Louisiana Revised Statutes 22:1836 – A. Coordination of benefits requirements adopted by health insurance issuers shall, at a minimum, adhere to the following requirements:
Terms Used In Louisiana Revised Statutes 22:1836
- Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1831
- coverage: means benefits consisting of health care services provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as health care services under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization agreement, or health maintenance organization contract offered by a health insurance issuer. See Louisiana Revised Statutes 22:1831
- insured: means an individual who is enrolled or insured by a health insurance issuer for health insurance coverage. See Louisiana Revised Statutes 22:1831
- issuer: means any entity that offers health insurance coverage through a policy, contract, or certificate of insurance subject to state law that regulates the business of insurance. See Louisiana Revised Statutes 22:1831
- person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
- provider: means :
(a) A physician or other health care practitioner licensed, certified, registered, or otherwise authorized to perform specified health care services consistent with state law. See Louisiana Revised Statutes 22:1831
A. Coordination of benefits requirements adopted by health insurance issuers shall, at a minimum, adhere to the following requirements:
(1) No plan shall contain a provision that its benefits are “always excess” or “always secondary” except in accordance with rules adopted by the commissioner pursuant to this Subpart.
(2) A coordination of benefits provision may not be used that permits a plan to reduce its benefits on the basis of any of the following:
(a) That another plan exists and the covered person did not enroll in the plan.
(b) That a person is or could have been covered under another plan, except with respect to Part B of Medicare.
(c) That a person has elected an option under another plan providing a lower level of benefits than another option that could have been elected.
(3) A coordination of benefits provision shall not be used that permits a plan to pend, delay, or deny payment to a healthcare provider for rendered healthcare services solely on the basis of the insured‘s failure to provide the health insurance issuer notice of the existence of an additional plan or lack thereof. A contracted healthcare provider shall share with a plan any coordination of benefits information obtained by the provider from the insured.
B. The commissioner shall be authorized to adopt such reasonable regulations as necessary for determining the order of benefit payments when a person is covered by two or more plans of health insurance coverage.
Acts 1999, No. 1017, §1, eff. July 9, 1999; Redesignated from La. Rev. Stat. 22:250.36 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2022, No. 166, §1, eff. Jan. 1, 2023.