2006 Louisiana Laws - RS 22:213.2 — Health and accident policy provisions; service charges; penalties

§213.2.  Health and accident policy provisions; service charges; penalties

A.  Any health and accident insurance policy issued under this Part or Part VI-A of this Title, and any health and accident insurance policy having effect in this state, shall provide coverage without regard to the insured's obligation of deductibles or copayments for the service charges assessed pursuant to R.S. 22:239.  The service charges assessed to a patient pursuant to R.S. 22:239 shall be a mandated benefit of any health and accident insurance coverage issued by any insurer or insurance arrangement over and above any insurance policy limits, negotiated per diem, or managed care arrangement, except an insolvent insurer.

B.  Each service charge for each patient admission shall be paid by the insurer or insurance arrangement in accordance with the plan of operation adopted pursuant to R.S. 22:235.  Failure to pay each service charge for each patient according to this Section shall cause the insurer or insurance arrangement to be liable to the Louisiana Health Plan, the commissioner of insurance, or both, for an amount determined by the board, not to exceed five hundred dollars, plus interest.  Any insurer or insurance arrangement found to have failed to comply with this Section as to each service charge for each patient admission on three or more occasions during a six-month period shall be liable for an amount determined by the board, no less than five hundred dollars and not to exceed one thousand five hundred dollars per failure to pay each service charge for each patient admission, together with attorney fees, interest, and court costs.  The Louisiana Health Plan, the commissioner, or both, are specifically authorized to conduct audits of insurers or insurance arrangements in order to enforce compliance with this Section.

C.  For the purposes of this Section, insurance or insurance arrangement also includes any policy or plan of insurance or of self-insurance which provides payment, indemnity, or reimbursement for charges resulting from accident, injury, or illness when an employer, insurer, or tortfeasor is responsible for those charges.

D.  For the purposes of this Section, insurance or insurance arrangement shall not include the State Employees Group Benefit Program.

Acts 1990, No. 131, §1, eff. Sept. 1, 1990; Acts 1991, No. 574, §1, eff. July 16, 1991; Acts 1993, No. 191, §1.

{{NOTE:  ACTS 1990, NO. 131, §3, PROVIDES ADDITIONAL DATES FOR IMPOSITION OF SERVICE CHARGES AND AUTHORITY TO ISSUE POLICIES.}}