1432 search results for Ben

LDI 48 Administrative Actions and Fines (000588-000622)

https://ldi.la.gov/docs/default-source/documents/legaldocs/public-comments-dec23/ldi/ldi-48-administrative-actions-and-fines-(000588-000622).pdf?sfvrsn=d8ac4552_0

of benefits had not been issued to enrollees. An EOB is issued to the insured to inform them, Louisiana Dept. of Health Medicaid Market A. Healthy Blue’s pharmacy benefit manager (PBM, Act. B. The Plan acted at variance with the enrollee’s EOC (Company assigned incorrect benefit, benefit level. C. Failure to process the January 10, 2020, claim at the enrollee’s in-network provider benefit level. D. Failed to adequately consider the enrollee’s grievance. 45 Blue Cross

EmergencyRule49-cur-suspensionofcertains-web

https://ldi.la.gov/docs/default-source/documents/legaldocs/rules/emergencyrule49-cur-suspensionofcertains-web.pdf?sfvrsn=951a5b52_12

of insurance issued for the benefit of insureds not subject to the Benefits, Entitlements, and Protections, ), pharmacy benefit managers (PBMs), and third party administrators (TPAs) acting on behalf of an HMO, to Hurricane Francine §4901. Benefits, Entitlements, Protections and Applicable Parishes A. The benefits, identified in §4901.A.1, shall be eligible for the benefits, entitlements and protections, the benefits, entitlements, and protections of Emergency Rule 49. These insurers are directed

2014 Annual Summary Report Cover and Directions

https://ldi.la.gov/docs/default-source/documents/health/2014-annual-summary-report-cover-and-directions.docx?sfvrsn=6c457352_0

benefit exclusion appeals, enter 10 under the column Number of First-Level Appeals in the row, which corresponds with benefit limitation/exclusion. Please do the following after completing

2015 Utilization Review Organization Annual Report Cover and Directions

https://ldi.la.gov/docs/default-source/documents/health/2015-utilization-review-organization-annual-report-cover-and-directions.pdf?sfvrsn=e7a97752_0

, if you have 10 first-level benefit exclusion appeals, enter 10 under the column Number of First-Level Appeals in the row, which corresponds with benefit limitation/exclusion. Please do the following

Reg100-cur-CoverageOfPrescripti

https://ldi.la.gov/docs/default-source/documents/legaldocs/regulations/reg100-cur-coverageofprescripti.pdf?sfvrsn=f2c27352_44

insurance issuer under a health benefit plan. INSURANCE Louisiana Administrative Code August 2022, shall be at the contracted benefit level until the renewal of the enrollee’s current plan. A health, ) and Individual Market Pursuant to R.S. 22:1074(D)(3). A “Notice of Modification of Benefit Coverage, of benefit coverage or drug coverage of a particular product is to become effective. For individual, no later than the sixtieth day before any modification of benefit coverage or drug coverage

Reg91-Cur-TheRecognitionOfPref

https://ldi.la.gov/docs/default-source/documents/legaldocs/regulations/reg91-cur-therecognitionofpref.pdf?sfvrsn=12c27352_6

Benefits Model Regulation." AUTHORITY NOTE: Promulgated in accordance with R.S.22:3, 22:163, 22:168, value of death benefits over the next 10 years after the valuation date, using the anticipated, class, is less than the present value of death benefits using the valuation basic table corresponding to the valuation table being used for that class; 2. the present value of death benefits over, of death benefits using the valuation basic table corresponding to the valuation table being used

NOI Amend Regulation 90 FINAL (For Website)

https://ldi.la.gov/docs/default-source/documents/legaldocs/regulations/noi/noi-amend-regulation-90-final-(for-website).pdf?sfvrsn=260d5b52_0

to bring Pharmacy Benefit Management processes into compliance. Title 37 INSURANCE Part XIII, services covered under insurance or other contracts that provide for pharmacy benefits, and to require the filing of policies and procedures to bring Pharmacy Benefit Management processes, . ESTIMATED COSTS AND/OR ECONOMIC BENEFITS TO DIRECTLY AFFECTED PERSONS, SMALL BUSINESSES, OR NON, benefits to directly affected persons or non-governmental groups. The regulation revisions amend

Regulation 128 (Amend) Summary Report Final

https://ldi.la.gov/docs/default-source/documents/legaldocs/regulations/summary-report/regulation-128-(amend)-summary-report-final.pdf?sfvrsn=494f5b52_0

of policies and procedures to bring Pharmacy Benefit Management processes into compliance. II. ESTIMATED, . ESTIMATED COSTS AND/OR ECONOMIC BENEFITS TO DIRECTLY AFFECTED PERSONS, SMALL BUSINESSES, OR NONGOVERNMENTAL GROUPS (Summary) The proposed rule change will benefit directly affected persons by providing, to bring Pharmacy Benefit Management processes into compliance. IV. ESTIMATED EFFECT, governmental revenues. III. ESTIMATED COSTS AND/OR ECONOMIC BENEFITS TO DIRECTLY AFFECTED PERSONS

Reg81-Cur-MilitaryPersonnelAut

https://ldi.la.gov/docs/default-source/documents/legaldocs/regulations/reg81-cur-militarypersonnelaut.pdf?sfvrsn=4ec27352_12

of benefits or rates for an insured. AUTHORITY NOTE: Promulgated in accordance with R.S. 22:3 and R.S. 22, claiming the benefit of the rebuttable presumption if the insurer knew or should have known that the AMP, obtain or are claimants or beneficiaries of products or services primarily for personal, family

Rule36-cur-PatientProtections

https://ldi.la.gov/docs/default-source/documents/legaldocs/rules/rule36-cur-patientprotections.pdf?sfvrsn=e0354f52_18

), managed care organizations (MCOs), preferred provider organizations (PPOs), pharmacy benefit managers, of Coronavirus Disease (COVID-19) §3101. Benefits, Entitlements, and Protections A. The benefits, provider organization (PPO), pharmacy benefit manager (PBM), and third party administrator (TPA