Health Maintenance Organization plans for all individual and group policyholder types
Excess / Stop-Loss Insurance Products
All types of Excess / Stop-Loss Insurance Products falling under definition of Health & Accident Insurance
Blanket Group Plans
Blanket Group plans for Limited Benefit coverage only
Health Maintenance Organization
Long Term Care
Long Term Care insurance for all individual and group policyholder types
Major Medical plans for all individual and group policyholder contract types (including Blanket Group)
Limited Benefit Plans
Limited Benefit plans for all individual and group policyholder contract types (except Blanket group)
Primary Types of Health Insurance
Explains the primary coverage types and primary policyholder types for health insurance products
Major Medical Plans
HEALTH INSURANCE PRODUCT CODES
Insurance of human beings against bodily injury, disablement, or death by accidental means. Benefits are provided in the form of cash payments rather than services. H-Ind
PRIMARY SUBTYPES:MAJOR MEDICAL - Insurance coverage of hospital, surgical and medical expenses for both in-patient and out-patient services. Hospital Surgical Medical Expense Plans offer limited benefits for out-patient services.
LIMITED BENEFIT PLANS - Insurance providing benefits for diagnosis and treatment of specifically named health related perils. Benefits may be paid as expense incurred, per diem, or a principle sum. Also includes Medicare supplement and select plans, designed to help fill the "gaps" in protections granted by the federal Medicare program.
LONG TERM CARE - Insurance providing coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital. Also includes Nursing Home and Home Health Care policies.
Health Maintenance Organizations provide or arrange for the provision of basic and other health care services through a network of medical providers to enrollees residing within a defined service area in return for a prepaid charge, negotiated rate or discounted fee.
H-Hmo
Health and Accident insurance covering the losses of an insured above a specific amount or a self-insurer for losses over a stated amount. H-ESL
Association Group for Individual Members
Group health and accident insurance issued to an organization that has been legally formed and is being maintained under a constitution and by-laws for purposes other than the procurement of insurance, providing coverage to one or more individual members, with or without eligible dependents.
H-Ind01
PRIMARY TYPES OF HEALTH INSURANCE POLICYHOLDERS
Health Maintenance Organization
Excess Stop-Loss
PRIMARY TYPES OF HEALTH INSURANCE
Health & Accident Indemnity
Individual Family Group
Individual policies of health and accident insurance covering any one person, with or without any eligible family members including spouse, unmarried children under 21 years of age, and grandchildren who are in the legal custody of and residing with the grandparent under 21 years of age or, in the case of full-time students, unmarried children and grandchildren under the age of 24.
H-Ind02
Association Group for Employer Members
Group health and accident insurance issued to an organization that has been actively in existence for at least five years, legally formed and maintained in good faith under a constitution and by-laws for purposes other than the procurement of insurance, providing coverage to the employees of one or more member employers. Membership may not be conditioned upon any health status-related factor, coverage must be available to all employees and other individuals eligible for coverage through a member employer, and coverage may not be available other than in connection with a member employer.
H-Ind03
Multiple Employer Trust
Group health and accident insurance issued to the trustees of a fund established by two or more employers in the same industry, by one or more labor unions, or by a bona-fide association of employer members to insure employees and members with or without any eligible family members.
H-Ind04
Single Employer Group Group health and accident insurance issued to a single employer to insure employees with or without any eligible family members. H-Ind05
Blanket Group Plans Health and Accident Insurance issued to special groups of persons. H-Ind07
Association Group for Individual Members
HMO coverage issued to an organization that has been legally formed and is being maintained under a constitution and by-laws for purposes other than the procurement of insurance, providing coverage to one or more individual members with or without eligible dependents.
H-Hmo01
Individual Family Group
HMO coverage issued to any one person, with or without any eligible family members including spouse, unmarried children under 21 years of age, and grandchildren who are in the legal custody of and residing with the grandparent under 21 years of age or, in the case of full-time students, unmarried children and grandchildren under the age of 24.
H-Hmo02
Association Group for Employer Members
Group HMO coverage issued to an organization that has been actively in existence for at least five years, legally formed and maintained in good faith under a constitution and by-laws for purposes other than the procurement of insurance, providing coverage to the employees of one or more member employers. Membership may not be conditioned upon any health status-related factor, coverage must be available to all employees and other individuals eligible for coverage through a member employer, and coverage may not be available other than in connection with a member employer.
H-Hmo03
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Multiple Employer Trust
HMO Plan issued to the trustees of a fund established by two or more employers in the same industry or by one or more labor unions to insure employees or members with or without any eligible family members.
H-Hmo04
Single Employer Group HMO Plan issued to a single employer to insure employees with or without any eligible family members. H-Hmo05
Excess Stop Loss / Self-Funded Employer
Excess or Stop-Loss insurance intended for issue to cover losses of an employer sponsored, self-funded group health plan. H-ESL01
Excess Stop Loss / Self-Ins Plan
Group Excess or Stop-Loss insurance issued to a self-insurer authorized to make, provide or issue a self-insurance plan in Louisiana, including both aggregate and specific coverage and provisions to cover incurred, unpaid claims liability in the event of plan termination or insolvency.
H-ESL02
Excess Stop Loss / Provider -Managed Care
Excess or Stop-Loss insurance intended for issue to protect health care providers from a portion of the financial risk assumed in managed care contracts. H-ESL03
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Policyholder Types PRODUCT NAMES MAJOR MEDICAL PRODUCT DESCRIPTIONS LA DOI Product
Codes
Major MedicalMajor Medical Plan issued to Individual Members of an Association - Insurance coverage of hospital, surgical and medical expenses for both in-patient and out-patient services.
H-Ind01.MM-01
Major Medical / PPO
Major Medical PPO Plan issued to Individual Members of an Association - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind01.MM-02
Major Medical / POS Major Medical POS Plan issued to Individual Members of an Assn - Includes the option of seeking covered services at the point-of-service. H-Ind01.MM-03
Hospital Surgical Medical Expense
Hospital Surgical and Medical Expense Plan issued to Individual Members of an Assn - Insurance coverage of hospital, surgical and medical expenses for in-patient services and with limited benefits for out-patient services.
H-Ind01.MM-04
Hospital Surgical Medical Expense / PPO
Hospital Surgical and Medical Expense PPO Plan issued to Individual Members of an Assn - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind01.MM-05
Hospital Surgical Medical Expense / POS
Hospital Surgical and Medical Expense POS Plan issued to Individual Members of an Assn - Includes the option of seeking covered services at the point-of-service.
H-Ind01.MM-06
Major MedicalMajor Medical Plan issued to an Individual Family Group - Insurance coverage of hospital, surgical and medical expenses for both in-patient and out-patient services.
H-Ind02.MM-01
Major Medical / PPO
Major Medical PPO Plan issued to an Individual Family Group - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind02.MM-02
Major Medical / POS Major Medical POS Plan issued to an Individual Family Group - Includes the option of seeking covered services at the point-of-service. H-Ind02.MM-03
Hospital Surgical Medical Expense
Hospital Surgical Medical Expense Plan issued to an Individual Family Group - Insurance coverage of hospital, surgical and medical expenses for in-patient services and with limited benefits for out-patient services.
H-Ind02.MM-04
Indi
vidu
al F
amily
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upA
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for I
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idua
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bers
Policyholder Types PRODUCT NAMES MAJOR MEDICAL PRODUCT DESCRIPTIONS LA DOI Product
Codes
Hospital Surgical Medical Expense / PPO
Hospital Surgical Medical Expense PPO Plan issued to an Individual Family Group - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind02.MM-05
Hospital Surgical Medical Expense / POS
Hospital Surgical Medical Expense POS Plan issued to an Individual Family Group - Includes the option of seeking covered services at the point-of-service.
H-Ind02.MM-06
ConversionMajor Medical or Hospital Surgical Medical Expense Plan issued to an Individual Family Group under a guaranteed issue right to convert from group health and accident insurance coverage for specified reasons.
H-Ind02.MM-07
Short Term Health Plan
Major Medical or Hospital Surgical Medical Expense Plan issued to an Individual Family Group for a period of no more than six months. The policy is generally designed to provide insurance during a "gap" in coverage and is not renewable.
H-Ind02.ST
Short Term Major Medical
Major Medical Plan issued to an Individual Family Group for a period of no more than six months. The policy is generally designed to provide insurance during a "gap" in coverage and is not renewable.
H-Ind02.ST-01
Short Term Hospital Surgical Medical Expense
Hospital Surgical Medical Expense Plan issued to an Individual Family Group for a period of no more than six months. The policy is generally designed to provide insurance during a "gap" in coverage and is not renewable.
H-Ind02.ST-02
Major Medical / Any Size Group
Major Medical Plan issued to Employer Members of a Bona Fide Association who employ any number of employees. H-Ind03.MM-01
Major Medical / Small Group Only
Major Medical Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees. H-Ind03.MM-01A
Major Medical / Large Group Only
Major Medical Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees. H-Ind03.MM-01B
Major Medical / PPO - Any Size Group
Major Medical PPO Plan issued to Employer Members of a Bona Fide Association who employ any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind03.MM-02
Indi
vidu
al F
amily
Gro
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ssoc
iatio
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roup
for E
mpl
oyer
Mem
bers
Policyholder Types PRODUCT NAMES MAJOR MEDICAL PRODUCT DESCRIPTIONS LA DOI Product
Codes
Major Medical / PPO - Small Group Only
Major Medical PPO Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind03.MM-02A
Major Medical / PPO - Large Group Only
Major Medical PPO Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind03.MM-02B
Major Medical / POS - Any Size Group
Major Medical POS Plan issued to Employer Members of a Bona Fide Association who employ any number of employees - Includes the option of seeking covered services at the point-of-service.
H-Ind03.MM-03
Major Medical / POS - Small Group Only
Major Medical POS Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.
H-Ind03.MM-03A
Major Medical / POS - Large Group Only
Major Medical POS Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.
H-Ind03.MM-03B
Major Medical / High Deductible Reimbursement Acct - Any Size Grp
Major Medical Plan issued to Employer Members of a Bona Fide Association who employ any number of employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.
H-Ind03.MM-04
Major Medical / High Deductible Reimbursement Acct - Small Group Only
Major Medical Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.
H-Ind03.MM-04A
Major Medical / High Deductible Reimbursement Acct - Large Group Only
Major Medical Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.
H-Ind03.MM-04B
Hospital Surgical Medical Expense / Any Size Group
Hospital Surgical Medical Expense Plan issued to Employer Members of a Bona Fide Association who employ any number of employees. H-Ind03.MM-05
Hospital Surgical Medical Expense / Small Group Only
Hospital Surgical Medical Expense Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees.
H-Ind03.MM-05A
Ass
ocia
tion
Gro
up fo
r Em
ploy
er M
embe
rs
Policyholder Types PRODUCT NAMES MAJOR MEDICAL PRODUCT DESCRIPTIONS LA DOI Product
CodesHospital Surgical Medical Expense / Large Group Only
Hospital Surgical Medical Expense Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees. H-Ind03.MM-05B
Hospital Surgical Medical Expense / PPO - Any Size Group
Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Bona Fide Association who employ any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind03.MM-06
Hospital Surgical Medical Expense / PPO - Small Group Only
Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind03.MM-06A
Hospital Surgical Medical Expense / PPO - Large Group Only
Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind03.MM-06B
Hospital Surgical Medical Expense / POS - Any Size Group
Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Bona Fide Association who employ any number of employees - Includes the option of seeking covered services at the point-of-service.
H-Ind03.MM-07
Hospital Surgical Medical Expense / POS - Small Group Only
Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.
H-Ind03.MM-07A
Hospital Surgical Medical Expense / POS - Large Group Only
Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.
H-Ind03.MM-07B
Major Medical / Any Size Group
Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees. H-Ind04.MM-01
Major Medical / Small Group Only
Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees. H-Ind04.MM-01A
Major Medical / Large Group Only
Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees. H-Ind04.MM-01B
Ass
ocia
tion
Gro
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r Em
ploy
er M
embe
rs
Policyholder Types PRODUCT NAMES MAJOR MEDICAL PRODUCT DESCRIPTIONS LA DOI Product
Codes
Major Medical / PPO - Any Size Group
Major Medical PPO Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind04.MM-02
Major Medical / PPO - Small Group Only
Major Medical PPO Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind04.MM-02A
Major Medical / PPO - Large Group Only
Major Medical PPO Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind04.MM-02B
Major Medical / POS - Any Size Group
Major Medical POS Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees - Includes the option of seeking covered services at the point-of-service.
H-Ind04.MM-03
Major Medical / POS - Small Group Only
Major Medical POS Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.
H-Ind04.MM-03A
Major Medical / POS - Large Group Only
Major Medical POS Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.
H-Ind04.MM-03B
Major Medical / High Deductible Reimbursement Acct - Any Size Grp
Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.
H-Ind04.MM-04
Major Medical / High Deductible Reimbursement Acct - Small Group Only
Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.
H-Ind04.MM-04A
Major Medical / High Deductible Reimbursement Acct - Large Group Only
Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.
H-Ind04.MM-04B
Mul
tiple
Em
ploy
er T
rust
Policyholder Types PRODUCT NAMES MAJOR MEDICAL PRODUCT DESCRIPTIONS LA DOI Product
CodesHospital Surgical Medical Expense / Any Size Group
Hospital Surgical Medical Expense Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees. H-Ind04.MM-05
Hospital Surgical Medical Expense / Small Group Only
Hospital Surgical Medical Expense Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees.
H-Ind04.MM-05A
Hospital Surgical Medical Expense / Large Group Only
Hospital Surgical Medical Expense Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees. H-Ind04.MM-05B
Hospital Surgical Medical Expense / PPO - Any Size Group
Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind04.MM-06
Hospital Surgical Medical Expense / PPO - Small Group Only
Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind04.MM-06A
Hospital Surgical Medical Expense / PPO - Large Group Only
Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind04.MM-06B
Hospital Surgical Medical Expense / POS - Any Size Group
Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees - Includes the option of seeking covered services at the point-of-service.
H-Ind04.MM-07
Hospital Surgical Medical Expense / POS - Small Group Only
Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.
H-Ind04.MM-07A
Hospital Surgical Medical Expense / POS - Large Group Only
Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.
H-Ind04.MM-07B
Major Medical / Any Size Group
Major Medical Plan issued to an Employer who employs any number of employees. H-Ind05.MM-01
Mul
tiple
Em
ploy
er T
rust
Policyholder Types PRODUCT NAMES MAJOR MEDICAL PRODUCT DESCRIPTIONS LA DOI Product
CodesMajor Medical / Small Group Only
Major Medical Plan issued to an Employer who employs at least two but not more than fifty employees. H-Ind05.MM-01A
Major Medical / Large Group Only
Major Medical Plan issued to an Employer who employs at least fifty-one employees. H-Ind05.MM-01B
Major Medical / PPO - Any Size Group
Major Medical PPO Plan issued to an Employer who employs any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind05.MM-02
Major Medical / PPO - Small Group Only
Major Medical PPO Plan issued to an Employer who employs at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind05.MM-02A
Major Medical / PPO - Large Group Only
Major Medical PPO Plan issued to an Employer who employs at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind05.MM-02B
Major Medical / POS - Any Size Group
Major Medical POS Plan issued to an Employer who employs any number of employees - Includes the option of seeking covered services at the point-of-service.
H-Ind05.MM-03
Major Medical / POS - Small Group Only
Major Medical POS Plan issued to an Employer who employs at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.
H-Ind05.MM-03A
Major Medical / POS - Large Group Only
Major Medical POS Plan issued to an Employer who employs at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.
H-Ind05.MM-03B
Major Medical / High Deductible Reimbursement Acct - Any Size Grp
Major Medical Plan issued to an Employer who employs any number of employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.
H-Ind05.MM-04
Major Medical / High Deductible Reimbursement Acct - Small Group Only
Major Medical Plan issued to an Employer who employs at least two but not more than fifty employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.
H-Ind05.MM-04A
Major Medical / High Deductible Reimbursement Acct - Large Group Only
Major Medical Plan issued to an Employer who employs at least fifty-one employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.
H-Ind05.MM-04B
Sing
le E
mpl
oyer
Gro
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Policyholder Types PRODUCT NAMES MAJOR MEDICAL PRODUCT DESCRIPTIONS LA DOI Product
CodesHospital Surgical Medical Expense / Any Size Group
Hospital Surgical Medical Expense Plan issued to an Employer who employs any number of employees. H-Ind05.MM-05
Hospital Surgical Medical Expense / Small Group Only
Hospital Surgical Medical Expense Plan issued to an Employer who employs at least two but not more than fifty employees. H-Ind05.MM-05A
Hospital Surgical Medical Expense / Large Group Only
Hospital Surgical Medical Expense Plan issued to an Employer who employs at least fifty-one employees. H-Ind05.MM-05B
Hospital Surgical Medical Expense / PPO - Any Size Group
Hospital Surgical Medical Expense PPO Plan issued to an Employer who employs any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind05.MM-06
Hospital Surgical Medical Expense / PPO - Small Group Only
Hospital Surgical Medical Expense PPO Plan issued to an Employer who employs at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind05.MM-06A
Hospital Surgical Medical Expense / PPO - Large Group Only
Hospital Surgical Medical Expense PPO Plan issued to an Employer who employs at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.
H-Ind05.MM-06B
Hospital Surgical Medical Expense / POS - Any Size Group
Hospital Surgical Medical Expense POS Plan issued to an Employer who employs any number of employees - Includes the option of seeking covered services at the point-of-service.
H-Ind05.MM-07
Hospital Surgical Medical Expense / POS - Small Group Only
Hospital Surgical Medical Expense POS Plan issued to an Employer who employs at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.
H-Ind05.MM-07A
Hospital Surgical Medical Expense / POS - Large Group Only
Hospital Surgical Medical Expense POS Plan issued to an Employer who employs at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.
H-Ind05.MM-07B
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Gro
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Policyholder Types PRODUCT NAMES MAJOR MEDICAL PRODUCT DESCRIPTIONS LA DOI Product
Codes
Major Medical
Major Medical Plan issued to a college, school, or other institution of learning or to the head or principal thereof, covering students or teachers for hospital, surgical and medical expenses for both in-patient and out-patient services.
H-Ind07.ST-01
Hospital Surgical Medical Expense
Hospital Surgical Medical Expense Plan issued to a college, school, or other institution of learning or to the head or principal thereof, covering students or teachers for hospital, surgical and medical expenses for in-patient services and with limited benefits for out-patient services
H-Ind07.ST-02
Bla
nket
Gro
up
Plan
s
Assn Group for Individual
Members
Individual Family Group
Assn Group for Employer
Members
Multiple Employer
Trust
Single Employer
Group
Specified Disease / Serious Illness
Health insurance providing benefits for diagnosis and treatment of specifically named disease or diseases. Benefits may be paid as expense incurred, per diem, or a principle sum.
H-Ind01.LB-01 H-Ind02.LB-01 H-Ind03.LB-01 H-Ind04.LB-01 H-Ind05.LB-01
Cancer
Health insurance providing benefits for losses related to the diagnosis and treatment of cancer only. Benefits may be paid as expense incurred, per diem, or a principle sum.
H-Ind01.LB-01A H-Ind02.LB-01A H-Ind03.LB-01A H-Ind04.LB-01A H-Ind05.LB-01A
Critical IllnessHealth insurance providing a principle sum of benefit following diagnosis of specifically named perils.
H-Ind01.LB-01B H-Ind02.LB-01B H-Ind03.LB-01B H-Ind04.LB-01B H-Ind05.LB-01B
HIV Indemnity
Health insurance providing benefits for losses resulting from occupational exposure and infection from the Human Immunodeficiency Virus. Benefits may include some form of occupational income replacement and may be paid as expense incurred, per diem, or a principle sum.
H-Ind01.LB-01C H-Ind02.LB-01C H-Ind03.LB-01C H-Ind04.LB-01C H-Ind05.LB-01C
Organ Transplant
Health insurance providing benefits for treatment related to human and/or non-human organ transplant. Benefits are specific to the delivery of care associated with the covered organ or tissue and may be paid as expense incurred, per diem, or a principle sum.
H-Ind01.LB-01D H-Ind02.LB-01D H-Ind03.LB-01D H-Ind04.LB-01D H-Ind05.LB-01D
Intensive Care
Health insurance providing a daily benefit for confinement in a qualified intensive care unit of a hospital. Benefits are specific to services delivered by the staff of a hospital intensive care unit and do not exceed a stated dollar amount per day.
H-Ind01.LB-01E H-Ind02.LB-01E H-Ind03.LB-01E H-Ind04.LB-01E H-Ind05.LB-01E
PRODUCT NAMES
LIMITED BENEFIT PLANS - PRODUCT DESCRIPTIONS
POLICYHOLDER TYPES & LA DOI PRODUCT CODES
Assn Group for Individual
Members
Individual Family Group
Assn Group for Employer
Members
Multiple Employer
Trust
Single Employer
Group
PRODUCT NAMES
LIMITED BENEFIT PLANS - PRODUCT DESCRIPTIONS
POLICYHOLDER TYPES & LA DOI PRODUCT CODES
Disability Income Plans
Health insurance providing compensation for a portion of income lost because of a disabling injury or illness, with different benefit levels for short term and long term disabilities.
H-Ind01.LB-02 H-Ind02.LB-02 H-Ind03.LB-02 H-Ind04.LB-02 H-Ind05.LB-02
Business Overhead Expense
Health insurance providing compensation for business expenses lost because of a disabling injury or illness.
H-Ind01.LB-02A H-Ind02.LB-02A H-Ind03.LB-02A H-Ind04.LB-02A H-Ind05.LB-02A
Short Term Disability
Health insurance providing compensation for a portion of income lost because of a disabling injury or illness, featuring a maximum benefit period from one to five years.
H-Ind01.LB-02B H-Ind02.LB-02B H-Ind03.LB-02B H-Ind04.LB-02B H-Ind05.LB-02B
Long Term Disability
Health insurance providing compensation for a portion of income lost because of a disabling injury or illness, featuring a maximum benefit period greater than five years and commonly extending to age 65 or the insured's lifetime.
H-Ind01.LB-02C H-Ind02.LB-02C H-Ind03.LB-02C H-Ind04.LB-02C H-Ind05.LB-02C
Disability Income / Other
Any other health insurance providing compensation for a portion of income lost because of a disabling injury or illness, not otherwise specified in this Matrix.
H-Ind01.LB-02Z H-Ind02.LB-02Z H-Ind03.LB-02Z H-Ind04.LB-02Z H-Ind05.LB-02Z
Dental
Health insurance providing benefits for routine dental examinations, preventive dental work and/or dental procedures necessary to treat tooth decay and diseases of the teeth and jaw.
H-Ind01.LB-03 H-Ind02.LB-03 H-Ind03.LB-03 H-Ind04.LB-03 H-Ind05.LB-03
Dental / Preferred Provider Organization Plan
Health insurance providing benefits for dental services through dentists participating with an insurer acting as a dental service contractor.
H-Ind01.LB-03A H-Ind02.LB-03A H-Ind03.LB-03A H-Ind04.LB-03A H-Ind05.LB-03A
Assn Group for Individual
Members
Individual Family Group
Assn Group for Employer
Members
Multiple Employer
Trust
Single Employer
Group
PRODUCT NAMES
LIMITED BENEFIT PLANS - PRODUCT DESCRIPTIONS
POLICYHOLDER TYPES & LA DOI PRODUCT CODES
Hospital Indemnity
Health insurance providing a fixed dollar amount in benefits for expenses incurred while confined to a hospital as a result of covered illness or injury. Benefits may be paid as fixed dollar amount per illness, injury or confinement; or as expense incurred with maximum limitations applied per illness, injury or confinement.
H-Ind01.LB-04 H-Ind02.LB-04 H-Ind03.LB-04 H-Ind04.LB-04 H-Ind05.LB-04
Accident Only
Health insurance providing benefits for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.
H-Ind01.LB-05 H-Ind02.LB-05 H-Ind03.LB-05 H-Ind04.LB-05 H-Ind05.LB-05
Vision
Health insurance providing benefits for eye care and eye care accessories. Coverage generally provides a stated dollar amount for annual eye examinations, glasses, contact lens and may include surgical benefits for injury or illness associated with the eye.
H-Ind01.LB-06 H-Ind02.LB-06 H-Ind03.LB-06 H-Ind04.LB-06 H-Ind05.LB-06
Prescription Drug
Prescription Drug Insurance Plan issued to Individual Members of an Assn - Health insurance providing coverage for the costs of drugs that are required by either state or federal law to be dispensed by prescription, excluding those drugs dispensed while confined in a hospital or extended care facility. Drugs for which prescriptions are not required by law may also be covered.
H-Ind01.LB-07 H-Ind02.LB-07 H-Ind03.LB-07 H-Ind04.LB-07 H-Ind05.LB-07
Accidental Death & Dismemberment
Health or life insurance providing a stated benefit in the event of death and/or dismemberment caused by an accident or specified kinds of accidents.
H-Ind01.LB-08 H-Ind02.LB-08 H-Ind03.LB-08 H-Ind04.LB-08 H-Ind05.LB-08
Limited Benefit / Other
Any other limited benefit health insurance not otherwise specified in this Matrix. H-Ind01.LB-49 H-Ind02.LB-49 H-Ind03.LB-49 H-Ind04.LB-49 H-Ind05.LB-49
Assn Group for Individual
Members
Individual Family Group
Assn Group for Employer
Members
Multiple Employer
Trust
Single Employer
Group
PRODUCT NAMES
LIMITED BENEFIT PLANS - PRODUCT DESCRIPTIONS
POLICYHOLDER TYPES & LA DOI PRODUCT CODES
Short Term Care
Health insurance providing benefits for periods of less than one year, covering medical and non-medical services rendered to ill, disabled, or infirm persons in their home; or for health related services in a nursing facility for the purpose of supporting frail, impaired elderly or other disabled adults who require continued care and attention.
H-Ind01.LB-50 H-Ind02.LB-50 H-Ind03.LB-50 H-Ind04.LB-50 H-Ind05.LB-50
Short Term Care / Home Health Care
Health insurance providing benefits for medical and non-medical services to ill, disabled, or infirm persons in their home for periods of less than one year.
H-Ind01.LB-50A H-Ind02.LB-50A H-Ind03.LB-50A H-Ind04.LB-50A H-Ind05.LB-50A
Short Term Care / Nursing Home Care
Health insurance providing benefits for health related services in a nursing facility for the purpose of supporting frail, impaired elderly or other disabled adults who require continued care and attention for periods of less than one year.
H-Ind01.LB-50B H-Ind02.LB-50B H-Ind03.LB-50B H-Ind04.LB-50B H-Ind05.LB-50B
Short Term Care / Adult Day Care
Health insurance providing coverage for social and health related services provided during the day in a community group setting for the purpose of supporting frail, impaired elderly or other disabled adults who benefit from care in a group setting outside the home.
H-Ind01.LB-50C H-Ind02.LB-50C H-Ind03.LB-50C H-Ind04.LB-50C H-Ind05.LB-50C
Champus / Tri-Care Supplement
A private health plan that provides beneficiaries of the Civilian Health and Medical Program of the Uniformed Services with supplemental health care coverage.
H-Ind02.LB-51
Assn Group for Individual
Members
Individual Family Group
Assn Group for Employer
Members
Multiple Employer
Trust
Single Employer
Group
PRODUCT NAMES
LIMITED BENEFIT PLANS - PRODUCT DESCRIPTIONS
POLICYHOLDER TYPES & LA DOI PRODUCT CODES
Medicare Supplement
Standardized health insurance plans designed to help fill the "gaps" in the protections granted by the federal Medicare program. It supplements reimbursements by Medicare by paying for Medicare's deductibles and co-payments and cannot duplicate any benefits provided by Medicare. It may also cover some services and expenses that are not covered by Medicare.
H-Ind01.MS-01 H-Ind02.MS-01
Medicare Select
A type of Medicare Supplement or "Medigap" insurance plan that restricts policyholder access to specific hospitals and possibly other medical providers within a defined network in order to receive full supplemental benefits.
H-Ind01.MS-01A H-Ind02.MS-01A
1 Assn Grp - Individual Members /
LTC
Individual Family
Group / LTC
1 Assn Group - Employer Member /
LTC
2 Multiple Employer
Trust / LTC
3 Single Employer
Group / LTC
4
Discretionary Group / LTC
Long Term Care /
Qualified
Long Term Care health insurance that meets federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.
H-Ind01.LTC-01
H-Ind02.LTC-01
H-Ind03.LTC-01
H-Ind04.LTC-01
H-Ind05.LTC-01
H-Ind06.LTC-01
Long Term Care / Non-Qualified
Long Term Care health insurance that does not meet federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.
H-Ind01.LTC-01A
H-Ind02.LTC-01A
H-Ind03.LTC-01A
H-Ind04.LTC-01A
H-Ind05.LTC-01A
H-Ind06.LTC-01A
Home Health Care /
Qualified
Long Term Care health insurance that meets federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a covered person's own home or adult day care setting. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.
H-Ind01.LTC-02
H-Ind02.LTC-02
H-Ind03.LTC-02
H-Ind04.LTC-02
H-Ind05.LTC-02
H-Ind06.LTC-02
PRODUCT NAMES
LONG TERM CARE INSURANCE PRODUCT
DESCRIPTONS
POLICYHOLDER TYPES & LA DOI PRODUCT CODES
1 Assn Grp - Individual Members /
LTC
Individual Family
Group / LTC
1 Assn Group - Employer Member /
LTC
2 Multiple Employer
Trust / LTC
3 Single Employer
Group / LTC
4
Discretionary Group / LTC
PRODUCT NAMES
LONG TERM CARE INSURANCE PRODUCT
DESCRIPTONS
POLICYHOLDER TYPES & LA DOI PRODUCT CODES
Home Health Care / Non-
Qualified
Long Term Care health insurance that does not meet federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a covered person's own home or adult day care setting. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.
H-Ind01.LTC-02A
H-Ind02.LTC-02A
H-Ind03.LTC-02A
H-Ind04.LTC-02A
H-Ind05.LTC-02A
H-Ind06.LTC-02A
Nursing Home Care /
Qualified
Long Term Care health insurance that meets federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services while the covered person is confined to a nursing home. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.
H-Ind01.LTC-03
H-Ind02.LTC-03
H-Ind03.LTC-03
H-Ind04.LTC-03
H-Ind05.LTC-03
H-Ind06.LTC-03
Nursing Home Care / Non-
Qualified
Long Term Care health insurance that does not meet federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services while the covered person is confined to a nursing home. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.
H-Ind01.LTC-03A
H-Ind02.LTC-03A
H-Ind03.LTC-03A
H-Ind04.LTC-03A
H-Ind05.LTC-03A
H-Ind06.LTC-03A
1 Assn Grp - Individual Members /
LTC
Individual Family
Group / LTC
1 Assn Group - Employer Member /
LTC
2 Multiple Employer
Trust / LTC
3 Single Employer
Group / LTC
4
Discretionary Group / LTC
PRODUCT NAMES
LONG TERM CARE INSURANCE PRODUCT
DESCRIPTONS
POLICYHOLDER TYPES & LA DOI PRODUCT CODES
Nursing Home & Home
Health Care / Qualified
Long Term Care health insurance that meets federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a covered person's own home, adult day care setting, or confined to a nursing home. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.
H-Ind01.LTC-04
H-Ind02.LTC-04
H-Ind03.LTC-04
H-Ind04.LTC-04
H-Ind05.LTC-04
H-Ind06.LTC-04
Nursing Home & Home
Health Care / Non-Qualified
Long Term Care health insurance that does not meet federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a covered person's own home, adult day care setting, or confined to a nursing home. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.
H-Ind01.LTC-04A
H-Ind02.LTC-04A
H-Ind03.LTC-04A
H-Ind04.LTC-04A
H-Ind05.LTC-04A
H-Ind06.LTC-04A
Long Term Care / Other
Long Term Care health insurance coverage not otherwise defined in this Matrix.
H-Ind01.LTC-99
H-Ind02.LTC-99
H-Ind03.LTC-99
H-Ind04.LTC-99
H-Ind05.LTC-99
H-Ind06.LTC-99
1 Assn Group - Individual or
Employer Member / LTC
Group Long Term Care insurance issued to a professional, trade, or occupational association legally formed and maintained under a constitution and by-laws for purposes other than the procurement of insurance. Additionally, the association: 1) must have had an active existence for at least one year; 2) at the outset, must have a minimum of one hundred members; 3) must hold regular meetings not less than annually to further the purposes of the members; 4) must collect dues or solicit contributions from members other than members of credit unions; 5) members must have voting privileges and representation on the governing board and committees; 6) must make coverage available to employees of members, all of whom are or were actively engaged in the same profession, trade or occupation.
1 Assn Grp - Individual Members /
LTC
Individual Family
Group / LTC
1 Assn Group - Employer Member /
LTC
2 Multiple Employer
Trust / LTC
3 Single Employer
Group / LTC
4
Discretionary Group / LTC
PRODUCT NAMES
LONG TERM CARE INSURANCE PRODUCT
DESCRIPTONS
POLICYHOLDER TYPES & LA DOI PRODUCT CODES
2 Multiple Employer
Trust / LTC3 Single Emp Group / LTC
4 Discretionary Group / LTC
Group Long Term Care insurance issued to the trustees of a fund established by two or more employers or labor organizations, or a combination thereof, for employees or former employees or a combination thereof or for members or former members or a combination thereof, of the labor organizations.
Group Long Term Care insurance issued to an Employer to cover employees or former employees or a combination thereof.
Group Long Term Care insurance issued to a group determined by the Commissioner to be in the best interest of the public, would result in economies of acquisition or administration, and providing benefits that are reasonable in relation to the premiums charged.
Policyholder Types
PRODUCT NAMES
BLANKET GROUP - LIMITED BENEFIT PLANS PRODUCT DESCRIPTIONS
LA DOI Product Codes
Hospital Indemnity
Hospital Indemnity Insurance Plan issued to a college, school, or other institution of learning or to the head or principal thereof, providing a fixed dollar amount in benefits to students or teachers for expenses incurred while confined to a hospital as a result of covered illness or injury. Benefits may be paid as fixed dollar amount per illness, injury or confinement; or as expense incurred with maximum limitations applied per illness, injury or confinement.
H-Ind07.ST-03
Accident Only
Accident Only Insurance Plan issued to a college, school, or other institution of learning or to the head or principal thereof, providing benefits to passengers for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.
H-Ind07.ST-04
Limited Benefit / Other
Limited Benefit Health and Accident Insurance Plan issued to a college, school, or other institution of learning or to the head or principal thereof, covering students or teachers, that is not otherwise defined in this Matrix.
H-Ind07.ST-05
Credit Disability Income
Insurance providing monthly loan payments to the creditor/policyholder upon disablement of an insured debtor. H-Ind07.CR-01
Credit / Other Health and Accident Insurance Plan issued to a creditor, that is not otherwise defined in this Matrix. H-Ind07.CR-02
Accident OnlyAccident Only Insurance Plan issued to a common carrier, providing benefits to passengers for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.
H-Ind07.PCC-01
Common Carrier / Other
Health and Accident Insurance Plan issued to a common carrier, that is not otherwise defined in this Matrix. H-Ind07.PCC-02
Accident OnlyAccident Only Insurance Plan issued to an employer, providing benefits to employees, defined by reference to exceptional hazards, for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.
H-Ind07.EEH-01
Employer - Exceptional Hazards / Other
Health and Accident Insurance Plan issued to an employer, providing benefits to employees, defined by reference to exceptional hazards, that is not otherwise defined in this Matrix.
H-Ind07.EEH-02
Accident OnlyAccident Only Insurance Plan issued to a volunteer fire department, first aid, or other such volunteer group, for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.
H-Ind07.VFD-01
Bla
nket
Gro
up /
Volu
ntee
r Fire
D
ept
Bla
nket
Gro
up /
Pass
enge
rs -
Com
mon
C
arrie
r
Bla
nket
Gro
up
/ Em
ploy
er -
Exce
ptio
nal
Haz
ards
Bla
nket
Gro
up /
Stud
ents
& T
each
ers
Bla
nket
G
roup
/ C
redi
t
Policyholder Types
PRODUCT NAMES
BLANKET GROUP - LIMITED BENEFIT PLANS PRODUCT DESCRIPTIONS
LA DOI Product Codes
Volunteer Fire Dept / Other
Health and Accident Insurance Plan issued to a volunteer fire department, first aid, or other such volunteer group, providing benefits to employees, defined by reference to exceptional hazards, that is not otherwise defined in this Matrix.
H-Ind07.VFD-02
Accident Only
Accident Only Insurance Plan issued to a group, determined by the Commissioner to be subject to the issuance of a blanket health and accident policy, for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.
H-Ind07.DG-01
Discretionary Group / Other
Health and Accident Insurance Plan issued to a group, determined by the Commissioner to be subject to the issuance of a blanket health and accident policy, that is not otherwise defined in this Matrix.
H-Ind07.DG-02
Bla
nket
Gro
up /
Volu
ntee
r Fire
D
ept
Bla
nket
Gro
up /
Dis
cret
iona
ry G
roup
Policyholder Types
PRODUCT NAMES
HEALTH MAINTENANCE ORGANIZATION PRODUCT DESCRIPTIONS
LA DOI Product Code
HMO / In-Network Only Plan
HMO Plan issued to Individual Members of an Association providing or arranging for the provision of basic and other health care services only through medical providers participating in the HMO's network of health care providers.
H-Hmo01.INO
HMO / PPO Option
HMO Plan issued to Individual Members of an Association with an incentive to receive covered services through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.
H-Hmo01.PPO
HMO / POS Option HMO Plan issued to Individual Members of an Association which includes the option of seeking covered services at the point-of-service. H-Hmo01.POS
HMO / In-Network Only Plan
HMO Plan issued to Individual Family Groups, providing or arranging for the provision of basic and other health care services only through medical providers participating in the HMO's network of health care providers.
H-Hmo02.INO
HMO / PPO Option
HMO Plan issued to Individual Family Groups with an incentive to receive covered services through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.
H-Hmo02.PPO
HMO / POS Option HMO Plan issued to Individual Family Groups which includes the option of seeking covered services at the point-of-service. H-Hmo02.POS
HMO / Conversion HMO Plan issued to an Individual Family Group under a guaranteed issue right to convert from group HMO coverage for specified reasons. H-Hmo02.Con
HMO / In-Network Only Plan - Any
Size Group
HMO Plan issued to Employer Members of a Bona Fide Association who employ any number of employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.
H-Hmo03.INO-01
HMO / In-Network Only Plan - Small
Group Only
HMO Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.
H-Hmo03.INO-01A
Indi
vidu
al F
amily
Gro
up /
HM
OA
ssoc
iatio
n G
roup
- Em
ploy
er M
embe
r / H
MO
Ass
ocia
tion
Gro
up -
Indi
vidu
al M
embe
rs /
HM
O
Policyholder Types
PRODUCT NAMES
HEALTH MAINTENANCE ORGANIZATION PRODUCT DESCRIPTIONS
LA DOI Product Code
HMO / In-Network Only Plan - Large
Group Only
HMO Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.
H-Hmo03.INO-01B
HMO / Preferred Provider
Organization Option - Any Size
Group
HMO Plan issued to Employer Members of a Bona Fide Association who employ any number of employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.
H-Hmo03.PPO-01
HMO / Preferred Provider
Organization Option - Small
Group Only
HMO Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.
H-Hmo03.PPO-01A
HMO / Preferred Provider
Organization Option - Large
Group Only
HMO Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.
H-Hmo03.PPO-01B
HMO / Point of Service Option - Any Size Group
HMO Plan issued to Employer Members of a Bona Fide Association who employ any number of employees, which includes the option of seeking covered services at the point-of-service.
H-Hmo03.POS-01
HMO / Point of Service Option -
Small Group Only
HMO Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees, which includes the option of seeking covered services at the point-of-service.
H-Hmo03.POS-01A
HMO / Point of Service Option -
Large Group Only
HMO Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees, which includes the option of seeking covered services at the point-of-service.
H-Hmo03.POS-01B
HMO / In-Network Only Plan - Any
Size Group
HMO Plan issued to Employers participating in a Multiple Employer Trust who employ any number of employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.
H-Hmo04.INO-01
Ass
ocia
tion
Gro
up -
Empl
oyer
Mem
ber /
HM
O
Policyholder Types
PRODUCT NAMES
HEALTH MAINTENANCE ORGANIZATION PRODUCT DESCRIPTIONS
LA DOI Product Code
HMO / In-Network Only Plan - Small
Group Only
HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least two but not more than fifty employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.
H-Hmo04.INO-01A
HMO / In-Network Only Plan - Large
Group Only
HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least fifty-one employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.
H-Hmo04.INO-01B
HMO / Preferred Provider
Organization Option - Any Size
Group
HMO Plan issued to Employers participating in a Multiple Employer Trust who employ any number of employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.
H-Hmo04.PPO-01
HMO / Preferred Provider
Organization Option - Small
Group Only
HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least two but not more than fifty employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.
H-Hmo04.PPO-01A
HMO / Preferred Provider
Organization Option - Large
Group Only
HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least fifty-one employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.
H-Hmo04.PPO-01B
HMO / Point of Service Option - Any Size Group
HMO Plan issued to Employers participating in a Multiple Employer Trust who employ any number of employees, which includes the option of seeking covered services at the point-of-service.
H-Hmo04.POS-01
HMO / Point of Service Option -
Small Group Only
HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least two but not more than fifty employees, which includes the option of seeking covered services at the point-of-service.
H-Hmo04.POS-01A
HMO / Point of Service Option -
Large Group Only
HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least fifty-one employees, which includes the option of seeking covered services at the point-of-service.
H-Hmo04.POS-01B
Mul
tiple
Em
ploy
er T
rust
/ H
MO
Policyholder Types
PRODUCT NAMES
HEALTH MAINTENANCE ORGANIZATION PRODUCT DESCRIPTIONS
LA DOI Product Code
HMO / In-Network Only Plan - Any
Size Group
HMO Plan issued to an Employer who employs any number of employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.
H-Hmo05.INO-01
HMO / In-Network Only Plan - Small
Group Only
HMO Plan issued to an Employer who employs at least two but not more than fifty employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.
H-Hmo05.INO-01A
HMO / In-Network Only Plan - Large
Group Only
HMO Plan issued to an Employer who employs at least fifty-one employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.
H-Hmo05.INO-01B
HMO / Preferred Provider
Organization Option - Any Size
Group
HMO Plan issued to an Employer who employs any number of employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.
H-Hmo05.PPO-01
HMO / Preferred Provider
Organization Option - Small
Group Only
HMO Plan issued to an Employer who employs at least two but not more than fifty employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.
H-Hmo05.PPO-01A
HMO / Preferred Provider
Organization Option - Large
Group Only
HMO Plan issued to an Employer who employs at least fifty-one employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.
H-Hmo05.PPO-01B
HMO / Point of Service Option - Any Size Group
HMO Plan issued to an Employer who employs any number of employees, which includes the option of seeking covered services at the point-of-service.
H-Hmo05.POS-01
HMO / Point of Service Option -
Small Group Only
HMO Plan issued to an Employer who employs at least two but not more than fifty employees, which includes the option of seeking covered services at the point-of-service.
H-Hmo05.POS-01A
HMO / Point of Service Option -
Large Group Only
HMO Plan issued to an Employer who employs at least fifty-one employees, which includes the option of seeking covered services at the point-of-service.
H-Hmo05.POS-01B
Sing
le E
mpl
oyer
Gro
up /
HM
O
Policyholder Types
PRODUCT NAMES
EXCESS / STOP-LOSS PRODUCT DESCRIPTIONS
LA DOI Product Code
Excess Stop Loss / Single
Employer
Individual Excess or Stop-Loss insurance issued to a single employer to cover losses of a self-funded group health plan. H-ESL01-IND
Excess Stop Loss / Multiple Employer Trust
Group Excess or Stop-Loss insurance issued to a multiple employer trust established by two or more employers in the same industry, to cover the losses of each participating employer's self-funded group health plan. Losses of two or more employers may not be pooled. Each employer must be treated separately and independent of other participating employers.
H-ESL01-MET
Exce
ss S
top
Loss
/ S
elf-I
ns P
lan
/ M
EWA Excess Stop
Loss / Self-Ins Plan
Group Excess or Stop-Loss insurance issued to a self-insurer authorized to make, provide or issue a self-insurance plan in Louisiana, including both aggregate and specific coverage and provisions to cover incurred, unpaid claims liability in the event of plan termination or insolvency.
H-ESL02-MEWA
Exce
ss S
top
Loss
/ Pr
ovid
er -
Man
aged
C
are Excess Stop
Loss / Provider -Managed Care
Excess or Stop-Loss insurance intended for issue to protect health care providers from a portion of the financial risk assumed in managed care contracts. H-ESL03-PMC
Exce
ss S
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Loss
/ Se
lf-Fu
nded
Em
ploy
er