§ 40:2212 — Basic benefit plans

A. A qualified plan shall provide full disclosure of services to each enrollee or prospective enrollee, including covered benefits, restrictions and/or limitations, specialty care, prescription drugs and biologics, the inclusion of essential community providers, the use of providers outside of a plan's provider network, and experimental treatments.
B. Each qualified plan shall disclose to each enrollee or prospective enrollee orally or in writing in a manner understandable at a fifth grade reading level and reviewed and approved by the literacy program of the Louisiana State University Health Sciences Center in Shreveport:
(1) A definition of basic covered benefits.
(2) Guidelines for confidential communication with caregivers.
(3) Availability and access to choice of providers.
(4) Quality assurance requirements.
(5) Disclosure of protocols as it relates to courteous treatment, timely referrals, and access to specialty care.
(6) Disclosure of deductibles.
(7) Extent of inclusion or exclusion of preventive health services in all basic benefit programs.
(8) Disclosure of definition of "necessary treatment".
(9) Information regarding appeal process.
C.(1) Any qualified plan shall not exclude from direct reimbursement health care services provided by an advanced practice registered nurse who provides health care services in accordance with the collaborative practice agreement for basic benefit services covered by the basic health plan.
(2) Any qualified plan shall not reimburse health care services provided by an advanced practice registered nurse at a rate less than the rate paid to other health care providers who perform the same services.

Legislative History

Acts 1995, No. 621, §1, eff. June 18, 1995; Acts 1999, No. 802, §5, eff. July 2, 1999; Acts 2001, No. 704, §1; Acts 2006, No. 106, §1.