Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 141 - Regulation Number 100-Coverage of Prescription Drugs through a Drug Formulary › Section XIII-14109 - Required Notices

Current through Register Vol. 50, No. 6, June 20, 2024
A. There shall
				be three different and distinct types of notice that a health insurance issuer
				is required to provide to every applicable enrollee. Each notice shall be filed
				with and approved by the Department of Insurance prior to use in
				Louisiana.
B. Notice and Disclosure
				of Drug Formulary Pursuant to
				R.S.
				22:1060.2(A)(1)(e). A health
				insurance issuer shall file a "Notice and Disclosure of Drug Formulary" form
				with the Department of Insurance as a part of its coverage documentation. The
				"Notice and Disclosure of Drug Formulary" shall contain all of the information
				enumerated in
				R.S.
				22:1060.2. A health insurance issuer shall
				submit this form for approval by the commissioner. Once the form is approved by
				the commissioner, the health insurance issuer shall only utilize said form. A
				health insurance issuer shall maintain written evidence such as a record,
				report or data compilation of enrollees who request disclosure or information
				about any specific drug that is included in a formulary. The written evidence
				such as a record, report, or data compilation shall include the name of the
				enrollee, the date of request, the date of response by the health insurance
				issuer and the specific drug requested. A health insurance issuer shall provide
				a copy of the written evidence such as a record, report or data compilation as
				described herein to the commissioner within 15 days of written request by the
				commissioner.
C. Notice that
				Enrollee Has Right to Continuation of Coverage Pursuant to
				R.S.
				22:1060.3. A health insurance issuer shall
				notify an enrollee as a part of coverage documentation that the enrollee shall
				have the right to continue the coverage of any prescription drug that was
				approved or covered by the health insurance issuer, and that the coverage of
				such prescription drug shall be at the contracted benefit level until the
				renewal of the enrollee's current plan. A health insurance issuer shall
				maintain written evidence such as a record, report or data compilation of
				enrollees who request continuation of coverage and the name of the specific
				drug. The written evidence such as a record, report, or data compilation shall
				include the name of the enrollee, the date of request, the date of response by
				the health insurance issuer and the name of the specific drug requested. A
				health insurance issuer shall provide a copy of the written evidence such as a
				record, report or data compilation as described herein to the commissioner
				within 15 days of written request by the commissioner.
D. Notice of Modification-Group Market
				Pursuant to
				R.S.
				22:1068(D)(3) and Individual
				Market Pursuant to
				R.S.
				22:1074(D)(3). A "Notice of
				Modification of Benefit Coverage or Drug Coverage of a Particular Product" form
				is required to contain the information required in
				R.S.
				22:1068(D)(3) and
				22:1074(D)(3).
				Such form used by a health insurance issuer shall be approved by the
				commissioner and no form may be used until approved by the commissioner. For
				group policies, such notice shall be delivered to the affected covered small
				group or large group employer and all enrollees at the last known address no
				later than the sixtieth day before any modification of benefit coverage or drug
				coverage of a particular product is to become effective. For individual
				policies, such notice shall be delivered to each affected individual at the
				last known address no later than the sixtieth day before any modification of
				benefit coverage or drug coverage of a particular product is to become
				effective.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  R.S.
				  22:1068(F) and
				  R.S.
				  22:1074(F).