§ 22:272 — Notice required for certain prepaid charge rate increases, cancellation or nonrenewal

§272. Notice required for certain prepaid charge rate increases, cancellation or nonrenewal
of service agreements; other requirements
A.(1) Every health maintenance organization regulated by this Subpart shall notify
each master contract group in writing at least forty-five days before any increase of twenty
percent or more in prepaid charges or at least sixty days before any cancellation or
nonrenewal of an agreement for basic health care services.
(2) The notice required by Paragraph (1) of this Subsection may be waived for a
basic health care service agreement which covers one hundred or more persons, provided a
provision for such waiver is made part of the basic health care services agreement agreed
upon by the insurer and the holder of the master contract.
B. Nothing in this Section shall be construed to grant to the health maintenance
organization any additional authorization in relation to cancellation, nonrenewal, or other
termination of an agreement for basic health care services and all provisions of this Subpart
which regulate such events shall apply. No basic health care services agreement shall be
cancelled, nonrenewed, or otherwise terminated because the health maintenance organization
failed to meet the notice provisions of this Section.
C.(1) The notice provisions of Subsections A and B of this Section shall not apply
to cancellations due to nonpayment on a timely basis of the prepaid charges.
(2) Every health maintenance organization issuing a contract for health care services
shall include in such contract a provision providing the subscriber or enrollee a grace period
of thirty days from the date the prepaid charge was due. If the prepaid charge is paid during
the grace period, then coverage shall remain in effect pursuant to the provisions of the
contract.
(3) Whenever a health maintenance organization does not receive a prepaid charge
payment fifteen days prior to the end of the grace period, the health maintenance organization
shall mail, by first class mail, a notice to the subscriber or enrollee. The notice shall state
that if the prepaid charge has not been paid by the end of the grace period, the contract will
lapse as provided by the provisions of the contract. The notice shall also state that the
contract will be reinstated with no penalties whatsoever to the subscriber or enrollee if the
full payment is received within the period allowed for reinstatement.
D.(1)(a) Every health maintenance organization authorized under this Subpart may
include in its plan obstetricians or gynecologists as primary care physicians. In addition, the
health maintenance organization shall not limit direct access to an in-network obstetrician
or gynecologist for routine gynecological care. This selection shall be permitted without
penalty or denial of the benefits provided under the health maintenance organization.
(b) Routine gynecological care as used in this Section shall mean a minimum of two
routine annual visits, provided that the second visit shall be permitted based upon medical
need only, and follow-up treatment within sixty days following either visit if related to a
condition diagnosed or treated during the visits, and any care related to a pregnancy. Nothing
in this Section shall prevent a policy, program, or plan from requiring that an obstetrician-gynecologist treating a covered patient coordinate that care with the patient's primary care
physician, if applicable, or in conjunction with other oversight procedures.
(2) Any provision in a health maintenance organization plan which is delivered,
renewed, issued for delivery, or otherwise contracted for in this state which is contrary to this
Section shall, to the extent of such conflict, be void.
E. Repealed by Acts 2016, No. 145, §2, eff. May 19, 2016.
F. Every health maintenance organization authorized under this Subpart shall also
be subject to the requirements of Subpart B of Part II of Chapter 6 of this Title, R.S. 22:1831
et seq.

Legislative History

Acts 1990, No. 538, §1; Acts 1995, No. 637, §1; Acts 1997, No. 1313, §1; Acts 1997, No. 1341, §1; Acts 1999, No. 1017, §1, eff. July 9, 1999; Acts 2006, No. 396, §1, eff. Jan. 1, 2007; Redesignated from R.S. 22:2027 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2009, No. 503, §1; Acts 2010, No. 919, §1, eff. Jan. 1, 2011; Acts 2016, No. 145, §2, eff. May 19, 2016.