La. Admin. Code tit. 37 § XIII-3135

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

Section XIII-3135 - Limitations

A. Pre-Existing Conditions

1. Until coverage for an insured enrolled in the LA Health Plan has been in force for 12 consecutive months, benefits for services to be paid to an authorized carrier shall not be available for any illness, injury, or other condition for which:

a. the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care, or treatment, or 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 individual insured.

2. Maternity benefits are available to an insured only if the date of conception occurred after the effective date of coverage under the LA Health Plan.

3. No coverage is available to inpatient hospital admissions which begin before an insured's effective date.

La. Admin. Code tit. 37, § XIII-3135

Promulgated by the Department of Insurance, Office of the Commissioner, LR 20:1012 (September 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 22:244-247 of the Insurance Code.