Current through Register Vol. 50, No. 9, September 20, 2024
A. Upon
notification of the birth of a newborn child who is potentially eligible under
Title XIX of the Social Security Act, the health insurance issuer shall be
required to:
1. verify that dependant
coverage is available for the newborn child or make a determination that no
coverage is available for the newborn child;
2. make a determination of the benefit limits
with regard to the newborn child;
3. make a determination of any additional
premium, if applicable, that may be due in order to provide dependent coverage
for the newborn child; and
4.
designate a point of contact (which may be a specific position), with telephone
number and physical address, to represent the health insurance issuer to
facilitate all matters relative to the newborn child.
B. Upon notification of the birth of a
newborn child who is potentially eligible under Title XIX of the Social
Security Act, the health insurance issuer shall be required to notify the
following persons:
1. with regard to an
individual policy, the policyholder;
2. with regard to a group policy, both the
employer and the employee;
3. with
regard to either an individual policy or a group policy, the health care
facility that rendered any medical service to the newborn child from the moment
of birth until such time as the infant is discharged from said health care
facility to his or her home.
C. The notification that the health insurance
issuer is required to send to the persons referred to in Subsection B above
shall include the following information:
1.
verification as to whether the health plan provides coverage under which the
newborn child could be enrolled as a dependent or, if such coverage is not
available under the health care plan, an explanation of why such coverage is
not available;
2. the additional
amount of premium due, if any, in order to provide dependent coverage for the
newborn child;
3. designate a point
of contact (which may be a specific position), with telephone number and
physical address, to represent the health insurance issuer to facilitate all
matters relative to the newborn child; and
4. statement to the policyholder under an
individual policy or the employee and employer under a group plan that
additional information is needed by the health insurance issuer. A health
insurance issuer may request that the signature of the policyholder of an
individual policy or employee and employer under a group plan be on the
enrollment form. However, the failure of the policyholder or employee or
employer, as applicable, to place a signature on the enrollment form shall not
be a requirement for the enrollment of the newborn child, as the newborn child
is enrolled as a matter of law.
D. The health insurance issuer shall be
required to provide 90 days written notice to the Secretary of the Department
of Health and Hospitals prior to the cancellation of health coverage for a
potential qualifying newborn child. This notice shall provide the following
documents and/or information:
1. the group
identification/policy number or the individual identification/policy number, as
applicable, including, but not limited to, the major medical identification
number and the prescription drug identification number;
2. summary of benefits, including, but not
limited to, an itemization of all covered benefits and applicable co-payments
and deductibles;
3. amount of
additional premium due in order to provide dependent coverage for the newborn
child, including, but not limited to, the total premium (month or portion of a
month) due to effectuate coverage for the newborn child from the date of
birth;
4. the name(s) of the member
subscriber of the newborn child, including, but not limited to, the name(s) of
any and all other dependent(s) and the effective date of coverage for each
person(s) named as a dependent;
5.
designate a point of contact (which may be a specific position), with telephone
number and physical address, to represent the health insurance issuer to
facilitate all matters relative to the newborn child.
E. Additionally, no later than three days
after the mailing of the written notice to the Secretary of the Department of
Health and Hospitals referred to in Subsection D above, the health insurance
issuer shall provide the same documents and/or information to any and all
health care facilities and any and all health care providers who, prior to or
on the date of the notice of cancellation, have either:
1. submitted a claim to the health insurance
issuer for health care services rendered to the newborn child; or
2. provided notice to the health insurance
issuer that it is rendering or has rendered health care services to the newborn
child.
F. The Secretary
of the Department of Health and Hospitals shall have 90 days, commencing the
day after the secretary receives the written notice, via certified mail, return
receipt requested, from the health insurance issuer as provided in Subsection D
above, to pay the applicable additional premium attributable to the newborn
child to retain the newborn child as a covered dependent under the policy of
health insurance.
G. If that
portion of the applicable additional premium attributable to the newborn child
being retained as a covered dependent under the policy of health insurance
remains unpaid after the expiration of the 90 day written notice time period
referred to in Subsection E above to the Secretary of Department of Health and
Hospitals, the health insurance issuer may thereafter cancel the dependent
coverage for the newborn child effective as of the date of birth of the newborn
child.
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.
