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Organ Transplant   LA Product Code:  H-Ind01.LB-01D
Policyholder Type:  Assn Grp - Individual Members / Ltd Benefit Plans
Organ & Tissue Transplant Plan issued to Individual Members of an Assn - Health insurance providing benefits for treatment related to human and/or non-human organ transplant. Benefits are specific to the delivery of care associated with the covered organ or tissue and may be paid as expense incurred, per diem, or a principle sum.

All Legal References For Product Compliance.

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ReferenceDescription
LDI Reg 78:§10101.A
The purpose of this regulation is: (1) to provide for the uniform and practicable administration of the form filing, review and approval requirements of the Louisiana Insurance Code; (2) to clarify the provisions of R.S. 22:821.B; (3) to protect the interests of insurance consumers and the public through improvements to the form filing, review and approval processes; and (4) to assist all insurers in complying with the form filing, review and approval requirements of the Louisiana Insurance Code.
LDI Reg 78:§10105.A
This regulation applies to all insurers doing business in the State of Louisiana subject to the form filing, review and approval provisions of the Louisiana Insurance Code.
LDI Reg 78:§10107.A
Filing and Review of Health Insurance Policy Forms - Definitions
LDI Reg 78:§10107.B.1
Pursuant to LRS-22:861 A, no basic insurance policy form, or application form where written application is required and is to be attached to the policy or be a part of the contract, or printed rider or endorsement form, may be issued or delivered in this state unless and until it has been filed with and approved by the commissioner of insurance. This requirement also applies to any group health or accident insurance policy covering residents of Louisiana, regardless of where issued or delivered. Every page of each such form, including rider and endorsement forms, filed with the department must be identified by a form number in the lower left corner of the page.
LDI Reg 78:§10107.B.2
A Health and Accident Transmittal Document must accompany every filing, describing the items included in the filing, the insurance product for which the filing is being made, and the method of marketing to be used for the product. If the filing will include life insurance to be offered as an optional benefit under the base health insurance contract, the policy forms should be submitted in triplicate, notwithstanding the provisions of §10107.C.2 hereof, and include the appropriate Statement of Compliance for said life insurance product.
LDI Reg 78:§10107.C.1
The department shall designate, by directive, those insurance products which must be filed pursuant to the requirements for certified approval as set forth in §10107.F hereof. A directive issued pursuant to this Subsection may also designate those insurance products which may, at the discretion of the insurer, be filed either pursuant to said requirements for Certified Approval, or as ordinary filings subject to review as set forth in §10107.E hereof. All insurance products not so designated shall be filed pursuant to the requirements for Compliance Review as set forth in §10107.E hereof.
LDI Reg 78:§10107.C.2
Other than as specified in §10107.D hereof, only complete filings will be accepted, whether by mail or as otherwise authorized. In order for the department to conduct a proper compliance review or compliance audit of an insurance product, all items associated therewith must be included. A filing will be determined incomplete and will be disapproved if it does not contain all applicable items.
LDI Reg 78:§10107.C.2.a.i
All filings of an insurance product must include the required filing fee, per insurance product, per insurance company.
LDI Reg 78:§10107.C.2.a.ii
All filings of an insurance product must include a completed Health and Accident Transmittal Document, as prescribed by the department.

Comments
The Transmittal Document requirement has been waived for Health and Accident form filings being submitted through SERFF.
LDI Reg 78:§10107.C.2.a.iii
All filings of an insurance product must include a Statement of Compliance for said product.

Comments
Insurers are required to indicate the policy form section and/or page number where compliance with a legal reference is demonstrated or, indicate "N/A" where inapplicable to the specific product being filed. All entries of "N/A" must be explained in an addendum to the Statement of Compliance. FAILURE TO PROPERLY COMPLETE THE STATEMENT OF COMPLIANCE (including correct section and page numbers) WILL RESULT IN AN INCOMPLETE FILING AND DISAPPROVAL THEREOF.
LDI Reg 78:§10107.C.2.a.iv
All filings of an insurance product must include the policy forms filed for approval.
LDI Reg 78:§10107.C.2.a.ix
All filings of an insurance product must include stamped, self-addressed envelope of sufficient size for use in returning the company's set of the policy forms filed, unless filed electronically.
LDI Reg 78:§10107.C.2.a.v
All filings of an insurance product must include the application form.
LDI Reg 78:§10107.C.2.a.vi
All filings of an insurance product must include the rider or endorsement forms.
LDI Reg 78:§10107.C.2.a.vii
All filings of an insurance product must include copies of any sample identification card intended for issue to covered persons.
LDI Reg 78:§10107.C.2.a.viii
All filings of an insurance product must include the initial premium rates and classification of risks.
LDI Reg 78:§10107.C.2.d
Filings of all group insurance products must include the group master contract, individual certificates or subscriber agreements or other statements of coverage, group application, individual enrollment forms, and any conversion insurance policy and application for conversion, if offered under the group master contract.
LDI Reg 78:§10107.C.2.e
Filings of group health and accident products intended for issue to an association are limited to associations as defined in Regulation 78 and must include the association's constitution, by-laws, membership application, membership agreement and brochure of membership benefits other than the insurance products offered.
LDI Reg 78:§10107.D
Exceptions to the requirements for a complete filing may be allowed, at the discretion of the department, subject to the conditions stated herein, for the policy forms described in §10107.D.1 - §10107.D.12.
LDI Reg 78:§10107.D.1

Associated References
LDI Reg 78:§10107.D
Exceptions: Application forms or enrollment forms to be used with a particular insurance product, or with multiple insurance products, provided that the policy form filings and dates approved are identified for each previously approved product with which the application form or enrollment form will henceforth be used, and the application form or enrollment form is included with any subsequently filed basic insurance policy forms as needed to constitute a complete filing. No filing fees will be required for these filings.
LDI Reg 78:§10107.D.10

Associated References
LDI Reg 78:§10107.D
Exceptions: Following approval of a complete filing of a Medicare Supplement insurance product, subsequent filings by the same insurer of standardized plans of insurance of the same type do not require inclusion of associated forms such as the replacement notice or plan of operation, unless changes have been made or the plan of operation has changed. No filing fees will be required for any of the above associated forms. However, subsequent filings of an outline of coverage will require a filing fee in accordance with the most current fee schedule applicable to such filings, as set forth by the Louisiana Legislature.
LDI Reg 78:§10107.D.2

Associated References
LDI Reg 78:§10107.D
Exceptions: Identification cards. No filing fees will be required for these filings.
LDI Reg 78:§10107.D.7

Associated References
LDI Reg 78:§10107.D
Exceptions: Medicare Supplement Rate Filings. Such filings must clearly indicate the percentage of increase in rates for each standardized plan and existing pre-standardized plan. Such filings must include statutory filing fees for standardized plans in accordance with the most current fee schedule applicable to such filings, as set forth by the Louisiana Legislature.
LDI Reg 78:§10107.E
Time Periods and Requirements for Compliance Review of Basic Insurance Policy Forms.
LDI Reg 78:§10107.E.1

Associated References
LDI Reg 78:§10107.D
The time periods for Compliance Review of basic insurance policy forms do not begin until the date a complete filing, or a filing pursuant to §10107.D hereof, is received by the department.
LDI Reg 78:§10107.E.2

Associated References
La. R.S. 22:§862 (6)
If a filing made is incomplete, notice of disapproval in accordance with LRS-22:862(6) will be issued for failure to comply with the requirements of LDI Reg 78.
LDI Reg 78:§10107.E.3
A basic insurance policy form must be submitted to the department in accordance with the "General Filing Requirements" of this Section no less than 45 days in advance of planned issuance, delivery or use.
LDI Reg 78:§10107.E.4
If affirmatively approved by the department prior to expiration of the 45-day period allowed for department review of a filing, the policy forms filed may be used on or after the date approved.
LDI Reg 78:§10107.E.5
If disapproved, the policy forms filed may not be used.
LDI Reg 78:§10107.E.6
At the expiration of 45 days, if no order has been issued affirmatively approving or disapproving a filing, the insurer shall submit written notice to the department if the filing has been deemed approved on a specific date, or advise when the filing is withdrawn from consideration. Such date specified by the insurer shall be on or after day 46, but not earlier than the 45-day expiration period. Such written notice shall be sent to the department within 30 days after the expiration of the 45-day period clearly stating the date deemed approved or withdrawn from consideration and the anticipated date to be used by the insurer (if different from the date deemed approved). Deemed approval shall not be effective until the insurer has so notified the commissioner, by certified mail/return receipt requested.
LDI Reg 78:§10107.E.7
The commissioner of insurance may send written notice prior to expiration of the initial 45-day period extending the time allowed for approval or disapproval by an additional 15 days.
LDI Reg 78:§10107.E.7.a
If affirmatively approved by order of the commissioner prior to expiration of the 15-day extended period allowed for department review, the policy forms filed may be used on or after the date approved.
LDI Reg 78:§10107.E.7.b
At the expiration of the 15-day extended period, if no order has been issued affirmatively approving or disapproving the policy form filing, the insurer shall submit written notice to the department if the policy form filing has been deemed approved on a specific date, or advise when the policy form filing is withdrawn from consideration. Such date specified by the insurer shall be on or after day 46 referred to in Paragraph E.6 or day 61, but not earlier than the 45-day expiration period. Such written notice shall be sent to the department within 30 days after the expiration of the 15-day extended period, clearly stating the date deemed approved or withdrawn from consideration and the anticipated date to be used by the insurer (if different from the date deemed approved). Deemed approval shall not be effective until the insurer has so notified the commissioner, by certified mail/return receipt requested.
LDI Reg 78:§10107.F
Time Periods and Requirements for Certified Approval of Policy Form Filings.
LDI Reg 78:§10107.F.1
The department will make available Statements of Compliance setting forth the statutory and regulatory requirements specific to the various forms of coverage and contract types, as well as Certification of Compliance forms.
LDI Reg 78:§10107.F.2

Associated References
LDI Reg 78:§10107.C.2
2. A policy form filing submitted for certified approval must include the following documents: a. Statement of Compliance applicable to the form of coverage and contract type being submitted; b. signed and dated Certification of Compliance; c. all other items as set forth in Paragraph C.2 hereof.
LDI Reg 78:§10107.F.3

Associated References
La. R.S. 22:§862 (6)
If the filing is incomplete, notice of disapproval in accordance with LRS-22:862(6) will be issued for failure to comply with the requirements of LDI Reg 78.
LDI Reg 78:§10107.F.4
At the expiration of 15 days from acknowledged receipt of a filing by the department, if no order has been issued affirming certified approval or disapproving the policy form filing, the insurer shall submit written notice to the department if the policy form filing has been deemed approved on a specific date, or advise when the policy form filing is withdrawn from consideration. Such date specified by the insurer shall be on or after day 16, but not earlier than the 15-day expiration period. Such written notice shall be sent to the department within 30 days after the expiration of the 15-day period clearly stating the date deemed approved or withdrawn from consideration and the anticipated date to be used by the insurer (if different from the date deemed approved). Deemed approval shall not be effective until the insurer has so notified the commissioner, by certified mail/return receipt requested.
LDI Reg 78:§10107.F.5

Associated References
LDI Reg 78:§10107.I
No insurer, through an officer or authorized representative, shall file a certification of compliance containing false attestations, or from which material facts or information have been omitted. In the event that the department subsequently learns that a certification of compliance contains any inaccuracies, false attestations, or material omissions, approval of the subject forms may be withdrawn, and the insurer may be subjected to the provisions of 10107.I hereof.
LDI Reg 78:§10107.G
Requirements for Resubmission of Filings.
LDI Reg 78:§10107.G.1

Associated References
LDI Reg 78:§10107.E
LDI Reg 78:§10107.F
LDI Reg 78:§10107.I
When submitting revised forms in response to an order of disapproval, or withdrawal of approval, whether issued pursuant to §10107.E, §10107.F or §10107. I hereof, the revised forms will constitute a new filing; include the required filing fee and must comply with all provisions of this Section for such a filing.
LDI Reg 78:§10107.G.1.a
A resubmission of previously disapproved forms must include: An outline of the proposed revisions, referencing the specific sections and page numbers for each form being revised.
LDI Reg 78:§10107.G.1.b
A resubmission of previously disapproved forms must include: A restatement of the form with all necessary revisions, as set forth in the prior order of disapproval, underlined in red or similarly emphasized.
LDI Reg 78:§10107.G.1.c
A resubmission of previously disapproved forms must include: A copy of the prior order of disapproval, or withdrawal of approval, issued by the department on the previous filing.
LDI Reg 78:§10107.G.2

Associated References
LDI Reg 78:§10107.C.2
When submitting revisions to previously approved forms, the revised forms will constitute a new filing; must be a complete filing as set forth in §10107.C hereof, and include the required filing fee.
LDI Reg 78:§10107.G.2.a
A resubmission of revised previously approved forms must include: A copy of the previously approved form.
LDI Reg 78:§10107.G.2.b
A resubmission of revised previously approved forms must include: An outline of the proposed revisions, referencing the specific sections and page numbers for each previously approved form being revised.
LDI Reg 78:§10107.G.2.c
A resubmission of revised previously approved forms must include: A restatement of the form, with all proposed revisions underlined in red or similarly emphasized.
LDI Reg 78:§10107.G.2.d
A resubmission of revised previously approved forms must include: A copy of the prior order of approval, issued by the department on the previous filing.
LDI Reg 78:§10107.G.3
When a previously approved form has been rewritten, it must be assigned a unique form number, and such form must be filed as an original filing.
LDI Reg 78:§10107.H.1
Approval of a basic insurance policy form does not assure perpetual compliance. Following subsequent changes in applicable law, insurers shall not fail to revise and file updated insurance products, or amendatory riders or endorsements where appropriate, with the department for approval as required to maintain continuous compliance with the current requirements of law. This provision shall apply to all new business issued, or in-force business renewed, following any such subsequent changes in applicable law, or as otherwise determined by the Louisiana Legislature.
LDI Reg 78:§10107.H.2
A retrospective review process will be utilized to verify compliance of approved filings and to assure that all approved filings remain in compliance with currently applicable law. Compliance audits may be conducted by random selection, prompted by complaints filed with the department or requests for information made by the department, or performed during the course of examinations conducted by the department.
LDI Reg 78:§10107.H.3
Insurers shall notify the department in writing to advise when a previously approved basic insurance policy form will no longer be marketed in this state and is being permanently withdrawn from the market. Such notification shall also advise whether or not coverage issued in this state under the policy form remains in force and whether or not such existing business will continue to be renewed. The notification shall provide the policy form numbers being discontinued and dates originally approved by the department.
LDI Reg 78:§10107.I
Requirements for Withdrawal of Approval and Corrective Action.
LDI Reg 78:§10107.I.1

Associated References
La. R.S. 22:§862
The department shall withdraw any affirmative approval of a filing previously granted, or withdraw any approval of a filing previously deemed approved by an insurer, if the department determines that any of the reasons for disapproval as stated in R.S. 22:862 apply to the filing in question. The notice of withdrawal of approval by the department shall state that such withdrawal of approval is effective 30 days after receipt of such notice by the affected insurer or immediately where there has been a violation of the Louisiana Insurance Code that results in irreparable injury, loss, or damage and injunctive relief is necessary. In the event injunctive relief is granted to the department, the insurer or its duly authorized representative shall be enjoined or restrained from engaging in any prohibitory activity set forth in the injunctive order or judgment rendered by a court of competent jurisdiction.
LDI Reg 78:§10107.I.1.a
The affected insurer may request a hearing on the withdrawal of approval, by written request mailed to the department within 30 days of receipt of the notice of withdrawal of approval.
LDI Reg 78:§10107.I.1.b
Upon receipt by the department of a timely request for a hearing, the 30-day notice period precedent to withdrawal of approval being effective shall be suspended for the duration of the hearing process, and shall recommence upon the date of a ruling adverse to the insurer requesting the hearing, unless injunctive relief has been requested and granted to the department by a court of competent jurisdiction. Such suspension of the notice of withdrawal of approval shall be applicable to Paragraphs I.2, 3, 4 and 5 hereof.
LDI Reg 78:§10107.I.2
2. Upon receipt of the notice of withdrawal of approval by the department, the affected insurer must: a. immediately amend its procedures to assure that all in-force business is properly administered in accordance with the findings stated in the department's withdrawal of approval; b. immediately review and ascertain any negative impact upon covered persons caused directly or indirectly by non-compliant provisions of the forms for which department approval has been withdrawn; and c.immediately review other products being marketed by the insurer to assure that they do not contain such non-compliant provisions.
LDI Reg 78:§10107.I.3
Within 30 days of receipt of the notice of withdrawal of approval by the department, a corrective action plan must be submitted to the department by the affected insurer.
LDI Reg 78:§10107.I.3.a
If the affected product will no longer be marketed, amendatory endorsement forms or rider forms to affect any in-force business written utilizing the non-compliant forms, correcting all areas of non-compliance as stated in the withdrawal of approval by the department; and a prototype of the notice to be utilized in notifying any affected policyholders of the changes to their existing coverage.
LDI Reg 78:§10107.I.3.b
If the insurer desires to continue marketing the affected product, the corrective action plan must include a complete filing of properly revised forms in accordance with §10107.G.1 hereof; and amendatory endorsement forms or rider forms to affect any in-force business written utilizing the noncompliant forms, correcting all areas of non-compliance as stated in the withdrawal of approval by the department; and a prototype of the notice to be utilized in notifying any affected policyholders of the changes to their existing coverage.
LDI Reg 78:§10107.I.3.c
Where such a required change can be clearly explained to prospective policyholders through amendatory endorsement forms or rider forms, such approval shall not extend to any reprinting of such forms.
LDI Reg 78:§10107.I.4
Thirty days following receipt of the notice by the affected insurer, of withdrawal of approval by the department, an affected product shall not be issued by the insurer, except in accordance with a corrective action plan approved by the department. The insurer has the obligation to timely notify its marketing force, or to otherwise adjust its business operations, accordingly. In the event the affected insurer issues the product without approval from the department, and injunctive relief is necessary and granted to the department, the insurer or its duly authorized representative shall be enjoined or restrained from engaging in any prohibitory activity set forth in the injunctive order or judgment rendered by a court of competent jurisdiction.
LDI Reg 78:§10107.I.5
The department may, in its discretion, extend the 30-day period for approval of a corrective action plan, upon the written request of the affected insurer and for good cause shown. In the event such an extension is granted, the date by which the insurer must cease issuing the affected product, except in accordance with a corrective action plan approved by the department, shall likewise be so extended.
LDI Reg 78:§10107.I.6
Failure to timely respond as required herein shall result in a formal investigation to establish the extent of statutory violations, followed by an administrative hearing to determine appropriate sanctions against the insurer.
LDI Reg 78:§10107.J
Any person aggrieved by a failure to approve any filing, or the disapproval of any filing, or the withdrawal of approval of any filing, or any related action taken by the department pursuant to this Section, may request an administrative hearing in accordance with the provisions of Chapter 12 of Title 22 of the Louisiana Revised Statutes. Pursuant to R.S. 22:2191, such demand must be in writing, must specify in what respects such person is aggrieved and the grounds to be relied upon as basis for relief to be demanded at the hearing, and must be made within 30 days of receipt of actual notice or, if actual notice is not received, within 30 days of the date such insurer or other person learned of the act, or failure to act, upon which the demand for hearing is based.
LDI Reg 78:§10107.K
Maintenance of Records; Alteration of Forms Prohibited.
LDI Reg 78:§10107.K.1
Every person filing policy forms, or related forms, for approval by the department shall maintain the original set of any and all forms as returned by the department, along with all related correspondence and transmittal documents from the department. Alternatively, images of such documents may be maintained in electronic/digital form. Such files shall be available for inspection by the department upon request, and must be maintained for a period of five years after the forms have been withdrawn from the market in accordance with Paragraph H.3 hereof and no coverage issued on risks in this state utilizing such forms remains in force.
LDI Reg 78:§10107.K.2
The alteration of, or any change to, any such form approved by the department is prohibited. Any such altered or changed form shall be submitted to the department as a new filing, and shall comply with all provisions of this Section applicable to a new filing. This Subsection shall not apply to typographical corrections and format improvements that do not affect the terms, provisions or clarity of the product.
LDI Reg 78:§10107.K.3
A change of company name or logo, a change of address, and changes in listed officers do not require a new filing of forms when the department is otherwise properly notified of such change, and a copy of such notification is maintained on file by the insurer.
LDI Reg 78:§10117
If any provision of this regulation, or its application to any person or circumstance, is held invalid, such determination shall not affect other provisions or applications of this regulation which can be given effect without the invalid provision or application, and to that end, the provisions of this regulation are severable.
La. R.S. 22:§821 B

Associated References
LDI Dir 168:Dir 168
Fees for approval of policy form filings.
La. R.S. 22:§851 A
The applicable provisions of this Part shall apply to insurance other than ocean marine and foreign trade insurances. This Part shall not apply to life insurance policies or annuities not issued for delivery in this state nor delivered in this state. This Part also shall not apply to any health and accident insurance policy not issued for delivery in this state nor delivered in this state, except for any group policy covering residents of Louisiana, regardless of from where it was issued or delivered.
La. R.S. 22:§861

Associated References
LDI Dir 169:Dir 169
LDI Reg 78:§10107.B.1
LDI Reg 78:§10109.B.1
LDI Reg 78:§10113.B.1
Approval of policy forms required.
La. R.S. 22:§861 A(2)

Associated References
LDI Reg 78:§10107.A
LDI Reg 78:§10109.A
LDI Reg 78:§10113.A
Basic insurance policy form includes a certificate of coverage, subscriber agreement, or any other evidence of coverage.
La. R.S. 22:§861 A(3)

Associated References
LDI Reg 78:§10107.A
LDI Reg 78:§10109.A
LDI Reg 78:§10113.A
Basic insurance policy form does not include policies, riders, or endorsements designed to delineate the coverage for and used with relation to insurance upon a particular subject or which relate to the manner of distribution of benefits or to the reservation of rights and benefits under such policy, and which is used at the request of the individual policyholder, contract holder or certificate holder.
La. R.S. 22:§861 A(4)
Any insurer may insert in its policies any provisions or conditions required by its plan of insurance or method of operation which are not prohibited by the provisions of LRS-22.
La. R.S. 22:§861 B

Associated References
LDI Dir 169:Dir 169
LDI Reg 78:§10107.E
LDI Reg 78:§10109.E
LDI Reg 78:§10113.E
Time periods for review of basic insurance policy form filings.
La. R.S. 22:§861 C
The commissioner's order disapproving a basic insurance policy form or withdrawing a previous approval shall state the grounds therefor.
La. R.S. 22:§861 E

Associated References
La. R.S. 22:§861
LDI Dir 169:Dir 169
The commissioner may exempt by order any insurance document or form or type from the requirements of §861 that may not practicably be applied, or the filing and approval of are not desirable or necessary for the protection of the public.
La. R.S. 22:§863 A
Insurance contracts shall contain such standard provisions as required by applicable chapters of LRS-22 pertaining to particular kinds of insurance.
La. R.S. 22:§863 C
Standard provisions required by the law of a foreign or alien insurer's domicile may be used if approved by the commissioner.
La. R.S. 22:§864 A
The written instrument, in which a contract of insurance is set forth, is the policy.
La. R.S. 22:§864 B(1)
A policy shall specify the names of the parties to the contract. The insurer's name and if not a life insurer, the type of organization shall be clearly shown in the policy.
La. R.S. 22:§864 B(2)
A policy shall specify the subject of the insurance.
La. R.S. 22:§864 B(3)
A policy shall specify the risks insured against.
La. R.S. 22:§864 B(4)
A policy shall specify the time at which the insurance thereunder takes effect and the period during which the insurance is to continue.
La. R.S. 22:§864 B(5)
A policy shall include a statement of the premium. If other than life, accident or health, or title insurance, the premium rate should also be specified.
La. R.S. 22:§864 B(6)
A policy shall specify the conditions pertaining to the insurance.
La. R.S. 22:§864 B(8)
Every printed portion of the text matter of the policy and of any endorsements or attached papers shall be printed in uniform, no less than ten-point type. The text matter shall include all printed matter except the name and address of the insurer, name or title of the policy, captions, sub-captions, and form numbers.
La. R.S. 22:§864 B(9)

Associated References
LDI Reg 78:§10107.B.1
Each policy form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of each page.
La. R.S. 22:§865
A policy may contain additional provisions, which are not inconsistent with this Code, and which are, (1) Required to be so inserted by the laws of the insurer's state of domicile; or (2) Necessary, on account of the manner in which the insurer is constituted or operated, to state the rights and obligations of the parties to the contract.
La. R.S. 22:§869
Every insurance contract shall be executed in the name of and on behalf of the insurer by its officer, employee, or representative duly authorized by the insurer. A facsimile signature of any such executing officer, employee, or representative may be used in lieu of an original signature.
La. R.S. 22:§972 A

Associated References
LDI Dir 169:Dir 169
LDI Reg 78:§10107.B.1
LDI Reg 78:§10107.E.3
No form may be issued in this state until approved by the Commissioner or until the time period allowed for granting approval or disapproval has expired. The premium rates and classification of risks must be included. Written notice of disapproval must be provided advising of the insurer's right to hearing within 20 days of receipt of written request.

Comments
LDI Reg 78, §10107.E.3 allows 45-days before a filing may be "deemed approved".
La. R.S. 22:§972 B

Associated References
La. R.S. 22:§862
LDI Reg 78:§10107.I.1
Withdrawal of approval must be preceded by 20-days advance written notice of hearing.

Comments
LDI Reg 78, §10107.I.1 allows 30-days notice before the withdrawal of approval takes effect.
La. R.S. 22:§972 C

Associated References
La. R.S. 22:§862
La. R.S. 22:§975 A
A form shall not be disapproved or approval withdrawn for non-compliance with §975 or on the ground that a form is not printed in uniform type if it is shown that the rights of the insured / beneficiary as a whole are not less favorable.
La. R.S. 22:§973 (4)

Associated References
La. R.S. 22:§864 B(8)
No health and accident policy or contract shall be delivered or issued for delivery on risks in this state unless every printed portion of the text matter of the policy and of any endorsements or attached papers is printed in type the size of which shall be uniform and the face of which shall be not less than ten-point. The "text" shall include all printed matter except the name and address of the insurer, name or title of the policy, captions and sub-captions, and form numbers.
La. R.S. 22:§973 (6)

Associated References
La. R.S. 22:§864 B(9)
Each form must be identified by a form number in the lower left hand corner.
La. R.S. 22:§974

Associated References
La. R.S. 22:§863 A
La. R.S. 22:§863 B
La. R.S. 22:§863 C
The commissioner of insurance may from time to time, after hearing, promulgate such rules and regulations as he deems necessary to establish reasonable minimum standard conditions for basic benefits to be provided by health and accident insurance contracts which are subject to R.S. 22:972, 973, 975-983, 985-990, 992, 993, 999-1014, 1021-1048, 1091-1096, 1111, and 1156, for the purpose of expediting his approval of such contracts pursuant to this Code. No such promulgation shall be inconsistent with standard provisions as required pursuant to R.S. 22:863.
La. R.S. 22:§975 C
If any provision of this Section is inapplicable or inconsistent with any risk covered by a particular form of policy, subject to the approval of the commissioner of insurance the insurer may omit such inapplicable provision or modify such inconsistent provision to make it consistent with the coverage provided by the policy.
LDI Dir 168:Dir 168

Associated References
La. R.S. 22:§821 B
Notification of changes affecting policy form filing fees.
LDI Dir 169:Dir 169
Notification of changes affecting approval of forms.
LDI Dir 174:Dir 174
Insurance coverages and contracts for which the Certified Approval procedure is required, or which may, at the filer's option, be filed utilizing the Certified Approval procedure.
Form Filing Prohibitions   Back To Top
ReferenceDescription
La. R.S. 22:§861 A(1)

Associated References
LDI Dir 169:Dir 169
LDI Reg 78:§10107.B.1
LDI Reg 78:§10109.B.1
LDI Reg 78:§10113.B.1
No basic insurance policy form, or application form where written application is required and is to be attached to the policy or be a part of the contract, or life, annuity, or health or accident rider or endorsement form shall be issued, delivered, or used unless it has been filed with and approved by the commissioner of insurance.
La. R.S. 22:§861 D
No basic insurance policy form that has been disapproved or had approval withdrawn shall knowingly be issued or delivered.
La. R.S. 22:§862

Associated References
LDI Reg 78:§10107.I
LDI Reg 78:§10109.I
LDI Reg 78:§10113.I
The commissioner shall disapprove or withdraw any previous approval of any basic insurance policy form under certain grounds.
La. R.S. 22:§862 (1)
Grounds for Disapproval - If the form is in any respect in violation of or does not comply with law.
La. R.S. 22:§862 (2)
Grounds for Disapproval - If the form does not comply with any controlling filing theretofore made and approved.
La. R.S. 22:§862 (3)
Grounds for Disapproval - If it contains or incorporates by reference any inconsistent, ambiguous, or misleading clauses or exceptions and conditions which unreasonably or deceptively affect the risk purported to be assumed in the general coverage of the contract.
La. R.S. 22:§862 (4)
Grounds for Disapproval - If it has any title, heading, or other indication of its provisions which is misleading.
La. R.S. 22:§862 (5)
Grounds for Disapproval - If purchase of insurance thereunder is being solicited by deceptive advertising.
La. R.S. 22:§862 (6)
Grounds for Disapproval - If it is in any respect in violation of or does not fully comply with the law or any rule or regulation promulgated by the commissioner.
La. R.S. 22:§863 B
No insurance contract shall contain any provision inconsistent with or contradictory to required or optional standard provisions, unless a more favorable provision is approved by the commissioner. No endorsement, rider, or other documents attached to contracts shall vary, extend or in any respect conflict with such standard provisions in a less favorable manner.
La. R.S. 22:§866
No policy shall contain any provision purporting to make any portion of the articles of incorporation, by-laws, or other constituent document of the insurer a part of the contract unless such portion is set forth in full in the policy. Any policy provision in violation of this Section shall be invalid.
La. R.S. 22:§867
No agreement in conflict with, modifying, or extending the coverage of any contract of insurance shall be valid unless it is in writing and physically made a part of the policy or other written evidence of insurance, or it is incorporated in the policy or other written evidence of insurance by specific reference to another policy or written evidence of insurance. Any written agreement in conflict with, modifying, or extending the coverage of any contract of insurance shall be deemed to be physically made a part of a policy or other written evidence of insurance.
La. R.S. 22:§868 A
No insurance contract delivered or issued for delivery in this state and covering subjects located, resident, or to be performed in this state or any group health and accident policy insuring a resident of this state, regardless of where made or delivered shall contain any condition, stipulation, or agreement that fails to meet certain requirements.
La. R.S. 22:§868 A(1)
No insurance contract shall contain any condition, stipulation, or agreement requiring it to be construed according to the laws of any other state or country except as necessary to meet the requirements of the motor vehicle financial responsibility laws of such other state or country.
La. R.S. 22:§868 A(2)

Associated References
LDI Dir 173:Dir 173
No insurance contract shall contain any condition, stipulation, or agreement depriving the courts of this state of the jurisdiction of action against the insurer.
La. R.S. 22:§868 B
No insurance contract delivered or issued in this state and covering subjects located, resident, or to be performed in this state, or any health and accident policy insuring a resident of this state regardless of where made or delivered, shall contain any condition, stipulation, or agreement limiting right of action against the insurer to a period of less than twenty-four months next after the inception of the loss when the claim is a first-party claim under property coverages, or to a period of less than one year from the time when the cause of action accrues in connection with all other insurances unless otherwise specifically provided in this Code.
La. R.S. 22:§868 C
Any such condition, stipulation, or agreement in violation of this Section shall be void, but such voiding shall not affect the validity of the other provisions of the contract.
La. R.S. 22:§880
Any insurance policy, rider, or endorsement hereafter issued and otherwise valid, which contains any condition or provision not in compliance with the requirements of this Code, shall not be rendered invalid thereby, but shall be construed and applied in accordance with such conditions and provisions as would have applied had such policy, rider or endorsement been in full compliance with this Code.
La. R.S. 22:§881
Every insurance contract shall be construed according to the entirety of its terms and conditions as set forth in the policy, and as amplified, extended, or modified by any rider, endorsement, or application attached to or made a part of the policy.
Cover / Face Page   Back To Top
ReferenceDescription
La. R.S. 22:§973 (2)
Time at which the insurance takes effect and terminates must be expressed in the policy.
La. R.S. 22:§973 (7)(a)
No health and accident policy or contract shall be delivered or issued for delivery on risks in this state unless there is prominently printed on or attached, a notice to the insured that ten days are allowed, from the date of his receipt of the policy, to examine its provisions. If such policy was solicited by deceptive advertising or negotiated by deceptive, misleading, or untrue statements of the insurer or any agent on behalf of the insurer, such policy may be surrendered within said ten-day period. Any premium advanced by the insured, upon such surrender, shall be immediately returned to him; however, the insurer shall have the option of printing or attaching the notice required by this Subparagraph or a notice of equal prominence which, in the opinion of the commissioner of insurance, is not less favorable to the policyholder. This Paragraph shall not apply to travel insurance policies which by their terms are not renewable.
Definitions   Back To Top
ReferenceDescription
La. R.S. 22:§1023 A

Associated References
LDI Reg 63:Reg 63
Definitions for this Section regarding prohibited discrimination based upon genetic information.

Comments
Under LRS 22::§213.7 A (12), reference to "franchise" coverage was redesignated to "association" coverage pursuant to ACT No. 129 of the 2003 Regular Session of the Lousiana Legislature
Insurable Interest   Back To Top
ReferenceDescription
La. R.S. 22:§901 A
No person shall procure insurance upon the life or body of another individual unless the benefits are payable to the individual insured or his personal representatives or a person having an insurable interest in the insured at the time the contract is made.
La. R.S. 22:§901 B

Associated References
La. R.S. 22:§901 A
The insured, his executor or administrator may maintain an action to recover benefits paid to an individual that did not have an insurable interest in the insured at the time the contract was made.
La. R.S. 22:§901 C
"Insurable interest" includes only interest as follows: (1) In the case of individuals related closely by blood or by law, a substantial interest engendered by love and affection; (2) In the case of other persons, a lawful and substantial economic interest in having the life, health or bodily safety of the individual insured continue, as distinguished from an interest which would arise only by, or would be enhanced in value by, the death, disablement or injury of the individual insured; and (3) A party to an agreement has an insurable interest in the life of each individual party to such agreement for the purposes of such agreement in addition to any insurable interest which may otherwise exist as to the life of such individual party.
Eligibility Provisions   Back To Top
ReferenceDescription
La. R.S. 22:§1000 A (1)(a)(vi)(bb)
Eligible dependents include unmarried children or grandchildren in the legal custody of and residing with the grandparent until the age of twenty-one and unmarried children or grandchildren if enrolled as a full time student until the age of twenty-four.
La. R.S. 22:§1000 C
New members becoming eligible for insurance in an existing group or class shall be added.

Comments
Reference to "franchise" was redesignated to "association" pursuant to ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature.
La. R.S. 22:§1000 E
It is prohibited for an insurer to consider the availability or eligibility for medical assistance under state or federal law as a requirement for coverage.

Comments
Reference to "franchise" was redesignated to "association" pursuant to ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature.
La. R.S. 22:§1004 A
Any unmarried child who is placed in the home of an insured pursuant to an adoption placement agreement executed with a licensed adoption agency shall be considered a dependent child of the insured from the date of placement in the home of the insured.

Comments
Reference to "franchise" coverage was redesignated to "association" coverage pursuant to ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature.
La. R.S. 22:§1004 B
Any unmarried child who is placed in the home of an insured following execution of an act of voluntary surrender in favor of the insured or the insured's legal representative shall be considered a dependent child of the insured effective on the date on which the act of voluntary surrender becomes irrevocable.

Comments
Reference to "franchise" coverage was redesignated to "association" coverage pursuant to ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature.
Policyholder Requirements   Back To Top
ReferenceDescription
La. R.S. 22:§1000 A(1)(a)

Associated References
La. R.S. 22:§868 A(1)
La. R.S. 22:§868 A(2)
Group policy issued to an employer or association or trustees of a fund established by an employer or association, covering one or more employees or one or members or employee of members of such association.

Comments
22:§215 A(1) was amended under ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature to include Health Maintenance Organization to the definition of Group health and accident insurance. Also, reference to "franchise" coverage was redesignated to "association" coverage.
Note - the Louisiana Insurance Code extraterritorially applies to any group policy of health and accident insurance covering residents of Louisiana, regardless of from where it was issued or delivered.
La. R.S. 22:§1000 A(1)(a)(iv)

Associated References
La. R.S. 22:§1061 (5)(b)
LDI Reg 78:§10107.C.2.e
LDI Reg 78:§10107.C.2.f
Insurance coverage may be issued under individual certificates via a group policy issued to an association provided the association has a constitution and by laws, has been organized and is maintained in good faith for purposes other than those of obtaining insurance.

Comments
22:§215 A(1) was amended under ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature to include Health Maintenance Organization to the definition of Group health and accident insurance. Also, reference to "franchise" coverage was redesignated to "association" coverage.
Pursuant to Act No. 325, of the 2004 Regular Legislative Session, associations are required to have an active existence for at least five years.
La. R.S. 22:§973 (3)

Associated References
La. R.S. 22:§1000 A(1)(a)
La. R.S. 22:§1000 A(2)
La. R.S. 22:§1000 A(3)
The policy or contract may insure only one person, unless written as individual family group or otherwise specifically provided in Part VI, i.e. group policy issued to an employer, association, or trust or a blanket group policy.
Limitations / Exclusions   Back To Top
ReferenceDescription
La. R.S. 22:§973 (5)
Exceptions and Reductions of indemnity (Exclusions / Limitations) are clearly set forth in the policy, either with the applicable benefit or under an appropriate caption.
La. R.S. 22:§975 A(13)(b)
No claim for loss incurred after three years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition, not excluded from coverage by name or specific description, pre-existed the effective date of coverage.
La. R.S. 22:§975 B(1)
OPTIONAL PROVISION for reduction in coverage due to an insured's "Change of occupation".
La. R.S. 22:§975 B(10)
OPTIONAL PROVISION excluding coverage for any loss in consequence of the insured's involvement with "Intoxicants and narcotics", unless administered on the advice of a physician.

Comments
Limitation provisions referring to "any drug" are ambiguous and may unreasonably be construed to include accidental overdose of over-the-counter medicines.
La. R.S. 22:§975 B(2)
OPTIONAL PROVISION for reduction in coverage or return of premiums paid due to a "Misstatement of age".
La. R.S. 22:§975 B(3)
OPTIONAL PROVISION for reduction in benefits payable due to "Other insurance in this insurer".
La. R.S. 22:§975 B(4)
OPTIONAL PROVISION for reduction in benefits payable due to the insured's failure to provide written notice of "Insurance with other insurers".
La. R.S. 22:§975 B(5)
OPTIONAL PROVISION for reduction in benefits payable in "Relation of earnings to insurance".
La. R.S. 22:§975 B(6)
OPTIONAL PROVISION for deduction of "Unpaid premium" from benefits payable.
La. R.S. 22:§975 B(9)
OPTIONAL PROVISION excluding coverage for any loss contributed by the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an "Illegal occupation".
Discrimination Prohibitions   Back To Top
ReferenceDescription
La. R.S. 22:§1022

Associated References
LDI Reg 63:Reg 63
No health and accident insurance policy, self-insurance plan or health maintenance organization subscriber agreement shall discriminate on the basis of any prenatal test result.

Comments
Reference to "franchise" coverage was redesignated to "association" coverage pursuant to ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature.
La. R.S. 22:§1023 B(1)
No insurer shall discriminate on the basis of any genetic information concerning an individual or family member or on the basis of an individual's or family member's request for or receipt of genetic services, or the refusal to submit to a genetic test or make available the results of a genetic test.
La. R.S. 22:§995

Associated References
LDI Dir 20:Dir 20
LDI Dir 73:Dir 73
Policies or contracts providing payment or reimbursement for services that may be legally performed by a chiropractor licensed in this state, such payment or reimbursement shall not be denied when such service is rendered by a person so licensed. Terminology in such policy or contract deemed discriminatory against any such person or method of practice shall be void.
La. R.S. 22:§997
Any contract of insurance providing for reimbursement of any visual services which are within the lawful scope of practice of a duly licensed optometrist as defined in R.S. 37:1041, shall not discriminate in the amount of reimbursement allowed for such visual services, whether performed by an optometrist or physician, in instances where the services performed are within the lawful scope of practice of both professions.
LDI Dir 203:Dir 203
PAYMENT AND REIMBURSEMENT FOR HEALTH CARE SERVICES RENDERED BY A LICENSED CHIROPRACTOR AND THE CO-PAYMENT, COINSURANCE, DEDUCTIBLE OR BENEFIT LIMITATION IMPOSED ON AN ENROLLEE OR INSURED FOR HEALTH CARE SERVICES RENDERED BY A LICENSED CHIROPRACTOR.
LDI Dir 73:Dir 73

Associated References
La. R.S. 22:§995
LDI Dir 20:Dir 20
Notice of insurers, medical service plan corporations, hospital service corporations, and medical service corporations - "Chiropractors".
LDI Reg 63:Reg 63

Associated References
La. R.S. 22:§1022
La. R.S. 22:§1023 A
Prohibitions on the Use of Medical Information and Genetic Test Results.
Benefit / Claim Payment Provisions   Back To Top
ReferenceDescription
La. R.S. 22:§1000 A(1)(b)
The benefits payable under any policy or contract of group health and accident insurance shall be payable to the employee, members or employees of members of multiple associations or to some beneficiary or beneficiaries designated by him, other than the employer or association or multiple associations, but if there is no designated beneficiary as to all or any part of the insurance at the death of the employee, member or employee of members, then the amount of insurance payable for which there is no designated beneficiary shall be payable to the estate of the employee, member or employee of members, except that the insurer may in such case, at its option, pay such insurance to any one or more of the following surviving relatives of the employee, member or employee of members: wife, husband, mother, father, child, or children, brothers or sisters; and except that payment of benefits for expenses incurred on account of hospitalization or medical or surgical aid, may be made by the insurer to the hospital or other person or persons furnishing such aid. Payment so made shall discharge the insurer's obligations with respect to the amount of insurance so paid.

Comments
22:§1000 A(1) was amended under ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature to include Health Maintenance Organization to the definition of Group health and accident insurance. Also, reference to "franchise" coverage was redesignated to "association" coverage.
La. R.S. 22:§1015
The proceeds of all contracts of health and accident insurance and of provisions providing benefits on account of the insured's disability which are supplemental to life insurance or annuity contracts shall be exempt from all liability for any debt of the insured, and from any debt of the beneficiary existing at the time the proceeds are made available for his use.
La. R.S. 22:§1821 A

Associated References
La. R.S. 22:§975 A(6)
All claims shall be paid not more than thirty days from the date upon which written notice and proof of claim, in the form required by the terms of the policy, are furnished to the insurer unless just and reasonable grounds, such as would put a reasonable and prudent businessman on his guard, exist. Failure to comply with the provisions of this Section shall subject the insurer to a penalty payable to the insured of double the amount of the health and accident benefits due under the terms of the policy or contract during the period of delay, together with attorney's fees to be determined by the court.
La. R.S. 22:§877
Whenever the proceeds or payments under a life endowment or health and accident insurance policy or any annuity contract issued by a life insurance company become payable and the insurer makes payment in accordance with the terms of the policy, the person then designated in the policy or by assignment shall be entitled to receive such proceeds or payments. Such payment shall fully discharge the insurer from all claims unless, before payment is made, the insurer has received at its home office, written notice that another person claims to be entitled to such payment or some interest in the policy or contract.
La. R.S. 22:§878
Any insurer shall furnish proof of loss forms upon written request.
La. R.S. 22:§879
None of the following acts by or on behalf of an insurer shall be deemed to constitute a waiver of any provision of a policy or of any defense of the insurer thereunder: (1) Acknowledgment of the receipt of notice of loss or claim under the policy; (2) Furnishing forms for reporting a loss or claim, for giving information relative thereto, or for making proof of loss, or receiving or acknowledging receipt of any such forms or proofs completed or incompleted; or (3) Investigating any loss or claim under any policy or engaging in negotiations looking toward a possible settlement of any such loss or claim.
La. R.S. 22:§975 A(6)

Associated References
La. R.S. 22:§1821 A
REQUIRED PROVISION for Time of payment of claims: Indemnity claims payable under this policy for any loss other than loss of time on account of disability will be paid immediately upon receipt of written proof of such loss. Subject to written proof of loss, accrued indemnity claims for loss of time on account of disability will be paid (insert period of payment which must not be less frequently than monthly) and any balance remaining unpaid upon the termination of liability will be paid immediately.
La. R.S. 22:§975 A(7)
REQUIRED PROVISION for payment of claims: Indemnity for loss of life and any other accrued indemnity claims unpaid at the insured's death will be paid to the beneficiary, if surviving the insured, and otherwise to the estate of the insured. All other indemnity claims will be paid to the insured. The policy may, at the insurer's option, provide that if there is no beneficiary, or the beneficiary is the estate of the insured, or the insured or beneficiary is a minor or not competent to give a valid release, the insurer may pay any amount not exceeding one thousand dollars, otherwise payable to the insured or his estate to any relative by blood or connection by marriage of the insured appearing to the insurer to which they may be equitably entitled, and may make payment of any amount not exceeding one thousand dollars, otherwise payable to the beneficiary to any relative by blood or connection by marriage of such beneficiary appearing to the insurer to which they may be equitably entitled. The policy may, at the insurer's option, also provide that all or a portion of any indemnities provided by any such policy on account of hospital, nursing, medical, or surgical services may be paid directly to the hospital or person rendering such services; however, the policy may not require that the services be rendered by a particular hospital or person.
LDI Dir 157:Dir 157

Associated References
La. R.S. 46:§2625
Pharmacy Fees.
Beneficiary Designation   Back To Top
ReferenceDescription
La. R.S. 22:§901 D
No benefits may be paid upon the death, disablement, or injury of an individual insured if the payee is held criminally responsible for the loss; or judicially determined to have participated in the intentional, unjustified killing of the insured.
Arbitration   Back To Top
ReferenceDescription
LDI Dir 173:Dir 173

Associated References
La. R.S. 22:§868 A(2)
Policy Forms - Binding Arbitration and/or Appraisal Provisions - not allowed
Subrogation / Right of Recovery   Back To Top
ReferenceDescription
La. R.S. 22:§882
Under any policy of insurance which authorizes the insured to waive the right of recovery of the insured against any party prior to loss without additional premium, the insured shall also be entitled to waive in writing after loss without invalidating the policy the right of recovery against any of the following: (1) Anyone insured under the same policy; (2) A corporation, partnership or other entity in which the insured owns stock or has a proprietary interest; (3) Anyone who owns stock or has a proprietary interest in the insured; (4) An employee or employer of the insured; (5) Anyone having an interest as owner, lessor or lessee of the insured premises or the premises on which the loss occurred and the employees, partners and stockholders of such owner, lessor or lessee; and (6) Any relative by blood or marriage of the insured. The insurer shall be entitled to recover from the insured any compensation received by the insured for such waiver after loss not to exceed the amount paid to the insured for such loss by the insurer.
LDI Dir 175:Dir 175
Policy Forms - Subrogation Provisions
Cancellation / Termination Provisions   Back To Top
ReferenceDescription
La. R.S. 22:§1000 A(1)(c)

Associated References
La. R.S. 22:§1012
La. R.S. 22:§1068 C(1)
La. R.S. 22:§1068 C(2)(a)
La. R.S. 22:§1068 D
La. R.S. 22:§887 F
Agreement to modify, amend or cancel shall be without prejudice to any prior claim for benefits accrued or expenses incurred.

Comments
22:§215 A(1) was amended under ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature to include Health Maintenance Organization to the definition of Group health and accident insurance. Also, reference to "franchise" coverage was redesignated to "association" coverage.
La. R.S. 22:§1000 A(1)(c)**

Associated References
La. R.S. 22:§1012
La. R.S. 22:§1074 C(1)
La. R.S. 22:§1074 C(2)(a)
La. R.S. 22:§1074 D
La. R.S. 22:§887 F
Agreement to modify, amend or cancel shall be without prejudice to any prior claim for benefits accrued or expenses incurred.

Comments
22:§215 A(1) was amended under ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature to include Health Maintenance Organization to the definition of Group health and accident insurance. Also, reference to "franchise" coverage was redesignated to "association" coverage.
La. R.S. 22:§1000 A(1)(d)

Associated References
La. R.S. 22:§1000 A(1)(c)*
Insurer shall not be liable for coverage after such termination date where the policyholder failed to pay premium or maintain eligibility requirements.

Comments
22:§215 A(1) was amended under ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature to include Health Maintenance Organization to the definition of Group health and accident insurance. Also, reference to "franchise" coverage was redesignated to "association" coverage.
La. R.S. 22:§1012
No insurer shall unilaterally cancel a policy after the insurer has received any covered claim or notice of any covered claim for a terminal, incapacitating, or debilitating condition if the insured continues to meet all other eligibility criteria.
La. R.S. 22:§889
No insurer shall cancel any policy of insurance for nonpayment of premium to the insurer when the payment of such premium is made to the commissioner of insurance pursuant to the provisions of R.S. 22:2011.
La. R.S. 22:§975 A(9)
REQUIRED PROVISION for cancellation by insured: If the insured shall at any time change his occupation to one classified by the insurer as less hazardous than that stated in the policy, the insurer, upon written request of the insured, and at the insured's option, will either cancel the policy upon its surrender and refund the unearned premium or will reduce the premium rate accordingly and refund the excess pro rata unearned premium from the date of receipt of proof of such change of occupation.
La. R.S. 22:§978*

Associated References
La. R.S. 22:§887 F
The insurer shall notify the policyholder in writing at least sixty days before any cancellation or nonrenewal.

Comments
Reference to "franchise" coverage was redesignated to "association" coverage pursuant to ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature.
La. R.S. 22:§979
No health and accident insurer may unilaterally cancel a policy of insurance except for nonpayment of premiums or reduce the benefits provided by such insurance policy after receipt or notice of any covered claim. The insurer may cancel the policy, as otherwise provided by law, after the claimant has been discharged from treatment for that condition and no further claims for that condition are expected, provided there has been no other receipt or notice of claim under that policy.
Renewal Provisions   Back To Top
ReferenceDescription
La. R.S. 22:§887 F
No insurer shall cancel or refuse to renew any policy of group or family group health and accident insurance except for nonpayment of premium or failure to meet the requirements for being a group or family group insurance policy until sixty days after the insurer has mailed written notice of such cancellation or nonrenewal by certified mail to the policyholder. The notice shall also include the reason the policy is being cancelled.
La. R.S. 22:§973 (8)
Policies subject to cancellation or renewal at the option of the insurer must include a statement prominently printed on face page so informing the policyholder.
Reinstatement Provisions   Back To Top
ReferenceDescription
La. R.S. 22:§975 A(2)
REQUIRED PROVISION for reinstatement of a policy following default in payment of premium shall cover only loss resulting from accidental injury thereafter sustained or loss due to sickness beginning more than ten days after the date of such acceptance.
Continuation of Benefits / Coverage   Back To Top
ReferenceDescription
La. R.S. 22:§1001
Any policy which provides that coverage of a dependent child shall terminate upon attainment of the limiting age shall also provide that coverage shall continue while the child is and continues to be both (1) incapable of self sustaining employment, and (2) chiefly dependent upon the policyholder, employee or member for support and maintenance. Proof of such incapacity and dependency may be furnished to the insurer by the employee or member within 31 days of the child's attainment of the limiting age and subsequently may be required by the insurer not more frequently than annually after the 2-year period following the child's attainment of the limiting age.

Comments
Policy provisions limiting mental handicaps to those caused by "mental retardation" or similar language are too restrictive. Such provisions are unacceptable conditions to the mandated continuation of coverage for handicapped dependents.
La. R.S. 22:§975 B(7)

Associated References
La. R.S. 22:§1012
La. R.S. 22:§887 F
OPTIONAL PROVISION for "Cancellation" by the insurer by written notice and with refund of the pro rata unearned portion of any premium paid. Such cancellation shall be without prejudice to any claim incurred prior to cancellation. The insured may likewise cancel this policy on the above terms. Upon cancellation by the insurer, the insurer shall only be liable for any claim for expenses incurred subsequent to the cancellation date if the subsequent claim is for an illness or condition which was the basis of any claim prior to cancellation and for which the insurer had notice and if the policy of insurance is cancelled for reasons other than failure of the policyholder to pay premiums or failure of the insured to maintain eligibility as provided in the policy.
Premium Rating Requirements   Back To Top
ReferenceDescription
La. R.S. 22:§1000 D

Associated References
La. R.S. 22:§1091
La. R.S. 22:§1095 A
La. R.S. 22:§1095 B
La. R.S. 22:§979
LDI Reg 51:§2707
Readjustment of the rate of premium based on the experience maybe retroactive only for the prior year.

Comments
Reference to "franchise" was redesignated to "association" pursuant to ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature.
La. R.S. 22:§864 C
If under the contract the exact amount of premiums is determinable only at termination or at periodic intervals of the contract, a statement of the basis and rates upon which the final premium is to be determined and paid shall be furnished to any policy examining bureau having jurisdiction or to the insured upon request.
Premium Rate Adjustment   Back To Top
ReferenceDescription
La. R.S. 22:§1096
Premium rates shall not be increased during the initial twelve months of coverage and not more than once in any six-month period following the initial twelve-month period, except for increases in the premium amount due to the addition of a newly covered person or a change in age or geographic location of an individual insured or policyholder or an increase in the policy benefit level.
La. R.S. 22:§978
The insurer shall notify the policyholder in writing at least forty-five days before any increase of twenty percent or more in the policy rates.

Comments
Reference to "franchise" coverage was redesignated to "association" coverage pursuant to ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature
La. R.S. 22:§979*
No health and accident insurer may increase the premium for such policy after receipt or notice of any covered claim. This Section shall not prohibit any group or individual health and accident insurer from increasing its premium if the increase is applicable to all members of the group or all insureds having the same individual policy.
Premium Payment / Grace Period Prov.   Back To Top
ReferenceDescription
La. R.S. 22:§977
Whenever an insurer does not receive a premium payment fifteen days prior to the end of the grace period, the insurer shall mail, by first class mail, a notice to the policyholder. The notice shall state that if the premium has not been paid by the end of the grace period, the policy will lapse as provided by the provisions of the policy. The notice shall also state that the policy will be reinstated with no penalties whatsoever to the insured if the full premium payment is received within the period allowed for reinstatement.
General / Standard Provisions   Back To Top
ReferenceDescription
La. R.S. 22:§973 (1)
Entire money and other consideration therefor must be expressed in the policy.
La. R.S. 22:§975
Required and optional health and accident insurance policy provisions.
La. R.S. 22:§975 A
Each policy shall contain in substance the required provisions of this section or provisions which in the opinion of the Commission of Insurance which are not less favorable to the policyholder.
La. R.S. 22:§975 A(1)
REQUIRED PROVISION for what constitutes the "entire contract" of insurance. No change shall be valid until approved by an officer or endorsed on the policy.
La. R.S. 22:§975 A(10)
REQUIRED PROVISION for consent of beneficiary: Consent of the beneficiary shall not be requisite to surrender or assignment of this policy, nor to change of beneficiary, nor to any other changes in this policy.
La. R.S. 22:§975 A(11)
REQUIRED PROVISION for an insured's right to bring Legal Action: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after proofs of loss have been filed in accordance with the requirements of this policy. No such action shall be brought after the expiration of one year after the time proofs of loss are required to be filed.
La. R.S. 22:§975 A(12)
REQUIRED PROVISION for Extension of time limitations: If any limitation of this policy with respect to giving notice of claim, furnishing proof of loss, or bringing any action on this policy is less than that permitted by law of the state, district or territory in which the insured resides at the time this policy is issued, such limitation is hereby extended to agree with the minimum period permitted by such law.
La. R.S. 22:§975 A(13)(a)

Associated References
La. R.S. 22:§975 B(1)
La. R.S. 22:§975 B(2)
La. R.S. 22:§975 B(3)
La. R.S. 22:§975 B(4)
REQUIRED PROVISION for "Time Limit on Certain Defenses" / Incontestability is three years of the date of issue of the policy after which the policy becomes incontestable as to the statements contained in the application.
La. R.S. 22:§975 A(8)
REQUIRED PROVISION for the insurer's right and opportunity to require a Physical Examinations: The insurer shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law.
La. R.S. 22:§975 B(8)
OPTIONAL PROVISION for "Conformity with state statutes" stating that any provision of the policy which, on the date of issue, is in conflict with the statutes of the state in which the insured resides at the date of issue is understood to be amended to conform to such statutes.
Claim Filing Provisions   Back To Top
ReferenceDescription
La. R.S. 22:§1824

Associated References
La. R.S. 22:§982
LDI Reg 48:Reg 48
The uniform claim forms prescribed by the Department shall include the National Uniform Bill-82 (UB-82) or its successor for appropriate hospital services, and the current Health Care Financing Administration* (HCFA) Form 1500 or its successor for physical and other appropriate professional services.
La. R.S. 22:§975 A(14)

Associated References
La. R.S. 22:§1824
La. R.S. 22:§975 A(4)
La. R.S. 22:§982
LDI Reg 48:Reg 48
REQUIRED PROVISION for processing of claims in conformity with the "Uniform claim forms" issued by the Department of Insurance pursuant LRS-22:1824.
La. R.S. 22:§975 A(3)
REQUIRED PROVISION for providing Notice of Claim: Written notice of claim for injury or for sickness must be given to the insurer within twenty days after the date of the accident causing such injury or the commencement of the disability from such sickness, except that in case of industrial policies such notice of claim must be given to the insurer within ten days in such cases. In the event of accidental death, immediate notice thereof must be given to the insurer. Such notice given by or on behalf of the insured or the beneficiary to the insurer at (insert the location of such office as the insurer may designate for that purpose), or to any authorized agent of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer. Failure to give such notice within such time shall not invalidate nor reduce any claim if it was not reasonably possible to give such notice within the time required, provided written notice of claim is given as soon as reasonably possible. (In this paragraph the requirement relating to immediate notice of claim in event of accidental death may be omitted at the option of the insurer.)
La. R.S. 22:§975 A(4)
REQUIRED PROVISION for the insurer to provide Claim Forms: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such notice the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, affirmative written proof covering the occurrence, the character and the extent of the loss for which claim is made.
La. R.S. 22:§975 A(5)
REQUIRED PROVISION for a claimant to submit written Proofs of Loss: Affirmative written proof of loss must be furnished to the insurer at its said office in case of claim for loss of time from disability within ninety days after the termination of the period for which the insurer is liable and in case of claim for any other loss within ninety days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event later than one year from the time proof is otherwise required. Any such policy may also provide, at the insurer's option that written notice or proof of continuance of disability must be furnished not less frequently than each ninety days during the continuance of disability.
La. R.S. 22:§982

Associated References
La. R.S. 22:§1824
LDI Reg 48:Reg 48
No insurance company writing policies of health and accident insurance or any administrator of a health benefit plan may require proof of loss to be on any claim form but the UB-82, or its successor, or HCFA Form 1500, or its successor, whichever is appropriate for the services rendered.
LDI Reg 48:Reg 48

Associated References
La. R.S. 22:§1824
La. R.S. 22:§975 A(14)
La. R.S. 22:§982
Standardized Claims Forms.
Underwriting   Back To Top
ReferenceDescription
La. R.S. 22:§34
No insurer shall make or permit any unfair discrimination in favor of particular individuals or persons, or between insureds or subjects of insurance having substantially like insuring risk, and exposure factors, or expense elements, in the terms or conditions of any insurance contract, or in the rate or amount of premium charged therefor, or in the benefits payable or in any other rights or privileges accruing thereunder. This provision shall not prohibit fair discrimination by a life insurer as between individuals having unequal life expectancies.
La. R.S. 22:§860 B
Statements made in written applications are deemed representations and not warranties in the absence of fraud. False statements shall not bar right to recovery unless made with the intent to deceive or the false statement materially affected the risk.
La. R.S. 22:§875
If any breach of a warranty or condition in any insurance contract occurs prior to a loss under the contract, such breach shall not avoid the contract nor avail the insurer to avoid liability, unless the breach exists at the time of the loss.
Application / Enrollment Form   Back To Top
ReferenceDescription
La. R.S. 22:§1023 B(2)
No insurer shall require an applicant for coverage or an individual or family member who is presently covered under a policy or plan, to be the subject of a genetic test or to be subjected to questions relating to genetic information.

Comments
Applications should request information specifically from persons applying for coverage only. Medical questions and authorizations to release medical information should not refer to "any family member".
La. R.S. 22:§1023 B(3)
All insurers shall, in the application or enrollment information provided by the insurer concerning a policy or plan, provide an applicant or enrollee with a written statement disclosing the rights of the applicant or enrollee under this Section. Such statement shall be in a form and manner that is noticeable to and understandable by an average applicant or enrollee.
La. R.S. 40:§1424(B)
Required Fraud Statement. "Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison."
La. R.S. 22:§856

Associated References
La. R.S. 22:§901 C
Written application for individual life, health and accident insurance and legal capacity to contract is required.
La. R.S. 22:§857
Correct copy of application must be made a part of the policy or contract when issued and delivered in order to be admissible as evidence in actions relative to the policy or contract.
La. R.S. 22:§858
Release of medical records must be provided to the applicant upon written request.
La. R.S. 22:§859
Applications shall be altered solely by applicant or by his written consent.
La. R.S. 22:§871
Every duly licensed insurance agent who solicits information to be contained on any application for individual life or individual family group health and accident insurance shall affix his legal signature thereto. No such agent shall sign any application described above unless he personally obtained the information shown on such application. Such information may be obtained by the agent in person, by telephone, or by any other means of direct communication between the agent and the applicant.

Comments
ACT 410 of the Regular Session of the Louisiana Legislature amends LRS 22:1460 to specify the manner in which certain life and health insurance agents may obtain information from applicants.
Reference to "franchise" coverage was redesignated to "association" coverage pursuant to ACT No. 129 of the 2003 Regular Session of the Louisiana Legislature.
La. R.S. 22:§983 A
A. The falsity of any statement in the application for any policy covered by this Subpart shall not bar the right to recovery thereunder unless such false statement materially affected either the acceptance of the risk or the hazard assumed by the insurer. The insured shall not be bound by any statement unless made in a written application in the case of domestic industrial insurers, and in the case of other insurers, unless a copy of such application is attached to or endorsed on the policy as a part thereof.
La. R.S. 22:§983 B
No alteration of any written application for any policy shall be made by any person other than the applicant without his written consent, except that insertions may be made by the insurer, for administrative purposes only, in such manner as to indicate clearly that such insertions are not to be ascribed to the applicant.
Disclosure / Notice Requirements   Back To Top
ReferenceDescription
La. R.S. 22:§1023 C(2)
Requirements to assure valid authorization for disclosure of genetic information.
La. R.S. 22:§1023 C(3)
A copy of the authorization shall be provided to the individual.
La. R.S. 22:§1023 C(4)
An individual may revoke or amend the authorization, in whole or in part, at any time.
La. R.S. 22:§1023 C(5)
A general authorization for the release of medical records or medical information shall not be construed as an authorization for disclosure of genetic information.
La. R.S. 22:§2083 A
The Louisiana Life and Health Guaranty Association Act shall provide coverage for the policies and contracts specified in §2083 B, to any person who is the beneficiary, assignee, or payee of a person who is the owner of or certificate holder under such a policy or contract.
La. R.S. 22:§2083 B(1)
The Louisiana Life and Health Guaranty Association Act shall provide coverage to the persons specified in §2083 A for direct nongroup life, health, annuity and supplemental policies or contracts, for certificates under direct group policies and contracts, and for unallocated annuity contracts issued by member insurers.
La. R.S. 22:§2083 B(2)
The Louisiana Life and Health Guaranty Association Act shall not provide coverage for: (a) Any portion of a policy not guaranteed by the insurer; (b) Any contract of reinsurance, unless assumption certificates have been issued; (c) Any portion of a policy to the extent that the rate of interest is based on certain factors; (d) Any plan of an employer, association, or similar entity which is self funded or uninsured: (i) A Multiple Employer Welfare Arrangement, (ii) a minimum premium group insurance plan, (iii) a stop-loss group insurance plan, and (iv) an administrative services only contract; (e) Any portion of a policy to the extent that it provides dividends, premium refunds, or experience rating credits, or provides that any fees or allowances be paid to any person; (f) Any policy issued in this state by a member insurer at a time when it was not licensed or did not have a certificate of authority to issue such policy or contract in this state; or (g) Any unallocated annuity contract except unallocated annuity contracts and defined contribution government plans.
La. R.S. 22:§2084(8)
"Member insurer" means any insurer licensed or which holds a certificate of authority to transact in this state any kind of insurance covered by the Louisiana Life and Health Insurance Guaranty Association, but shall not include: (a) a health maintenance organization; (b) a fraternal benefit society; (c) a mandatory state pooling plan; (d) a mutual assessment company or entity operating on an assessment basis; (e) an insurance exchange; (f) a nonprofit hospital or medical service organization; (e) or any other similar entity.
La. R.S. 22:§2098 B

Associated References
La. R.S. 22:§2083 A
La. R.S. 22:§2083 B(1)
La. R.S. 22:§2083 B(2)
LDI Reg 40:Reg 40
No insurer may deliver a policy or contact described in §2083 B(1) unless the Summary Document, as prescribed by Reg 40, is delivered to the policy or contract holder prior to or at the time of delivery, except if §2098 D applies.
Advertising   Back To Top
ReferenceDescription
La. R.S. 22:§2098 A
No person, directly or indirectly, shall make, publish, disseminate, circulate, or place before the public, any advertisement, announcement or written or oral statement, which uses the existence of the Life and Health Insurance Guaranty Association for the purpose of sales, solicitation, or inducement to purchase any form of insurance covered by the Association.
LDI Rule 3:Rule 3
Advertisements of Accident and Sickness Insurance
Marketing Requirements   Back To Top
ReferenceDescription
La. R.S. 22:§1964 (1)
The following are declared to be unfair methods of competition and unfair or deceptive acts or practices in the business of insurance: Misrepresentations and false advertising of insurance policies.
La. R.S. 22:§1964 (10)(a)
Unfair Trade Practice: Tying means the requirement by a health and accident agent, insurer, or health maintenance organization, as a condition to the offer or sale of a health benefit plan to a group or individual insured, that such insured purchase any other insurance policy.
La. R.S. 22:§1964 (10)(b)
Unfair Trade Practice: Tying the purchase of a health and life insurance policy or policies to another insurance product. "Tying" is the requirement by any small employer or individual health insurance carrier, as a condition to the offer or sale of a health benefit plan, health maintenance organization, or prepaid limited health care service plan to a small employer or to an individual, that such employer or individual purchase any other insurance product.
La. R.S. 22:§1964 (10)(c)
Tying does not include the joint sale of group life and group health coverages or the joint sale of group life and/or group health and any other employee benefit plan.
La. R.S. 22:§1964 (2)
The following are declared to be unfair methods of competition and unfair or deceptive acts or practices in the business of insurance: Directly or indirectly making, publishing, disseminating, circulating, or placing before the public in a newspaper, magazine or other publication, or in the form of a notice, circular, pamphlet, letter or poster, or over any radio or television station, or in any other way, an advertisement, announcement or statement containing any assertion, representation or statement with respect to the business of insurance or with respect to any person in the conduct of his insurance business, which is untrue, deceptive or misleading.
La. R.S. 22:§973 (7)(b)
Delivery receipt required when the policy is delivered by Producer.
La. R.S. 22:§973 (7)(c)
Policies delivered by mail must be sent by Certified mail, return receipt requested.
LDI Reg 40:Reg 40

Associated References
La. R.S. 22:§2098 D
LLHIGA - Summary Document and Disclaimer and Notice of Non-Coverage.

Comments
Excess / Stop-loss insurance written to cover losses under a self-funded group health plan is excluded from coverage under LLHIGA.
Administration   Back To Top
ReferenceDescription
La. R.S. 22:§1000 A(1)(a)(v)
Insurer shall issue to the employer or association individual certificates of coverage for delivery to each insured employee or member.

Comments
22:§215 A(1) was amended under ACT No. 129 of the 2003 Regular Session of the Lousiiana Legislature to include Health Maintenance Organization to the definition of Group health and accident insurance. Also, reference to "franchise" coverage was sredesignated to "association" coverage.
La. R.S. 22:§1023 C(1)
No insurer shall obtain genetic information from an insured or enrollee, or from their DNA sample, without first obtaining written informed consent from the insured, enrollee, or their representative.
La. R.S. 22:§1821 E
No action for the recovery of penalties or attorney fees provided in this Section shall be brought after the expiration of one year after the date proofs of loss are required to be filed.
La. R.S. 22:§1967
The commissioner of insurance shall have power to examine and investigate into the affairs of every person engaged in the business of insurance, including violations of R.S. 22:1902 et seq., in order to determine whether such person has been or is engaged in any unfair method of competition or in any unfair or deceptive act or practice prohibited by this Part.
La. R.S. 46:§2625

Associated References
LDI Dir 157:Dir 157
Fees on health care providers; disposition of fees.
La. R.S. 22:§852 A
Any person of competent legal capacity may contract for insurance.
La. R.S. 22:§852 B
A minor not less than 15 years of age may contract for insurance for his own benefit or for any person with an insurable interest and may exercise all rights and powers under the insurance contract.
La. R.S. 22:§873 A
Subject to the insurer's requirements as to payment of premium, every policy shall be delivered to the insured or to the person entitled thereto within a reasonable period of time after its issuance.
La. R.S. 22:§981
Any rejection for individual health and accident insurance shall contain information stating that health insurance may be available through the Louisiana Health Insurance Plan and include the address and telephone number at which information on the Louisiana Health Insurance Plan can be obtained.
La. R.S. 22:§985
The acknowledgement by any insurer of the receipt of notice given under any policy covered by this Subpart or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under such policy.
La. R.S. 22:§989

Associated References
La. R.S. 22:§975
Any insurer authorized to write health and accident insurance in this state shall have power to issue industrial health and accident policies wherein the premium is payable weekly. Every such policy must have printed thereon the words "Industrial Policy" and must contain in substance those provisions in R.S. 22:975 as may be applicable. Insurers issuing policies under this Section shall be subject to all the other applicable provisions of this Subpart.
La. R.S. 22:§992
A transportation ticket policy, which may be issued by a health and accident insurer, is any ticket policy sold at stations, ticket offices or travel bureaus by employees of railroads, steamship lines, air lines and other common carriers, or by individuals or employees of persons engaged in selling transportation on such common carriers, having as its dominant feature the protection of the insured from a transportation hazard.
La. R.S. 22:§993
A policy issued in violation of Part III shall be held valid but shall be construed as provided herein, and when any provision in such a policy is in conflict with any provisions of this Part, the rights, duties and obligations of the insurer, the policyholder and the beneficiary shall be governed by the provisions of this Part.
Enforcement   Back To Top
ReferenceDescription
LDI Reg 78:§10115

Associated References
La. R.S. 22:§44
Pursuant to LRS-22:44, "False or Fraudulent Material Information", in accordance with all provisions thereof, and specifically applicable to all documents required by this regulation.
La. R.S. 22:§1961
The purpose of this Part is to regulate the trade practices in the business of insurance, in accordance with the intent of congress as expressed in Public Law 15-79th Congress*, by defining or providing for the determination of all acts, methods, and practices which constitute unfair methods of competition and unfair or deceptive acts and practices in this state, and to prohibit the same.
La. R.S. 22:§1963
No person shall engage in this state in any trade practice which is defined in this Part to be an unfair method of competition or an unfair or deceptive act or practice in the conduct of the business of insurance, including unauthorized insurance as provided in R.S. 22:1902 et seq.
La. R.S. 22:§1964 (12)
Unfair Trade Practice: Any violation of any prohibitory law of this state.
La. R.S. 22:§1969
If, after the hearing, the commissioner shall determine that the person charged has engaged in an unfair method of competition or an unfair or deceptive act or practice, he shall reduce his findings to writing and shall issue and cause to be served upon the person charged with the violation a copy of such findings and an order requiring such person to cease and desist from engaging in such method of competition, act, or practice and order any one or more of the following: (1) Payment of a monetary penalty of not more than one thousand dollars for each and every act or violation, but not to exceed an aggregate penalty of one hundred thousand dollars unless the person knew or reasonably should have known he was in violation of this Part, in which case the penalty shall be not more than twenty-five thousand dollars for each and every act or violation, but not to exceed an aggregate penalty of two hundred fifty thousand dollars in any six-month period. (2) Suspension or revocation of the license of the person if he knew or reasonably should have known he was in violation of this Part.
La. R.S. 22:§1970
Any person who violates a cease and desist order of the commissioner under R.S. 22:1969 and while such order is in effect may after notice and hearing under R.S. 22:2191 and upon order of the commissioner be subject at the discretion of the commissioner to any one or more of the following: (1) A monetary penalty of not more than twenty-five thousand dollars for each and every act or violation, not to exceed an aggregate of two hundred fifty thousand dollars pursuant to such hearing. (2) Suspension or revocation of such person's license or certificate of authority.
La. R.S. 22:§44

Associated References
LDI Reg 78:§10115
It shall be unlawful for any person to intentionally and knowingly supply false or fraudulent material information pertaining to any document or statement required by the Department of Insurance. Whoever violates the provisions of this Section shall be imprisoned, with or without hard labor, for not more than five years, or fined not more than five thousand dollars, or both.
La. R.S. 22:§886
The commissioner of insurance may order the immediate cancellation of any policy procured or effected through or accompanied by a violation of this Code, except in cases where the policy by its terms is not cancellable by the insurer and the insured did not knowingly participate in any such violation.