Table of Contents

Title 37 INSURANCE

Louisiana Administrative Code September 2006 i

Part I. Risk Management

Subpart 1. Insurance and Related Matters

Chapter 1. Underwriting................................................................................................................................1 §101. Underwriting...............................................................................................................................1

Chapter 3. Auditing and Statistics .................................................................................................................1 §301. Auditing and Statistics................................................................................................................1

Chapter 5. Billing ..........................................................................................................................................2 §501. Billing and Collection of Insurance Premiums ..........................................................................2

Chapter 7. Reporting of Claims.....................................................................................................................2 §701. Reporting of Property Damage Claims ...................................................................................... 2 §703. Reporting of Boiler and Machinery Claims ...............................................................................3 §705. Reporting of Comprehensive General Liability Claims.............................................................3 §707. Reporting of Worker's Compensation and Maritime Claims .....................................................4 §709. Reporting of State Automobile Liability and Physical Damage Claims....................................4 §711. Reporting of Aviation Claims ....................................................................................................5 §713. Reporting of Wet Marine Claims (Over 26 Feet).......................................................................6 §715. Reporting of Bond and Crime Claims ........................................................................................6 §717. Reporting of Medical Malpractice Liability Claims ..................................................................7 §719. Reporting of Road and Bridge Hazard Claims (Department of Transportation and Development) ....................................................................7 §721. Claims Unit Contacts..................................................................................................................8

Chapter 9. Risk Analysis and Loss Prevention .............................................................................................8 §901. Risk Analysis and Loss Prevention ............................................................................................8

Chapter 11. Law Enforcement Officers' and Firemen's Survivor Benefit Review Board.............................9 §1101. Survivors Benefits ......................................................................................................................9

Subpart 2. Worker's Compensation Fee Schedule

Chapter 25. Fees ..........................................................................................................................................11

§2501. Fee Schedule.............................................................................................................................11

Part III. Patients' Compensation Fund Oversight Board

Chapter 1. General Provisions.....................................................................................................................13 §101. Scope ........................................................................................................................................13 §103. Source and Authority................................................................................................................13 §105. Patients' Compensation Fund: Description...............................................................................13 §107. Purpose and Objective of Rules; Construction, Application....................................................13 §109. General Definitions ..................................................................................................................13 §111. Interpretive Definitions ............................................................................................................14 §113. Severability...............................................................................................................................15

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Chapter 3. Organization, Functions, and Delegations of Authority ............................................................15 §301. Board Organization ..................................................................................................................15 §303. Executive Director of the Patients' Compensation Fund Oversight Board ..............................15 §305. Fund Property ...........................................................................................................................16 §307. Expenses of Administration and Defense.................................................................................16

Chapter 5. Enrollment with the Fund ..........................................................................................................16 §501. Scope of Chapter ......................................................................................................................16 §503. Basic Qualifications for Enrollment .........................................................................................17 §505. Financial Responsibility: Insurance .........................................................................................17 §507. Financial Responsibility: Self-Insurance..................................................................................18 §509. Financial Responsibility: Self-Insurance Trusts.......................................................................19 §511. Coverage: Partnerships and Professional Corporations ...........................................................21 §513. Enrollment Procedure...............................................................................................................21 §515. Certification of Enrollment.......................................................................................................22 §517. Expiration, Renewal of Enrollment ..........................................................................................22

Chapter 7. Surcharges..................................................................................................................................22 §701. PCF Consulting Actuary...........................................................................................................22 §703. Annual Actuarial Study ............................................................................................................23 §705. Risk Rating ...............................................................................................................................23 §707. Rate Applications, Filings; Notice of Rates .............................................................................24 §709. Interim, Emergency Rate Filings..............................................................................................24 §711. Payment of Surcharges: Insurers ..............................................................................................24 §713. Payment of Surcharges: Self-Insureds......................................................................................24 §715. Amount of Surcharges; Form of Coverage; Conversions ........................................................25

Chapter 9. Scope of Coverage .....................................................................................................................26 §901. Effective Date...........................................................................................................................26 §903. Term of Enrollment ..................................................................................................................26 §905. Scope of Coverage: Insureds ....................................................................................................26 §907. Scope of Coverage: Self-Insureds ............................................................................................26 §909. Scope of Coverage: Self-Insurance Trusts ...............................................................................26

Chapter 11. Reporting .................................................................................................................................27 §1101. Reporting of Claims, Reserves, Proposed Settlement ..............................................................27 §1103. Claims Experience Reporting: Insurers, Institutions and Self-Insured ....................................27 §1105. Noncompliance; Failure to Report ...........................................................................................27 §1107. Confidentiality..........................................................................................................................28

Chapter 13. Fund Data Collection, Maintenance; Accounting and Reporting............................................28 §1301. Fund Data Collection, Maintenance .........................................................................................28 §1303. Fund Accounting ......................................................................................................................28 §1305. Annual Budget..........................................................................................................................28 §1307. Appropriation Request..............................................................................................................28 §1309. Periodic Reports .......................................................................................................................28 §1311. Annual Report ..........................................................................................................................28

Chapter 14. Medical Review Panels............................................................................................................29 §1401. Procedure..................................................................................................................................29 §1403. Malpractice Complaint .............................................................................................................29 §1405. Attorney Chairman ...................................................................................................................29

Chapter 15. Defense of the Fund.................................................................................................................29 §1501. Claims Defense.........................................................................................................................29 §1503. Claims Accounting ...................................................................................................................30 §1505. Claim Reserves.........................................................................................................................30

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§1507. Settlement of Claims ................................................................................................................30 §1509. Privileged Communications, Records ......................................................................................30

Chapter 17. Transitional Rules ....................................................................................................................30 §1701. Continuing Enrollment of Self-Insureds ..................................................................................30 §1703. Continuing Enrollment of Self-Insurance Trusts .....................................................................30

Chapter 19. Future Medical Care and Related Benefits ..............................................................................31 §1901. Scope of Chapter ......................................................................................................................31 §1903. Definitions ................................................................................................................................31 §1905. Obligation of the Fund..............................................................................................................31 §1907. Claims for Future Medical Care and Related Benefits.............................................................31 §1909. Attorneys; Medical Experts; Architects; Adjusters ..................................................................31 §1911. Examinations; Notice Requirements ........................................................................................32 §1913. Choice of Health Care Provider ...............................................................................................32 §1915. Psychological /Psychiatric Treatment and Counseling ............................................................32 §1917. Nursing Care; Sitter Care .........................................................................................................33 §1919. Treatment Protocol ...................................................................................................................33 §1921. Vehicles ....................................................................................................................................33 §1923. Ancillary Cost; Mileage ...........................................................................................................34 §1925. Modifications/Renovations to Patient's Residence...................................................................34 §1927. Testimony; Communications....................................................................................................34 §1929. Fees and Costs ..........................................................................................................................35 §1931. Attorney Fees............................................................................................................................35

Part VII. Motor Vehicles

Chapter 1. Insurance....................................................................................................................................37 Subchapter A. Self Insurance ....................................................................................................................37

§101. Certificates of Self Insurance ...................................................................................................37 Subchapter B. Compulsory Motor Vehicle Liability Security ..................................................................37

§123. Maintenance of Compulsory Motor Vehicle Liability Security...............................................37 §129. Compulsory Insurance Hardship License.................................................................................39

Part IX. Agricultural Commodities

Chapter 1. Self-Insurance Fund...................................................................................................................41

§101. Definitions ................................................................................................................................41 §103. The Fund...................................................................................................................................41 §105. Purpose .....................................................................................................................................41 §107. Fees...........................................................................................................................................41 §109. Insurance Coverage ..................................................................................................................42 §111. Claim Provisions ......................................................................................................................42 §113. Appeal Procedure .....................................................................................................................43 §115. Subrogation...............................................................................................................................43 §117. Limit of Self-Insurance Fund ...................................................................................................43 §121. Participation in the Self-Insurance Fund ..................................................................................43 §123. Prohibited Acts: Criminal Penalties .........................................................................................43 §125. Validity of Rules.......................................................................................................................44 §127. Pending Litigation; Stay of Claims ..........................................................................................44

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Part XI. Rules Chapter 1. Rule Number 3A―Advertisement of Medicare Supplement Insurance ...................................45

§101. Purpose .....................................................................................................................................45 §103. Applicability .............................................................................................................................45 §105. Definitions ................................................................................................................................46 §107. Method of Disclosure of Required Information .......................................................................47 §109. Form and Content of Advertisements.......................................................................................47 §111. Advertisements of Benefits, Losses Covered, or Premiums Payable.......................................47 §113. Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability, and Termination ...............................................................................................48 §115. Testimonials or Endorsements by Third Parties.......................................................................48 §117. Use of Statistics ........................................................................................................................49 §119. Disparaging Comparisons and Statements ...............................................................................49 §121. Jurisdictional Licensing and Status of Insurer..........................................................................49 §123. Identity of Insurer .....................................................................................................................50 §125. Group or Quasi-Group Implications.........................................................................................50 §127. Introductory, Initial or Special Offers ......................................................................................50 §129. Statements about an Insurer......................................................................................................51 §131. Enforcement Procedures...........................................................................................................51 §133. Severability Provision ..............................................................................................................51 §135. Effective Date...........................................................................................................................51 §137. Interpretive Guidelines for Rules Governing Advertisements of Medicare Supplement Insurance ..............................................................................................................52

Chapter 3. Rule Number 4―Interlocal Risk Management Agency............................................................56 §301. Purpose .....................................................................................................................................56 §303. Applicability .............................................................................................................................56 §305. Definitions ................................................................................................................................56 §307. Requirements Necessary to Obtain a Certificate of Authority as an Interlocal Risk Management Agency .......................................................................................................57 §309. Filing of Reports.......................................................................................................................58 §311. Solvency or Risk Management Agencies; Trustee Responsibilities ........................................58 §313. Interlocal Risk Management Self-Insurance Funds; Advance Premium Discounts; Surplus Distribution; Deficit ....................................................................................................59 §315. Aggregate Excess Insurance, Interlocal Risk Management Agency; Self-Insurance ..............59 §317. Servicing Interlocal Risk Management Agencies; Application; Requirements; Noncompliance.........................................................................................................................60 §319. Penalty for Non-Compliance....................................................................................................60 §321. Severability...............................................................................................................................60

Chapter 5. Rule Number 9― Pre-Licensing Insurance Education Advisory Council ................................61 §501. Purpose .....................................................................................................................................61 §503. Applicability and Scope ...........................................................................................................61 §505. Effective Date...........................................................................................................................61 §507. Course Requirements................................................................................................................61 §509. Provider Requirements .............................................................................................................62 §511. Instructor Qualifications...........................................................................................................62 §513. Training Facility Requirements ................................................................................................63 §515. Licensing Procedure of Applicant ............................................................................................63 §517. Course Completion...................................................................................................................63 §519. Fees...........................................................................................................................................63

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§521. Complaints................................................................................................................................63 §523. Violations .................................................................................................................................63 §525. Expiration Date.........................................................................................................................64

Chapter 7. Rule Number 10―Continuing Education..................................................................................64 §701. Purpose .....................................................................................................................................64 §703. Basic Requirements ..................................................................................................................64 §705. Applicability .............................................................................................................................64 §707. Insurance Education Advisory Council....................................................................................65 §709. Program Requirements .............................................................................................................65 §711. Provider Requirements .............................................................................................................67 §713. Instruction Requirements..........................................................................................................68 §715. Training Facility Requirements ................................................................................................68 §717. Rule 10.10. Measurement of Credit .........................................................................................68 §719. Controls and Reporting.............................................................................................................69 §721. Program Review―Disciplinary Action ...................................................................................70 §723. Rule 10.13 Credit for Individual Study Programs....................................................................70 §725. Credit for Service as Instructor.................................................................................................71 §727. Effective Date...........................................................................................................................71 §729. Separability...............................................................................................................................71 §731. Periodic Review........................................................................................................................71 §733. Appendix 1―Request for Program/Course Approval .............................................................72 §735. Appendix 2―Continuing Education Provider Training Schedule...........................................73 §737. Appendix 3―Continuing Education Provider Application .....................................................73 §739. Appendix 4―Continuing Education Instructor Application....................................................73 §741. Appendix 5―Continuing Education Certificate ......................................................................73 §743. Appendix 6―Continuing Education Statement .......................................................................74 §745. Appendix 7―Administrative and Reporting Requirements Survey ........................................74

Chapter 9. Rule Number 12―Transmission of Forms and Documents......................................................74 §901. Transmission of Forms and Documents Filed with the Department of Insurance ...................74

Chapter 11. Rule Number 1―Rules of Practice and Procedure before the Commissioner of Insurance ...75 §1101. Definitions ................................................................................................................................75 §1103. Commencement of Hearings ....................................................................................................75 §1105. Petitions, Complaints or Orders ...............................................................................................75 §1107. Notice .......................................................................................................................................75 §1109. Service of Notice ......................................................................................................................75 §1111. Proof of Service........................................................................................................................75 §1113. Answer or Appearance .............................................................................................................76 §1115. Leave to Intervene Necessary...................................................................................................76 §1117. Docket.......................................................................................................................................76 §1119. Default in Answering or Appearing .........................................................................................76 §1121. Subpoenas.................................................................................................................................76 §1123. Prehearing Conference .............................................................................................................76 §1125. Hearing .....................................................................................................................................77 §1127. Order of Procedure at Hearing .................................................................................................77 §1129. Witnesses to be Sworn..............................................................................................................77 §1131. Rules of Pleading and Evidence ...............................................................................................77 §1133. Attorneys ..................................................................................................................................77 §1135. Stenographic Record of Hearing ..............................................................................................78 §1137. Depositions ...............................................................................................................................78 §1139. Decision, Findings of Fact and Conclusions of Law and Order...............................................78

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§1141. Rehearings ................................................................................................................................78 §1143. Appeals to the District Court ....................................................................................................78 §1145. Transcript in Case on Appeal ...................................................................................................79 §1147. Amendment of Rules................................................................................................................79 §1149. Exclusions.................................................................................................................................79 §1151. Declaratory Orders and Rulings, Judicial Review ...................................................................79 §1153. Forms........................................................................................................................................79 §1155. Supersedes All Prior Rules.......................................................................................................79

Chapter 13. Rule Number 3―Advertisements of Accident and Sickness Insurance..................................79 §1301. Purpose .....................................................................................................................................79 §1303. Applicability .............................................................................................................................79 §1305. Definitions ................................................................................................................................80 §1307. Method of Disclosure of Required Information .......................................................................80 §1309. Form and Content of Advertisements.......................................................................................80 §1311. Advertisements of Benefits Payable, Losses Covered or Premiums Payable ..........................80 §1313. Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability and Termination........................................................................................................................82 §1315. Testimonials or Endorsements by Third Parties.......................................................................82 §1317. Use of Statistics ........................................................................................................................82 §1319. Identification of Plan or Number of Policies............................................................................82 §1321. Disparaging Comparisons and Statements ...............................................................................83 §1323. Jurisdictional Licensing and Status of Insurer.......................................................................... 83 §1325. Identity of Insurer .....................................................................................................................83 §1327. Group or Quasi-Group Implications.........................................................................................83 §1329. Introductory, Initial or Special Offers ......................................................................................83 §1331. Statements about an Insurer......................................................................................................84 §1333. Enforcement Procedures...........................................................................................................84 §1335. Severability Provision ..............................................................................................................84 §1337. Effective Date...........................................................................................................................84

Chapter 15. Rule Number 5―Unfair Trade Practices.................................................................................85 §1501. Purpose .....................................................................................................................................85 §1503. Applicability .............................................................................................................................85 §1505. Definitions ................................................................................................................................85 §1507. Rule...........................................................................................................................................85

Chapter 17. Rule Number 6―Vehicle Mechanical Breakdown Insurer .....................................................85 §1701. Purpose .....................................................................................................................................85 §1703. Applicability .............................................................................................................................85 §1705. Definitions ................................................................................................................................85 §1707. Qualifications ...........................................................................................................................86 §1709. Reserves....................................................................................................................................86 §1711. Reports......................................................................................................................................86 §1713. Penalty for Non-Compliance....................................................................................................87 §1715. Severability...............................................................................................................................87

Chapter 19. Rule Number 7―Legal Expense Insurers ...............................................................................87 §1901. Purpose .....................................................................................................................................87 §1903. Applicability .............................................................................................................................87 §1905. Definitions ................................................................................................................................87 §1907. Exemptions ...............................................................................................................................87 §1909. Qualifications as Insurer Required ...........................................................................................88 §1911. Licensing of Agents Required ..................................................................................................88

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§1913. Compliance Required ...............................................................................................................88 §1915. Penalty for Non-Compliance....................................................................................................88 §1917. Severability...............................................................................................................................88

Chapter 21. Rule Number 8―A New Annuity Mortality Table for Use in Determining Reserve Liabilities for Annuities............................................................................................88

§2100. Authority...................................................................................................................................88 §2101. Purpose .....................................................................................................................................88 §2103. Definitions ................................................................................................................................88 §2105. Individual Annuity for Pure Endowment Contracts .................................................................89 §2107. Group Annuity or Pure Endowment Contracts ........................................................................89 §2108. Application of the 1994 GAR Table ........................................................................................89 §2109. Separability...............................................................................................................................89 §2111. Effective Date...........................................................................................................................89

Chapter 23. Rule 13―Special Assessment to Pay the Cost of Investigation, Enforcement, and Prosecution of Insurance Fraud ........................................................................................89

§2301. Purposes....................................................................................................................................89 §2303. Fee Assessment ........................................................................................................................90 §2305. Limitations on the Fee Assessment ..........................................................................................90 §2307. Allocation of the Fee Assessment ............................................................................................90 §2309. Payment of the Fee Assessment ...............................................................................................90 §2311. Sunset .......................................................................................................................................90

Chapter 25. Rule 14―Records Management ..............................................................................................90 §2501. Records Management; General ................................................................................................90

Part XIII. Regulations

Chapter 1. Regulation 31―Holding Company ...........................................................................................91

§101. Purpose .....................................................................................................................................91 §103. Severability Clause...................................................................................................................91 §105. Definitions ................................................................................................................................91 §107. Subsidiaries of Domestic Insurers ............................................................................................91 §109. Acquisition of Control―Statement Filing ...............................................................................91 §111. Amendments to Form A ...........................................................................................................91 §113. Acquisition of Section 1004.A(l)(2) Insurers ...........................................................................91 §115. Annual Registration of Insurers―Statement Filing .................................................................92 §117. Summary of Registration―Statement Filing ...........................................................................92 §119. Amendments to Form B ...........................................................................................................92 §121. Alternative and Consolidated Registrations .............................................................................92 §123. Disclaimers and Termination of Registration...........................................................................92 §125. Extraordinary Dividends and Other Distributions....................................................................92 §127. Adequacy of Surplus ................................................................................................................93 §129. Transactions Subject to Prior Notice―Notice Filing...............................................................93 §131. Instructions for Forms A, B, C, and D .....................................................................................93 §133. Form A―Acquisition of Control or Merger with a Domestic Insurer.....................................95 §135. Form B―Annual Registration Statement ................................................................................97 §137. Form C―Registration Statement Summary.............................................................................99 §139. Form D―Prior Notice of a Transaction.................................................................................100

Chapter 3. Regulation 32―Group Coordination of Benefits ....................................................................101 §301. Purpose and Applicability ......................................................................................................101 §303. Definitions ..............................................................................................................................101

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§305. Use of Model COB Contract Provision..................................................................................103 §307. Rules for Coordination of Benefits.........................................................................................104 §309. Procedure to be Followed by Secondary Plan........................................................................105 §311. Notice to Covered Persons .....................................................................................................105 §313. Miscellaneous Provisions .......................................................................................................105 §315. Effective Date; Existing Contracts .........................................................................................106 §317. Appendix A―Model COB Contract Provisions Coordination of This Group Contract's Benefits with Other Benefits .................................................................................106 §319. Appendix B―Consumer Explanatory Booklet Coordination of Benefits .............................109

Chapter 5. Regulation 33—Medicare Supplement Insurance Minimum Standards .................................110 §501. Purpose ...................................................................................................................................110 §502. Applicability and Scope .........................................................................................................110 §503. Definitions ..............................................................................................................................110 §504. Policy Definitions and Terms.................................................................................................112 §505. Policy Provisions ....................................................................................................................112 §506. Premium Increase Requirements............................................................................................113 §507. Rate Increases Requirements..................................................................................................113 §510. Minimum Benefit Standards for Policies or Certificates Issued for Delivery Prior to July 20, 1992 .............................................................................................113 §515. Benefit Standards for Policies or Certificates Issued or Delivered on or after July 20, 1992 114 §520. Standard Medicare Supplement Benefit Plans .......................................................................118 §525. Medicare Select Policies and Certificates ..............................................................................119 §530. Open Enrollment ....................................................................................................................122 §535. Guaranteed Issue for Eligible Persons.................................................................................... 122 §540. Standards for Claims Payment ...............................................................................................124 §545. Loss Ratio Standards and Refund or Credit of Premium .......................................................125 §550. Filing and Approval of Policies and Certificates and Premium Rates ...................................127 §555. Permitted Compensation Arrangements.................................................................................128 §560. Required Disclosure Provisions .............................................................................................128 §565. Requirements for Application Forms and Replacement Coverage ........................................147 §570. Filing Requirements for Advertising......................................................................................149 §575. Standards for Marketing .........................................................................................................149 §580. Appropriateness of Recommended Purchase and Excessive Insurance.................................150 §585. Reporting of Multiple Policies ...............................................................................................150 §590. Prohibition against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies or Certificates ...............................................150 §595. Severability.............................................................................................................................150 §596. Appendix A—Calculation Forms...........................................................................................151 §597. Appendix B—Medicare Supplement Policies Reporting Form .............................................153 §598. Appendix C—Disclosure Statements .....................................................................................153 §599. Effective Date.........................................................................................................................157

Chapter 7. Regulation 39―Statement of Actuarial Opinion.....................................................................157 §701. Purpose ...................................................................................................................................157 §703. Applicability and Scope .........................................................................................................157 §705. Definitions ..............................................................................................................................157 §707. Content ...................................................................................................................................158 §709. Exemptions .............................................................................................................................158

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Chapter 9. Regulation 40―Summary Document and Disclaimer and Notice of Noncoverage ...............158 §901. Purpose ...................................................................................................................................158 §903. Applicability and Scope .........................................................................................................159 §905. Form and Content ...................................................................................................................159 §907. Exhibit A―Summary of the Louisiana Life and Health Insurance Guaranty Association Act and Notice Concerning Coverage Limitations and Exclusions ...159 §909. Exhibit B―Notice of Noncoverage .......................................................................................160

Chapter 11. Regulation 42―Group Self-Insurance Funds........................................................................160 §1101. Definitions ..............................................................................................................................160 §1103. Application to Create a Group Self-Insurance Fund ..............................................................161 §1105. Conditions for Retaining the Self-Insurance Privilege...........................................................161 §1107. Financial and Actuarial Reports for Group Self-Insurance Funds .........................................162 §1109. Excess Insurance Requirements for Group Self-Insurance Funds .........................................162 §1111. Indemnity Agreement .............................................................................................................163 §1113. Rates and Reporting of Rates .................................................................................................163 §1115. Authorized Investments for Group Self-Insurance Funds......................................................164 §1117. Premium Audit .......................................................................................................................164 §1119. Board of Trustees ...................................................................................................................164 §1121. Group Membership; Termination, Liability ...........................................................................164 §1123. Service Companies .................................................................................................................165 §1125. Licensing of Agents................................................................................................................165 §1127. Deficits and Insolvencies........................................................................................................165 §1129. Review of Rate Determination ...............................................................................................165 §1131. Cease and Desist Orders.........................................................................................................166 §1133. Revocation of Certificate of Authority...................................................................................166 §1135. Examinations ..........................................................................................................................166

Chapter 13. Regulation 43―Companies in Hazardous Financial Condition............................................166 §1301. Purpose ...................................................................................................................................166 §1303. Definitions ..............................................................................................................................166 §1305. Standards ................................................................................................................................166 §1307. Commissioner's Authority ......................................................................................................167

Chapter 15. Regulation 44―Accelerated Benefits ...................................................................................168 §1501. Purpose ...................................................................................................................................168 §1503. Definitions ..............................................................................................................................168 §1505. Type of Product ......................................................................................................................168 §1507. Assignee/Beneficiary..............................................................................................................168 §1509. Criteria for Payment ...............................................................................................................168 §1511. Disclosures .............................................................................................................................169 §1513. Effective Date of the Accelerated Benefits ............................................................................169 §1515. Waiver of Premiums...............................................................................................................169 §1517. Discrimination ........................................................................................................................170 §1519. Actuarial Standards ................................................................................................................170 §1521. Actuarial Disclosure and Reserves.........................................................................................170 §1523. Filing Requirement .................................................................................................................171

Chapter 17. Regulation 45―Filing of Affirmative Action Plans..............................................................171 §1701. Purpose ...................................................................................................................................171 §1703. Applicability and Scope .........................................................................................................171 §1705. Content and Procedure ...........................................................................................................171 §1707. Effective Date.........................................................................................................................171

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Chapter 19. Regulation 46―Long-Term Care Insurance .........................................................................171 §1901. Purpose ...................................................................................................................................171 §1903. Applicability and Scope .........................................................................................................171 §1905. Definitions ..............................................................................................................................172 §1907. Policy Definitions...................................................................................................................172 §1909. Policy Practices and Provisions..............................................................................................173 §1911. Unintentional Lapse................................................................................................................175 §1913. Required Disclosure Provisions .............................................................................................176 §1915. Required Disclosure of Rating Practices to Consumers.........................................................176 §1917. Initial Filing Requirements.....................................................................................................177 §1919. Requirements to Offer Inflation Protection............................................................................178 §1921. Prohibition against Post-Claim Underwriting (former §1915)...............................................179 §1923. Minimum Standards for Home Health and Community Care Benefits in Long-Term Care Insurance Policies (former §1917) .............................................................179 §1925. Requirements for Application Forms and Replacement Coverage (former §1921)...............180 §1927. Reporting Requirements (former §1923) ...............................................................................181 §1929. Licensing (former §1925).......................................................................................................182 §1931. Discretionary Powers of Commissioner (former §1927) ......................................................182 §1933. Reserve Standards (former §1929) .........................................................................................182 §1935. Loss Ratio (former §1931) .....................................................................................................183 §1937. Premium Rate Schedule Increases..........................................................................................183 §1939. Filing Requirement (former §1933) .......................................................................................186 §1941. Filing Requirements for Advertising (former §1935) ...........................................................186 §1943. Standards for Marketing (former §1937) ...............................................................................186 §1945. Suitability (former §1939)......................................................................................................187 §1947. Prohibition against Pre-Existing Conditions and Probationary Periods in Replacement Policies or Certificates (former §1941) ............................................................188 §1949. Nonforfeiture Benefit Requirement (former §1943) .............................................................188 §1951. Standards for Benefit Triggers (former §1945)......................................................................190 §1953. Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts (former §1947) .......................................................................................................190 §1955. Standard Format Outline of Coverage (former §1949) .........................................................191 §1957. Requirement to Deliver Shopper's Guide (former §1951) .....................................................193 §1959. Penalties (former §1953) ........................................................................................................193 §1961. Appendices (former §1955)....................................................................................................193

Chapter 21. Regulation 47―Actuarial Opinion and Memorandum Regulation.......................................197 §2101. Purpose ...................................................................................................................................197 §2103. Authority.................................................................................................................................197 §2105. Scope ......................................................................................................................................197 §2107. Definitions ..............................................................................................................................197 §2109. General Requirements ............................................................................................................198 §2111. Statement of Actuarial Opinion Based on an Asset Adequacy Analysis ...............................199 §2113. Description of Actuarial Memorandum Including an Asset Adequacy Analysis and Regulatory Asset Adequacy Issues Summary........................................................................202

Chapter 23. Regulation 48―Standardized Claims Forms ........................................................................204 §2301. Purpose ...................................................................................................................................204 §2303. Definitions ..............................................................................................................................204 §2305. Applicability and Scope .........................................................................................................205 §2307. Requirements for Use of HCFA Form 1500 ..........................................................................205 §2309. Requirements for Use of HCFA Approved Form UB92........................................................205

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§2311. Requirements for Use of J512 Form ......................................................................................206 §2313. General Provisions..................................................................................................................206

Chapter 25. Regulation 49―Billing Audit Guidelines .............................................................................206 §2501. Purpose ...................................................................................................................................206 §2503. Applicability and Scope .........................................................................................................206 §2505. Definitions ..............................................................................................................................207 §2507. Qualifications of Auditors and Audit Coordinators ...............................................................207 §2509. Notification of Audit ..............................................................................................................207 §2511. Provider Audit Coordinators ..................................................................................................208 §2513. Conditions and Scheduling of Audits.....................................................................................208 §2515. Confidentiality and Authorizations ........................................................................................209 §2517. Documentation .......................................................................................................................209 §2519. Fees and Payments .................................................................................................................209

Chapter 27. Regulation 51―Individual Health Insurance Rating Requirements .....................................210 §2701. Purpose ...................................................................................................................................210 §2703. Applicability and Scope .........................................................................................................210 §2705. Definitions ..............................................................................................................................210 §2707. Restrictions on Premium Rates ..............................................................................................211 §2709. General Provisions..................................................................................................................211

Chapter 29. Regulation 52―Small Group Health Insurance Rating Requirements .................................211 §2901. Purpose ...................................................................................................................................211 §2903. Applicability and Scope .........................................................................................................211 §2905. Definitions ..............................................................................................................................211 §2907. Restrictions on Premium Rates ..............................................................................................212 §2909. General Provisions..................................................................................................................213

Chapter 31. Regulation 53―Basic Health Insurance Plan Pilot Program ................................................213 §3101. Purposes..................................................................................................................................213 §3103. Applicability and Scope .........................................................................................................213 §3105. Definitions ..............................................................................................................................213 §3107. Pilot Plan in General...............................................................................................................214 §3109. Pilot Plan Authorized Carrier .................................................................................................215 §3111. Application Process ................................................................................................................215 §3113. Authorization of Pilot Plan.....................................................................................................215 §3115. Revocation of an Authorized Carrier's Authority...................................................................216 §3117. Evaluation and Reporting Requirements................................................................................216 §3119. Premium Taxes.......................................................................................................................216 §3121. Guaranty Association .............................................................................................................217 §3123. Health Insurance Agents.........................................................................................................217 §3125. Eligibility................................................................................................................................217 §3127. Benefits...................................................................................................................................217 §3129. Hospital Services ....................................................................................................................217 §3131. Emergency Room Benefits.....................................................................................................218 §3133. Provider Services....................................................................................................................218 §3135. Limitations..............................................................................................................................219 §3137. Exclusions...............................................................................................................................219 §3139. Outpatient Prescription Rider .................................................................................................220 §3141. Premium Maximums, Method for Calculating.......................................................................220 §3143. Payment of Benefits ...............................................................................................................221 §3145. General Provisions..................................................................................................................221 §3147. Termination of Coverage........................................................................................................221

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Chapter 33. Regulation 55―Life Insurance Illustrations..........................................................................221 §3301. Purpose ...................................................................................................................................221 §3303. Applicability and Scope .........................................................................................................221 §3305. Definitions ..............................................................................................................................222 §3307. Policies to Be Illustrated.........................................................................................................223 §3309. General Rules and Prohibitions ..............................................................................................223 §3311. Standards for Basic Illustrations.............................................................................................224 §3313. Standards for Supplemental Illustrations................................................................................225 §3315. Delivery of Illustrations and Record Retention......................................................................225 §3317. Annual Report; Notice to Policy Owners...............................................................................226 §3319. Annual Certifications..............................................................................................................227 §3321. Severability.............................................................................................................................227 §3323. Effective Date.........................................................................................................................228

Chapter 35. Regulation 56―Credit for Reinsurance ................................................................................228 §3501. Purpose ...................................................................................................................................228 §3503. Severability.............................................................................................................................228 §3505. Credit for Reinsurance―Reinsurer Authorized in this State .................................................228 §3507. Credit for Reinsurance―Accredited Reinsurer......................................................................228 §3509. Credit for Reinsurance―Reinsurer Maintaining Trust Funds ...............................................228 §3511. Credit for Reinsurance Required by Law...............................................................................230 §3513. Reduction from Liability for Reinsurance Ceded to an Unauthorized Assuming Insurer .....230 §3515. Trust Agreements Qualified under §3513. .............................................................................230 §3517. Letters of Credit Qualified under §3513 ................................................................................233 §3519. Other Security.........................................................................................................................234 §3521. Reinsurance Contract..............................................................................................................234 §3523. Agreements Requiring Approval............................................................................................234 §3525. Contracts Affected..................................................................................................................235

Chapter 37. Regulation 57―Life and Health Reinsurance Agreements...................................................235 §3701. Preamble .................................................................................................................................235 §3703. Scope ......................................................................................................................................235 §3705. Accounting Requirements ......................................................................................................236 §3707. Written Agreements................................................................................................................237 §3709. Existing Agreements ..............................................................................................................238 §3711. Effective Date.........................................................................................................................238

Chapter 39. Regulation 58―Viatical Settlements.....................................................................................238 §3901. Purposes..................................................................................................................................238 §3903. Applicability and Scope .........................................................................................................238 §3905. Definitions ..............................................................................................................................238 §3907. License Requirements for Viatical Settlement Providers.......................................................239 §3909. License Requirements for Viatical Settlement Brokers .........................................................239 §3911. Approval of Viatical Settlement Contract ..............................................................................239 §3913. Reporting Requirements.........................................................................................................240 §3915. Standards for Evaluation of Reasonable Payments ................................................................240 §3917. General Rules .........................................................................................................................240

Chapter 41. Regulation 60― Advertising of Life Insurance ....................................................................241 §4101. Purpose ...................................................................................................................................241 §4103. Definitions ..............................................................................................................................241 §4105. Applicability ...........................................................................................................................242 §4107. Form and Content of Advertisements.....................................................................................242 §4109. Disclosure Requirements........................................................................................................242

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§4111. Identity of Insurer ...................................................................................................................245 §4113. Jurisdictional Licensing and Status of Insurer........................................................................246 §4115. Statements about the Insurer ..................................................................................................246 §4117. Enforcement Procedures.........................................................................................................246 §4119. Conflict with Other Rules.......................................................................................................246 §4121. Severability.............................................................................................................................246 §4123. Effective Date.........................................................................................................................247

Chapter 45. Regulation 63―Prohibitions on the Use of Medical Information and Genetic Test Results ...............................................................................................................247

§4501. Purpose ...................................................................................................................................247 §4503. Authority.................................................................................................................................247 §4505. Definitions ..............................................................................................................................247 §4507. Applicability and Scope .........................................................................................................248 §4509. Prohibitions on the Use of Pregnancy Test Results................................................................248 §4511. Requirements for Release of Genetic Test and Related Medical Information.......................248 §4513. Prohibitions on the Use of Medical Information and Genetic Test Results ...........................249 §4515. General Provisions..................................................................................................................249

Chapter 47. Regulation 64―Vehicle Mechanical Breakdown Insurers Cancellation Provisions ............250 §4701. Purpose ...................................................................................................................................250 §4703. Authority.................................................................................................................................250 §4705. Applicability and Scope .........................................................................................................250 §4707. Cancellation Standards ...........................................................................................................250 §4709. Failure to Comply...................................................................................................................250 §4711. Severability.............................................................................................................................251 §4713. Effective Date.........................................................................................................................251

Chapter 49. Regulation 65―Bail Bond Licensing Requirements/Bounty Hunter....................................251 §4901. Purpose ...................................................................................................................................251 §4903. Definitions ..............................................................................................................................251 §4905. Bail Recovery Agent License Requirements for Louisiana ...................................................251 §4907. Bail Recovery Persons License Requirement from Other States ...........................................251 §4909. Out of State Bail Enforcement Procedure and Notification Requirements ............................252 §4911. In State Bail Enforcement Procedure and Notification Requirement ....................................252 §4913. Prohibited Acts .......................................................................................................................252 §4915. Enforcement of Regulation.....................................................................................................252 §4917. Effective Date.........................................................................................................................252

Chapter 51. Regulation 66―Requirements for Officers, Directors, and Trustees of Domestic Regulated Entities .................................................................................................253

§5101. Purpose ...................................................................................................................................253 §5103. Definitions ..............................................................................................................................253 §5105. Review of Officers, Directors and Trustees by Commissioner Required ..............................253 §5107. Procedure for Requesting Letter of No Objection from Commissioner.................................253 §5109. Conditions for Refusal of Letter of No Objection..................................................................254 §5111. Waiver of Submission of Biographical Information ..............................................................254 §5113. Scope and Limitations ............................................................................................................254

Chapter 53. Regulation 62―Managed Care Contracting Requirements ..................................................254 §5301. Purpose ...................................................................................................................................254 §5303. Definitions ..............................................................................................................................254 §5305. Applicability and Scope .........................................................................................................255 §5307. Provider Contracting Requirements .......................................................................................256 §5309. Requirements for Inclusion of Rural Hospitals ......................................................................256

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§5311. Requirements for Inclusion of Physicians Practicing in Qualifying Rural Hospitals ............257 §5313. General Provisions..................................................................................................................257

Chapter 55. Regulation 9―Deferred Payment of Fire Premiums in Connection with the Term Rule .....258 §5501. Payment of Fire Premiums .....................................................................................................258

Chapter 57. Regulation 14―Limiting Exclusions in Industrial Policies, Restricting Payments for Death Caused in Specified Manner .................................................................................258

§5701. Payment of Death or Funeral Benefits ...................................................................................258 §5703. Rider or Endorsement.............................................................................................................259

Chapter 60. Regulation 74―Payment of Health Coverage Claims ..........................................................259 §6001. Purpose ...................................................................................................................................259 §6003. Applicability and Scope .........................................................................................................259 §6005. Claim Payments―Definitions................................................................................................260 §6007. Nonelectronic Claim Submission Standards ..........................................................................261 §6009. Electronic Claim Submission Standards ................................................................................261 §6011. Thirty-Day Payment Standard................................................................................................261 §6013. Claim Handling Procedures....................................................................................................261 §6015. Limitations on Claim Filing and Audits.................................................................................262 §6017. Effective Date.........................................................................................................................262

Chapter 61. Regulation 16―Investment by Insurers of Part of Premium Paid, Return Guaranteed ........262 §6101. Policy Directive Number Three to Insurance Companies ......................................................262

Chapter 62. Regulation 77―Medical Necessity Review Organizations...................................................262 §6201. Purpose ...................................................................................................................................262 §6203. Definitions ..............................................................................................................................263 §6205. Authorization or Licensure as an MNRO...............................................................................265 §6207. Procedure for Application to Act as an MNRO .....................................................................265 §6211. Expiration and Renewal of License for Entities other than Health Insurance Issuers ...........266 §6213. Scope and Content of Medical Necessity Determination Process..........................................266 §6215. Medical Necessity Review Organization Operational Requirements ....................................267 §6217. Procedures for Making Medical Necessity Determinations...................................................267 §6219. Informal Reconsideration ........................................