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health care services rendered. Health care providers and/or health care professionals shall be deemed to have released, discharged and waived any and all rights to take any legal action or redress, either in person or via transfer, assignment or subrogation, to collect any unpaid amounts from insureds and/or health insurance issuers, HMOs, PPOs, MCOs, TPAs or any or all other health insurance entities doing business in Louisiana or regulated by the commissioner. Any violation by health care providers and/or health care professionals of this provision may be deemed an unfair trade practice under R.S. 22:250.41 et seq. and may be referred to the Louisiana Attorney General. The Louisiana Attorney General may pursue remedies as provided for in R.S. 51:1401 et seq.

AUTHORITY NOTE:Promulgated in accordance with Executive Order BJ 2008-93.

HISTORICAL NOTE:Promulgated by the Department of Insurance, Office of the Commissioner, LR 34:

§4513.Assuring Portability—Compliance

A.All health insurance issuers and HMOs shall maintain compliance with R.S. 22:250.1, et seq., titled Assuring Portability, Availability and Renewability of Health Insurance Coverage, and any applicable federal law.

AUTHORITY NOTE:Promulgated in accordance with Executive Order BJ 2008-93.

HISTORICAL NOTE:Promulgated by the Department of Insurance, Office of the Commissioner, LR 34:

§4515.Assuring Portability—Suspension

A.All health insurance issuers and HMOs shall maintain compliance with R.S. 22:250.1, et seq., titled Assuring Portability, Availability and Renewability of Health Insurance Coverage, except for the time periods enumerated in the §4515 shall be suspended during the pendency of Emergency Rule 25. All such notices required in §4515.A-D must be reissued de novo on October 1, 2008.

1.The HIPAA portability provisions generally provide that a group health plan or group health insurance issuer may disregard a period of creditable coverage if there is a subsequent 63-day break in coverage.
2.Also, a newborn, adopted child, or child placed for adoption may not be subject to a preexisting condition exclusion period if covered under creditable coverage within 30 days of birth, adoption, or placement for adoption.
3.The HIPAA special enrollment provisions generally provide that employees must request enrollment within 30 days of a special enrollment trigger (including loss of eligibility of coverage for loss of employer contributions) to be eligible for special enrollment.
4.The HIPAA certification rules prescribe time periods for the provision of certificates of creditable coverage upon loss of coverage. Under the regulations, plans and issuers subject to COBRA continuation coverage provisions are required to provide an automatic certificate no later than the time for providing a COBRA election notice. Plans and issuers not subject to COBRA are required to provide the automatic certificate within a reasonable time after coverage ceases.

AUTHORITY NOTE:Promulgated in accordance with Executive Order BJ 2008-93.

HISTORICAL NOTE:Promulgated by the Department of Insurance, Office of the Commissioner, LR 34:

§4517.Suspension of Cancellation, Nonrenewal, and Nonreinstatment Provisions

A.All cancellation, termination, nonrenewal and nonreinstatment provisions, including, but not limited to, R.S. 22:250.7, 22:250.13, 22:215.9, 22:213.3 and 22:2027 are hereby suspended. Additionally, all provisions of Emergency Rule 24 relating to notice of cancellation, termination, nonrenewal and nonreinstatement are incorporated herein by reference as if set forth herein in extenso.

AUTHORITY NOTE:Promulgated in accordance with Executive Order BJ 2008-93.

HISTORICAL NOTE:Promulgated by the Department of Insurance, Office of the Commissioner, LR 34:

§4519.Denying, Pending or Rejecting a Claim

A.The commissioner hereby suspends the right of denying, pending or rejecting a claim from any pharmacists or pharmacy for a 30 day supply of prescription medications, regardless of the date of the last refill. In furtherance of this suspension, health insurance issuers, HMOs, PPOs, MCOs, TPAs or any or all other health insurance entities doing business in Louisiana or regulated by the commissioner shall pay all such claims for reimbursement submitted by a pharmacist or pharmacy.

1.The commissioner hereby suspends any and all precertification or step-therapy procedures in order to fill a prescription. This authorization shall be for a thirty (30) day supply.
2.The commissioner hereby suspends any provisions in the Louisiana Insurance Code which place restrictions on replacement prescriptions pertaining to mail order prescriptions. Mail order prescriptions should be mailed to an alternate address if requested by the insured.
3.All health insurance issuers, HMOs, PPOs, MCOs, TPAs or any or all other health insurance entities doing business in Louisiana or regulated by the commissioner shall waive any and all restrictions relative to out-of-network access to pharmacy services or prescriptions.

AUTHORITY NOTE:Promulgated in accordance with Executive Order BJ 2008-93.

HISTORICAL NOTE:Promulgated by the Department of Insurance, Office of the Commissioner, LR 34:

§4521.Cancellation or Termination of Policy for Non-Payment

A.Health insurance issuers, HMOs, PPOs, MCOs, TPAs or any or all other health insurance entities doing business in Louisiana or regulated by the commissioner may pend a claim(s), as required pursuant Emergency Rule 25, and may subsequently cancel or terminate a policy only for non-payment of premium in accordance with the procedure set forth in Emergency Rule 24 and Emergency Rule 25.

AUTHORITY NOTE:Promulgated in accordance with Executive Order BJ 2008-93.

HISTORICAL NOTE:Promulgated by the Department of Insurance, Office of the Commissioner, LR 34:

§4523.Discount Billing

A.Those amounts representing coinsurance, copayments, deductibles, noncovered health care services or other amounts identified by the health insurance issuer, HMO, PPO, MCO, TPA or any or all other health insurance

Louisiana Register   Vol. 34, No. 10   October 20, 2008

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