La. Admin. Code tit. 37 § XI-4919

Current through Register Vol. 50, No. 11, November 20, 2024

Section XI-4919 - [Effective until 11/11/2024] Timely Payment of Health Claims

A. Only to the extent necessary to permit the pending of claims during a premium payment delinquency by the insured, the provisions of R.S. 22:1832-1834 and Regulation 74 related to timely payment of claims are hereby suspended.

B. For any policy of insurance described in §4903.B which, as a result of nonpayment of premium, would be subject to cancellation or termination but for the suspension ordered in §4905, the health insurance issuer may pend all claims which would not have been denied under such cancellation or termination until the health insurance issuer receives the delinquent premium payment or until such time the health insurance issuer is subsequently entitled to cancel or terminate the policy for non-payment of premium.

C. The health insurance issuer shall notify providers of the possibility for denied claims when and insured is in the grace period.

D. Once a health insurance issuer receives the delinquent premium payment during the grace period, all pending claims associated for the time period to which such payment applies shall be processed and adjudicated. The health insurance issuer shall notify the health care provider that the claim is no longer pending and is being processed and adjudicated for payment. Furthermore, the suspension provided for in §4919.A shall be automatically lifted, and all applicable timely payment requirements reinstated upon the date of the payment of premium.

La. Admin. Code tit. 37, § XI-4919

Promulgated by the Department of Insurance, Office of the Commissioner, LR 50, exp. 11/11/2024 (Emergency).

AUTHORITY NOTE: Promulgated in accordance with Executive Order Number JML 24-142, R.S. 22:2, R.S. 22:11, and R.S. 22:1961 et seq, R.S. 49:950 et seq.