Louisiana Administrative Code
Title 37 - INSURANCE
Part XIII - Regulations
Chapter 111 - Regulation 86-Dependent Coverage of Newborn Children in the Group and Individual Market
Section XIII-11107 - Definitions
Current through Register Vol. 50, No. 3, March 20, 2024
A. As used in this regulation, these terms shall have the following meaning.
Cancellation for Nonpayment of Premium-the cancellation of coverage for a newborn child who was added as a dependent due to the nonpayment of the applicable premium adjustment for the additional coverage for the newborn child within the time frames established by law or in this regulation.
Effective Date of Birth-the date of the moment of live birth of a newborn child.
Eligibility Provisions-a newborn child who meets the requirements set forth in the State Plan Medical Assistance under Title XIX of the Social Security Act.
Health Care Facility-a facility or institution providing health care services including, but not limited to, a hospital (specifically including a neonatal special care unit) or other licensed inpatient center, ambulatory surgical or treatment center, diagnostic, laboratory, or imaging center, or rehabilitation or other therapeutic health setting.
Health Care Provider-a physician or other health care practitioner licensed, certified or registered to perform specified health care services consistent with state law.
Health Insurance Issuer-an insurance company, including a health maintenance organization as defined and licensed to engage in the business of insurance under Part XII of Chapter 2 of Title 22 of the Louisiana Revised Statutes, unless preempted as a qualified employee benefit plan under the Employee Retirement Income Security Act of 1974.
Newborn Child-an infant from the time of birth through and until such time as the infant is discharged from a health care facility to his or her home.
Non-Qualifying Newborn Child-a newborn child who does not meet the eligibility requirements of the State Plan Medical Assistance under Title XIX of the Social Security Act.
Notice of Cancellation-the written notice sent from the health insurance issuer to the Secretary of the Department of Health and Hospitals by certified mail, return receipt requested, with regard to the cancellation of coverage for a newborn child. This notice of cancellation may, as a courtesy, also be sent via electronic means to the Secretary of the Department of Health and Hospitals; however, such electronic notice shall not satisfy the notice requirement set forth in the enabling statute that requires the notice of cancellation be sent by certified mail, return receipt requested, to the Secretary of the Department of Health and Hospitals.
Qualifying Newborn Child-a newborn child who meets the eligibility provisions of the State Plan Medical Assistance under Title XIX of the Social Security Act.
AUTHORITY NOTE: Promulgated in accordance with R.S. 22:3 to implement and enforce the provisions of R.S. 22:250.2.E.(2)(b) and (c), and 22:250.4.F, and 22:250.11.E, and 22:250.15.A of Part VI-C of Chapter 1 of Title 22 of the Louisiana Revised Statutes of 1950, as amended.
