§1075. Standards relating to benefits for mothers and newborns
A.
(1)The provisions of R.S. 22:1065(A), (B), and (C) shall apply to health insurance
coverage offered by a health insurance issuer in the individual market in the same manner
as it applies to health insurance coverage offered by a health insurance issuer in connection
with a group health plan in the small or large group market.
(2)Notwithstanding any other provisions to the contrary, a newborn child upon birth
shall be enrolled as a dependent under a group health plan, policy, or certificate of coverage
issued by a health insurance issuer, effective as of the date of such birth, under which such
newborn child may be enrolled.
(3)If applicable, the premium for a newborn child added to a policy, plan, or
certificate of coverag
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§1075. Standards relating to benefits for mothers and newborns
A.(1) The provisions of R.S. 22:1065(A), (B), and (C) shall apply to health insurance
coverage offered by a health insurance issuer in the individual market in the same manner
as it applies to health insurance coverage offered by a health insurance issuer in connection
with a group health plan in the small or large group market.
(2) Notwithstanding any other provisions to the contrary, a newborn child upon birth
shall be enrolled as a dependent under a group health plan, policy, or certificate of coverage
issued by a health insurance issuer, effective as of the date of such birth, under which such
newborn child may be enrolled.
(3) If applicable, the premium for a newborn child added to a policy, plan, or
certificate of coverage may be subject to adjustment for the additional coverage provided.
Such coverage shall be effective as of the date of birth of such newborn child and pursuant
to applicable provisions of the policy, plan, or certificate, shall be subject to the payment of
such additional premium, if any, and receipt of any required enrollment information within
the time period required by the health insurance issuer.
(4) To the extent that such newborn child meets, at birth, the eligibility provisions
as set forth in state laws, rules, or regulations implementing the State Plan Medical
Assistance under Title XIX of the Social Security Act, such additional coverage shall not be
cancelled for nonpayment of any additional premium due, if any, prior to the health insurance
issuer giving the secretary of the Louisiana Department of Health ninety days written notice
thereof via United States mail, certified, return receipt requested.
(5) If the premium remains unpaid after the notice period, the health insurance issuer
may cancel the newborn child's coverage effective as of the birth of the newborn child. The
health insurance issuer shall mail a copy of the notice provided to the secretary of the
Louisiana Department of Health to each health care provider that has submitted a claim for
services rendered to the newborn child. The health insurance issuer shall mail the copy of the
notice no later than three days after mailing the notice to the secretary of the Louisiana
Department of Health.
B.(1) A summary plan description of any individual health plan shall be furnished
to participants and beneficiaries. The summary plan description shall:
(a) Include the information described in Paragraph (3) of this Subsection.
(b) Be written in a manner calculated to be understood by the average plan
participant.
(c) Be sufficiently accurate and comprehensive to reasonably apprise such
participants and beneficiaries of their rights and obligations under the plan.
(2) A summary of any material modification in the terms of the plan and any change
in the information required under Paragraph (3) of this Subsection shall be written in a
manner calculated to be understood by the average plan participant and shall be furnished
within ninety days after he becomes a participant or after he first receives benefits. If later,
the information shall be furnished one hundred twenty days after the plan becomes subject
to this Subpart.
(3) The plan description and summary plan description shall contain the following
information:
(a) The name and type of administration of the plan.
(b) The name and address of the person designated as agent for the service of legal
process, if such person is not the administrator.
(c) The name and address of the administrator.
(d) The names, titles, and addresses of any trustee or trustees if they are persons
different from the administrator.
(e) A description of the relevant provisions of any applicable collective bargaining
agreement.
(f) The plan's requirements respecting eligibility for participation and benefits.
(g) A description of the provisions providing for nonforfeitable pension benefits.
(h) The circumstances which may result in disqualification, ineligibility, or denial
or loss of benefits.
(i) The source of financing of the plan and the identity of any organization through
which benefits are provided.
(j) The date of the end of the plan year and whether the records of the plan are kept
on a calendar, policy, or fiscal year basis.
(k) The procedures to be followed in presenting claims for benefits under the plan
and the remedies available under the plan for the redress of claims which are denied in whole
or in part.
NOTE: Former R.S. 22:1075 redesignated as R.S. 22:795 by Acts 2008, No.
415, §1, eff. Jan. 1, 2009.