RS 22:1569

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RS 22:1569

§1569. Contract with health insurance issuer; notification

A. A material change made by a health insurance issuer to the terms and conditions of a contract between the health insurance issuer and a producer shall not become effective until the health insurance issuer has delivered to the producer, at least ninety days prior to the effective date of the change, written or electronic notice indicating the change or changes to the contract. For purposes of this Section, a "material change" is a change made to a provision of the contract affecting any of the following:

(1)Commissions, bonuses, and incentives paid to the producer.

(2)Right of survivorship.

(3)Indemnification of the producer by the health insurance issuer.

(4)Errors and omissions coverage requirements for the producer.

B. Subsection A of this Section shall not apply under either of the following circumstances:

(1)When the change to the contract is mutually agreed upon by the health insurance issuer and the producer.

(2)When the change to the contract is required by state or federal law.

C. For purposes of this Section:

(1)"Health benefit plan" means a policy, contract, certificate, or agreement entered into, offered, or issued by a health insurance issuer to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services. "Health benefit plan" shall not include a plan providing coverage for excepted benefits as defined in R.S. 22:1061 and short-term policies that have a term of less than twelve months.

(2)"Health insurance issuer" means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including through a health benefit plan as defined in this Section, and shall include a sickness and accident insurance company, a health maintenance organization, a preferred provider organization or any similar entity, or any other entity providing a plan of health insurance or health benefits.

Acts 2016, No. 56, §1.