HLS 10RS-1077 ORIGINAL
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Regular Session, 2010
HOUSE BILL NO. 244
BY REPRESENTATIVE KLECKLEY
INSURANCE/HEALTH-ACCID: Provides relative to health insurance coverage for
unmarried dependent children
AN ACT1
To amend and reenact R.S. 22:1000(A)(1)(a)(vi) and (2) and 1003, to enact R.S. 22:1003.1,2
and to repeal R.S. 22:1002, relative to dependent health insurance coverage for3
unmarried children or grandchildren; to provide for such coverage up to the age of4
twenty-six; to delete the requirement for full-time student status; to set certain5
requirements and restrictions for health insurance issuers and health maintenance6
organizations in providing such coverage; and to provide for related matters.7
Be it enacted by the Legislature of Louisiana:8
Section 1. R.S. 22:1000(A)(1)(a)(vi) and (2) and 1003 are hereby amended and9
reenacted and R.S. 22:1003.1 is hereby enacted to read as follows: 10
§1000. Group, family group, blanket, and association health and accident insurance11
A.12
* * *13
(1) Group health and accident insurance is any policy of health and accident14
insurance, or similar coverage issued by a health maintenance organization, covering15
more than one person, except family group, and blanket policies hereinafter16
specifically provided for, which shall conform to the following requirements:17
(a)18
* * *19 HLS 10RS-1077 ORIGINAL
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(vi) The policy may be issued to an employer, association, or to the trustees1
of a fund established by two or more employers in the same industry or by one or2
more labor unions, or by one or more employers and one or more labor unions, or to3
a multiple employer trust established by an insurer on behalf of participating4
employers, provided all participating employers and employees have the same5
statutory protections that would apply if such policy was purchased by the employer6
directly from the insurer, which trustees shall be deemed the policyholder, to insure7
with or without any eligible family members including spouse, unmarried children8
under twenty-one twenty-six years of age, and unmarried grandchildren who are in9
the legal custody of and residing with the grandparent under twenty-one twenty-six10
years of age, pursuant to R.S. 22:1003 and 1003.1, employees of the employers or11
members of the association or of the unions for the benefit of persons other than the12
employers or the unions.13
* * *14
(2)(a) Except as provided in Subparagraph (b) of this Paragraph, family15
Family group health and accident insurance or similar coverage issued by a health16
maintenance organization is an individual policy covering any one person, with or17
without any eligible members, including spouse and unmarried children under18
twenty-one years of age or, in the case of full-time students, unmarried children19
under the age of twenty-four, twenty-six and unmarried grandchildren under20
twenty-one years of age in the legal custody of and residing with the grandparent or,21
in the case of full-time students, unmarried grandchildren under the age of22
twenty-four twenty-six who are in the legal custody of and residing with the23
grandparent, pursuant to R.S. 22:1003 and 1003.1, except that the policy may24
provide for continuing coverage for any unmarried child or grandchild in the legal25
custody of and residing with the grandparent who is incapable of self-sustaining26
employment by reason of mental retardation or physical handicap, who became so27
incapable prior to attainment of age twenty-one, twenty-six, and any other person28
dependent upon the policyholder, written under a master policy issued to the head29 HLS 10RS-1077 ORIGINAL
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of such family. The policy shall contain a provision that the policy, and the1
application of the head of the family if attached thereto, shall constitute the entire2
contract between the parties.3
(b) Every family group health and accident insurance policy or health4
maintenance organization subscriber agreement which provides coverage, pursuant5
to Subparagraph (a) of this Paragraph, to a policyholder's unmarried children under6
the age of twenty-four who are full-time students or the policyholder's unmarried7
grandchildren in the legal custody of and residing with the policyholder who are full-8
time students under the age of twenty-four shall continue coverage under such policy9
if such child or grandchild develops a mental or nervous condition, problem, or10
disorder which, in the opinion of a qualified psychiatrist, subject, if deemed11
necessary by the insurer or health maintenance organization, to a second opinion,12
prevents the unmarried child or grandchild from attending school as a full-time13
student and from holding self-sustaining employment provided the child or14
grandchild is under the age of twenty-four.15
* * *16
§1003. Coverage of unmarried students children for group and individual health and17
accident insurance18
A.(1) Except as provided in Paragraph (2) of this Subsection, students who19
are unmarried Unmarried children, including an unmarried grandchild in the legal20
custody of and residing with a grandparent, who have not yet attained the age of21
twenty-four twenty-six and who are enrolled as full-time students at an accredited22
college or university, or at a vocational, technical, vocational-technical or trade23
school or institute, or secondary school, and who are dependent upon the primary24
insured under any group health and accident or association health and accident25
insurance policy or health maintenance organization subscriber agreement issued in26
this state for their support, shall be considered as dependents of the primary insured27
or enrollee under the provisions of said policy. any family group health and accident28 HLS 10RS-1077 ORIGINAL
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insurance policy, group health and accident insurance policy, or similar coverage1
issued by a health maintenance organization in this state.2
(2) Every unmarried child under the age of twenty-four who is enrolled as3
a full-time student at an accredited college or university, or a vocational, technical,4
vocational-technical, or trade school or institute, or secondary school and who is5
dependent for their support on the primary insured under any group health and6
accident or association health and accident insurance policy issued in this state shall7
continue to be considered a dependent under the provisions of such policy if the8
unmarried child develops a mental or nervous condition, problem, or disorder which9
renders the unmarried child, in the opinion of a qualified psychiatrist, subject, if10
deemed necessary by the insurer or health maintenance organization, to a second11
opinion, unable to attend school as a full-time student and from holding self-12
sustaining employment until the student reaches the age of twenty-four.13
B. The provisions of this Section shall apply to all policies issued or renewed14
or issued for delivery in this state after September 1, 1997. 2010. Any insurer who,15
on September 1, 1997, 2010, has health and accident insurance policies or health16
maintenance organization subscriber agreements in force in this state shall have until17
September 1, 1998, 2011, to convert such existing policies or agreements to conform18
to the provisions of this Section.19
§1003.1. Unmarried children; premiums; portability; enrollment20
A. In reference to R.S. 22:1003, the following shall apply:21
(1) The premium for coverage under any family group health and accident22
insurance policy, group health and accident insurance policy, or similar coverage23
issued by a health maintenance organization in this state shall not increase on the24
basis of the addition of an unmarried child or unmarried grandchild under the age of25
twenty-six unless there are no dependents covered under the policy prior to the26
addition of such unmarried child or unmarried grandchild. The health insurance27
issuer or health maintenance organization shall apply portability rights in reference28
to preexisting conditions to the newly added unmarried child or unmarried29 HLS 10RS-1077 ORIGINAL
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grandchild as described in R.S. 22:1062(A) and (B). The preexisting condition1
waiting period applicable to such unmarried child or unmarried grandchild shall be2
applied to the unmarried child or unmarried grandchild in the same manner as any3
other dependent.4
(2) The health insurance issuer or health maintenance organization shall5
offer to all insureds or enrollees a special enrollment period of not less than thirty6
days upon request of the insured or enrollee to include an unmarried child or7
unmarried grandchild under the age of twenty-six as a new entrant covered under the8
policy or subscriber agreement. It is solely the insured's or enrollee's decision9
whether to add such unmarried child or unmarried grandchild to the policy or10
subscriber agreement.11
(3) The health insurance issuer or health maintenance organization shall not12
limit or otherwise restrict the offer of coverage to an unmarried child or unmarried13
grandchild under the age of twenty-six by requiring any of the following:14
(a) That the unmarried child or unmarried grandchild had to have been15
previously covered as a dependent.16
(b) That the unmarried child or unmarried grandchild resides in this state.17
(c) That the unmarried child or unmarried grandchild demonstrate that he18
had previous creditable coverage.19
(d) That the enrollee or insured requested coverage for the unmarried child20
or unmarried grandchild the first time such child or grandchild was eligible for21
coverage.22
(4) The health insurance issuer or health maintenance organization may not23
deny coverage to an unmarried child or unmarried grandchild under the age of24
twenty-six when the enrollee or insured requests coverage.25
(5) The health insurance issuer or health maintenance organization shall26
offer coverage for an enrollee's or insured's unmarried children or unmarried27
grandchildren under the age of twenty-six as new entrants through special enrollment28
and shall annually provide at least a thirty-day enrollment period. The health29 HLS 10RS-1077 ORIGINAL
HB NO. 244
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insurance issuer or health maintenance organization may request documentation of1
such unmarried child's or unmarried grandchild's creditable coverage to determine2
portability.3
B. The provisions of this Section shall apply to all policies or subscriber4
agreements issued or renewed or issued for delivery in this state after September 1,5
2010. Any insurer who, on September 1, 2010, has health and accident insurance6
policies or health maintenance organization subscriber agreements in force in this7
state shall have until September 1, 2011, to convert such existing policies or8
agreements to conform to the provisions of this Section.9
Section 2. R.S. 22:1002 is hereby repealed in its entirety.10
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Kleckley HB No. 244
Abstract: Increases the age for dependent coverage of unmarried dependent children or
grandchildren under their parent's or grandparents' health insurance policy or
contract, deletes the requirement that they be full-time students, and sets certain
requirements and restrictions for health insurance issuers and health maintenance
organizations in providing such coverage
Proposed law provides as follows:
(1)Present law, with respect to group, family group, blanket, and association health and
accident insurance, allows dependent coverage of unmarried children under 21 years
of age and unmarried grandchildren who are in the legal custody of and residing with
the grandparent under 21 years of age.
Proposed law increases the age for such dependent coverage to 26 years of age;
otherwise retains present law.
(2)Present law, relative to family group health and accident insurance or similar
coverage issued by a health maintenance organization (HMO) as an individual
policy, allows dependent coverage of unmarried children under 21 years of age or,
in the case of full-time students, unmarried children under the age of 24, and
unmarried grandchildren under 21 years of age in the legal custody of and residing
with the grandparent or, in the case of full-time students, unmarried grandchildren
under the age of 24 who are in the legal custody of and residing with the
grandparent, except that the policy may provide for continuing coverage for any
unmarried child or grandchild in the legal custody of and residing with the
grandparent who is incapable of self-sustaining employment by reason of mental
retardation or physical handicap, who became so incapable prior to attainment of age
26 and any other person dependent upon the policyholder. HLS 10RS-1077 ORIGINAL
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Proposed law increases the age for dependent coverage to 26 years of age and deletes
the requirement that unmarried grandchildren under 21 years of age be in the legal
custody of and residing with the grandparent. Otherwise retains present law.
(3)Present law provides for dependent coverage if any dependent described in (2) above
develops a mental or nervous condition, problem, or disorder which, in the opinion
of a qualified psychiatrist, subject, if deemed necessary by the insurer or HMO, to
a second opinion, prevents the unmarried child or grandchild from attending school
as a full-time student and from holding self-sustaining employment if the child or
grandchild is under the age of 24.
Proposed law deletes present law as unnecessary since proposed law raises the
eligible age for dependent coverage to 26 years of age and deletes the requirement
for full-time student status.
(4)Present law provides that any hospital or medical expense insurance policy issued
in this state which provides that coverage of a dependent child of a policyholder shall
terminate upon attainment of the limiting age for dependent children specified in the
policy shall also provide in substance that attainment of such limiting age shall not
operate to terminate the coverage of such child while the child is and continues to be
both: (a) incapable of self-sustaining employment; and (b) chiefly dependent upon
the policyholder for support; and maintenance if proof of such incapacity and
dependency is furnished to the insurer within 31 days of the child's attainment of the
limiting age and subsequently as may be required by the insurer but not more
frequently than annually after the two-year period following the child's attainment
of the limiting age.
Proposed law retains present law.
(5)Present law, relative to group and individual health and accident insurance and
similar coverage issued by a HMO, allows dependent coverage of students who are
unmarried children who have not yet attained the age of 24 and who are enrolled as
full-time students at an accredited college or university, or at a vocational, technical,
vocational-technical or trade school or institute, or secondary school, and who are
dependent upon the primary insured under any such policy or subscriber agreement.
Proposed law specifies that such an unmarried child shall include an unmarried
grandchild in the legal custody of and residing with a grandparent, deletes the
requirement for full-time student status, and increases the age for dependent
coverage to the age of 26.
(6)Present law provides for dependent coverage if any dependent described in (4) above
develops a mental or nervous condition, problem, or disorder which renders the
unmarried child, in the opinion of a qualified psychiatrist, subject, if deemed
necessary by the insurer or HMO, to a second opinion, unable to attend school as a
full-time student and from holding self-sustaining employment until the student
reaches the age of 24.
Proposed law deletes present law as unnecessary since proposed law raises the
eligible age for dependent coverage to 26 years of age and deletes the requirement
for full-time student status.
(7)Proposed law further provides that the premium for coverage under any family
group health and accident insurance policy, group health and accident insurance
policy, or similar coverage issued by a HMO shall not increase on the basis of the
addition of an unmarried child or unmarried grandchild under the age of 26 unless
there are no dependents covered under the policy prior to the addition of such child.
Requires the health insurance issuer or HMO to apply portability rights in reference HLS 10RS-1077 ORIGINAL
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to pre-existing conditions to the newly added unmarried child or unmarried
grandchild as described in present law relative to such conditions. Specifies that the
preexisting condition waiting period applicable to such child shall be applied to the
that child in the same manner as any other dependent.
(8)Proposed law also requires that the health insurance issuer or HMO offer to all
insureds or enrollees a special enrollment period of not less than 30 days upon
request of the insured or enrollee to include an unmarried child or unmarried
grandchild under the age of 26 as a new entrant covered under the policy or
subscriber agreement. Makes it solely the insured's or enrollee’s decision whether
to add such child to the policy or subscriber agreement.
(9)Proposed law additionally prohibits the health insurance issuer or HMO from
limiting or otherwise restricting the offer of coverage to an unmarried child or
unmarried grandchild under the age of 26 by requiring any of the following:
(a)That such child had to have been previously covered as a dependent.
(b)That such child resides in this state.
(c)That such child demonstrate that he had previous creditable coverage.
(d)That the enrollee or insured requested coverage for such child the first time
he was eligible for coverage.
(10)Proposed law further prohibits the health insurance issuer or HMO from denying
coverage to an unmarried child or unmarried grandchild under the age of 26 when
the enrollee or insured requests coverage.
(11)Proposed law further requires that the health insurance issuer or HMO offer coverage
for an enrollee's or insured's unmarried children or unmarried grandchildren under
the age of 26 as new entrants through special enrollment and annually provide at
least a 30-day enrollment period. Allows the health insurance issuer or HMO to
request documentation of such child's creditable coverage to determine portability.
(12)Proposed law provides that it shall apply to all policies issued or renewed in this state
after Sept. 1, 2010. Also gives any insurer who on that date has health and accident
insurance policies or HMO subscriber agreements in force in this state until Sept. 1,
2011, to convert such existing policies or agreements to conform to proposed law.
(Amends R.S. 22:1000(A)(1)(a)(vi) and (2) and 1003; Adds R.S. 22:1003.1; Repeals R.S.
22:1002)