La. Admin. Code tit. 37 § XIII-17913

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

Section XIII-17913 - Benefits, Entitlements, Protections and Applicable Parishes

A. The benefits, entitlements and protections of the Emergency Rule shall be applicable to insureds, policyholders, members, subscribers, enrollees and certificate holders (hereinafter "insureds") who, as of 12:01 a.m. on the effective date of the Emergency Rule, have an insurance policy, insurance contract, or certificate of coverage for any of the kinds of insurance enumerated in §17915, as delineated below, and who meet one of the following criteria.

1. Any person who, as of the effective date of the Emergency Rule, resided in the geographic area specified in the Emergency Rule. Said person is entitled to the protections of the Emergency Rule for the kinds of insurance enumerated in §17915.A and B.

2. For the kinds of insurance enumerated in §17915 B, any person whose primary place of employment was in, or whose permanent employer had assigned said person to a business located in the geographic area specified in §17913.A 1, shall be eligible for the benefits, entitlements and protections of the Emergency Rule if said person verifies such employment status by written documentation to his health insurance issuer. No health insurance issuer shall unreasonably withhold eligibility to insureds upon receipt of such written documentation.

3. For the kinds of insurance enumerated in §17915 A, any insured who does not reside in the geographic area specified in §17913.A 1, but has filed with an authorized insurer or surplus lines insurer a notice of loss on a property claim for damage caused by the disaster or emergency and its aftermath to property located in the geographic area specified in §17913 A, shall be entitled to contact the insurer and request the benefits, entitlements, and protections of the Emergency Rule. These insurers are directed to work with their insureds who have filed a notice of loss on a property claim for damage caused by the disaster or emergency and its aftermath and provide accommodation as applicable, relevant and appropriate.

B. The Emergency Rule shall apply to any authorized insurer as defined in R.S. 22:46(3) operating in Louisiana, and to any approved unauthorized insurer, eligible unauthorized insurer, or domestic surplus lines insurer as defined in R.S. 22:46(17.1) operating in Louisiana (sometimes hereinafter referred to as a surplus lines insurer).

C. The Emergency Rule shall apply to every health and accident insurer, health maintenance organization (HMO), managed care organization (MCO), preferred provider organization (PPO), pharmacy benefit manager (PBM), and third party administrator (TPA) acting on behalf of a health insurance issuer, HMO, MCO, PPO, and any and all other insurance related entities licensed by the commissioner or doing business in Louisiana (collectively known as "health insurance issuers").

La. Admin. Code tit. 37, § XIII-17913

Promulgated by the Department of Insurance, Commissioner of Insurance, LR 471533 (10/1/2021).

AUTHORITY NOTE: Promulgated in accordance with R.S. 22:11.