Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 111 - Regulation 86-Dependent Coverage of Newborn Children in the Group and Individual Market › Section XIII-11107 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. As used in this
				regulation, these terms shall have the following meaning.
Cancellation for Nonpayment of Premium
-the
				  cancellation of coverage for a newborn child who was added as a dependent due
				  to the nonpayment of the applicable premium adjustment for the additional
				  coverage for the newborn child within the time frames established by law or in
				  this regulation.
Effective Date of Birth
-the date of the
				  moment of live birth of a newborn child.
Eligibility Provisions
-a newborn child who
				  meets the requirements set forth in the State Plan Medical Assistance under
				  Title XIX of the Social Security Act.
Health Care Facility
-a facility or
				  institution providing health care services including, but not limited to, a
				  hospital (specifically including a neonatal special care unit) or other
				  licensed inpatient center, ambulatory surgical or treatment center, diagnostic,
				  laboratory, or imaging center, or rehabilitation or other therapeutic health
				  setting.
Health Care Provider
-a physician or other
				  health care practitioner licensed, certified or registered to perform specified
				  health care services consistent with state law.
Health Insurance Issuer
-an insurance
				  company, including a health maintenance organization as defined and licensed to
				  engage in the business of insurance under Part XII of Chapter 2 of Title 22 of
				  the Louisiana Revised Statutes, unless preempted as a qualified employee
				  benefit plan under the Employee Retirement Income Security Act of 1974.
Newborn Child
-an infant from the time of
				  birth through and until such time as the infant is discharged from a health
				  care facility to his or her home.
Non-Qualifying Newborn Child
-a newborn child
				  who does not meet the eligibility requirements of the State Plan Medical
				  Assistance under Title XIX of the Social Security Act.
Notice of Cancellation
-the written notice
				  sent from the health insurance issuer to the Secretary of the Department of
				  Health and Hospitals by certified mail, return receipt requested, with regard
				  to the cancellation of coverage for a newborn child. This notice of
				  cancellation may, as a courtesy, also be sent via electronic means to the
				  Secretary of the Department of Health and Hospitals; however, such electronic
				  notice shall not satisfy the notice requirement set forth in the enabling
				  statute that requires the notice of cancellation be sent by certified mail,
				  return receipt requested, to the Secretary of the Department of Health and
				  Hospitals.
Qualifying Newborn Child
-a newborn child who
				  meets the eligibility provisions of the State Plan Medical Assistance under
				  Title XIX of the Social Security Act.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:3 to implement and enforce the provisions
				  of
				  R.S.
				  22:250.2.E.(2)(b) and (c), and 22:250.4.F,
				  and 22:250.11.E, and 22:250.15.A of Part VI-C of Chapter 1 of Title 22 of the
				  Louisiana Revised Statutes of 1950, as
				  amended.