§ 22:2401 — Requirements of federal laws and regulations; minimum requirements

§2401. Requirements of federal laws and regulations; minimum requirements
Health insurance issuers shall implement effective processes for appeals of coverage
determinations and claims. The processes shall comply with any applicable federal law or
regulation. Under such processes, a health insurance issuer shall, at a minimum:
(1) Have in effect an internal claims appeal process.
(2) Provide notice to covered persons, in a culturally and linguistically appropriate
manner, of available internal and external appeals processes and the availability of the office
of consumer advocacy of the Department of Insurance to assist such persons with the appeals
process.
(3) Allow covered persons, upon request and free of charge, to review and have
copies of all documents relevant to the claim for benefits and to submit comments and
documents relating to the claim, without regard to whether that information was submitted
or considered in the initial benefit determination, and to receive continued coverage pending
the outcome of the appeals process where required by applicable law or the plan document
or policy.

Legislative History

Acts 2013, No. 326, §1, eff. Jan. 1, 2015; Acts 2020, No. 36, §1.