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Regular Session, 2010
HOUSE BILL NO. 244
BY REPRESENTATIVE KLECKLEY
INSURANCE/HEALTH-ACCID: Provides relative to health insurance coverage for
dependent children
AN ACT1
To amend and reenact R.S. 22:1000(A)(1)(a)(vi) and (2), 1002, and 1003 and to enact R.S.2
22:1003.1, relative to dependent health insurance coverage for children or3
grandchildren; to provide for such coverage until the age of twenty-six; to delete the4
requirement for full-time student status; to delete the requirement for unmarried5
status; to provide for exceptions; to set certain requirements and restrictions for6
health insurance issuers and health maintenance organizations in providing such7
coverage; to exempt the Office of Group Benefits; and to provide for related matters.8
Be it enacted by the Legislature of Louisiana:9
Section 1. R.S. 22:1000(A)(1)(a)(vi) and (2), 1002, and 1003 are hereby amended10
and reenacted and R.S. 22:1003.1 is hereby enacted to read as follows: 11
§1000. Group, family group, blanket, and association health and accident insurance12
A.13
* * *14
(1) Group health and accident insurance is any policy of health and accident15
insurance, or similar coverage issued by a health maintenance organization, covering16
more than one person, except family group, and blanket policies hereinafter17
specifically provided for, which shall conform to the following requirements:18
(a)19
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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 years of age, and unmarried until the age of twenty-six and9
grandchildren who are in the legal custody of and residing with the grandparent10
under twenty-one years of age, until the age of twenty-six pursuant to R.S. 22:100311
and 1003.1, employees of the employers or members of the association or of the12
unions for the benefit of persons other than the 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 until 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 until 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 REENGROSSED
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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
§1002. Coverage of vocational-technical students unmarried dependent children and17
grandchildren by the Office of Group Benefits18
A. Notwithstanding any other provision of law to the contrary, and in19
particular the provisions of R.S. 22:1001, 1003, and 1003.1, coverage of dependent20
children or grandchildren by the Office of Group Benefits shall be controlled by this21
Section as to limitations relative to age, marital status, and full-time student status.22
B. Except as otherwise provided by Subsection D of this Section, for those23
dependent children or grandchildren who are unmarried but who are not full-time24
students, coverage shall extend to those under the age of twenty-one years.25
C. For those dependent children or grandchildren who are unmarried but who26
are full-time students, coverage shall extend to those under the age of twenty-four27
years.28 HLS 10RS-1077 REENGROSSED
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D. Coverage for an unmarried dependent child or grandchild who is a full-1
time student and who develops a mental or nervous condition, problem, or disorder2
which renders the child or grandchild, in the opinion of a qualified psychiatrist,3
subject to a second opinion if deemed necessary by the Office of Group Benefits,4
unable to attend school as a full-time student and from holding self-sustaining5
employment shall extend until the child or grandchild reaches the age of twenty-four6
years.7
E. (1) Children Unmarried dependent children who attend are enrolled as8
students at an accredited college or university or at a vocational, technical,9
vocational-technical, or trade schools school or institutes in Louisiana institute on10
a full-time basis shall be considered as full-time students for purposes of coverage11
by family group health and accident insurance policies issued in this state. the Office12
of Group Benefits. 13
(2) In order to qualify for coverage as a dependent of a grandparent, an14
unmarried child must be in the legal custody of and reside with the grandparent.15
The provisions of this section shall apply to all policies issued more than16
ninety days following July 31, 1974. Any insurer who, on July 31, 1974, has health17
and accident insurance policies in force shall have until July 31, 1975 to convert such18
existing policies to conform to the provisions of this section.19
§1003. Coverage of unmarried students children for group and individual health and20
accident insurance; exception21
A.(1) Except as provided in Paragraph (2) of this Subsection, students who22
are unmarried children Children, including a grandchild in the legal custody of and23
residing with a grandparent, who have not yet attained until the age of twenty-four24
twenty-six and who are enrolled as full-time students at an accredited college or25
university, or at a vocational, technical, vocational-technical or trade school or26
institute, or secondary school, and who are dependent upon the primary insured27
under any group health and accident or association health and accident insurance28
policy or health maintenance organization subscriber agreement issued in this state29 HLS 10RS-1077 REENGROSSED
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for their support, shall be considered as dependents of the primary insured or enrollee1
under the provisions of said policy. any family group health and accident insurance2
policy, group health and accident insurance policy, or similar coverage issued by a3
health maintenance organization in this state.4
(2) Every unmarried child under the age of twenty-four who is enrolled as5
a full-time student at an accredited college or university, or a vocational, technical,6
vocational-technical, or trade school or institute, or secondary school and who is7
dependent for their support on the primary insured under any group health and8
accident or association health and accident insurance policy issued in this state shall9
continue to be considered a dependent under the provisions of such policy if the10
unmarried child develops a mental or nervous condition, problem, or disorder which11
renders the unmarried child, in the opinion of a qualified psychiatrist, subject, if12
deemed necessary by the insurer or health maintenance organization, to a second13
opinion, unable to attend school as a full-time student and from holding self-14
sustaining employment until the student reaches the age of twenty-four.15
B. For group plans in existence before March 30, 2010, only, the provisions16
of this Section shall apply only if the child is not eligible to enroll in an eligible17
employer-sponsored health plan. The provisions of this Subsection shall not apply18
for plan years beginning after January 1, 2014.19
B.C. The provisions of this Section shall apply to all policies issued or20
renewed or issued for delivery in this state after September 1, 1997. 2010. Any21
insurer who, on September 1, 1997, 2010, has health and accident insurance policies22
or health maintenance organization subscriber agreements in force in this state shall23
have until September 1, 1998, 2011, to convert such existing policies or agreements24
to conform to the provisions of this Section.25
§1003.1. Children; premiums; portability; enrollment; exception26
A. In reference to R.S. 22:1003, the following shall apply:27
(1) The premium for coverage under any family group health and accident28
insurance policy, group health and accident insurance policy, or similar coverage29 HLS 10RS-1077 REENGROSSED
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issued by a health maintenance organization in this state shall not increase on the1
basis of the addition of a child or grandchild until the age of twenty-six unless there2
are no dependents covered under the policy prior to the addition of such child or3
grandchild. The health insurance issuer or health maintenance organization shall4
apply portability rights in reference to preexisting conditions to the newly added5
child or grandchild as described in R.S. 22:1062(A) and (B). The preexisting6
condition waiting period applicable to such child or grandchild shall be applied to7
the child or grandchild in the same manner as any other dependent.8
(2) The health insurance issuer or health maintenance organization shall9
offer to all insureds or enrollees a special enrollment period of not less than thirty10
days upon request of the insured or enrollee to include a child or grandchild until the11
age of twenty-six as a new entrant covered under the policy or subscriber agreement.12
It is solely the insured's or enrollee's decision whether to add such child or13
grandchild to the policy or subscriber agreement.14
(3) The health insurance issuer or health maintenance organization shall not15
limit or otherwise restrict the offer of coverage to a child or grandchild until the age16
of twenty-six by requiring any of the following:17
(a) That the child or grandchild had to have been previously covered as a18
dependent.19
(b) That the child or grandchild resides in this state.20
(c) That the child or grandchild demonstrate that he had previous creditable21
coverage.22
(d) That the enrollee or insured requested coverage for the child or23
grandchild the first time such child or grandchild was eligible for coverage.24
(4) The health insurance issuer or health maintenance organization may not25
deny coverage to a child or grandchild until the age of twenty-six when the enrollee26
or insured requests coverage.27
(5) The health insurance issuer or health maintenance organization shall28
offer coverage for an enrollee's or insured's children or grandchildren until the age29 HLS 10RS-1077 REENGROSSED
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of twenty-six as new entrants through special enrollment and shall annually provide1
at least a thirty-day enrollment period. The health insurance issuer or health2
maintenance organization may request documentation of such child's or grandchild's3
creditable coverage to determine portability.4
B. For group plans in existence before March 30, 2010, only, the provisions5
of this Section shall apply only if the child is not eligible to enroll in an eligible6
employer-sponsored health plan. The provisions of this Subsection shall not apply7
for plan years beginning after January 1, 2014.8
C. The provisions of this Section shall apply to all policies or subscriber9
agreements issued or renewed or issued for delivery in this state after September 1,10
2010. Any insurer who, on September 1, 2010, has health and accident insurance11
policies or health maintenance organization subscriber agreements in force in this12
state shall have until September 1, 2011, to convert such existing policies or13
agreements to conform to the provisions of this Section.14
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 dependent children or grandchildren
under their parent's or grandparent's health insurance policy or contract until age 26,
deletes the requirement that they be unmarried or full-time students, provides for
exceptions, and sets certain requirements and restrictions for health insurance issuers
and health maintenance organizations in providing such coverage. Exempts the
Office of Group Benefits.
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 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 until the age of 26 and
deletes the requirement that such children be unmarried; 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, HLS 10RS-1077 REENGROSSED
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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.
Proposed law increases the age for dependent coverage until the age of 26, deletes
the requirement that such children be unmarried, and deletes the requirement that
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 until the age of 26 and deletes the requirement
for full-time student and unmarried 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 a child shall include a grandchild in the legal
custody of and residing with a grandparent, deletes the requirement for full-time
student status, increases the age for dependent coverage until the age of 26, and
deletes the requirement that such child be unmarried; however, provides that such
coverage shall apply only if the child or grandchild is not eligible to enroll in an
eligible employer-sponsored health plan.
(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 HLS 10RS-1077 REENGROSSED
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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 until the age of 26 and deletes the requirement
for full-time or unmarried or student status.
(7)Proposed law further provides that the premium for coverage under any family
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 until 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 to preexisting conditions to the newly
added child or 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 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 a child or grandchild until 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 child or grandchild until
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 a child or grandchild until 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 children or grandchildren until 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 for group plans in existence before March 30, 2010, it
shall apply only if the child is not eligible to enroll in an eligible employer-sponsored
health plan. Provides that this shall not apply for plan years beginning after January
1, 2014.
(13)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. HLS 10RS-1077 REENGROSSED
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(14)Exempts the Office of Group Benefits from proposed law, generally providing
dependent coverage for unmarried children not in school under the age of 21,
unmarried students under the age of 24, and incapacitated children under the age of
24.
(Amends R.S. 22:1000(A)(1)(a)(vi) and (2), 1002, and 1003; Adds R.S. 22:1003.1)
Summary of Amendments Adopted by House
Committee Amendments Proposed by House Committee on Insurance to the original
bill.
1. Deleted the requirement that a child be unmarried to qualify for dependent
coverage by a parent or grandparent.
2. Provided that dependent coverage extends through the age of 26 rather than
under the age of 26.
3. Added an exception by providing that proposed law shall apply only if the child
or grandchild is not eligible to enroll in an eligible employer-sponsored health
plan.
House Floor Amendments to the engrossed bill.
1. Provided that dependent coverage extends until the age of 26 rather than through
the age of 26.
2. Clarified that for group plans in existence before March 30, 2010, proposed law
shall apply only if the child is not eligible to enroll in an eligible employer-
sponsored health plan. Provides that this shall not apply for plan years beginning
after Jan. 1, 2014.
3. Exempted the Office of Group Benefits from proposed law, generally providing
dependent coverage for unmarried children not in school under the age of 21,
unmarried students under the age of 24, and incapacitated children under the age
of 24.