La. Admin. Code tit. 32 § I-507

Current through Register Vol. 50, No. 8, August 20, 2024

Section I-507 - Legal Limitations and Statement of Contractual Agreement

A. A plan participant's rights and benefits under any OGB plan of benefits are personal to him/her.

B. The OGB self-funded plan, as amended, including the schedule of benefits, together with the application for coverage and any related documents executed by or on behalf of the enrollee, constitute the entire agreement between the parties.

C. In the event of any conflict between the written provisions of the OGB plan or any OGB plan of benefits with any information provided by OGB or its contractors or rules or regulations promulgated by OGB, the written provisions of the OGB plan or plan of benefits shall supersede and control.

D. A plan participant shall exhaust the administrative claims review procedure before filing a suit for benefits. No legal action shall be brought to recover benefits under an OGB plan or plan of benefits more than one year after the time a claim is required to be filed or more than 30 days after mailing of the notice of a final administrative decision, whichever is later, unless otherwise provided in the terms of the participant's plan. A decision is not final until all levels of the administrative appeals process are exhausted.

La. Admin. Code tit. 32, § I-507

Promulgated by Office of the Governor, Division of Administration, Office of Group Benefits, LR 41:346 (February 2015), effective March 1, 2015.

AUTHORITY NOTE: Promulgated in accordance with R.S. 42:801(C) and 802(B)(1).