Louisiana Revised Statutes 22:271 – Enrollment application; required statement; annual notification and disclosure of information
Terms Used In Louisiana Revised Statutes 22:271
- Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:242
- Enrollee: means an individual who is enrolled in a health maintenance organization. See Louisiana Revised Statutes 22:242
- Health maintenance organization: means any corporation organized as either a business corporation or a nonprofit corporation and domiciled in this state which undertakes to provide or arrange for the provision of basic health care services to enrollees in return for a prepaid charge. See Louisiana Revised Statutes 22:242
- Provider: means any physician, hospital, or other person, organization, institution, or group of persons licensed or otherwise authorized in this state to furnish health care services. See Louisiana Revised Statutes 22:242
- Subscriber: means the person who is responsible for payment to a health maintenance organization or whose employment or other status, except for family dependence, is the basis for eligibility for enrollment in the health maintenance organization. See Louisiana Revised Statutes 22:242
A. Every application for enrollment in a health maintenance organization shall contain the following statement conspicuously displayed on the front of such application in at least ten point bold-face capital letters:
“NOTICE – YOU MUST PERSONALLY BEAR ALL COSTS IF YOU UTILIZE HEALTH CARE NOT AUTHORIZED BY THIS PLAN OR PURCHASE DRUGS WHICH ARE NOT AUTHORIZED BY THIS PLAN.”
B. The commissioner shall assess a penalty if he determines that a health maintenance organization’s enrollment application or annual notices do not contain the language required in this Section. Any insurer violation of this Section shall be considered an unfair trade practice and subject to the penalties provided for under La. Rev. Stat. 22:1969.
C. Every subscriber and enrollee shall at the time of enrollment and annually thereafter be provided with a written notice which fully explains copayment and deduction amounts applicable to each covered service. Any separate deductible amounts shall be fully disclosed. The written notice shall be printed in ten-point or larger type and shall outline any limitations on the choice of primary care physicians, access to specialists, and application of preexisting medical condition exclusions from coverage.
D. Every subscriber, enrollee, and participating provider shall be provided with an annual plan notification statement which provides:
(1) A listing of compensation mechanisms utilized to pay providers including incentive arrangements.
(2) A description of the services or treatments which will be covered under the plan.
(3) A statement regarding the coverage of experimental treatments.
(4) A statement regarding the coverage of prescription drugs. Such statement shall include the procedure used for adding or deleting coverage of specific prescribed drugs.
Acts 1989, No. 695, §1, eff. Jan 1, 1990; Acts 1997, No. 238, §1, eff. June 16, 1997; Redesignated from La. Rev. Stat. 22:2026 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.