Affirmative Approval-department approval, as a result of the department taking action, following compliance review of a complete filing, or a filing pursuant to Subsection D hereof
Association-an organization legally formed for purposes other than the procurement of insurance and, depending upon the particular insurance products in question, meeting the requirements of R.S. 22:1000 A(1)(a)(iv), or R.S. 22:1061(5)(b), or R.S. 22:1184(4), whichever is applicable.
Benchmark Plan-a basic insurance policy form establishing the essential health benefits required of every plan sold in Louisiana under the Patient Protection and Affordable Care Act (Pub. L. 111-148), as amended by the Health Care and Education and Reconciliation Act of 2010
(Pub. L. 111-152), together referred to as the Affordable Care Act.
Basic Insurance Policy Form-an insurance contractual agreement delineating the terms, provisions and conditions of a particular insurance product. It includes certificates of coverage and any other evidence of coverage, subscriber agreements, application forms where written application is required and is to be attached to the policy or be a part of the contract, and any life or health and accident rider or endorsement form. It does not include policies, riders, or endorsements designed, at the request of the individual policyholder, contract holder, or certificate holder, to delineate insurance coverage upon a particular subject or which relate to the manner of distribution of benefits or to the reservation of rights and benefits under such policy.
Certification of Compliance-certification by an insurer, executed by an officer or authorized representative of the insurer on a form prescribed by the department, that upon knowledge and belief a filing is complete and in compliance with all applicable statutes, and rules and regulations promulgated by the department. A certification of compliance must be included with any filing for certified approval.
Certified Approval-approval on the basis of an expedited review by the department of a complete filing based upon the inclusion of a statement of compliance and a certification of compliance, executed by an officer or authorized representative of the filing insurer on a form prescribed by the department. The department shall by directive determine those specific types of coverages and particular types of contracts for which the certified approval procedure is either required or available at the option of the insurer.
Commissioner-the commissioner of insurance of the Louisiana Department of Insurance.
Complete Filing-the filing of a single insurance product, including any required filing fees; a basic insurance policy form, application form and supplemental application form, if any, to be attached to the policy or be a part of the contract; any life or health and accident rider or endorsement forms; all items required under Subsection C hereof, "General Filing Requirements," and any other requirements as may be set forth in the applicable statement of compliance.
Compliance Audit-a retrospective review conducted by the department of previously approved basic insurance policy forms to determine compliance with applicable law.
Compliance Review-department review of a filing made pursuant to this Section to determine either that the filing is in compliance with all applicable statutes, rules and regulations, or that the filing should be disapproved for noncompliance.
Deemed Approval-approval of a complete filing based upon notice, as provided herein, made to the department by the filing insurer, following expiration of the specific time periods as provided herein, where affirmative approval has not been granted and the filing has not been disapproved by the department.
Department-the Louisiana Department of Insurance.
Endorsement-a written agreement attached to an insurance product to add or subtract coverage, or otherwise modify the product.
Insurance Product-a basic insurance policy form delineating the terms, provisions and conditions of a specific type of coverage under a particular type of contract.
Insurer-every person engaged in the business of making contracts of insurance, as further defined in R.S. 22:46(10). As used in this Section, insurer shall also include fraternal benefit societies and health maintenance organizations.
Method of Marketing-marketing either through independent or captive agents; telephone, electronic mail or direct mail solicitation; groups, organizations, associations or trusts; and/or the internet.
Optional Endorsement or Rider-a form used to permit policyholders, certificate holders, or enrollees to obtain supplemental benefits.
Required Filing Fee-the fee assessed per product or filing pursuant to state insurance law.
Rider-an endorsement to an insurance product that modifies clauses and provisions of the product, including adding or excluding coverage.
Statement of Compliance-a form prescribed by the department, detailing the requirements specific to a particular form of coverage and contract type.
Trust-a fund established by an employer, two or more employers in the same industry, one or more labor unions, an association, multiple associations, or to a multiple employer trust established by an insurer on behalf of participating employers, pursuant to a trust instrument which transfers title to property and/or funds to one or more trustees to be administered as fiduciaries for the benefit of others, pursuant to R.S. 22:1000. All participating employers and employees must have the same statutory protections that would apply if such policy was purchased by the employer directly from the insurer.
La. Admin. Code tit. 37, § XIII-10107