Loading Requirements

Click here to hide the product tree

Product

Print this Page
Home Health Care / Partnership   LA Product Code:  H-Ind02.LTC-02B
Policyholder Type:  Individual Family Group / Long Term Care

A home health care policy that complies with federal requirements as a Partnership policy allowing a state to disregard certain resources when determining Medicaid eligibility.


All Legal References For Product Compliance.

Click here to view a Statement of Compliance that displays the specific filing requirements for this product. Click here to view and print the transmittal document for this product.


Jump To:

Requirements:

Form Filing Requirements   Back To Top
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.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.c.i
Filings of policy forms for Long Term Care insurance must include the required filing fee, per insurance product, per insurance company.
LDI Reg 78:§10107.C.2.c.ii
Filings of policy forms for Long Term Care insurance must include a completed Health and Accident Transmittal document, as prescribed by the department.
LDI Reg 78:§10107.C.2.c.iii
Filings of policy forms for Long Term Care insurance must include a Statement of Compliance for said product.
LDI Reg 78:§10107.C.2.c.iv
Filings of policy forms for Long Term Care insurance must include the policy forms filed for approval, in duplicate.
LDI Reg 78:§10107.C.2.c.ix
Filings of policy forms for Long Term Care insurance must include the premium rates and classification of risks.
LDI Reg 78:§10107.C.2.c.v
Filings of policy forms for Long Term Care insurance must include the outline of coverage, in duplicate.
LDI Reg 78:§10107.C.2.c.vi
Filings of policy forms for Long Term Care insurance must include the application form, in duplicate.
LDI Reg 78:§10107.C.2.c.vii
Filings of policy forms for Long Term Care insurance must include the replacement notice, in duplicate.
LDI Reg 78:§10107.C.2.c.viii
Filings of policy forms for Long Term Care insurance must include the rider or endorsement forms, in duplicate.
LDI Reg 78:§10107.C.2.c.x
Filings of policy forms for Long Term Care insurance must include the personal worksheet, as per LDI Reg 46, Appendix B, in duplicate.
LDI Reg 78:§10107.C.2.c.xi
Filings of policy forms for Long Term Care insurance must include the disclosure, as per LDI Reg 46, Appendix C, in duplicate.
LDI Reg 78:§10107.C.2.c.xii
Filings of policy forms for Long Term Care insurance must include the suitability letter, as per LDI Reg 46, Appendix D, in duplicate.
LDI Reg 78:§10107.C.2.c.xiii
Filings of policy forms for Long Term Care insurance must include any new related advertising as defined in Rule 3, in duplicate.
LDI Reg 78:§10107.C.2.c.xiv
Filings of policy forms for Long Term Care insurance must include a 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.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.4

Associated References
LDI Reg 78:§10107.D
Exceptions: Long term care advertising. 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.D.9

Associated References
LDI Reg 78:§10107.D
Exceptions: Assumption certificates, which must be filed in duplicate, with a single copy of the assumption agreement, letter of domiciliary state approval, information fully identifying the block of business being assumed, the number of covered lives residing in the state of Louisiana to be affected by the assumption, and the effective date of the assumption. No filing fees will be required for these filings.
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.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:§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.
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:§1186 F
Long-term care insurance applicants shall have the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
LDI Reg 46:§1913.A.1
This Section concerns required disclosure provisions for renewability.

Comments
Individual policies shall contain a renewability provision.
The renewability provision shall appear on the first page of the policy.
This provision shall not apply to policies which are not required to contain a renewability provision.
LDI Reg 46:§1913.A.2
A long-term care insurance policy or certificate, other than one where the insurer does not have the right to change the premium, shall include a statement that premium rates may change.
LDI Reg 46:§1913.H
A qualified long-term care insurance contract shall include a disclosure statement in the policy that the policy is intended to be a qualified long-term care insurance contract.
LDI Reg 46:§1921.C.2
The mandatory caution statement contained in this Section shall be included on the cover page of the policy or certificate. This Section shall not apply to policies that are guaranteed issue.
LDI Reg 46:§1943.A.2
Required Notice for Long-Term Care Insurance Coverage- Every insurer, health care service plan, or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall: display prominently by type, stamp, or other appropriate means, on the first page of the outline of coverage and policy the following: Notice to buyer: This policy may not cover all of the costs associated with long-term care incurred by the buyer during the period of coverage. The buyer is advised to review carefully all policy limitations.
La. R.S. 22:§973 (2)
Time at which the insurance takes effect and terminates must be expressed in the policy.
Schedule of Benefits   Back To Top
ReferenceDescription
La. R.S. 22:§1034 C
The benefits provided in this Section shall be subject to the same annual deductibles or co-insurance established for all other covered benefits within a given policy.
Definitions   Back To Top
ReferenceDescription
La. R.S. 22:§1184 (2)
Provides a definition for certificate.
La. R.S. 22:§1184 (7)
Defines a qualifed long-term care contract.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
LDI Reg 46:§1905
This Section contains definitions for long-term care. If any of these terms are used, they must be defined and they must satisfy the requirements of this Section.

Comments
The definitions for Applicant, Commissioner, Group Long-Term Care Insurance, and Policy are identical to those in LRS 22:1734. The definition for Certificate is substantially similar to the one in §1734.
LDI Reg 46:§1907
This Section contains policy definitions for long-term care. If any of these terms are used, they must be defined and they must satisfy the requirements of this Section.
LDI Reg 46:§1913.C
A long-term care insurance policy which provides for the payment of benefits based on standards described as usual and customary, reasonable and customary or words of similar import shall include a definition of such terms and an explanation of such terms in its accompanying outline of coverage.
LDI Reg 46:§1953.A
This section contains definitions for long-term care. If any of these terms are used, they must be defined and they must satisfy the requirements of this section.
26 USCA:§7702 B(c)(4)

Associated References
LDI Reg 46:§1953.C
The United States Code defines a licensed health care practitioner as: any physician (as defined in Section 1861(r)(1) of the Social Security Act) and any registered professional nurse, licensed social worker, or other individual who meets such requirements as may be prescribed by the Secretary.
Eligibility Provisions   Back To Top
ReferenceDescription
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:§1186 D(1)(a)
No long-term care insurance policy may condition eligibility for any benefits on a prior hospitalization requirement.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1186 D(1)(b)
No long-term care insurance policy if such policy contains conditions for eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1186 D(1)(c)
No long-term care insurance policy if such policy contains conditions eligibility for any benefits other than a waiver of the premium, post-confinement, post-acute care, or recuperative benefits on a prior institutionalization requirement.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1186 D(2)(a)

Associated References
LDI Reg 46:§1913.E
A long-term care insurance policy containing post-confinement, post-care, or recuperative benefits shall clearly label in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits", such limitations or conditions, including any required number of days of confinement.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1186 D(2)(b)
A long-term care insurance policy or rider which conditions eligibility of noninstitutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than thirty (30) days.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
Benefit / Coverage Provisions   Back To Top
ReferenceDescription
La. R.S. 22:§1188.1 F
Any violation of this Section by an insurer if committed flagrantly and in conscious disregard of the provisions of this Section with such frequency as to constitute a general business practice shall be considered a violation of R.S. 22:1963 et seq.
LDI Reg 46:§1913.G
Activities of daily living and cognitive impairment shall be used to measure an insured's need for long-term care and shall be described in the policy or certificate in a separate provision and shall be labeled "Eligibility for the Payment of Benefits."
IRS Notice 97-31:97-31

Associated References
26 USCA:§7702 B(c)(2)(A)(i)
The only interpretive guidance published to date by the U.S. Internal Revenue Service as it relates to qualified LTC terms and benefit triggers used in 26 USCA §7702B (and 213 and 4980C).
Mandated Benefits / Provisions   Back To Top
ReferenceDescription
LDI Reg 46:§1949.C
If the offer required to be made under R.S. 22:1188 is rejected, the insurer shall provide the contingent benefit upon lapse described in §1949.
LDI Reg 46:§1949.D
If the nonforfeiture offer is rejected then the insurer shall provide a contingent benefit upon lapse that complies with this section.
Mandated Coverage Options   Back To Top
ReferenceDescription
LDI Reg 46:§1919.A.1

Associated References
LDI Reg 46:§1919.G.1
Insurers must offer to each policyholder, at the time of purchase, the option to purchase a policy with an inflation protection feature no less favorable than one of the following: 1. Increases benefit levels annually in a manner so that the increases are compounded annually at a rate not less than 5 percent.
LDI Reg 46:§1919.A.2
Section 1919.A requires insurers to offer to each policyholder, at the time of purchase, the option to purchase a policy with an inflation protection feature no less favorable than one of three options set forth therein. Section 1919.A.2. provides the following option: 2. Guarantees the insured individual the right to periodically increase benefit levels without providing evidence of insurability or health status, so long as the option for the previous period has not been declined. The amount of the additional benefit shall be no less than the difference between the existing policy benefit and that benefit compounded annually at a rate of at least 5 percent for the period beginning with the purchase of the existing benefit and extending until the year in which the offer is made.
LDI Reg 46:§1919.A.3
Insurers must offer to each policyholder, at the time of purchase, the option to purchase a policy with an inflation protection feature no less favorable than one of the following: 3. Covers a specified percentage of actual or reasonable charges and does not include a maximum specified indemnity amount or limit.
LDI Reg 46:§1919.E
Inflation protection benefit increases, under a policy which contains such benefits, shall continue without regard to an insured's age, claim status, or claim history, or the length of time the person has been insured under the policy.
LDI Reg 46:§1919.F
An offer of inflation protection which provides for automatic benefit increases shall include an offer of a premium which the insurer expects to remain constant.

Comments
Such offer shall disclose, in a conspicuous manner, that the premium may change in the future, unless the premium is guaranteed to remain constant.
LDI Reg 46:§1919.G.1

Associated References
LDI Reg 46:§1919.A.1
Inflation protection, as provided in 1919.A.1 of this Section, shall be included in a long-term care insurance policy unless an insurer obtains a rejection of inflation protection, signed by the policyholder, as required in this Subsection.

Comments
In the case of a qualified long-term care insurance contract, the rejection may be either in the application or on a separate form.
LDI Reg 46:§1949.B
To comply with the requirement to offer a nonforfeiture benefit pursuant to the provisions of R.S. 22:1188.

Comments
Include in the application/enrollment form the offer for providing a Non-forfeiture benefit.
LDI Reg 46:§1949.E
The nonforfeiture benefit shall comply with this section.
Non-forfeiture Provisions   Back To Top
ReferenceDescription
La. R.S. 22:§1188 A

Associated References
Legislative Acts - 2004:ACT 780
Effective January 1, 2005, in the event the policyholder or certificate holder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that shall be available for a specified period of time following a substantial increase in premium rates.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
LDI Reg 46:§1949.F
All benefits paid by the insurer while the policy or certificate is in premium paying status and in the paid up status will not exceed the maximum benefits which would have been payable if the policy or certificate had remained in premium paying status.
LDI Reg 46:§1949.G
There shall be no difference in the minimum non-forfeiture benefits, as required under §1949, for group and individual policies.
LDI Reg 46:§1949.I

Associated References
LDI Reg 46:§1935
Premiums charged for a policy or certificate containing nonforfeiture benefits or a continuing benefit on lapse shall be subject to the loss ratio requirements of §1935 treating the policy as a whole.
LDI Reg 46:§1949.K.
Non-forfeiture benefits in a qualified long-term care insurance shall comply with this section.
Limitations / Exclusions   Back To Top
ReferenceDescription
La. R.S. 22:§1186 B(2)
No long-term care policy may contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1186 B(3)
No long-term care policy may provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1186 C(1)

Associated References
La. R.S. 22:§1184 (4)(a)
No long-term care insurance shall use a definition of "preexisting condition" which is more restrictive than the following, "preexisting condition" means a condition for which medical advice or treatment was recommended by, or received from, a provider of health care services, within six months preceding the effective date of coverage of an insured person.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
LDI Rule 3:§1309 A
Form and Content of Advertisements must be complete and clear to avoid deception or the capacity to mislead or deceive.
LDI Reg 46:§1909.B
This Section contains acceptable limitations and exclusions.

Comments
Do not use "as a result of", "arising out of" , "from", or other similar language when excluding for alcoholism and drug addiction.
LDI Reg 46:§1913.D
Limitations. If a long-term care insurance policy or certificate contains any limitations with respect to preexisting conditions, such limitations shall appear as a separate paragraph of the policy or certificate and shall be labeled as "Pre-Existing Condition Limitations."
LDI Reg 46:§1913.E

Associated References
La. R.S. 22:§1186 D(2)(a)
Other Limitations or Conditions on Eligibility for Benefits. A long-term care insurance policy or certificate containing post confinement, post-acute care, or recuperative benefits shall set forth a description of such limitations or conditions, including any required number of days of confinement, in a separate Paragraph of the policy or certificate and shall clearly label such Paragraph, "Limitations or Conditions on Eligibility for Benefits."
LDI Reg 46:§1923.A
This Section concerns LTC Insurance Policies that have Home Health and Community Care Benefits. The minimum standards 1-9 of this Section must be complied with. A. A long-term care insurance policy or certificate shall not, if it provides benefits for home health care or community care services, limit or exclude benefits: 1. by requiring that the insured or claimant would need care in a skilled nursing facility if home health care services were not provided; 2. by requiring that the insured or claimant first, or simultaneously, receive nursing or therapeutic services, or both, in a home, community, or institutional setting before home health care services are covered; 3. by limiting eligible services to services provided by registered nurses or licensed practical nurses; 4. by requiring that a nurse or therapist provide services covered by the policy that can be provided by a home health aide, or other licensed or certified home care worker acting within the scope of his or her licensure or certification; 5. by excluding coverage for personal care services provided by a home health aide; 6. by requiring that the provision of home health care services be at a level of certification or licensure greater than that required by the eligible service; 7. by requiring that the insured or claimant have an acute condition before home health care services are covered; 8. by limiting benefits to services provided by Medicare-certified agencies or providers; 9. by excluding coverage for adult day care services.
LDI Reg 46:§1947.A
If a long-term care insurance policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive any time periods applicable to preexisting conditions and probationary periods in the new long-term care policy for similar benefits, to the extent that similar exclusions have been satisfied under the original policy.
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(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(6)
OPTIONAL PROVISION for deduction of "Unpaid premium" from benefits payable.
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:§1186 B(1)
No long-term care policy may be cancelled, nonrenewed, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
Benefit / Claim Payment Provisions   Back To Top
ReferenceDescription
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:§1188.1 A(1)
"Claim" means a request for payment of benefits under an in-force policy, regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met.
La. R.S. 22:§1188.1 A(2)
"Clean claim" means a claim that has no defect or impropriety, including any lack of required substantiating documentation, such as satisfactory evidence of expenses incurred or particular circumstances requiring special treatment that prevents timely payment from being made on the claim.
La. R.S. 22:§1188.1 B
Within thirty business days after receipt of a claim for benefits under a long-term care insurance policy or certificate, an insurer shall pay such claim if it is a clean claim or send a written notice acknowledging the date of receipt of the claim and either of the following: (1) That the insurer is declining to pay all or part of the claim and the specific reason or reasons for denial. (2) That additional information is necessary to determine if all or part of the claim is payable and the specific additional information that is necessary.
La. R.S. 22:§1188.1 C
Within thirty business days after receipt of all requested additional information pursuant to Paragraph (B)(2) of this Section, an insurer shall pay a claim for benefits under a long-term care insurance policy or certificate if it is a clean claim or send a written notice that the insurer is declining to pay all or part of the claim and the specific reason or reasons for denial.
La. R.S. 22:§1188.1 D
If an insurer fails to comply with Subsection B or C of this Section, such insurer shall pay interest at the rate of one percent per month on the amount of the claim that should have been paid but that remains unpaid forty-five business days after the receipt of the claim pursuant to Subsection B of this Section or after receipt of all requested additional information pursuant to Subsection C of this Section. The interest payable pursuant to this Subsection shall be included in any late reimbursement without requiring the person who filed the original claim to make any additional claim for such interest.
La. R.S. 22:§1188.1 E
The provisions of this Section shall not apply where the insurer has a reasonable basis supported by specific information that such claim was fraudulently submitted.
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.
LDI Reg 46:§1953.C

Associated References
26 USCA:§7702 B(c)(2)(A)(i)
26 USCA:§7702 B(c)(4)
A qualified long-term care insurance contract shall condition the payment of benefits on a determination of the insured's ability to perform activities of daily living for an expected period of at least 90 days due to a loss of functional capacity or to severe cognitive impairment.

Comments
Eligibility for the payment of benefits shall not be more restrictive than requiring a deficiency in the ability to perform not more than 2 of the ADL's.
LDI Reg 46:§1953.D
Certifications regarding activities of daily living and cognitive impairment required pursuant to §1953.C shall be performed by the following licensed or certified professionals: physicians, registered professional nurses, licensed social workers, or other individuals who meet requirements prescribed by the Secretary of the Treasury.
26 USCA:§7702 B(c)(2)(A)(i)

Associated References
IRS Notice 97-31:97-31
LDI Reg 46:§1953.C
A qualified long-term care policy must meet the federal requirements for ADL's which are: being unable to perform (without substantial assistance from another individual) at least 2 activities of daily living for a period of at least 90 days due to a loss of functional capacity.
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.
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
Grievance / Appeals Rights   Back To Top
ReferenceDescription
LDI Reg 46:§1953.F
Qualified long-term care contracts shall include a clear description of the process for appealing and resolving disputes with respect to benefit determinations.
Cancellation / Termination Provisions   Back To Top
ReferenceDescription
LDI Reg 46:§1911.A.1.b
The insurer shall notify the insured the right to change the written designation, no less often than once every 2 years.
LDI Reg 46:§1911.A.1.d

Associated References
LDI Reg 46:§1911.A.1.a
No long-term care contract shall lapse or be terminated for nonpayment of premium unless the insurer, at least 30 days before the effective date of the lapse or termination, has given notice to the insured and to those persons designated pursuant to §1911.A.1.a, at the address provided by the insured for purposes of receiving notice of lapse or termination.
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:§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
LDI Reg 46:§1909.A.5
A qualified long-term insurance contract shall be guaranteed renewable.
Reinstatement Provisions   Back To Top
ReferenceDescription
LDI Reg 46:§1911.B

Associated References
LDI Reg 46:§1911.A.1.a
A long-term care contract shall include a provision which provides for reinstatement of coverage, in the event of lapse, if the insurer is provided proof that the policyholder or certificateholder was cognitively impaired or had a loss of funtional capacity before the grace period contained in the policy expired. This option shall be available to the insured, if requested within five months after termination, and shall allow for the collection of past due premium where appropriate
Premium Rating Requirements   Back To Top
ReferenceDescription
LDI Reg 46:§1909.F.1.a
The premium charged to an insured shall not increase due to either: the increasing age of the insured at ages beyond 65; or
LDI Reg 46:§1909.F.1.b
The premium charged to an insured shall not increase due to either: b. the duration the insured has been covered under the policy.
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.
LDI Reg 46:§1915.E
An insurer shall provide notice of an upcoming premium rate schedule increase to all policyholders or certificateholders, if applicable, at least 45 days prior to the implementation of the premium rate schedule increase by the insurer. The notice shall include the information required by §1915.B when the rate increase is implemented.
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.
General / Standard Provisions   Back To Top
ReferenceDescription
La. R.S. 22:§1187 A

Associated References
Legislative Acts - 2004:ACT 780
Effective January 1, 2005-For a policy or certificate that has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance of the coverage.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1187 B

Associated References
Legislative Acts - 2004:ACT 780
Effective January 1, 2005-For a policy or certificate that has been in force for at least six months but less than two years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1187 C

Associated References
Legislative Acts - 2004:ACT 780
Effective January 1, 2005-After a policy or certificate has been in force for two years, it is not contestable upon the grounds of material misrepresentation alone; such policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented material facts relating to the insured’s health.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
LDI Reg 46:§1909.C
This Section concerns Extension of Benefits.
LDI Reg 46:§1913.B
Except for riders or endorsements by which the insurer effectuates a request made, in writing, by the insured under an individual long-term care insurance policy, all riders or endorsements added to an individual long-term care insurance policy after date of issue or at reinstatement or renewal which reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the individual insured.
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(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(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.
LDI Bltn 09-13:Bltn 09-13
If policy/certifcate wants to be a long-term care partnership policy then it must comply with the provisions set forth in this Bulletin.
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(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. 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."
LDI Reg 46:§1911.A.1.a

Associated References
LDI Reg 46:§1911.A.1.c
LDI Reg 46:§1911.A.1.d
LDI Reg 46:§1911.B
This section must be complied with to protect against unintentional lapse of a long-term care insurance policy.
LDI Reg 46:§1911.A.1.c

Associated References
LDI Reg 46:§1911.A.1.a
When the premium is paid through a payroll or pension deduction plan, the requirements contained in §1911.A.1.a need not be met until 60 days after such payment plan.

Comments
The application or enrollment form for such policies or certificates shall clearly indicate the payment plan selected by the applicant.
LDI Reg 46:§1919.G.2
The Inflation Protection rejection statement shall state: I have reviewed the outline of coverage and the graphs that compare the benefits and premiums of this policy with and without inflation protection. Specifically, I have reviewed Plans ______, and I reject inflation protection.
LDI Reg 46:§1921.A
All applications for long-term care insurance policies or certificates, except those which are guaranteed issue, shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant.
LDI Reg 46:§1921.B.1
If application asks what medications have been prescribed, the application must also ask applicant to list the medication prescribed.
LDI Reg 46:§1921.C.1
The mandatory caution statement contained in this Section shall be included in the application. This Section shall not apply to policies that are guaranteed issue.
LDI Reg 46:§1925.A
Application forms shall include the four questions contained within this Section.
LDI Reg 46:§1925.B
Producers shall list any other health insurance policies they have sold to the applicant, as follows: 1. List policies sold which are still in force. 2. List policies sold in the past five years which are no longer in force.
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.
Outline of Coverage   Back To Top
ReferenceDescription
La. R.S. 22:§1186 G(1)
An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means which prominently direct the attention of the recipient of the document and its purpose.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1186 G(1)(a)

Associated References
LDI Reg 46:§1955.A
The commissioner shall prescribe a standard format, including style, arrangement, and overall appearance, and the content of an outline of coverage.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1186 G(2)(d)
A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1186 G(2)(g)
A statement that discloses to the policyholder or certificate holder whether the policy is intended to be a federally tax-qualified long-term care insurance contract under 7702B(b) of the Internal Revenue of 1986, as amended.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
LDI Reg 46:§1913.H*
A qualified long-term care insurance contract shall include a disclosure statement in the outline of coverage, that the policy is intended to be a qualified long-term care insurance contract.
LDI Reg 46:§1919.D.1.a
Insurers shall include the following information in or with the outline of coverage, a graphic comparison of the benefit levels of a policy that increases benefits over the policy period with a policy that does not increase benefits. The graphic comparison shall show benefit levels over at least a 20-year period.
LDI Reg 46:§1919.D.2.a
Insurers shall include the following information in or with the outline of coverage, any expected premium increases or additional premiums to pay for automatic or optional benefit increases.
LDI Reg 46:§1943.A.2*
Required Notice for Long-Term Care Insurance- Every insurer, health care service plan, or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall: display prominently by type, stamp, or other appropriate means, on the first page of the outline of coverage and policy the following: Notice to Buyer: This policy may not cover all of the costs associated with long-term care incurred by the buyer during the period of coverage. The buyer is advised to review carefully all policy limitations.
LDI Reg 46:§1955.B
The outline of coverage shall be a free-standing document, using no smaller than 10-point type.
LDI Reg 46:§1955.C
Outline of coverage shall contain no material of an advertising nature.
LDI Reg 46:§1955.D
Text that is capitalized or underscored in the standard format outline of coverage may be emphasized by other means that provide prominence equivalent to the capitalization or underscoring.
LDI Reg 46:§1955.E
Use of the text and sequence of text of the standard format outline of coverage is mandatory, unless otherwise specifically indicated.
LDI Reg 46:§1955.F
This Section contains the required format for the outline of coverage.
LDI Reg 46:§1955.F.1
This Section explains what is the type of long-term care policy.

Comments
Explains it is an individual or group policy.
LDI Reg 46:§1955.F.10
Include any limitations and exclusions: Describe any a) preexisting conditions; b) noneligible facilities and provider; c) noneligible levels of care; d) Exclusions and exceptions; e) Limitations.
LDI Reg 46:§1955.F.11
Include the relationship of cost of care and benefits.
LDI Reg 46:§1955.F.12
State that the policy provides coverage for insureds clinically diagnosed as having Alzheimer's disease or related degenerative and dementing illnesses. Specifically describe each benefit screen or other policy provision which provides preconditions to the availability of policy benefits for such an insured.
LDI Reg 46:§1955.F.13
State the total annual premium for the contract. If the premium varies with an applicant's choice among benefits, indicate the portion of annual premium which corresponds to each benefit option.
LDI Reg 46:§1955.F.14
This covers any additional features the contract may provide such as indicating if medical underwriting is used and also to describe other important features.
LDI Reg 46:§1955.F.15
Formatting Requirement for Outline of Coverage- Must include the following notice on the outine of coverage regarding contacting the state senior health insurance assistance program: CONTACT THE STATE SENIOR HEALTH INSURANCE ASSISTANCE PROGRAM IF YOU HAVE GENERAL QUESTIONS REGARDING LONG-TERM CARE INSURANCE. CONTACT THE INSURANCE COMPANY IF YOU HAVE SPECIFIC QUESTIONS REGARDING YOUR LONG-TERM CARE INSURANCE POLICY OR CERTIFICATE.
LDI Reg 46:§1955.F.2
This Section explains the purpose of the outline of coverage.
LDI Reg 46:§1955.F.3
This Section is for the statement that the plan is a qualified long-term care plan.
LDI Reg 46:§1955.F.4
This Section describes the terms under which a policy may be continued.
LDI Reg 46:§1955.F.5
TERMS UNDER WHICH THE COMPANY MAY CHANGE PREMIUMS.
LDI Reg 46:§1955.F.6
TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE RETURNED AND PREMIUM REFUNDED.
LDI Reg 46:§1955.F.7
Include a statement that this contract does not provide medicare supplement coverage.
LDI Reg 46:§1955.F.8
Policies of this category are designed to provide coverage for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting other than an acute care unit of a hospital, such as in a nursing home, in the community or in the home. This policy provides coverage in the form of a fixed dollar indemnity benefit for covered long-term care expenses, subject to policy [limitations] [waiting periods] and [coinsurance] requirements. [Modify this paragraph if the policy is not an indemnity policy.]
LDI Reg 46:§1955.F.9
Include the following for benefits provided by the policy: a) Covered services, related deductible(s), waiting periods, elimination periods and benefit maximums. b) Institutional benefits, by skill level. c) Noninstitutional benefits, by skill level. d) Eligibility for Payment of Benefits.
Disclosure / Notice Requirements   Back To Top
ReferenceDescription
LDI Reg 46:§1915.B
This section concerns the required disclosures of rating practices to consumers.
LDI Reg 46:§1915.C
For disclsoure conerning rating practices, the applicant must sign an acknowledgement that the insurer has made the required disclosures that are required under §1915.B1 and 5.
LDI Reg 46:§1915.D
An insurer shall use the forms in Appendices B and F to comply with the requirements of §1915.B and §1915.C of this Section.
LDI Reg 46:§1925.C
For determining a replacement of a policy, solicitations other than direct response shall comply with this Section.
LDI Reg 46:§1925.D
For determining a replacement of a policy, for direct response solicitations these shall comply with this Section.
LDI Reg 46:§1943.A.6
If the state in which the policy or certificate is to be delivered or issued for delivery has a senior insurance counseling program, approved by the commissioner, the insurer shall, at solicitation, provide written notice to the prospective policyholder and certificateholder that such a program is available and the name, address and telephone number of the program.

Comments
Senior Health Insurance Program Address is: Louisiana Department of Insurance PO Box 64214, Baton Rouge, LA 70804-9214.
Senior Health Insurance Program Phone Number is: 1-800-259-5301
LDI Reg 46:§1957.A
A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the commissioner, shall be provided to all prospective applicants of a long-term care insurance policy or certificate.
LDI Reg 46:§1961.B
This Section contains an example of a Personal Worksheet.
LDI Reg 46:§1961.C
This Section contains an example of a Disclosure Form.
LDI Reg 46:§1961.D
This Section contains an example of a Suitability Letter.
LDI Reg 46:§1961.F
This section contains the Long-term care insurance potential rate increase disclosure form.
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.
Reporting Requirements   Back To Top
ReferenceDescription
LDI Reg 46:§1927.A

Associated References
LDI Reg 46:§1927.B
Every insurer shall maintain records for each producer of that producer's amount of replacement sales as a percentage of the producer's total annual sales and the amount of lapses of long-term care insurance policies sold by the producer as a percentage of the producer's total annual sales.
LDI Reg 46:§1927.B

Associated References
LDI Reg 46:§1927.A
Each insurer shall report annually, by June 30, the 10 percent of its producers with the greatest percentages of lapses and replacements, as measured by §1927.A (Appendix G)
LDI Reg 46:§1927.C
Reported replacement and lapse rates do not alone constitute a violation of insurance laws or necessarily imply wrongdoing. The reports are for the purpose of reviewing more closely producer activities regarding the sale of long-term care insurance.
LDI Reg 46:§1927.D
Every insurer shall report annually, by June 30, the number of lapsed policies as a percentage of its total annual sales and as a percentage of its total number of policies in force as of the end of the preceding calendar year. (Appendix G)
LDI Reg 46:§1927.E
Every insurer shall report annually, by June 30, the number of replacement policies sold as a percentage of its total annual sales and as a percentage of its total number of policies in force as of the preceding calendar year.(Appendix G)
LDI Reg 46:§1927.F
Every insurer shall report annually, by June 30, for qualified long-term care insurance contracts, the number of claims denied for each class of business, expressed as a percentage of claims denied.(Appendix E)
LDI Reg 46:§1945.H
The issuer shall report annually to the commissioner the total number of applications received from residents of this state, the number of those who declined to provide information on the personal worksheet, the number of applicants who did not meet the suitability standards, and the number of those who chose to confirm after receiving a suitability letter.
LDI Reg 46:§1961.A.
This Section contains an example of a Rescission Reporting Form. This report is due March 1 annually.
LDI Reg 46:§1961.E
This section contains the Claims Denial Reporting Form which is due June 30, annually.
LDI Reg 46:§1961.G
This section contains the Replacement and Lapse Reporting Form. The report is due June 30, annually.
Advertising   Back To Top
ReferenceDescription
LDI Rule 3:§1305
This Section contains definitions for accident and sickness advertising.
LDI Rule 3:§1309.B

Associated References
LDI Rule 3:§1311.C.1
Advertisements shall be truthful and not misleading in fact or in implication.
LDI Rule 3:§1311.A.1
No advertisement shall omit information or use words, phrases, statements, references or illustrations if the omission of such information or use of such words, phrases, statements, references or illustrations has the capacity, tendency or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any policy benefit payable, loss covered, or premium payable.
LDI Rule 3:§1311.A.10
An advertisement that makes a reference to the policy benefits being paid directly to an insured is prohibited unless, in making such a reference, the advertisement includes a statement that the benefits will be paid directly to a hospital or any other provider of health care services if an assignment of the policy benefits has been made.
LDI Rule 3:§1311.A.2
No advertisement shall contain or use words or phrases such as all, full, complete, comprehensive, unlimited, up to, as high as, this policy will help pay your hospital and surgical bills, this policy will help fill some of the gaps that Medicare and your present insurance leave out, this policy will help to replace your income (when used to express loss of time benefits); or similar words and phrases, in a manner which exaggerates any benefits beyond the terms of the policy, or which may lead the policyholder to expect payment of benefits which he is not likely to derive, except in very unusual circumstances.
LDI Rule 3:§1311.A.3
An advertisement shall not contain descriptions of a policy limitation, exception, or reduction, worded in a positive manner to imply that is a benefit, such as, describing a waiting period as a benefit builder, or stating even preexisting conditions are covered after two years. Words and phrases used in an advertisement to describe such policy limitations, exceptions, and reductions shall fairly and accurately describe the negative features of such limitations, exceptions, and reductions of the policy offered.
LDI Rule 3:§1311.A.4
No advertisement of a benefit for which payment is conditional upon confinement in a hospital or similar facility shall use words or phrases such as extra cash, extra income, extra pay, or substantially similar words or phrases because such words and phrases have the capacity, tendency or effect of misleading the public into believing that the policy advertised will, in some way, enable them to make a profit from being hospitalized.
LDI Rule 3:§1311.A.5
No advertisement of a hospital or other similar facility confinement benefit shall advertise that the amount of the benefit is payable on a monthly or weekly basis when, in fact, the amount of the benefit payable is based upon a daily pro rata basis relating to the number of days of confinement unless such statements of such monthly or weekly benefit amounts are followed immediately by equally prominent statements of the benefit payable on a daily basis; for example, either of the following statements is acceptable: "$1,000.00 a month ($33.33 a day) or $33.33 a day ($1,000.00 a month)". When the policy contains a limit on the number of days of coverage provided, such limit must appear in the advertisement.
LDI Rule 3:§1311.A.8
An advertisement of a direct response insurance product shall not imply that because "no insurance agent will call and no commissions will be paid to agents" that it is "a low cost plan," or use other similar words or phrases because the cost of advertising and servicing such policies is a substantial cost in the marketing of a direct response insurance product.
LDI Rule 3:§1311.B.1
When an advertisement refers to either a dollar amount, or a period of time for which any benefit is payable, or the cost of the policy, or specific policy benefit, or the loss for which such benefit is payable, it shall also disclose those exceptions, reductions and limitations affecting the basic provisions of the policy without which the advertisement would have the capacity or tendency to mislead or deceive.
LDI Rule 3:§1311.B.2
When a policy contains a waiting, elimination, probationary or similar time period between the effective date of the policy and the effective date of coverage under the policy or a time period between the date a loss occurs and the date benefits begin to accrue for such loss, an advertisement which is subject to the requirements of the preceding paragraph shall disclose the existence of such periods.
LDI Rule 3:§1311.B.3
An advertisement shall not use the words only, just, merely, minimum or similar words or phrases to describe the applicability of any exceptions and reductions, such as: "This policy is subject to the following minimum exceptions and reductions".
LDI Rule 3:§1311.C.1

Associated References
LDI Rule 3:§1309.B
An advertisement which is subject to the requirements of §1309.B shall, in negative terms, disclose the extent to which any loss is not covered if the cause of such loss is traceable to a condition existing prior to the effective date of the policy. The use of the term preexisting condition without an appropriate definition or description shall not be used.
LDI Rule 3:§1311.C.2
When a policy does not cover losses resulting from preexisting conditions, no advertisement of the policy shall state or imply that the applicant's physical condition or medical history will not affect the issuance of the policy or payment of a claim thereunder. This rule prohibits the use of the phrase no medical examination required and phrases of similar import, but does not prohibit explaining automatic issue. If an insurer requires a medical examination for a specified policy, the advertisement shall disclose that a medical examination is required.
LDI Rule 3:§1311.C.3
When an advertisement contains an application form to be completed by the applicant and returned by mail for a direct response insurance product, such application form shall contain a question or statement which reflects the preexisting condition provisions of the policy immediately preceding the blank space for the applicant's signature.
LDI Rule 3:§1313.A
When an advertisement refers to either a dollar amount or a period of time for which any benefit is payable, or the cost of the policy, or specific policy benefit, or the loss for which such benefit is payable, it shall disclose the provisions relating to renewability, cancellability and termination and any modification of benefits, losses covered or premiums because of age or for other reasons, in a manner which shall not minimize or render obscure the qualifying conditions.
LDI Rule 3:§1315.A
Testimonials used in advertisements must be genuine, represent the current opinion of the author, be applicable to the policy advertised and be accurately reproduced.
LDI Rule 3:§1315.B
If the person making a testimonial, an endorsement or an appraisal has a financial interest in the insurer or a related entity as a stockholder, director, officer, employee, or otherwise, such fact shall be disclosed in the advertisement. If a person is compensated for making a testimonial, endorsement or appraisal, such fact shall be disclosed in the advertisement by language substantially as follows: "Paid Endorsement."
LDI Rule 3:§1315.C
An advertisement shall not state or imply that an insurer or a policy has been approved or endorsed by any individual, group of individuals, society, association or other organizations, unless such is the fact, and unless any proprietary relationship between an organization and the insurer is disclosed.
LDI Rule 3:§1315.D
When a testimonial refers to benefits received under a policy, the specific claim data, including claim number, date of loss, and other pertinent information, shall be retained by the insurer for inspection for a period of four years or until the filing of the next regular report on examination of the insurer, whichever is the longer period of time.
LDI Rule 3:§1317.A
An advertisement relating to the dollar amounts of claims paid, the number of persons insured, or similar statistical information relating to any insurer or policy shall not use irrelevant facts, and shall not be used unless it accurately reflects all the relevant facts.
LDI Rule 3:§1317.C
The source of any statistics used in an advertisement shall be identified in such advertisement.
LDI Rule 3:§1319.A
When a choice of the amount of benefits is referred to, an advertisement shall disclose that the amount of benefits provided depends upon the plan selected and that the premium will vary with the amount of the benefits selected.
LDI Rule 3:§1319.B
When an advertisement refers to various benefits which may be contained in two or more policies, other than group master policies, the advertisement shall disclose that such benefits are provided only through a combination of such policies.
LDI Rule 3:§1321.A
An advertisement shall not directly or indirectly make unfair or incomplete comparisons of policies or benefits or comparisons of non-comparable policies of other insurers, and shall not disparage competitors, their policies, services or business methods, and shall not disparage or unfairly minimize competing methods of marketing insurance.
LDI Rule 3:§1323.A
An advertisement which is intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond those limits.
LDI Rule 3:§1323.B
An advertisement shall not create the impression, directly or indirectly, that the insurer, its financial condition or status, or the payment of its claims, or the merits, desirability, or advisability or its policy forms or kinds or plans of insurance are approved, endorsed, or accredited by any division or agency of this State or the United States Government.
LDI Rule 3:§1325.A
The name of the actual insurer and the form number or numbers advertised shall be identified and made clear in all of its advertisements.

Comments
Note: The above paragraph does not require disclosure of a policy form number where the advertisement does not relate specifically to a particular policy or benefit, but is general in nature and would be regarded as Institutional Advertisement according to custom and usage.
LDI Rule 3:§1325.B
No advertisement shall use any combination of words, symbols, or physical materials which by their content, phraseology, shape, color, or other characteristics are so similar to combination of words, symbols or physical materials used by agencies of the federal government or of this State, or otherwise appear to be of such a nature that it tends to confuse or mislead prospective insureds into believing that the solicitation is in some manner connected with an agency of the municipal, state, or federal government.
LDI Rule 3:§1329.A.1
An advertisement of an individual policy shall not directly or by implication represent that a contract or combination of contracts is an introductory, initial or special offer, or that applicants will receive substantial advantages not available at a later date, or that the offer is available only to a specified group of individuals, unless such is the fact. An advertisement shall not contain phrases describing an enrollment period as special, limited, or similar words or phrases when the insurer uses such enrollment periods as the usual method of advertising accident and sickness insurance.
LDI Rule 3:§1329.B
An advertisement shall not offer a policy which utilizes a reduced initial premium rate in a manner which overemphasizes the availability and the amount of the initial reduced premium. When an insurer charges an initial premium that differs in amount from the amount of the renewal premium payable on the same mode, the advertisement shall not display the amount of the reduced initial premium either more frequently or more prominently than the renewal premium and both the initial reduced premium and the renewal premium must be stated in juxtaposition in each portion of the advertisement where the initial reduced premium appears.
LDI Rule 3:§1329.C
Special awards, such as a safe drivers' award shall not be used in connection with advertisements of accident or accident and sickness insurance.
LDI Rule 3:§1329.D
An advertisement using terminology to indicate that a particular form of coverage is unlike any other form of coverage presently in existence is prohibited if similar plans and offers are available.
LDI Rule 3:§1329.E.1
An advertisement of an individual policy which provides an application or enrollment form shall contain a policy summary setting out the essential features of the policy that will be issued upon acceptance of an application by the insurer.
LDI Rule 3:§1329.E.2
The policy summary shall be prominently displayed and readily distinguishable from all other portions of the advertisement.
LDI Rule 3:§1331.A
An advertisement shall not contain statements which are untrue in fact, or by implication misleading, with respect to the assets, corporate structure, financial standing, age or relative position of the insurer in the insurance business. An advertisement shall not contain a recommendation by any commercial rating system unless it clearly indicates the purpose of the recommendation and the limitations of the scope and extent of the recommendation.
LDI Rule 3:§1333.A
This Section describes enforcement procedures for advertising file.
LDI Rule 3:§1333.B
This Section concerns enforcement procedures certificate of compliance.
LDI Reg 46:§1941.A
Every insurer, health care service plan, or other entity providing long-term care insurance or benefits in this state shall provide a copy of any long-term care insurance advertisement intended for use in this state, whether through written, radio, or television medium, to the commissioner of Insurance of this state for review or approval by the commissioner to the extent it may be required under state law.
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:§1186 B(4)
No long-term care policy may be marketed or sold as a federally tax exempt policy, unless such policy contains provisions for automatic amendment to conform with mandatory federal requirements necessary to maintain such tax exempt status and provides notice thereof approved by the commissioner.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1187 D(1)
Effective January 1, 2005-No long-term care insurance policy or certificate may be field issued based on medical or health status.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
La. R.S. 22:§1187 D(2)
Effective January 1, 2005-For purposes of this Section, "field issued" means a policy or certificate issued by a producer or a third-party administrator pursuant to the underwriting authority granted to the producer or third-party administrator by an insurer.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
LDI Reg 46:§1943.A.3
Provide copies of the disclosure forms required in §1915.C (Appendices B and F) to the applicant;
LDI Reg 46:§1943.A.8
Provide an explanation of contingent benefit upon lapse provided in §1949.D.3.
LDI Reg 46:§1943.B
In addition to the practices prohibited in LRS 22:1961 et seq., the following acts and practices are prohibited: 1)Cold Lead Advertising 2)High Pressure Tactics 3) Misrepresentation 4)Twisting
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:§1186 A
Subsection (A) of La. R.S. 22:1186 states that the commissioner may adopt rules and regulations concerning long-term care insurance.

Comments
Effective January 1, 2005 Act 780-amends and reenacts LRS 22§ 1732, 1734,(2), and (5), and 1735 through 1737 and to enact LRS 22§ 1734 (7) and 1738 through 1741, relative to long-term care.
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.
LDI Reg 46:§1921.C.3
Prior to issuance of a long-term care policy or certificate to an applicant age 80 or older, the insurer shall obtain one of the following: a report of a physical examination; an assessment of functional capacity; an attending physician's statement; or copies of medical records.
LDI Reg 46:§1921.D
A copy of the completed application or enrollment form (whichever is applicable) shall be delivered to the insured no later than at the time of delivery of the policy or certificate, unless it was retained by the applicant at the time of application.
LDI Reg 46:§1921.E
Every insurer or other entity selling or issuing long-term care insurance benefits shall maintain a record of all policy or certificate rescissions, both state and countrywide, except those which the insured voluntarily effectuated, and shall annually furnish this information to the Insurance commissioner in the format prescribed by the National Association of Insurance Commissioners in Appendix A.
LDI Reg 46:§1935

Associated References
LDI Reg 46:§1949.I
This section shall apply to all long-term care insurance policies or certificates except those covered under §1917 and §1937.
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. 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:§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:§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.
LDI Reg 46:Reguation 46
This contains Regulation 46 in its entirety.
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.
Actuarial Requirements   Back To Top
ReferenceDescription
LDI Reg 46:§1917.B
This Section concerns the initial filing requirements that must be submitted to the commissioner 45 days prior to making a long-term care insurance form available for sale in this state.