Louisiana Revised Statutes 22:1208 – Administration
Terms Used In Louisiana Revised Statutes 22:1208
- Benefits plan: means the coverages offered by the plan to eligible persons as defined by La. See Louisiana Revised Statutes 22:1202
- Board: means the board of directors of the plan. See Louisiana Revised Statutes 22:1202
- Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1202
- Health and accident insurance: means hospital and medical expense incurred policies, nonprofit service plan corporation contracts, and coverages provided by health maintenance organizations, individual practices, associations, the Office of Group Benefits, and other similar entities and self-insurers. See Louisiana Revised Statutes 22:1202
- Insured: means any natural person domiciled in this state, other than a member of the plan, who is eligible to receive benefits from any insurer or insurance arrangement as defined in this Section. See Louisiana Revised Statutes 22:1202
- Insurer: means any insurance company or other entity authorized to transact and transacting health and accident insurance business in this state. See Louisiana Revised Statutes 22:1202
- Plan: means the Louisiana Health Plan as created in La. See Louisiana Revised Statutes 22:1202
- Plan of operation: means the plan of operation of the plan, including articles, bylaws, and operating rules, adopted by the board pursuant to La. See Louisiana Revised Statutes 22:1202
A. The board shall select an administrator or administrators, which may consist of an insurer or insurers, a third-party administrator or administrators, medical or pharmaceutical providers, or a combination thereof, through a competitive bidding process to administer the benefits plan of the plan. The board shall evaluate bids submitted based on criteria established by the board which shall include:
(1) The administrator’s proven ability to handle individual health and accident insurance.
(2) The efficiency of the administrator’s claim payment procedures.
(3) An estimate of total charges for administering the benefits plan.
(4) The administrator’s ability to administer the benefits plan in a cost-efficient manner.
B.(1) The commissioner shall appoint the administrator or administrators if the administrator or administrators have not been selected within sixty days of the appointment of the board.
(2) The administrator or administrators shall serve for a period of three years, subject to removal for cause.
(3) At least six months prior to the expiration of each three-year period of service by an administrator, the board shall invite all administrators, including the current administering administrator or administrators, to submit bids to serve as an administrator for the succeeding three-year period. Selection of an administrator for the succeeding period shall be made at least three months prior to the end of the current three-year period. Nothing in this Section shall prohibit a competitive bid process prior to the three-year period in the event of termination of an administrator or administrators.
C.(1) The administrator shall perform all eligibility and administrative claims payment functions relating to the plan.
(2) The administrator shall establish a premium billing procedure for collection of premiums from persons insured by the plan. Billings shall be made on a periodic basis as determined by the board.
(3) The administrator shall perform all necessary functions to assure timely payment of benefits to persons insured by the plan, including:
(a) Making available information relating to the proper manner of submitting a claim for benefits to the plan and distributing forms upon which submission shall be made.
(b) Evaluation of the eligibility of each claim for payment by the plan.
(4) The administrator shall submit regular reports to the board regarding the operation of the plan. The frequency, content, and form of the report shall be determined by the board.
(5) Following the close of each calendar year, the administrator and actuarial consultants shall determine net written and earned premiums, the expense of administration, and the paid and incurred losses for the year, and report this information to the board.
(6) The administrator shall be paid as provided in the plan of operation for its expenses incurred in the performance of its services.
Acts 1990, No. 131, §1, eff. Sept. 1, 1990; Acts 1999, No. 163, §1; Acts 2004, No. 368, §1, eff. June 23, 2004; Redesignated from La. Rev. Stat. 22:238 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.