an uninsured or underinsured motorist plan,
				homeowner's plan, renter's plan, medical malpractice plan, worker's
				compensation plan or any general liability plan.
E. Under these subrogation and reimbursement
				rights, OGB has a right of first recovery to the extent of any judgment,
				settlement, or any payment made to the plan participant, his/her heirs or
				assigns. These rights apply whether such recovery is designated as payment for
				pain and suffering, medical benefits, or other specified damages, even if
				he/she is not made whole (i.e., fully compensated for his/her
				injuries).
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 5 - Uniform Provisions-Plan Administration › Section I-515 - Program Responsibility

Current through Register Vol. 50, No. 6, June 20, 2024
A. OGB
				will administer its self-funded plans in accordance with the plan terms, state
				and federal law, and OGB's established policies, interpretations, practices,
				and procedures. OGB will have maximum legal discretionary authority to construe
				and interpret the terms and provisions of the plan and its plan of benefits, to
				make determinations regarding eligibility for benefits, and to decide disputes
				which may arise relative to a plan participant's rights.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 5 - Uniform Provisions-Plan Administration › Section I-517 - Amendments to or Termination of the OGB Plan

Current through Register Vol. 50, No. 6, June 20, 2024
A. OGB has the statutory responsibility of
				providing life, health, and other benefit programs to the extent that funds are
				available. OGB reserves the right to terminate, amend, or make adjustment to
				the eligibility and benefit provisions of any OGB plan or any plan benefits
				from time to time as necessary to prudently discharge its duties. Except for
				the pharmacy benefits management program, such modifications will be
				promulgated subject to the applicable provisions of law. Nothing contained
				herein shall be construed to guarantee or vest benefits for any plan
				participant.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 5 - Uniform Provisions-Plan Administration › Section I-519 - Eligible Expenses

Current through Register Vol. 50, No. 6, June 20, 2024
A. Eligible
				expenses are the charges incurred for the services, drugs, supplies, and
				devices covered by the applicable plan of benefits, when performed, prescribed,
				or ordered by a physician or other authorized provider under a plan of benefits
				and medically necessary for the treatment of a plan participant. All charges
				are subject to applicable deductibles, co-payments, and/or co-insurance
				amounts, fee schedule limitations, schedule of benefits, limitations,
				exclusions, prior authorization requirements, benefit limits, drug utilization
				management, pharmacy benefits formulary, and other provisions of the plan of
				benefits. A charge is incurred on the date that the service, drug, supply, or
				device is performed or furnished.
B. Eligible expenses may be different
				depending on the plan of benefits selected by the enrollee. Eligible expenses
				for each plan of benefits are included in the respective plan document. OGB
				will make available a copy of its plan documents to its enrollees at the
				beginning of the plan year.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 5 - Uniform Provisions-Plan Administration › Section I-521 - Severability

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any provision
				or item of these rules or the application thereof is held invalid, such
				invalidity shall not affect other provisions, items, or applications of these
				rules which can be given effect without the invalidated provisions, items, or
				applications and to this end the provisions of these rules are hereby declared
				severable.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 7 - Group Benefits Policy and Planning Board › Section I-701 - Elected Board Member Seats

Current through Register Vol. 50, No. 6, June 20, 2024
A. Per
				R.S.
				42:882, the Group Benefits Policy and
				Planning Board (OGB board) shall be composed of 11 voting members, with 2
				members elected by retired participants of OGB plans of benefits, as follows:
1. one retiree member who shall be elected
				from among retired teachers or other school employees;
2. one retiree member who shall be elected
				from among retired state employees.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 7 - Group Benefits Policy and Planning Board › Section I-703 - Candidate Eligibility

Current through Register Vol. 50, No. 6, June 20, 2024
A. A
				candidate for a position on the OGB board must be a participant in an OGB plan
				of benefits as of the specified nomination date.
B. If elected, the board member must continue
				to be a participant in an OGB plan of benefits during his/her tenure on the
				board.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 7 - Group Benefits Policy and Planning Board › Section I-705 - Petitions for Candidacy

Current through Register Vol. 50, No. 6, June 20, 2024
A. To
				become a candidate, a person must be nominated by petition of 25 or more OGB
				plan enrollees from the constituency he/she will represent.
B. Each enrollees signature must be
				accompanied by his/her printed name, the last four digits of their Social
				Security number, and the agency they are affiliated with.
C. Each petition for candidacy must be signed
				by the OGB chief executive officer or his/her designated representative
				certifying that each candidate and each petitioner is a plan participant from
				the constituency he/she will represent, on the specified nomination
				date.
D. Petitions for candidacy
				must be received by OGB on or before the date indicated on the nomination
				materials.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 7 - Group Benefits Policy and Planning Board › Section I-707 - Ballot Preparation and Distribution

Current through Register Vol. 50, No. 6, June 20, 2024
A. Ballot positions of candidates will be
				determined by a drawing.
B. All
				candidates will be notified of the time and place of the drawing.
C. All candidates or his/her representative
				may attend the drawing.
D. Ballots
				and information sheets on candidates will be provided to eligible voters by OGB
				or its election vendor.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 7 - Group Benefits Policy and Planning Board › Section I-709 - Balloting Procedure

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				retired enrollees in an OGB plan of benefits on the specified election date are
				eligible to vote.
B. Each eligible
				retired enrollee may cast only one vote for any candidate listed on the ballot
				for his respective retiree group.
C. Each eligible retired enrollee must follow
				the voting directions provided by OGB. In the event OGB contracts with an
				election vendor for a particular election, each eligible retired enrollee must
				follow the voting directions provided by OGBs election vendor for his/her vote
				to be counted.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 7 - Group Benefits Policy and Planning Board › Section I-711 - Ballot Counting

Current through Register Vol. 50, No. 6, June 20, 2024
A. The ballots
				will be counted by the ballot counting committee.
1. The ballot counting committee shall be
				composed of OGB employees appointed by the chief executive officer.
2. The ballot counting committee and all
				candidates will be notified at the time and date fixed for tallying the
				ballots.
3. The ballot counting
				committee will be responsible for the opening, preparation, and counting of the
				ballots.
4. All candidates or
				his/her representative may observe the ballot counting procedure.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 7 - Group Benefits Policy and Planning Board › Section I-713 - Election Results

Current through Register Vol. 50, No. 6, June 20, 2024
A. The chief
				executive officer will certify the election results to the Senate for
				confirmation.
B. The chief
				executive officer will notify the successful candidates of his/her
				election.
C. The chief executive
				officer will announce the election results at the first regularly scheduled
				board meeting following the election.
D. The chief executive officer will certify
				the election results to the Secretary of State.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 7 - Group Benefits Policy and Planning Board › Section I-715 - Uniform Election Dates

Current through Register Vol. 50, No. 6, June 20, 2024
A. For each
				election date, the following dates will apply:
1. On second Wednesday in January, OGB
				submits nomination sheets to each agency benefits coordinator.
2. The second Wednesday in February is the
				nomination cutoff date. Nominees must be certified by the OGB chief executive
				officer or his/her designee before nominations can be accepted by
				OGB.
3. On the third Wednesday in
				February, OGB will hold the drawing at its principal office to determine the
				position each candidate will have on the ballot. All candidates are invited to
				attend or send a representative.
4.
				Prior to the first Wednesday in March, ballots will be sent to the proper
				authority for distribution.
5. The
				second Wednesday in April is the deadline for OGB to receive completed
				ballots.
6. By the third Wednesday
				in April, all completed ballots shall be counted.
7. By the first Wednesday in May, the chief
				executive officer shall certify the election results to the Senate for
				confirmation.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 7 - Group Benefits Policy and Planning Board › Section I-717 - Petition Form

Current through Register Vol. 50, No. 6, June 20, 2024
A. Nominating
				Petition. Nominations will be submitted on a form substantially in compliance
				with the following.
We the undersigned OGB enrollees are retired teachers
							 or retired school employees/retired state employees and hereby nominate
______________ for membership on the Office of Group
							 Benefits
Policy and Planning Board.
Signature
Printed Name
Last 4 of SSN
Agency
Date
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
I hereby certify the persons signing this petition
							 are retired teachers or other school employees/retired state employees and OGB
							 retired enrollees as of the specified nomination date.
_________________________________________________________
OGB Chief Executive Officer or his/her designated
							 representative
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 9 - Managed Care Arrangements Contracting Criteria › Section I-901 - Notice of Intent to Contract

Current through Register Vol. 50, No. 6, June 20, 2024
A. Notice
				of intent to contract with managed care arrangements shall be given by
				publication in the official journal of the State of Louisiana or by written
				direct solicitation setting forth OGB's intent to contract, describing the
				services sought, and providing a contact point for requesting a detailed
				explanation of the services sought and the criteria to be used in developing
				contracts.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 9 - Managed Care Arrangements Contracting Criteria › Section I-903 - Managed Care Arrangements Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. The following criteria shall govern
				contracting with managed care arrangements for the OGB plan of benefits.
1. The managed care arrangement shall be
				appropriately licensed in accordance with the laws of this state.
2. The managed care arrangement shall execute
				a contract with OGB.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 11 - Contributions › Section I-1101 - Collection and Deposit of Contributions

Current through Register Vol. 50, No. 6, June 20, 2024
A. OGB shall be responsible for preparing and
				transmitting to each participating employer a monthly invoice premium statement
				delineating the enrolled employees of that agency as determined by the
				employer, each enrollee's class of coverage, total amount of employer and
				employee contributions due to OGB, and such other items as are deemed necessary
				by OGB.
B. It shall be the
				responsibility of the participating employer to reconcile the monthly invoice
				premium statement, collect employee contributions by payroll deduction or
				otherwise, and remit the reconciled monthly invoice premium statement and both
				the employer and employee contributions to OGB within 30 days after receipt of
				the monthly premium invoice statement.
C. Payments received by OGB shall be
				allocated as follows:
1. first, to any late
				payment penalty due by the participating employer;
2. second, to any balance due from prior
				invoices; and
3. third, to the
				amount due under the current invoice.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 11 - Contributions › Section I-1103 - Adjustments for Terminated Employees

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Credit adjustments for premiums paid on behalf of enrollees whose coverage
				under an OGB plan of benefits is terminated by reason of termination of
				employment may not be made by the participating employer after reconciliation
				of the second invoice following the date of termination of
				employment.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 11 - Contributions › Section I-1105 - Penalty for Late Payment of Premiums

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				If any participating employer fails to remit, in full, both the employer and
				employee contributions to OGB within 30 days after receipt of the monthly
				invoice premium statement, then at the request of OGB, the state treasurer
				shall withhold from state funds due the participating employer the full amount
				of the delinquent employer and employee contributions. The participating
				employer shall also pay a penalty equal to 1 percent of the total amount due
				and unpaid, compounded monthly. The state treasurer shall remit this amount
				directly to OGB.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 11 - Contributions › Section I-1107 - State Contribution toward Retirees' Health Premiums

Current through Register Vol. 50, No. 6, June 20, 2024
A. For any person who is an active employee,
				as defined by
				R.S.
				42:808 or OGB rule, and who does not
				participate in an OGB plan of benefits before January 1, 2002, but subsequently
				enrolls in an OGB plan of benefits, or any person who commences employment with
				an OGB participating employer on or after January 1, 2002, the state
				contribution of the premium for participation in an OGB plan of benefits plan
				upon retirement shall be:
1. 19 percent for
				those persons with less than 10 years of participation in an OGB plan of
				benefits before retirement;
2. 38
				percent for those persons with 10 years of participation but less than 15 years
				of participation in an OGB plan of benefits before retirement;
3. 56 percent for those persons with 15 years
				of participation but less than 20 years of participation in an OGB plan of
				benefits before retirement;
4. 75
				percent for those persons with 20 or more years of participation in an OGB plan
				of benefits before retirement.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 11 - Contributions › Section I-1109 - Retirees with Medicare Parts A and B

Current through Register Vol. 50, No. 6, June 20, 2024
A. Employees who retire on or after July 1,
				1997, and who are not rehired retirees in a benefit-eligible position, shall
				receive a reduced premium rate when enrolled in Medicare Parts A and
				B.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 15 - Participation by Active or Retired Members of the Louisiana National Guard › Section I-1501 - Eligibility

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any active or
				retired member of the Louisiana National Guard shall be eligible to participate
				in OGB sponsored life, health, or other programs provided that:
1. other coverage is not available through
				the member's employment; and
2. the
				member is not eligible for Medicare coverage.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 15 - Participation by Active or Retired Members of the Louisiana National Guard › Section I-1503 - Certification

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any eligible
				active or retired member of the Louisiana National Guard who submits an
				enrollment application to participate in OGB sponsored life, health, or other
				programs shall provide, contemporaneous with the enrollment application,
				written certification as follows:
1. from the
				member's employer, that other coverage is not available through the member's
				employment; and
2. from the
				appropriate federal administrative agency that the member is not eligible for
				Medicare;
3. OGB may require
				additional written certification at such times as it deems necessary to verify
				eligibility for participation in its sponsored programs.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 15 - Participation by Active or Retired Members of the Louisiana National Guard › Section I-1505 - Payment of Premiums

Current through Register Vol. 50, No. 6, June 20, 2024
A. The member
				must agree to pay the full amount of all premiums due for selected coverage
				without contribution from the state of Louisiana or any of the governmental or
				administrative subdivisions, departments, or agencies of the executive,
				legislative, or judicial branches of the state of Louisiana, or the governing
				boards and authorities of the state universities, colleges, and public
				elementary and secondary school systems in the state.
B. Contemporaneous with the enrollment
				application, the member must complete and submit to OGB all documentation
				necessary to provide for the payment of premiums via electronic funds transfer
				(EFT) from a licensed financial institution doing business in the state of
				Louisiana.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C), 802(B)(2), and
				  42:808.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 15 - Participation by Active or Retired Members of the Louisiana National Guard › Section I-1507 - Effective Dates of Health Coverage

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Unless an earlier effective date is mandated by applicable law or regulation,
				the effective date of health coverage for active or retired members of the
				Louisiana National Guard and their eligible dependents shall be:
1. the first day of the month following the
				date of receipt by OGB of the properly completed enrollment application,
				together with all required documentation, when such application and
				documentation are received by OGB prior to the fifteenth of the
				month;
2. the first day of the
				second month following the date of the receipt by OGB of the properly completed
				enrollment application and all required documentation when such application and
				documentation are received by OGB on or after the fifteenth of the
				month.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 15 - Participation by Active or Retired Members of the Louisiana National Guard › Section I-1509 - Health Benefits-Pre-Existing Condition Limitation (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  42:801(C),
				  802(B)(2), and
				  42:808.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 15 - Participation by Active or Retired Members of the Louisiana National Guard › Section I-1511 - Term Life Insurance

Current through Register Vol. 50, No. 6, June 20, 2024
A. Evidence of
				Insurability. Any active or retired member of the Louisiana National Guard or
				dependent(s) of such member for whom application for life insurance is made
				shall, in addition to all other required documentation, provide evidence of
				insurability acceptable to the insurer providing the OGB sponsored term life
				insurance. Such evidence of insurability shall be provided at no cost to OGB
				and/or the insurer providing the OGB sponsored term life insurance.
B. Effective Date
1. Unless delayed as set forth below, the
				effective date of life insurance will be the first of the month next following
				OGB's receipt of approval of the application for coverage from the insurer
				providing the OGB sponsored term life insurance.
2. Delay of Effective Date. If an active or
				retired member of the Louisiana National Guard, or dependent(s) of such member,
				is/are confined for medical care or treatment at home or elsewhere on the date
				that life insurance coverage would otherwise be effective, coverage for such
				individual(s) will take effect upon final medical release from such
				confinement.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 15 - Participation by Active or Retired Members of the Louisiana National Guard › Section I-1513 - Termination of Coverage

Current through Register Vol. 50, No. 6, June 20, 2024
A. All benefits
				will terminate on the earliest of the following dates:
1. on the last day of the month in which the
				active or retired member of the Louisiana National Guard ceases to be eligible
				to participate in OGB sponsored life, health, or other programs, as provided
				herein;
2. on the due date of any
				unpaid premium/contribution required for continuation of coverage; or
3. on the date that coverage would otherwise
				terminate for any other employee or retiree, or dependent(s) of such employee
				or retiree, participating in OGB sponsored health, life, or other programs in
				accordance with OGB rules.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 15 - Participation by Active or Retired Members of the Louisiana National Guard › Section I-1515 - Other Issues

Current through Register Vol. 50, No. 6, June 20, 2024
A. Other issues
				pertaining to eligibility for or participation in OGB sponsored life, health,
				or other programs by any active or retired member of the Louisiana National
				Guard not specifically addressed herein shall be resolved in accordance with
				OGB rules pertaining to other eligible employees and retirees. Nothing herein
				shall be construed to confer upon any active or retired member of the Louisiana
				National Guard greater rights relative to eligibility for or participation in
				OGB sponsored life, health, or other programs than those applicable to other
				eligible employees and retirees.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C), 802(B)(2), and
				  42:808.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 17 - Rulemaking Petitions › Section I-1701 - Submission of a Rulemaking Petition

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				In accordance with
				R.S.
				49:953(C)(1), any interested
				person may petition an agency to adopt a new rule, or to amend or repeal an
				existing rule.
B. To petition an
				agency within the Division of Administration for changes to the agency's
				current rules, or for the adoption of new rules within the agency's purview, an
				interested person shall submit a written petition to the Division of
				Administration, Office of the Commissioner. The petition shall include:
1. the petitioner's name and
				address;
2. the name of the
				promulgating agency for the rule in question;
3. specific text or a description of the
				proposed language desired for the adoption or amendment of a rule, or the
				specific rule and language identified for repeal;
4. justification for the proposed action;
				and
5. the petitioner's
				signature.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part I - General Provisions › Chapter 17 - Rulemaking Petitions › Section I-1703 - Consideration of a Rulemaking Petition

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Upon receipt, a rulemaking petition shall be forwarded to the promulgating
				agency for review.
B. Within 90
				days of receipt of the rulemaking petition, the agency shall either:
1. initiate rulemaking procedures to adopt a
				new rule, or to amend or repeal an existing rule; or
2. notify the petitioner in writing of the
				denial to proceed with rulemaking, stating the reason(s) therefor.
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part III - Primary Plan of Benefits › Chapter 1 - Operation of Primary Plan › Section III-101 - HMO Plan Structure-Magnolia Local Plus

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				R.S.
				42:851 H(1), OGB has authority to designate a
				primary plan. The Magnolia Local Plus Plan is designated hereby as the OGB
				primary plan.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part III - Primary Plan of Benefits › Chapter 1 - Operation of Primary Plan › Section III-103 - Deductibles

Current through Register Vol. 50, No. 6, June 20, 2024
Deductible Amount Per Benefit
							 Period
Individual:
Network
Non-Network
Active Employee/Retirees on or after March 1,
							 2015
$400
No Coverage
Retirees prior to March 1, 2015 (With and Without
							 Medicare)
$0
No Coverage
Individual, Plus One Dependent:
Active Employee/Retirees on or after March 1,
							 2015
$800
No Coverage
Retirees prior to March 1, 2015 (With and Without
							 Medicare)
$0
No Coverage
Individual, Plus Two or More
							 Dependents:
Active Employee/Retirees on or after March 1,
							 2015
$1,200
No Coverage
Retirees prior to March 1, 2015 (With and Without
							 Medicare)
$0
No Coverage
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part III - Primary Plan of Benefits › Chapter 1 - Operation of Primary Plan › Section III-105 - Out of Pocket Maximums

Current through Register Vol. 50, No. 6, June 20, 2024
Out-of-Pocket Maximum Per Benefit
							 Period
(Includes All Eligible Copayments, Coinsurance
							 Amounts and Deductibles)
Individual:
Network
Non-Network
Active Employee/Retirees on or after March 1,
							 2015
$3,500
No Coverage
Retirees prior to March 1, 2015 (With and Without
							 Medicare)
$2,000
No Coverage
Individual, Plus One Dependent:
Active Employee/Retirees on or after March 1,
							 2015
$6,000
No Coverage
Retirees prior to March 1, 2015 (With and Without
							 Medicare)
$3,000
No Coverage
Individual, Plus Two or More
							 Dependents:
Active Employee/Retirees on or after March 1,
							 2015
$8,500
No Coverage
Retirees prior to March 1, 2015 (With and Without
							 Medicare)
$4,000
No Coverage
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part III - Primary Plan of Benefits › Chapter 1 - Operation of Primary Plan › Section III-109 - Prescription Drug Benefits

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Prescription Drug Benefits
Network Pharmacy
Member pays
Tier 1- Generic
50% up to $30
Tier 2- Preferred
50% up to $55
Tier 3- Non-preferred
65% up to $80
Tier 4- Specialty
50% up to $80
90 day supplies for maintenance drugs from mail order
							 OR at participating 90-day retail network pharmacies
Two and a half times the cost of your applicable
							 copayment
Co-Payment after the Out Of Pocket Amount of
							 $1,500 Is Met
Tier 1- Generic
$0
Tier 2- Preferred
$20
Tier 3- Non-preferred
$40
Tier 4- Specialty
$40
Prescription drug benefits-31 day
							 refill
Plan pays balance of eligible
							 expenses
Diabetic supplies are not subject to a copayment if
							 enrolled in the In-Health/Disease Management Program.
Member who chooses a brand-name drug for which an
							 approved generic version is available, pays the cost difference between the
							 brand-name drug and the generic drug, plus the co-pay for the brand-name drug;
							 the cost difference does not apply to the $1,500 out of pocket amount.
Medications available over-the-counter in the same
							 prescribed strength are not covered under the pharmacy plan.
Smoking Cessation Medications: Benefits are available
							 for Prescription and over-the-counter (OTC) smoking cessation medications when
							 prescribed by a physician. (Prescription is required for over-the-counter
							 medications). Smoking cessation medications are covered at 100%.
This plan allows benefits for drugs and medicines
							 approved by the Food and Drug Administration or its successor that require a
							 prescription. Utilization management criteria may apply to specific drugs or
							 drug categories to be determined by PBM.
B.
				OGB shall have discretion to adopt a pharmacy benefits formulary to help
				enrollees select the most appropriate, lowest-cost options. The formulary will
				be reviewed on a quarterly basis to reassess drug tiers based on the current
				prescription drug market. The formulary may be changed from time to time
				subject to any applicable advance notice requirements. The amount enrollees pay
				toward prescription medications will depend on whether they purchase a generic,
				preferred brand, non-preferred brand, or specialty drug.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part V - Additional Plans and Operations › Chapter 1 - Authority for OGB Alternative Plan Options › Section V-101 - OGB Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				R.S.
				42:851 H(1) OGB may adopt, administer,
				operate, or contract for all or a portion of the administration, operation, or
				both of a primary self-funded program or additional programs with premium rate
				structures and state contribution rates which are different from the primary
				program.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part V - Additional Plans and Operations › Chapter 2 - PPO Plan Structure-Magnolia Open Access Plan › Section V-201 - Deductibles

Current through Register Vol. 50, No. 6, June 20, 2024
Deductible Amount Per Benefit
							 Period
Individual:
Network
Non-Network
Active Employee/Retirees on or after March 1,
							 2015
$900
$900
Retirees prior to March 1, 2015 (With and Without
							 Medicare)
$300
Individual, Plus One Dependent (Spouse or
							 Child):
Active Employee/Retirees on or after March 1,
							 2015
$1,800
$1,800
Retirees prior to March 1, 2015 (With and Without
							 Medicare)
$600
Individual, Plus Two or More
							 Dependents:
Active Employee/Retirees on or after March 1,
							 2015
$2,700
$2,700
Retirees prior to March 1, 2015 (With and Without
							 Medicare)
$900
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part V - Additional Plans and Operations › Chapter 2 - PPO Plan Structure-Magnolia Open Access Plan › Section V-203 - Out of Pocket Maximums

Current through Register Vol. 50, No. 6, June 20, 2024
Includes All Eligible Copayments, Coinsurance
							 Amounts and Deductibles
Active Employee/Retirees on or after March 1,
							 2015
Retirees prior to March 1, 2015 Without
							 Medicare
Retirees prior to March 1, 2015 With
							 Medicare
Network
Non-Network
Network
Non-Network
Network and Non-Network
Individual Only
$3,500
$4,700
$2,300
$4,300
$3,300
Individual Plus One (Spouse or Child)
$6,000
$8,500
$3,600
$7,600
$5,600
Individual Plus Two
$8,500
$12,250
$4,900
$10,900
$7,900
Individual Plus Three
$8,500
$12,250
$5,900
$13,700
$9,900
Individual Plus Four
$8,500
$12,250
$6,900
$13,700
$11,900
Individual Plus Five
$8,500
$12,250
$7,900
$13,700
$13,700
Individual Plus Six
$8,500
$12,250
$8,900
$13,700
$13,700
Individual Plus Seven
$8,500
$12,250
$9,900
$13,700
$13,700
Individual Plus Eight
$8,500
$12,250
$10,900
$13,700
$13,700
Individual Plus Nine
$8,500
$12,250
$11,900
$13,700
$13,700
Individual Plus Ten
$8,500
$12,250
$12,900
$13,700
$13,700
Individual Plus Eleven or More
$8,500
$12,250
$13,700
$13,700
$13,700
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part V - Additional Plans and Operations › Chapter 2 - PPO Plan Structure-Magnolia Open Access Plan › Section V-207 - Prescription Drug Benefits

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Prescription Drug Benefits
Network Pharmacy
Member Pays
Tier 1- Generic
50% up to $30
Tier 2- Preferred
50% up to $55
Tier 3- Non-preferred
65% up to $80
Tier 4- Specialty
50% up to $80
90 day supplies for maintenance drugs from mail order
							 OR at participating 90-day retail network pharmacies
Two and a half times the cost of your applicable
							 copayment
Co-Payment after the Out Of Pocket Amount of
							 $1,500 Is Met
Tier 1- Generic
$0
Tier 2- Preferred
$20
Tier 3- Non-preferred
$40
Tier 4- Specialty
$40
Prescription drug benefits-31 day
							 refill
Plan pays balance of eligible
							 expenses
Diabetic supplies are not subject to a copayment if
							 enrolled in the In-Health/Disease Management Program.
Member who chooses a brand-name drug for which an
							 approved generic version is available, pays the cost difference between the
							 brand-name drug and the generic drug, plus the co-pay for the brand-name drug;
							 the cost difference does not apply to the $1,500 out of pocket amount.
Medications available over-the-counter in the same
							 prescribed strength are not covered under the pharmacy plan.
Smoking Cessation Medications: Benefits are available
							 for Prescription and over-the-counter (OTC) smoking cessation medications when
							 prescribed by a physician. (Prescription is required for over-the-counter
							 medications). Smoking cessation medications are covered at 100%.
This plan allows benefits for drugs and medicines
							 approved by the Food and Drug Administration or its successor that require a
							 prescription. Utilization management criteria may apply to specific drugs or
							 drug categories to be determined by PBM.
B.
				OGB shall have discretion to adopt a pharmacy benefits formulary to help
				enrollees select the most appropriate, lowest-cost options. The formulary will
				be reviewed on a quarterly basis to reassess drug tiers based on the current
				prescription drug market. The formulary may be changed from time to time
				subject to any applicable advance notice requirements. The amount enrollees pay
				toward prescription medications will depend on whether they purchase a generic,
				preferred brand, non-preferred brand, or specialty drug.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part V - Additional Plans and Operations › Chapter 3 - Narrow Network HMO Plan Structure-Magnolia Local Plan (in certain geographical areas) › Section V-301 - Deductibles

Current through Register Vol. 50, No. 6, June 20, 2024
Deductible Amount Per Benefit
							 Period
Individual:
Network
Non-Network
Active Employee/Retirees on or after March 1,
							 2015
$400
No Coverage
Retirees prior to March 1, 2015
(With and Without Medicare)
$0
No Coverage
Individual, Plus One Dependent:
Active Employee/Retirees on or after March 1,
							 2015
$800
No Coverage
Retirees prior to March 1, 2015
(With and Without Medicare)
$0
No Coverage
Individual, Plus Two or More
							 Dependents:
Active Employee/Retirees on or after March 1,
							 2015
$1,200
No Coverage
Retirees prior to March 1, 2015
(With and Without Medicare)
$0
No Coverage
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part V - Additional Plans and Operations › Chapter 3 - Narrow Network HMO Plan Structure-Magnolia Local Plan (in certain geographical areas) › Section V-303 - Out of Pocket Maximums

Current through Register Vol. 50, No. 6, June 20, 2024
Out-of-Pocket Maximum Per Benefit Period
							 (Includes All Eligible Copayments, Coinsurance Amounts and
							 Deductibles)
Individual:
Network
Non-Network
Active Employee/Retirees on or after March 1,
							 2015
$2,500
No Coverage
Retirees prior to March 1, 2015
(With and Without Medicare)
$1,000
No Coverage
Individual, Plus One Dependent:
Active Employee/Retirees on or after March 1,
							 2015
$5,000
No Coverage
Retirees prior to March 1, 2015
(With and Without Medicare)
$2,000
No Coverage
Individual, Plus Two or More Dependents:
Active Employee/Retirees on or after March 1,
							 2015
$7,500
No Coverage
Retirees prior to March 1, 2015
(With and Without Medicare)
$3,000
No Coverage
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part V - Additional Plans and Operations › Chapter 3 - Narrow Network HMO Plan Structure-Magnolia Local Plan (in certain geographical areas) › Section V-307 - Prescription Drug Benefits

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Prescription Drug Benefits
Network Pharmacy
Member pays
Tier 1- Generic
50% up to $30
Tier 2- Preferred
50% up to $55
Tier 3- Non-preferred
65% up to $80
Tier 4- Specialty
50% up to $80
90 day supplies for maintenance drugs from mail order
							 OR at participating 90-day retail network pharmacies
Two and a half times the cost of your applicable
							 copayment
Co-Payment after the Out Of Pocket Amount of
							 $1,500 Is Met
Tier 1- Generic
$0
Tier 2- Preferred
$20
Tier 3- Non-preferred
$40
Tier 4- Specialty
$40
Prescription drug benefits-31 day
							 refill
Plan pays balance of eligible
							 expenses
Diabetic supplies are not subject to a copayment if
							 enrolled in the In-Health/Disease Management Program.
Member who chooses a brand-name drug for which an
							 approved generic version is available, pays the cost difference between the
							 brand-name drug & the generic drug, plus the co-pay for the brand-name
							 drug; the cost difference does not apply to the $1,500 out of pocket
							 amount.
Medications available over-the-counter in the same
							 prescribed strength are not covered under the pharmacy plan.
Smoking Cessation Medications: Benefits are available
							 for Prescription and over-the-counter (OTC) smoking cessation medications when
							 prescribed by a physician. (Prescription is required for over-the-counter
							 medications). Smoking cessation medications are covered at 100%.
This plan allows benefits for drugs and medicines
							 approved by the Food and Drug Administration or its successor that require a
							 prescription. Utilization management criteria may apply to specific drugs or
							 drug categories to be determined by PBM.
B.
				OGB shall have discretion to adopt a pharmacy benefits formulary to help
				enrollees select the most appropriate, lowest-cost options. The formulary will
				be reviewed on a quarterly basis to reassess drug tiers based on the current
				prescription drug market. The formulary may be changed from time to time
				subject to any applicable advance notice requirements. The amount enrollees pay
				toward prescription medications will depend on whether they purchase a generic,
				preferred brand, non-preferred brand, or specialty drug.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).
Louisiana Administrative Code › Title 32 - EMPLOYEE BENEFITS › Part V - Additional Plans and Operations › Chapter 4 - PPO/Consumer-Driven Health Plan Structure-Pelican HSA 775 Plan › Section V-401 - Deductibles

Current through Register Vol. 50, No. 6, June 20, 2024
Deductible Amount Per Benefit
							 Period:
Network
Non-Network
Individual:
$2,000
$4,000
Family:
$4,000
$8,000
Coinsurance:
Plan
Plan Participant
Network Providers
80%
20%
Non-Network Providers
60%
40%
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:801(C) and
				  802(B)(1).