Louisiana Revised Statutes 42:802.1 – Benefit plans for provision of coverage through a fully insured product provided by a health maintenance organization domiciled in Louisiana
Terms Used In Louisiana Revised Statutes 42:802.1
- Contract: A legal written agreement that becomes binding when signed.
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- office: means the Office of Group Benefits created in this Section. See Louisiana Revised Statutes 42:801
A. In the development of contracts for health insurance plans intended to be offered in each of the office‘s regions, the office shall utilize a solicitation for proposals or other competitive process to determine whether there exists a Louisiana HMO which is licensed and authorized to sell insurance in that region. In the event that a Louisiana HMO submits a competitive offer, proposal, bid, or other response to such solicitation, then the office shall include that Louisiana HMO in its plan of benefits for that region. However, if more than three different Louisiana HMOs submit competitive offers, proposals, or bids for a region, then the office shall select at least three Louisiana HMOs for inclusion in the plan of benefits for that region. The selection shall be based on a comparison of the quotes of each competitor for coverage of an active single insured which have been adjusted to an actuarially equivalent basis.
B. The contract between the office and a Louisiana HMO or any other insurer with respect to inclusion of its insurance products in the office’s plan of benefits for a region shall contain terms which provide for equal employer contributions. With respect to insureds who select a Louisiana HMO for their coverage, there shall be no extraordinary restrictions placed on their plan participation due to their selection of the Louisiana HMO.
C. As used in this Section, the term “Louisiana HMO” means a health maintenance organization which meets all of the following criteria:
(1) Offers fully insured commercial and/or Medicare Advantage products.
(2) Is domiciled, licensed, and operating within the state.
(3) Maintains its primary corporate office and at least seventy percent of its employees in the state.
(4) Maintains within the state its core business functions which include utilization review services, claim payment processes, customer service call centers, enrollment services, information technology services, and provider relations.
D. The provisions of this Section shall apply to all plan years beginning with Fiscal Year 2007-2008.
E. No provision of this Section shall require the Office of Group Benefits to utilize any insurance product that increases costs to the plan of benefits as determined by the independent actuarial process, all parties being represented. The comparison shall be based on at least twelve months experience beginning no earlier than January 1, 2008. All reasonable cost for the independent actuary shall be the responsibility of the health insurance provider which is the subject of such actuarial determination and not the Office of Group Benefits. The Office of Group Benefits shall arrange for this comparison and future comparisons at no more frequent intervals than annually.
Acts 2007, No. 479, §1, eff. July 19, 2007.
NOTE: See Acts 2007, No. 479, §2, regarding extraordinary or additional employee enrollment period for FY 2007-2008.