Table of Contents. Title 37 INSURANCE. Part I. Risk Management. Subpart 1. Insurance and Related Matters

Transcription

1 Table of Contents Title 37 INSURANCE Part I. Risk Management Subpart 1. Insurance and Related Matters Chapter 1. Underwriting Underwriting...1 Chapter 3. Auditing and Statistics Auditing and Statistics...1 Chapter 5. Billing Billing and Collection of Insurance Premiums...2 Chapter 7. Reporting of Claims Reporting of Property Damage Claims Reporting of Boiler and Machinery Claims Reporting of Comprehensive General Liability Claims Reporting of Worker's Compensation and Maritime Claims Reporting of State Automobile Liability and Physical Damage Claims Reporting of Aviation Claims Reporting of Wet Marine Claims (Over 26 Feet) Reporting of Bond and Crime Claims Reporting of Medical Malpractice Liability Claims Reporting of Road and Bridge Hazard Claims (Department of Transportation and Development) Claims Unit Contacts...8 Chapter 9. Risk Analysis and Loss Prevention Risk Analysis and Loss Prevention...8 Chapter 11. Law Enforcement Officers' and Firemen's Survivor Benefit Review Board Survivors Benefits...9 Subpart 2. Worker's Compensation Fee Schedule Chapter 25. Fees Fee Schedule...11 Part III. Patients' Compensation Fund Oversight Board Chapter 1. General Provisions Scope Source and Authority Patients' Compensation Fund: Description Purpose and Objective of Rules; Construction, Application General Definitions Interpretive Definitions Severability...15 i Louisiana Administrative Code September 2006

2 Table of Contents Chapter 3. Organization, Functions, and Delegations of Authority Board Organization Executive Director of the Patients' Compensation Fund Oversight Board Fund Property Expenses of Administration and Defense...16 Chapter 5. Enrollment with the Fund Scope of Chapter Basic Qualifications for Enrollment Financial Responsibility: Insurance Financial Responsibility: Self-Insurance Financial Responsibility: Self-Insurance Trusts Coverage: Partnerships and Professional Corporations Enrollment Procedure Certification of Enrollment Expiration, Renewal of Enrollment...22 Chapter 7. Surcharges PCF Consulting Actuary Annual Actuarial Study Risk Rating Rate Applications, Filings; Notice of Rates Interim, Emergency Rate Filings Payment of Surcharges: Insurers Payment of Surcharges: Self-Insureds Amount of Surcharges; Form of Coverage; Conversions...25 Chapter 9. Scope of Coverage Effective Date Term of Enrollment Scope of Coverage: Insureds Scope of Coverage: Self-Insureds Scope of Coverage: Self-Insurance Trusts...26 Chapter 11. Reporting Reporting of Claims, Reserves, Proposed Settlement Claims Experience Reporting: Insurers, Institutions and Self-Insured Noncompliance; Failure to Report Confidentiality...28 Chapter 13. Fund Data Collection, Maintenance; Accounting and Reporting Fund Data Collection, Maintenance Fund Accounting Annual Budget Appropriation Request Periodic Reports Annual Report...28 Chapter 14. Medical Review Panels Procedure Malpractice Complaint Attorney Chairman...29 Chapter 15. Defense of the Fund Claims Defense Claims Accounting Claim Reserves...30 Louisiana Administrative Code September 2006 ii

3 Table of Contents Settlement of Claims Privileged Communications, Records...30 Chapter 17. Transitional Rules Continuing Enrollment of Self-Insureds Continuing Enrollment of Self-Insurance Trusts...30 Chapter 19. Future Medical Care and Related Benefits Scope of Chapter Definitions Obligation of the Fund Claims for Future Medical Care and Related Benefits Attorneys; Medical Experts; Architects; Adjusters Examinations; Notice Requirements Choice of Health Care Provider Psychological /Psychiatric Treatment and Counseling Nursing Care; Sitter Care Treatment Protocol Vehicles Ancillary Cost; Mileage Modifications/Renovations to Patient's Residence Testimony; Communications Fees and Costs Attorney Fees...35 Part VII. Motor Vehicles Chapter 1. Insurance...37 Subchapter A. Self Insurance Certificates of Self Insurance...37 Subchapter B. Compulsory Motor Vehicle Liability Security Maintenance of Compulsory Motor Vehicle Liability Security Compulsory Insurance Hardship License...39 Part IX. Agricultural Commodities Chapter 1. Self-Insurance Fund Definitions The Fund Purpose Fees Insurance Coverage Claim Provisions Appeal Procedure Subrogation Limit of Self-Insurance Fund Participation in the Self-Insurance Fund Prohibited Acts: Criminal Penalties Validity of Rules Pending Litigation; Stay of Claims...44 iii Louisiana Administrative Code September 2006

4 Table of Contents Part XI. Rules Chapter 1. Rule Number 3A Advertisement of Medicare Supplement Insurance Purpose Applicability Definitions Method of Disclosure of Required Information Form and Content of Advertisements Advertisements of Benefits, Losses Covered, or Premiums Payable Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability, and Termination Testimonials or Endorsements by Third Parties Use of Statistics Disparaging Comparisons and Statements Jurisdictional Licensing and Status of Insurer Identity of Insurer Group or Quasi-Group Implications Introductory, Initial or Special Offers Statements about an Insurer Enforcement Procedures Severability Provision Effective Date Interpretive Guidelines for Rules Governing Advertisements of Medicare Supplement Insurance...52 Chapter 3. Rule Number 4 Interlocal Risk Management Agency Purpose Applicability Definitions Requirements Necessary to Obtain a Certificate of Authority as an Interlocal Risk Management Agency Filing of Reports Solvency or Risk Management Agencies; Trustee Responsibilities Interlocal Risk Management Self-Insurance Funds; Advance Premium Discounts; Surplus Distribution; Deficit Aggregate Excess Insurance, Interlocal Risk Management Agency; Self-Insurance Servicing Interlocal Risk Management Agencies; Application; Requirements; Noncompliance Penalty for Non-Compliance Severability...60 Chapter 5. Rule Number 9 Pre-Licensing Insurance Education Advisory Council Purpose Applicability and Scope Effective Date Course Requirements Provider Requirements Instructor Qualifications Training Facility Requirements Licensing Procedure of Applicant Course Completion Fees...63 Louisiana Administrative Code September 2006 iv

5 Table of Contents 521. Complaints Violations Expiration Date...64 Chapter 7. Rule Number 10 Continuing Education Purpose Basic Requirements Applicability Insurance Education Advisory Council Program Requirements Provider Requirements Instruction Requirements Training Facility Requirements Rule Measurement of Credit Controls and Reporting Program Review Disciplinary Action Rule Credit for Individual Study Programs Credit for Service as Instructor Effective Date Separability Periodic Review Appendix 1 Request for Program/Course Approval Appendix 2 Continuing Education Provider Training Schedule Appendix 3 Continuing Education Provider Application Appendix 4 Continuing Education Instructor Application Appendix 5 Continuing Education Certificate Appendix 6 Continuing Education Statement Appendix 7 Administrative and Reporting Requirements Survey...74 Chapter 9. Rule Number 12 Transmission of Forms and Documents Transmission of Forms and Documents Filed with the Department of Insurance...74 Chapter 11. Rule Number 1 Rules of Practice and Procedure before the Commissioner of Insurance Definitions Commencement of Hearings Petitions, Complaints or Orders Notice Service of Notice Proof of Service Answer or Appearance Leave to Intervene Necessary Docket Default in Answering or Appearing Subpoenas Prehearing Conference Hearing Order of Procedure at Hearing Witnesses to be Sworn Rules of Pleading and Evidence Attorneys Stenographic Record of Hearing Depositions Decision, Findings of Fact and Conclusions of Law and Order...78 v Louisiana Administrative Code September 2006

6 Table of Contents Rehearings Appeals to the District Court Transcript in Case on Appeal Amendment of Rules Exclusions Declaratory Orders and Rulings, Judicial Review Forms Supersedes All Prior Rules...79 Chapter 13. Rule Number 3 Advertisements of Accident and Sickness Insurance Purpose Applicability Definitions Method of Disclosure of Required Information Form and Content of Advertisements Advertisements of Benefits Payable, Losses Covered or Premiums Payable Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability and Termination Testimonials or Endorsements by Third Parties Use of Statistics Identification of Plan or Number of Policies Disparaging Comparisons and Statements Jurisdictional Licensing and Status of Insurer Identity of Insurer Group or Quasi-Group Implications Introductory, Initial or Special Offers Statements about an Insurer Enforcement Procedures Severability Provision Effective Date...84 Chapter 15. Rule Number 5 Unfair Trade Practices Purpose Applicability Definitions Rule...85 Chapter 17. Rule Number 6 Vehicle Mechanical Breakdown Insurer Purpose Applicability Definitions Qualifications Reserves Reports Penalty for Non-Compliance Severability...87 Chapter 19. Rule Number 7 Legal Expense Insurers Purpose Applicability Definitions Exemptions Qualifications as Insurer Required Licensing of Agents Required...88 Louisiana Administrative Code September 2006 vi

7 Table of Contents Compliance Required Penalty for Non-Compliance Severability...88 Chapter 21. Rule Number 8 A New Annuity Mortality Table for Use in Determining Reserve Liabilities for Annuities Authority Purpose Definitions Individual Annuity for Pure Endowment Contracts Group Annuity or Pure Endowment Contracts Application of the 1994 GAR Table Separability Effective Date...89 Chapter 23. Rule 13 Special Assessment to Pay the Cost of Investigation, Enforcement, and Prosecution of Insurance Fraud Purposes Fee Assessment Limitations on the Fee Assessment Allocation of the Fee Assessment Payment of the Fee Assessment Sunset...90 Chapter 25. Rule 14 Records Management Records Management; General...90 Part XIII. Regulations Chapter 1. Regulation 31 Holding Company Purpose Severability Clause Definitions Subsidiaries of Domestic Insurers Acquisition of Control Statement Filing Amendments to Form A Acquisition of Section 1004.A(l)(2) Insurers Annual Registration of Insurers Statement Filing Summary of Registration Statement Filing Amendments to Form B Alternative and Consolidated Registrations Disclaimers and Termination of Registration Extraordinary Dividends and Other Distributions Adequacy of Surplus Transactions Subject to Prior Notice Notice Filing Instructions for Forms A, B, C, and D Form A Acquisition of Control or Merger with a Domestic Insurer Form B Annual Registration Statement Form C Registration Statement Summary Form D Prior Notice of a Transaction Chapter 3. Regulation 32 Group Coordination of Benefits Purpose and Applicability Definitions vii Louisiana Administrative Code September 2006

8 Table of Contents 305. Use of Model COB Contract Provision Rules for Coordination of Benefits Procedure to be Followed by Secondary Plan Notice to Covered Persons Miscellaneous Provisions Effective Date; Existing Contracts Appendix A Model COB Contract Provisions Coordination of This Group Contract's Benefits with Other Benefits Appendix B Consumer Explanatory Booklet Coordination of Benefits Chapter 5. Regulation 33 Medicare Supplement Insurance Minimum Standards Purpose Applicability and Scope Definitions Policy Definitions and Terms Policy Provisions Premium Increase Requirements Rate Increases Requirements Minimum Benefit Standards for Policies or Certificates Issued for Delivery Prior to July 20, Benefit Standards for Policies or Certificates Issued or Delivered on or after July 20, Standard Medicare Supplement Benefit Plans Medicare Select Policies and Certificates Open Enrollment Guaranteed Issue for Eligible Persons Standards for Claims Payment Loss Ratio Standards and Refund or Credit of Premium Filing and Approval of Policies and Certificates and Premium Rates Permitted Compensation Arrangements Required Disclosure Provisions Requirements for Application Forms and Replacement Coverage Filing Requirements for Advertising Standards for Marketing Appropriateness of Recommended Purchase and Excessive Insurance Reporting of Multiple Policies Prohibition against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies or Certificates Severability Appendix A Calculation Forms Appendix B Medicare Supplement Policies Reporting Form Appendix C Disclosure Statements Effective Date Chapter 7. Regulation 39 Statement of Actuarial Opinion Purpose Applicability and Scope Definitions Content Exemptions Louisiana Administrative Code September 2006 viii

9 Table of Contents Chapter 9. Regulation 40 Summary Document and Disclaimer and Notice of Noncoverage Purpose Applicability and Scope Form and Content Exhibit A Summary of the Louisiana Life and Health Insurance Guaranty Association Act and Notice Concerning Coverage Limitations and Exclusions Exhibit B Notice of Noncoverage Chapter 11. Regulation 42 Group Self-Insurance Funds Definitions Application to Create a Group Self-Insurance Fund Conditions for Retaining the Self-Insurance Privilege Financial and Actuarial Reports for Group Self-Insurance Funds Excess Insurance Requirements for Group Self-Insurance Funds Indemnity Agreement Rates and Reporting of Rates Authorized Investments for Group Self-Insurance Funds Premium Audit Board of Trustees Group Membership; Termination, Liability Service Companies Licensing of Agents Deficits and Insolvencies Review of Rate Determination Cease and Desist Orders Revocation of Certificate of Authority Examinations Chapter 13. Regulation 43 Companies in Hazardous Financial Condition Purpose Definitions Standards Commissioner's Authority Chapter 15. Regulation 44 Accelerated Benefits Purpose Definitions Type of Product Assignee/Beneficiary Criteria for Payment Disclosures Effective Date of the Accelerated Benefits Waiver of Premiums Discrimination Actuarial Standards Actuarial Disclosure and Reserves Filing Requirement Chapter 17. Regulation 45 Filing of Affirmative Action Plans Purpose Applicability and Scope Content and Procedure Effective Date ix Louisiana Administrative Code September 2006

10 Table of Contents Chapter 19. Regulation 46 Long-Term Care Insurance Purpose Applicability and Scope Definitions Policy Definitions Policy Practices and Provisions Unintentional Lapse Required Disclosure Provisions Required Disclosure of Rating Practices to Consumers Initial Filing Requirements Requirements to Offer Inflation Protection Prohibition against Post-Claim Underwriting (former 1915) Minimum Standards for Home Health and Community Care Benefits in Long-Term Care Insurance Policies (former 1917) Requirements for Application Forms and Replacement Coverage (former 1921) Reporting Requirements (former 1923) Licensing (former 1925) Discretionary Powers of Commissioner (former 1927) Reserve Standards (former 1929) Loss Ratio (former 1931) Premium Rate Schedule Increases Filing Requirement (former 1933) Filing Requirements for Advertising (former 1935) Standards for Marketing (former 1937) Suitability (former 1939) Prohibition against Pre-Existing Conditions and Probationary Periods in Replacement Policies or Certificates (former 1941) Nonforfeiture Benefit Requirement (former 1943) Standards for Benefit Triggers (former 1945) Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts (former 1947) Standard Format Outline of Coverage (former 1949) Requirement to Deliver Shopper's Guide (former 1951) Penalties (former 1953) Appendices (former 1955) Chapter 21. Regulation 47 Actuarial Opinion and Memorandum Regulation Purpose Authority Scope Definitions General Requirements Statement of Actuarial Opinion Based on an Asset Adequacy Analysis Description of Actuarial Memorandum Including an Asset Adequacy Analysis and Regulatory Asset Adequacy Issues Summary Chapter 23. Regulation 48 Standardized Claims Forms Purpose Definitions Applicability and Scope Requirements for Use of HCFA Form Requirements for Use of HCFA Approved Form UB Louisiana Administrative Code September 2006 x

11 Table of Contents Requirements for Use of J512 Form General Provisions Chapter 25. Regulation 49 Billing Audit Guidelines Purpose Applicability and Scope Definitions Qualifications of Auditors and Audit Coordinators Notification of Audit Provider Audit Coordinators Conditions and Scheduling of Audits Confidentiality and Authorizations Documentation Fees and Payments Chapter 27. Regulation 51 Individual Health Insurance Rating Requirements Purpose Applicability and Scope Definitions Restrictions on Premium Rates General Provisions Chapter 29. Regulation 52 Small Group Health Insurance Rating Requirements Purpose Applicability and Scope Definitions Restrictions on Premium Rates General Provisions Chapter 31. Regulation 53 Basic Health Insurance Plan Pilot Program Purposes Applicability and Scope Definitions Pilot Plan in General Pilot Plan Authorized Carrier Application Process Authorization of Pilot Plan Revocation of an Authorized Carrier's Authority Evaluation and Reporting Requirements Premium Taxes Guaranty Association Health Insurance Agents Eligibility Benefits Hospital Services Emergency Room Benefits Provider Services Limitations Exclusions Outpatient Prescription Rider Premium Maximums, Method for Calculating Payment of Benefits General Provisions Termination of Coverage xi Louisiana Administrative Code September 2006

12 Table of Contents Chapter 33. Regulation 55 Life Insurance Illustrations Purpose Applicability and Scope Definitions Policies to Be Illustrated General Rules and Prohibitions Standards for Basic Illustrations Standards for Supplemental Illustrations Delivery of Illustrations and Record Retention Annual Report; Notice to Policy Owners Annual Certifications Severability Effective Date Chapter 35. Regulation 56 Credit for Reinsurance Purpose Severability Credit for Reinsurance Reinsurer Authorized in this State Credit for Reinsurance Accredited Reinsurer Credit for Reinsurance Reinsurer Maintaining Trust Funds Credit for Reinsurance Required by Law Reduction from Liability for Reinsurance Ceded to an Unauthorized Assuming Insurer Trust Agreements Qualified under Letters of Credit Qualified under Other Security Reinsurance Contract Agreements Requiring Approval Contracts Affected Chapter 37. Regulation 57 Life and Health Reinsurance Agreements Preamble Scope Accounting Requirements Written Agreements Existing Agreements Effective Date Chapter 39. Regulation 58 Viatical Settlements Purposes Applicability and Scope Definitions License Requirements for Viatical Settlement Providers License Requirements for Viatical Settlement Brokers Approval of Viatical Settlement Contract Reporting Requirements Standards for Evaluation of Reasonable Payments General Rules Chapter 41. Regulation 60 Advertising of Life Insurance Purpose Definitions Applicability Form and Content of Advertisements Disclosure Requirements Louisiana Administrative Code September 2006 xii

13 Table of Contents Identity of Insurer Jurisdictional Licensing and Status of Insurer Statements about the Insurer Enforcement Procedures Conflict with Other Rules Severability Effective Date Chapter 45. Regulation 63 Prohibitions on the Use of Medical Information and Genetic Test Results Purpose Authority Definitions Applicability and Scope Prohibitions on the Use of Pregnancy Test Results Requirements for Release of Genetic Test and Related Medical Information Prohibitions on the Use of Medical Information and Genetic Test Results General Provisions Chapter 47. Regulation 64 Vehicle Mechanical Breakdown Insurers Cancellation Provisions Purpose Authority Applicability and Scope Cancellation Standards Failure to Comply Severability Effective Date Chapter 49. Regulation 65 Bail Bond Licensing Requirements/Bounty Hunter Purpose Definitions Bail Recovery Agent License Requirements for Louisiana Bail Recovery Persons License Requirement from Other States Out of State Bail Enforcement Procedure and Notification Requirements In State Bail Enforcement Procedure and Notification Requirement Prohibited Acts Enforcement of Regulation Effective Date Chapter 51. Regulation 66 Requirements for Officers, Directors, and Trustees of Domestic Regulated Entities Purpose Definitions Review of Officers, Directors and Trustees by Commissioner Required Procedure for Requesting Letter of No Objection from Commissioner Conditions for Refusal of Letter of No Objection Waiver of Submission of Biographical Information Scope and Limitations Chapter 53. Regulation 62 Managed Care Contracting Requirements Purpose Definitions Applicability and Scope Provider Contracting Requirements Requirements for Inclusion of Rural Hospitals xiii Louisiana Administrative Code September 2006

14 Table of Contents Requirements for Inclusion of Physicians Practicing in Qualifying Rural Hospitals General Provisions Chapter 55. Regulation 9 Deferred Payment of Fire Premiums in Connection with the Term Rule Payment of Fire Premiums Chapter 57. Regulation 14 Limiting Exclusions in Industrial Policies, Restricting Payments for Death Caused in Specified Manner Payment of Death or Funeral Benefits Rider or Endorsement Chapter 60. Regulation 74 Payment of Health Coverage Claims Purpose Applicability and Scope Claim Payments Definitions Nonelectronic Claim Submission Standards Electronic Claim Submission Standards Thirty-Day Payment Standard Claim Handling Procedures Limitations on Claim Filing and Audits Effective Date Chapter 61. Regulation 16 Investment by Insurers of Part of Premium Paid, Return Guaranteed Policy Directive Number Three to Insurance Companies Chapter 62. Regulation 77 Medical Necessity Review Organizations Purpose Definitions Authorization or Licensure as an MNRO Procedure for Application to Act as an MNRO Expiration and Renewal of License for Entities other than Health Insurance Issuers Scope and Content of Medical Necessity Determination Process Medical Necessity Review Organization Operational Requirements Procedures for Making Medical Necessity Determinations Informal Reconsideration Appeals of Adverse Determinations; Standard Appeals Second Level Review Request for External Review Standard External Review Expedited Appeals Expedited External Review of Urgent Care Requests Binding Nature of External Review Decisions Minimum Qualifications for Independent Review Organizations External Review Register Emergency Services Confidentiality Requirements Severability Effective Date Chapter 63. Regulation 17 Reinstatement of Policies Policy Directive Number Four to Non-Profit Funeral Associations Chapter 65. Regulation 18 Non-Profit Funeral Service Associations, Reinstatement of Lapsed Policies Policy Directive Number Five to Non-Profit Funeral Service Associations Louisiana Administrative Code September 2006 xiv

15 Table of Contents Chapter 67. Regulation 19 Inclusion of Burial Plots, Vaults, etc., as Part of Funeral Service-Change in Reserve Basis Policy Directive Number Six to All Insurance Issuing Funeral Policies Chapter 69. Regulation 21 Special Policies and Provisions: Prohibitions, Regulations, and Disclosure Requirements Policy Directive Number Seven to All Companies Authorized to Write Life Insurance in the State of Louisiana Chapter 71. Regulation 24 Proxies, Consents and Authorizations of Domestic Stock Insurers Application of Regulation Proxies, Consents and Authorizations Disclosure of Equivalent Information Definitions Information to Be Furnished to Security Holders Requirements as to Proxy Material Required to be Filed Proposals of Stockholders False or Misleading Statements Prohibition of Certain Solicitations Special Provisions Applicable to Election Contest Schedule A Information Required in Proxy Statement Schedule B Information to Be Included in Statements Filed by or on Behalf of a Participant (other than the insurer) in a Proxy Solicitation in an Election Contest Chapter 73. Regulation 25 Sale of Stock to Public; Stock Options Sale of Stock; Stock Options Chapter 75. Regulation 27 Insider Trading of Equity Securities of a Domestic Stock Insurance Company Subchapter A. General Application Definitions Transactions Exempted from the Operation of Section 1526 of the Act Subchapter B. Regulations under Section 1525 of the Act Filing of Statements Ownership of More than 10 Percent of an Equity Security Disclaimer of Beneficial Ownership Exemptions from Sections 1525 and 1526 of the Act Exemption from the Act of Securities Purchased or Sold by Odd-Lot Dealers Certain Transactions Subject to Section 1525 of the Act Ownership of Securities Held in Trust Exemption for Small Transactions Exemption from Section 1526 of the Act of Transactions which Need Not Be Reported under Section Subchapter C. Regulations under Section 1526 of the Act Exemption from Section 1526 of Certain Transactions Effected in Connection with a Distribution Exemption from Section 1526 of Acquisitions of Shares of Stock and Stock Options under Certain Stock Bonus, Stock Option or Similar Plans Exemption from Section 1526 of Certain Transactions in which Securities Are Received by Redeeming other Securities Exemption of Long-Term Profits Incident to Sales within Six Months of the Exercise of an Option xv Louisiana Administrative Code September 2006

16 Table of Contents Exemption from Section 1526 of Certain Acquisitions and Dispositions of Securities Pursuant to Merger or Consolidations Exemption from Section Two of Certain Securities Received upon Surrender of Similar Equity Securities Exemption from Section Two of Certain Transactions Involving an Exchange of Similar Securities Subchapter D. Regulations under Section 1527 of the Act Exemption of Certain Securities from Section 1527 of the Act Exemption from Section 1527 of the Act of Certain Transactions Effected in Connection with a Distribution Exemption from Section 1527 of the Act of Sales of Securities to be Acquired Subchapter E. Regulation under Section 1529 of the Act Arbitrage Transactions under Section 1529 of the Act Form A Form B Chapter 77. Regulation 28 Variable Contract Regulation Authority Definition Qualification of Insurance Companies to Issue Variable Contracts Separate Account or Separate Accounts Filing of Contracts Contracts Providing for Variable Benefits Required Reports Foreign Companies Licensing of Agents and Other Persons Chapter 79. Regulation 29 Correlated Sales of Life Insurance and Equity Products Purpose Applicability Statement of Policy Responsibility of Company and Agent Tie-In Sales Written Proposal Contents of Proposal Statement to Be Separate Maintenance of File by Company Effective Date Chapter 81. Regulation 30 Certificates of Insurance Coverage Certificates of Insurance Chapter 83. Regulation 35 Variable Life Insurance Model Regulation Definitions Qualification of Insurer to Issue Variable Life Insurance Insurance Policy Requirements Reserve Liabilities for Variable Life Insurance Separate Accounts Information Furnished to Applicants Applications Reports to Policyholders Foreign Companies Life Insurance Severability Louisiana Administrative Code September 2006 xvi

17 Table of Contents Chapter 85. Regulation 36 Universal Life Insurance Model Regulation Purpose Definitions Scope Valuation Nonforfeiture Mandatory Policy Provisions Disclosure Requirements Periodic Disclosure to Policyowner Interest-Indexed Universal Life Insurance Policies Chapter 87. Regulation 69 Year 2000 Exclusions Subchapter A. General Provisions Authority Purpose Scope and Applicability Severability Definitions Forms Approval Subchapter B. Admitted Insurers Underwriting Standards Monitoring of Market Conduct Representations and Warranties Notice Exemptions Subchapter C. Surplus Lines Insurers Mandatory Policyholder Notice Claims Notice Issuance of Notices Subchapter D. Administrative Actions Hearings Penalties Chapter 89. Regulation 70 Replacement of Life Insurance and Annuities Purpose Definitions Exemptions Duties of Producers Duties of Insurers that Use Producers Duties of Replacing Insurers that Use Producers Duties of the Existing Insurer Duties of Insurers with Respect to Direct Response Solicitations Violations and Penalties Effective Date Appendix A Replacement Notice Appendix B Replacement Notice Appendix C Replacement Notice Chapter 90. Regulation 72 Commercial Lines Insurance Policy Form Deregulation Authority Purpose Scope and Applicability Severability xvii Louisiana Administrative Code September 2006

18 Table of Contents Definitions Types of Coverage Exempt from Filing and Approval Special Commercial Entities Disclosure Requirements and Certification Form Requirements for Maintaining Records Exempt Policy Forms Penalties for Failure to Comply Chapter 91. Regulation 68 Patient Rights under Health Insurance Coverage in Louisiana Purpose Definitions Applicability and Scope Patient Rights under Policies or Plans of Health Insurance Coverage Patient Responsibilities Chapter 93. Regulation 80 Commercial Lines Insurance Rate Deregulation Authority Purpose Scope and Applicability Severability Definitions Types of Insurance Exempt from Rate Filing and Approval Process Exempt Rates Noncompetitive Market; Public Notice and Hearing Disciplinary Hearings; Fines Effective Date Chapter 95. Regulation 81 Military Personnel Automobile Liability Insurance Premium Discount and Insurer Premium Tax Credit Program Authority Purpose Scope and Applicability Severability Definitions Premium Discount; Proof of Eligibility Requests for Tax Credit; Documentation; Dispute Resolution Recordkeeping; Annual Report Overpayments; Collection Proceedings; Fines and Hearings Louisiana Application for Military Discount Appendix Effective Date; Implementation Chapter 99. Regulation 76 Privacy of Consumer Subchapter A. General Provisions Authority Purpose Scope and Applicability Rule of Construction Definitions Subchapter B. Privacy and Opt Out Notices for Financial Information Initial Privacy Notice to Consumers Required Annual Privacy Notice to Customers Required Information to be Included in Privacy Notices Form of Opt Out Notice to Consumers and Opt Out Methods Revised Privacy Notices Louisiana Administrative Code September 2006 xviii

19 Table of Contents Delivery Subchapter C. Limits on Disclosures of Financial Information Limits on Disclosure of Nonpublic Personal Financial Information to Nonaffiliated Third Parties Limits on Re-Disclosure and Reuse of Nonpublic Personal Financial Information Limits on Sharing Account Number Information for Marketing Purposes Subchapter D. Exceptions to Limits on Disclosures of Financial Information Exception to Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information for Service Providers and Joint Marketing Exceptions to Notice and Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information for Processing and Servicing Transactions Other Exceptions to Notice and Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information Subchapter E. Additional Provisions Protection of Existing Requirements Nondiscrimination Violations and Penalties Severability Effective Date Appendix A Sample Clauses Chapter 101. Regulation 78 Policy Form Filing Requirements Purpose Authority Applicability and Scope; Severability Filing and Review of Health Insurance Policy Forms and Related Matters Filing and Review of Life and Annuity Insurance Policy Forms and Related Matters Filing and Review of Property and Casualty Insurance Policy Forms and Related Matters Penalties Effective Date Chapter 103. Regulation 79 Limited Licensing for Motor Vehicle Rental Companies Purpose Definitions Issuance of Limited License in General Limited Licensing; Application, Supplements, Requirements Renewals Limitations of License Insurance Charges Penalties for Violations Applicability Severability Chapter 105. Regulation Number 83 Domestic Insurer's Use of Custodial Agreements and the Use of Clearing Corporations Definitions Custody Agreement; Requirements Deposit with Affiliates; Requirements Custodian Affidavit Form A Custodian Affidavit Form B Custodian Affidavit Form C xix Louisiana Administrative Code September 2006

20 Table of Contents Chapter 107. Regulation Number 84 Recognition and Use of the 2001 CSO Mortality Table in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits Authority Purpose Definitions CSO Mortality Table Conditions Applicability of the 2001 CSO Mortality Table to Regulation Gender-Blended Tables Separability Effective Date Chapter 109. Regulation Number 85 Valuation of Life Insurance Policies Purpose Authority Applicability Definitions General Calculation Requirements for Basic Reserves and Premium Deficiency Reserves Calculation of Minimum Valuation Standard for Policies with Guaranteed Nonlevel Gross Premiums or Guaranteed Nonlevel Benefits (Other than Universal Life Policies) Calculation of Minimum Valuation Standard for Flexible Premium and Fixed Premium Universal Life Insurance Policies that Contain Provisions Resulting in the Ability of a Policy Owner to Keep a Policy in Force over a Secondary Guarantee Period Select Mortality Factors Appendix Effective Date Chapter 111. Regulation 86 Dependent Coverage of Newborn Children in the Group and Individual Market Authority Purpose Applicability and Scope Definitions Enrollment Notification Procedures for a Qualifying Newborn Child Procedures for a Non-Qualifying Newborn Child Timely Payment of Claims Sanctions Severability Effective Date Chapter 113. Regulation 88 Standardization of Health Benefits and Compliance Requirements for LaChoice Purpose Applicability and Scope Eligibility, Benefits and Underwriting Criteria Participation Requirement Underwriting Criteria for Health Insurance Issuer Criteria for Public Subsidy Enforcement Provisions Louisiana Administrative Code September 2006 xx

21 Table of Contents Financial Statement Requirements Discontinuation of Product Type Severability xxi Louisiana Administrative Code September 2006

22

23 Title 37 INSURANCE Part I. Risk Management Subpart 1. Insurance and Related Matters Chapter 1. Underwriting 101. Underwriting A. All coverages which are self-insured by the Office of Risk Management are mandatory for all Louisiana state departments, agencies, boards, and commissions. B. If any department, agency, board, or commission requires or wishes to procure any insurance coverages which are not written through the Louisiana Self Insurance Program, request is to be made to the Office of Risk Management to procure said coverage. It is the responsibility of the department, agency, board, or commission to provide the underwriting information required to procure or underwrite the risk. C. All leases for real and movable property (including vehicles) which are entered into by any state department, agency, board, or commission are to be forwarded to the Office of Risk Management for review in compliance of insurance requirements. D. All inquiries regarding interpretation of insurance coverages are to be addressed to the underwriting unit and are to be in a written form. E. Boiler and machinery equipment at new locations are to be reported to the underwriting unit. F. Builder's risk projects are to be reported to the underwriting unit when the construction contract has been awarded or the "Notice to Proceed" has been issued. G. All newly constructed state-owned buildings are to be reported to the underwriting unit upon acceptance/completion. H. All newly acquired state-owned aircraft are to be reported to the underwriting unit immediately but in no event more than 30 days after acquisition. All newly leased or borrowed aircraft are to be reported to the underwriting unit immediately but in no event more than 30 days after possession or lease. I. Any newly acquired, constructed, leased, or borrowed airport or heliport facilities are to be reported to the underwriting unit before coverage will be effective. J. All newly acquired state-owned marine vessels which are over 26 feet in length are to be reported to the underwriting unit immediately but in no event more than 30 days after acquisition. All newly leased or borrowed marine vessels which are over 26 feet in length are to be reported to the underwriting unit immediately but in no event more than 30 days after possession or lease. K. Applications for new crime policies are to be submitted to the underwriting unit. Coverage does not become effective until the insurance company has accepted the new risk. L. All departments, agencies, boards, and commissions are to provide the name, address, telephone number, and job title of the following: 1. the department, agency, board, or commission head; 2. the person(s) to receive insurance premium billings; 3. the safety coordinator or person(s) responsible for loss prevention matters; 4. the person(s) responsible for handling and disposition of claims matters; 5. the person(s) responsible for reporting exposure information. 39:1527, et seq. HISTORICAL NOTE: Promulgated by the Office of the Governor, Division of Administration, Office of Risk Management, LR 13:19 (January 1987), amended LR 31:61 (January 2005), LR 32:1435 (August 2006). Chapter 3. Auditing and Statistics 301. Auditing and Statistics A. The exposure data requested by the Office of Risk Management (ORM) are to be submitted in a timely manner and in the form specified. The exposures may include, but are not limited to: 1. payroll; 2. maritime payroll; 3. number of board and commission members; 4. mileage of all licensed vehicles which are stateowned or leased, and all mileage on personal vehicles driven in the course and scope of state employment; 5. number of licensed vehicles; 6. acquisition or appraised value of property including, but not limited to, buildings, improvements, and inventory (includes contents, all equipment including mobile equipment and watercraft 26 feet and under), and boiler and machinery; 7. medical malpractice exposures including, but not limited to, patient days, clinic visits, emergency room visits, number of residents/ interns, and miscellaneous categories; 1 Louisiana Administrative Code September 2006

24 INSURANCE 8. number of employees, and miscellaneous or special classes not falling within these definitions as required. B. Billed units are to allocate premiums to subunits if required. It is not the ORM's responsibility to provide breakdowns at a lower level than the level to which premiums were budgeted or billed. C. The Office of Risk Management is to receive immediate written notification of the abolishment, transfer, and/or merger of any department, agency, board or commission. D. The state agencies are to provide or allow access to ORM representatives to records or information necessary to the effective operation of the risk management program. 39:1527, et seq. HISTORICAL NOTE: Promulgated by the Office of the Governor, Division of Administration, Office of Risk Management, LR 13:19 (January 1987), amended LR 15:85 (February 1989), LR 31:62 (January 2005), LR 32:1436 (August 2006). Chapter 5. Billing 501. Billing and Collection of Insurance Premiums A. After an agency receives a billing invoice from the Office of Risk Management for payment of insurance premiums, the agency is to render payment in full within 30 days from the billing date. B. Every agency shall timely pay premiums billed by the Office of Risk Management. In the event any agency fails to pay any premiums due the Office of Risk Management within 120 days of the effective date of the appropriated insurance coverages, the commissioner of administration may upon request by the Office of Risk Management draw a warrant against budgeted funds of any delinquent agency directing the treasurer to pay the Office of Risk Management for the unpaid premiums. If an agency is a non-depository agency, the commissioner of administration may direct the head of such agency to render payment of insurance premiums due and owing to the Office of Risk Management. C. All billing inquiries are to be directed to the Office of Risk Management, Accounting Unit, Accounts Receivable Section. 39:1527, et seq. HISTORICAL NOTE: Promulgated by the Office of the Governor, Division of Administration, Office of Risk Management, LR 13:20 (January 1987), amended LR 31:62 (January 2005), LR 32:1436 (August 2006). Chapter 7. Reporting of Claims 701. Reporting of Property Damage Claims A. All claims must be reported as soon as possible, but no later than the prescription period outlined in Book III, Title 24, Chapter 4 of the Louisiana Civil Code. In most cases, prescription periods are one year. ORM will pay only for covered losses reported before one year from the date of the accident or discovery date. Policy language clearly states "you must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim." Failure to report potential claims as soon as possible severely limits the ability of ORM to investigate the facts and may compromise the state's legal rights to subrogation from a responsible third party. B. The state of Louisiana provides insurance coverage for damage to state-owned property which includes damage to buildings and improvements, contents, inventories, mobile equipment, heating and air conditioning systems, and marine hulls 26 feet and under. C. All claims for damage to property owned by the state are to be reported to the Office of Risk Management's Property Claim Unit in writing. If a loss or claim is serious in nature, it is to be reported by telephone to the Office of Risk Management's Property Claim Unit. D. Claims are to be submitted, in writing, to the Office of Risk Management, P.O. Box 91106, Baton Rouge, LA E. Information required to be submitted when a claim is reported to the Office of Risk Management's Property Claim Unit includes the following: 1. name of insured, location of property or unit; 2. date of loss; 3. description of loss; 4. location of item, state building ID/property control tag number; 5. size, model, and serial number of item, if applicable; 6. name of person reporting claim, listing job title, and telephone number; and 7. proof of ownership. F. After a loss has occurred, all property which has been damaged is to be protected against further damage and is to be made available for inspection by a claims adjuster assigned by the Office of Risk Management. G. If a loss occurs or a claim arises, the agency is not to assume any obligation or incur any expenses without authorization from the Office of Risk Management, but should act to protect property and minimize the loss. H. If repair or replacement is not accomplished within 36 months of the loss date; or, if approval is not obtained from the commissioner of administration to use the funds for some other purpose, or to extend the 36 month prescriptive period, the claim file will be closed. I. All lawsuits, demands, notices, summons, or other legal documents pertaining to a claim against a state agency are to be forwarded immediately to the Office of Risk Management, Property Claims Unit for further handling. J. Any objects and/or products which may have caused, contributed to, or which are suspective of causing an accident are to be retained and preserved as evidence. Louisiana Administrative Code September