Louisiana Revised Statutes 22:1205 – Plan of operation
Terms Used In Louisiana Revised Statutes 22:1205
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Benefits plan: means the coverages offered by the plan to eligible persons as defined by Louisiana Revised Statutes 22:1202
- Board: means the board of directors of the plan. See Louisiana Revised Statutes 22:1202
- Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1202
- Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
- Insurer: means any insurance company or other entity authorized to transact and transacting health and accident insurance business in this state. See Louisiana Revised Statutes 22:1202
- Plan: means the Louisiana Health Plan as created in Louisiana Revised Statutes 22:1202
- Plan of operation: means the plan of operation of the plan, including articles, bylaws, and operating rules, adopted by the board pursuant to Louisiana Revised Statutes 22:1202
A. The board shall submit to the commissioner a plan of operation for the plan and any amendments thereto necessary or suitable to assure the fair, reasonable, and equitable administration of the plan. The commissioner shall approve the plan of operation provided such is determined to be suitable to assure the fair, reasonable, and equitable administration of the plan.
B. The plan of operation shall become effective upon approval in writing by the commissioner. If the board fails to submit a suitable plan of operation within ninety days after its appointment or at any time thereafter fails to submit suitable amendments to the plan, the commissioner shall adopt and promulgate such reasonable rules and regulations, in accordance with the Administrative Procedure Act, as are necessary or advisable to effectuate the provisions of this Section. Such rules and regulations shall continue in force until modified by the commissioner or superseded by a plan submitted by the board and approved by the commissioner.
C. In its plan of operation the board shall:
(1) Establish procedures for the handling and accounting of assets and monies of the plan.
(2) Establish procedures for the payment of expenses incurred by an administering insurer in the performance of its services.
(3) Establish procedures for the reporting and remittance of charges assessed under La. Rev. Stat. 22:1209 to provide for claims paid under the benefits plan and for administrative expenses incurred for the operation of the plan.
(4) Develop and implement a program to publicize the existence of the benefits plan, the eligibility requirements, and procedures for enrollment of members, and to maintain public awareness of the benefits plan.
(5) Establish such other procedures for the operation of the plan to effectuate the purposes of this Subpart as the board in its discretion deems necessary and proper.
(6) Provide the details of the calculation of each participating insurer’s assessment.
(7) Repealed by Acts 2020, No. 313, §2, eff. June 12, 2020.
(8) The cessation plan approved and in effect on January 1, 2020, shall continue in effect until and unless the commissioner notifies the board in writing of his intent to exercise his authority under this Paragraph to reestablish the Louisiana Health Plan.
(9) Upon approval of the plan of operation provided for in La. Rev. Stat. 22:1203(E)(2), the board shall resume operations as provided for in that plan.
Acts 1990, No. 131, §1, eff. Sept. 1, 1990; Acts 1999, No. 163, §1; Redesignated from La. Rev. Stat. 22:235 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 123, §1, eff. June 8, 2010; Acts 2013, No. 325, §1, eff. June 17, 2013; Acts 2020, No. 313, §§1, 2, eff. June 12, 2020.
NOTE: Former La. Rev. Stat. 22:1205 redesignated as La. Rev. Stat. 22:1625 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.