Louisiana Department of Insurance 2008 Forms and Compliance Seminar

1. Louisiana Department of Insurance 2008 Forms and Compliance Seminar Property and Casualty Health Life

2. Complaint Rate And Form Tracking SystemCRAFT • Policy Forms • Rates and Rules • Consumer Affairs • All information submitted to the DOI may be done electronically, improving efficiency • 24 hour access

3. CRAFT Response Times • Initial Directives15 days • Additional Information10 days • Follow up to 10 days Initial Directive • “No Response” Directive5 days • Producers’ Initial Directive30 days

4. Industry Access Account Administrator Please contact the assigned industry account access administrator for your company for questions or concerns regarding passwords and logging into CRAFT.

5. Property and CasualtyNew Legislation • The minimum auto liability requirements will increase to 15/30/25 effective January 1, 2010. • The statewide deductible on renewals for a named storm is 4% or less of Coverage A. • Rules will be promulgated by the Louisiana Department of Insurance.

6. Incentive Program This program is designed to “attract” more property providers to Louisiana and to increase the private market. The program authorizes the Commissioner to approve grants ranging from $2 million to $10 million to qualified property insurance companies.  The total pool of funds to be allocated by the Commissioner  is $100 million.

7. Louisiana Incentive Program • The Go Zone includes the 26 high risk coastal parishes. • A third round of incentive money has been approved by the legislature.

8. Property and Casualty Fines • Failure to respond in $250 LRS 22:1316 timely manner • Interest accrued per month on refunds not 1.5% LRS 22:637.1 paid in a timely manner

9. LRS 22:1245 A B Insurance companies, producers, brokers, and adjusters are requiredby Title 22 to report fraud within 60 days of notice.

10. LRS 22:1210.71 The Louisiana Department of Insurance now regulates private and public adjusters. Adjusters are required to respond to directives.

11. Health • H.I.P.A.A is the health insurance portability accountability act. • Mini Cobra is the state continuation. • An employer must have 2-50 employees to be eligible for guaranteed issue.

12. Within ? Days….. • A health insurer or agent has to determine if a claim is acceptable within 5 working days of receiving an electronic claim. LRS 22:250.33(A)(1) • A health insurer has 45 days from the date of service to pay, deny, or pend a nonelectronic claim. LRS 22: 250.32.A(1) • The health care provider has 30 days from the receipt of written notification of recoupment to appeal the health insurer’s actions. LRS 22: 250.38 B • Louisiana consumers have a 10 day free look period for health insurance. LRS 22:212(7)(a) • Health insurers must give insureds a 45 day notice if premiums increase more than 20%. LRS 22:215.9(A)(1)

13. Medical Necessity Review OrganizationFour Appeal Levels • Informal Reconsideration LRS 22: 3078 • 1st or Standard Level LRS 22: 3079 • 2nd Level LRS 22: 3080 • External Review LRS 22: 3081

14. Medical Necessity Review OrganizationMNRO • MNRO has 72 hours to make a decision and notify the covered person. LRS 22: 3083 E • An expedited appeal is necessary when the time frame of a standard appeal would jeopardize the life or health of covered person. LRS 22: 3083 A • The Second Level Review allows the covered person to appear before authorized representatives of the MNRO. LRS 22: 3080 A • A Standard External Review can be filed after a notice of second level appeal adverse determination.LRS 22: 3082 A

15. New Legislation • Act 349 requires health insurance coverage of prosthetic devices and prosthetic services. It requires parity for such coverage with other benefits provided under the plan, including co-payments, deductibles; however, authorizes an annual limit of no less than $50, 000 per limb. • Act 648 requires health insurance coverage of the diagnosis and treatment of autism spectrum disorders in individuals less than 21 years of age. It makes such coverage subject to a maximum benefit of $36,000 per year and $144, 000 per lifetime. Provides that the requirement for coverage shall not apply to any health coverage plan issued to an employer with 50 or fewer employees.

16. Life • Insurable interest must exist before a life may be insured. LRS 22:613C • Replacement forms must be completed each time an individual life policy is sold. Regulation 70 • Delivery receipt is the document obtained any time a life contract is delivered by an agent or broker. LRS 22:170A(10)(b)

17. New Legislation • Act 205 prohibits a funeral home from being the owner of a life insurance policy that will be used to find a pre-need contract. The insurer will not pay the benefits of any policy that funds a pre-need plan unless the funeral home provides a certified copy of the death certificate.

18. Act 404 clarifies coverage under group life policies relative to dependents, students and minor children.

19. Recodification The restructuring of the current Louisiana Insurance Code (Title 22).

20. Office of Property and CasualtyContact Information Neysa P. Hurst Asst. Director, Consumer Affairs nhurst@ldi.state.la.us Barbara Payne Supervisor, Consumer Affairs bpayne@ldi.state.la.us Louisiana Department of Insurance P.O. Box 94214 Baton Rouge, LA 70804-9214 1-800-259-5300 or 225-342-1258 www.ldi.state.la.us

21. Office of HealthContact Information Tangela Ayo Asst. Director, Consumer Affairs tayo1@ldi.state.la.us Cheryl Gordon Asst. Director, Quality Assurance cgordon@ldi.state.la.us Louisiana Department of Insurance P.O. Box 94214 Baton Rouge, LA 70804-9214 1-800-259-5301 or 225-219-4770 www.ldi.state.la.us

22. Office of Life and AnnuityContact Information Sam Brooks Assistant Director, Consumer Affairs sbrooks@ldi.state.la.us Louisiana Department of Insurance P.O. Box 94214 Baton Rouge, LA 70804-9214 1-800-259-5301 or 225-342-1253 www.ldi.state.la.us