La. Admin. Code tit. 37 § XIII-3111

Current through Register Vol. 50, No. 9, September 20, 2024

Section XIII-3111 - Application Process

A. An applicant to become an authorized carrier shall apply for authorization to operate a LA Health Plan by submitting an application to the commissioner. The applicant shall provide at least the following information:

1. the name of the carrier and a description of its role in funding, insuring, and operating the pilot plan;

2. a full description of how the pilot plan will operate, including plan benefits, coverage limitations, premiums, provider networks, managed care provisions, and administrative procedures of the plan;

3. a listing of participating providers by service category and geographic service area;

4. a draft of all materials describing the LA Health Plan that are intended for distribution to insured members;

5. a description of the financial and organizational resources supporting the pilot plan.

B. Applications submitted to the commissioner's office will, furthermore, be judged on their ability to attain the intent of the LA Health Plan according to the following criteria:

1. their ability to guarantee issue of the LA Health Plan to the eligible population;

2. their ability to provide the LA Health Plan as a community rated product;

3. their ability to provide the LA Health Plan at premium amounts which are significantly lower than premium amounts for standard market policies of health and accident insurance;

4. their ability to implement cost containment features;

5. the degree to which their plan of benefits under the LA Health Plan emphasizes primary health care services designed to prevent the need for more expensive health care services; and

6. variance beneficial to the eligible LA Health population from the minimum standards established for the LA Health Plan's benefits outlined in §3127-3133 of this regulation.

C. Applications may be submitted to the commissioner's office on or after the effective date of this regulation. Applications received before the effective date shall be subject to any revisions required by changes in this regulation. Applications received in the commissioner's office after 90 days of the effective date of this regulation will not be considered.

La. Admin. Code tit. 37, § XIII-3111

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.