La. Admin. Code tit. 37 § XI-4901

Current through Register Vol. 50, No. 11, November 20, 2024

Section XI-4901 - [Effective until 11/11/2024] Benefits, Entitlements, Protections and Applicable Parishes

A. The benefits, entitlements and protections of Emergency Rule 49 shall be applicable to insureds, policyholders, members, subscribers, enrollees and certificate holders (hereinafter "insureds") who, as of 12:01 a.m. on September 9, 2024, have an insurance policy, insurance contract, or certificate of coverage for any of the kinds of insurance enumerated in §4903, as delineated below, and who meet one of the following criteria.

1. Any person who, as of September 9, 2024, resided in one of the following twenty-five (25) parishes, to wit: Ascension, Assumption, Cameron, East Baton Rouge, Iberia, Iberville, Jefferson, Lafayette, Lafourche, Livingston, Orleans, Plaquemines, Pointe Coupee, St. Bernard, St. Charles, St. James, St. John the Baptist, St. Martin, St. Mary, St. Tammany, Tangipahoa, Terrebonne, Vermilion, Washington, and West Baton Rouge. Said person is entitled to the protections of Emergency Rule 49 for the kinds of insurance set forth in §4903.A and B.

2. For the kinds of insurance enumerated in §4903.B, any person whose primary place of employment was in, or whose permanent employer had assigned said person to a business located in, one of the twenty-five (25) parishes identified in §4901.A.1, shall be eligible for the benefits, entitlements and protections of Emergency Rule 49 if said person verifies such employment status by written documentation to his health insurance issuer. No health insurance issuer shall unreasonably withhold eligibility to insureds upon receipt of such written documentation.

3. For the kinds of insurance enumerated in §4903.A, any insured who does not reside in one of the twenty-five (25) parishes enumerated in §4901.A.1, but has filed with an authorized insurer or surplus lines insurer a notice of loss on a property claim for damage caused by Hurricane Francine and its aftermath to property located in one of the twenty-five (25) parishes enumerated in §4901.A, shall be entitled to contact the insurer and request the benefits, entitlements, and protections of Emergency Rule 49. These insurers are directed to work with their insureds who have filed a notice of loss on a property claim for damage caused by Hurricane Francine and its aftermath and provide accommodation as applicable, relevant, and appropriate.

B. Emergency Rule 49 shall apply to any authorized insurer as defined in R.S. 22:46(3) operating in Louisiana, and to any approved unauthorized insurer, eligible unauthorized insurer, or domestic surplus lines insurer as defined in R.S. 22:46(27) operating in Louisiana (sometimes hereinafter referred to as a surplus lines insurer).

C. Emergency Rule 49 shall apply to every health and accident insurer, health maintenance organization (HMO), managed care organization (MCO), preferred provider organization (PPO), pharmacy benefit manager (PBM), and third party administrator (TPA) acting on behalf of a health insurance issuer, HMO, MCO, PPO, and any and all other insurance related entities licensed by the commissioner or doing business in Louisiana (collectively known as "health insurance issuers").

La. Admin. Code tit. 37, § XI-4901

Promulgated by the Department of Insurance, Office of the Commissioner, LR 50, exp. 11/11/2024 (Emergency).

AUTHORITY NOTE: Promulgated in accordance with Executive Order Number JML 24-142, R.S. 22:2, R.S. 22:11, and R.S. 22:1961 et seq, R.S. 49:950 et seq.