In the wake of Hurricane Katrina, the Louisiana Department of Insurance has issued three (3) emergency rules to address issues resulting from the current State of Emergency. All rules retroactively become effective as of 12:01 a.m. on August 26, 2005, and shall continue in full force and effect for the duration of the present State of Emergency proclaimed by Governor Kathleen Blanco. Emergency Rule 15 relates to cancellation of insurance policies, notification requirements, and rate increases. Emergency Rule 16 applies to the settlement and business practices of insurance adjusters and requires all public adjusters operating in Louisiana to register with the Department of Insurance. The focus of Emergency Rule 17 is the continuation of health insurance coverage and the payment of claims to medical providers.
EMERGENCY RULES 15 AND 17 APPLY TO:
All insureds who, as of August 26, 2005, resided in, whose primary place of employment was in, or whose permanent employer had assigned said person to a business located in one of the following seven (7) primary parishes:
* Jefferson
* Orleans
* Plaquemines
* St. Bernard
* St. Tammany
* Tangipahoa
* Washington
and
All insureds who, as of August 26, 2005, resided in one of the following seven (7) secondary parishes:
* Lafourche
* Livingston
* St. Charles
* St. James
* St. John the Baptist
* St. Mary
* Terrebonne
EMERGENCY RULE 15
In addition to the insureds listed above, Emergency Rule 15 also applies to:
* all insurers
* HMOs
* Health and Accident insurers, property and casualty insurers, surplus lines insurers, and any and all other entities doing business in Louisiana and/or regulated by the Commissioner
Emergency Rule 15 suspends:
* any policy provision imposing a time limit on an insured to act or transmit information on funds after August 26, 2005
* any notice of cancellation, non-renewal, non-reinstatement, or any other notice related to any type of insurance that was in force and effect on or after August 26, 2005. All notices of cancellation are suspended as of August 26, 2005, and shall remain in effect during the State of Emergency
Emergency Rule 15 prohibits:
* the cancellation or non-renewal of a policy because of a claim resulting from Hurricane Katrina or its aftermath
Emergency Rule 15 also provides that:
* any rate increase applicable to any and all types of insurance that was in effect on August 26, 2005 shall be deferred until January 1, 2006
* the insurer is required to provide an insured a copy of his policy without any charge or fee
* nothing in Rule 15 exempts or excuses an insured from the obligation to pay the premiums due for actual insurance coverage provided
* any person violating Emergency Rule 15 is subject to penalties to include $1,000 for each separate act or $25,000 for each separate act that the violator knew or reasonably knew he should have known he was violating Emergency Rule 15
EMERGENCY RULE 17
In addition to the insureds listed above, Emergency Rule 17 also applies to:
* all health insurance issuers, HMOs, PPOs, MCOs, third party administrators, and any other health insurance entity doing business in Louisiana and/or regulated by the Commissioner
* any and all types of health insurance
Emergency Rule 17 suspends:
* all cancellation, termination, non-renewal, and non-reinstatement provisions
* any health insurance subject to renewal between August 26, 2005 and January 1, 2006
* any rate increases that were to take effect between August 26, 2005 and January 1, 2006
* all claims notification procedures
* the statutory time limits for payments of medical care claims, including pharmacy claims
* physician credentialing requirements for all licensed physicians who provide medical services to insureds from the listed parishes
* requirements for the payment of Medicare supplement premiums
* all cancellations and non-renewals of health insurance are suspended until the expiration of the State of Emergency or subsequent State of Emergency unless the insured submits a written request to cancel the insurance
Emergency Rule 17 also provides that:
* any and all restrictions relative to out-of-network access to health care services are waived
* all medical certifications, pre-certifications, referrals, medical necessity reviews, and notification of hospital admissions are waived
* when the health insurance issuer receives the premium from the insured, the issuer shall be obligated to pay a claim at either the bill charges, or the higher of the non-participating rate or the contracted reimbursement rate
* the health insured shall be held harmless and indemnified by the health insurance issuer for any out-of-pocket expense, except for any co-payments, deductibles or co-insurance
* once a health insurance issuer receives the premium payment from an insured, all pending claims shall be processed and adjudicated
* the time limits for payment are reinstated upon payment of the premium by the insured
* a health insurance issuer shall not deny, append, or reject a claim from a pharmacy for a 30 day supply of prescription medications regardless of the date of the last refill
* in the event a health insurance issuer is entitled to cancel or terminate a policy for nonpayment of a premium, the insurer shall pay claims to health care providers at 50% of the contracted reimbursement rate or the nonparticipating rate or allowance for non-contracted health care providers
A copy of these Emergency Rules can be found on the Louisiana Department of Insurance website, www.ldi.la.gov/HurricaneKatrina.htm