ENROLLED
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Regular Session, 2010
HOUSE BILL NO. 244
BY REPRESENTATIVE KLECKLEY
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
* * *20
(vi) The policy may be issued to an employer, association, or to the trustees21
of a fund established by two or more employers in the same industry or by one or22
more labor unions, or by one or more employers and one or more labor unions, or to23
a multiple employer trust established by an insurer on behalf of participating24 ENROLLEDHB NO. 244
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employer s, provided all participating employers and employees have the same1
statutory protections that would apply if such policy was purchased by the employer2
directly from the insurer, which trustees shall be deemed the policyholder, to insure3
with or without any eligible family members including spouse, unmarried children4
under twenty-one years of age, and unmarried until the age of twenty-six, and5
grandchildren who are in the legal custody of and residing with the grandparent6
under twenty-one years of age, until the age of twenty-six pursuant to R.S. 22:10037
and 1003.1, employees of the employers or members of the association or of the8
unions for the benefit of persons other than the employers or the unions.9
* * *10
(2)(a) Except as provided in Subparagraph (b) of this Paragraph, family11
Family group health and accident insurance or similar coverage issued by a health12
maintenance organization is an individual policy covering any one person, with or13
without any eligible members, including spouse and unmarried children under14
twenty-one years of age or, in the case of full-time students, unmarried children15
under until the age of twenty-four, twenty-six, and unmarried grandchildren under16
twenty-one years of age in the legal custody of and residing with the grandparent or,17
in the case of full-time students, unmarried grandchildren under until the age of18
twenty-four twenty-six who are in the legal custody of and residing with the19
grandparent, pursuant to R.S. 22:1003 and 1003.1, except that the policy may20
provide for continuing coverage for any unmarried child or grandchild in the legal21
custody of and residing with the grandparent who is incapable of self-sustaining22
employment by reason of mental retardation or physical handicap, who became so23
incapable prior to attainment of age twenty-one, twenty-six, and any other person24
dependent upon the policyholder, written under a master policy issued to the head25
of such family. The policy shall contain a provision that the policy, and the26
application of the head of the family if attached thereto, shall constitute the entire27
contract between the parties.28
(b) Every family group health and accident insurance policy or health29
maintenance organization subscriber agreement which provides coverage, pursuant30 ENROLLEDHB NO. 244
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to Subparagraph (a) of this Paragraph, to a policyholder's unmarried children under1
the age of twenty-four who are full-time students or the policyholder's unmarried2
grandchildren in the legal custody of and residing with the policyholder who are full-3
time students under the age of twenty-four shall continue coverage under such policy4
if such child or grandchild develops a mental or nervous condition, problem, or5
disorder which, in the opinion of a qualified psychiatrist, subject, if deemed6
necessary by the insurer or health maintenance organization, to a second opinion,7
prevents the unmarried child or grandchild from attending school as a full-time8
student and from holding self-sustaining employment provided the child or9
grandchild is under the age of twenty-four.10
* * *11
§1002. Coverage of vocational-technical students unmarried dependent children and12
grandchildren by the Office of Group Benefits13
A. Notwithstanding any other provision of law to the contrary, and in14
particular the provisions of R.S. 22:1001, 1003, and 1003.1, coverage of dependent15
children or grandchildren by the Office of Group Benefits shall be controlled by this16
Section as to limitations relative to age, marital status, and full-time student status.17
B. Except as otherwise provided by Subsection D of this Section, for those18
dependent children or grandchildren who are unmarried but who are not full-time19
students, coverage shall extend to those under the age of twenty-one years.20
C. For those dependent children or grandchildren who are unmarried but who21
are full-time students, coverage shall extend to those under the age of twenty-four22
years.23
D. Coverage for an unmarried dependent child or grandchild who is a full-24
time student and who develops a mental or nervous condition, problem, or disorder25
which renders the child or grandchild, in the opinion of a qualified psychiatrist,26
subject to a second opinion if deemed necessary by the Office of Group Benefits,27
unable to attend school as a full-time student and from holding self-sustaining28
employment shall extend until the child or grandchild reaches the age of twenty-four29
years.30 ENROLLEDHB NO. 244
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E. (1) Children Unmarried dependent children who attend are enrolled as1
students at an accredited college or university or at a vocational, technical,2
vocational-technical, or trade schools school or institutes in Louisiana institute on3
a full-time basis shall be considered as full-time students for purposes of coverage4
by family group health and accident insurance policies issued in this state. the Office5
of Group Benefits. 6
(2) In order to qualify for coverage as a dependent of a grandparent, an7
unmarried child must be in the legal custody of and reside with the grandparent.8
The provisions of this section shall apply to all policies issued more than9
ninety days following July 31, 1974. Any insurer who, on July 31, 1974, has health10
and accident insurance policies in force shall have until July 31, 1975 to convert such11
existing policies to conform to the provisions of this section.12
§1003. Coverage of unmarried students children for group and individual health and13
accident insurance; exception14
A.(1) Except as provided in Paragraph (2) of this Subsection, students who15
are unmarried children Children, including a grandchild in the legal custody of and16
residing with a grandparent, who have not yet attained until the age of twenty-four17
twenty-six and who are enrolled as full-time students at an accredited college or18
university, or at a vocational, technical, vocational-technical or trade school or19
institute, or secondary school, and who are dependent upon the primary insured20
under any group health and accident or association health and accident insurance21
policy or health maintenance organization subscriber agreement issued in this state22
for their support, shall be considered as dependents of the primary insured or enrollee23
under the provisions of said policy. any family group health and accident insurance24
policy, group health and accident insurance policy, or similar coverage issued by a25
health maintenance organization in this state.26
(2) Every unmarried child under the age of twenty-four who is enrolled as27
a full-time student at an accredited college or university, or a vocational, technical,28
vocational-technical, or trade school or institute, or secondary school and who is29
dependent for their support on the primary insured under any group health and30 ENROLLEDHB NO. 244
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accident or association health and accident insurance policy issued in this state shall1
continue to be considered a dependent under the provisions of such policy if the2
unmarried child develops a mental or nervous condition, problem, or disorder which3
renders the unmarried child, in the opinion of a qualified psychiatrist, subject, if4
deemed necessary by the insurer or health maintenance organization, to a second5
opinion, unable to attend school as a full-time student and from holding self-6
sustaining employment until the student reaches the age of twenty-four.7
B. For group plans in existence before March 23, 2010, only, the provisions8
of this Section shall apply only if the child is not eligible to enroll in an eligible9
employer-sponsored health plan. The provisions of this Subsection shall not apply10
for plan years beginning after January 1, 2014.11
B.C. The provisions of this Section shall apply to all policies issued or12
renewed or issued for delivery in this state after September 1 23, 1997. 2010. Any13
insurer who, on September 1, 1997, has health and accident insurance policies or14
health maintenance organization subscriber agreements in force in this state shall15
have until September 1, 1998, to convert such existing policies or to conform to the16
provisions of this Section.17
§1003.1. Children; premiums; portability; enrollment; exception18
A. In reference to R.S. 22:1003, the following shall apply:19
(1) The premium for coverage under any family group health and accident20
insurance policy, group health and accident insurance policy, or similar coverage21
issued by a health maintenance organization in this state shall not increase on the22
basis of the addition of a child or grandchild under the age of twenty-six unless there23
are no dependent children covered under the policy prior to the addition of such child24
or grandchild. The health insurance issuer or health maintenance organization shall25
apply portability rights in reference to preexisting conditions to the newly added26
child or grandchild as described in R.S. 22:1062(A) and (B). The preexisting27
condition waiting period applicable to such child or grandchild shall be applied to28
the child or grandchild in the same manner as any other dependent.29 ENROLLEDHB NO. 244
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(2) The health insurance issuer or health maintenance organization shall1
offer to all insureds or enrollees a special enrollment period of not less than thirty2
days beginning on September 23, 2010, to include a child or grandchild under the3
age of twenty-six as a new entrant covered under the policy or subscriber agreement.4
It is solely the insured's or enrollee's decision whether to add such child or5
grandchild to the policy or subscriber agreement.6
(3) The health insurance issuer or health maintenance organization shall not7
limit or otherwise restrict the offer of coverage to a child or grandchild until the age8
of twenty-six by requiring any of the following:9
(a) That the child or grandchild had to have been previously covered as a10
dependent.11
(b) That the child or grandchild resides in this state.12
(c) That the child or grandchild demonstrate that he had previous creditable13
coverage.14
(d) That the enrollee or insured requested coverage for the child or15
grandchild the first time such child or grandchild was eligible for coverage.16
(4) The health insurance issuer or health maintenance organization may not17
deny coverage to a child or grandchild under the age of twenty-six when the enrollee18
or insured requests coverage.19
(5) The health insurance issuer or health maintenance organization shall20
offer coverage for an enrollee's or insured's children or grandchildren under the age21
of twenty-six as new entrants through special enrollment and shall annually provide22
at least a thirty-day enrollment period. The health insurance issuer or health23
maintenance organization may request documentation of such child's or grandchild's24
creditable coverage to determine portability.25
B. For group plans in existence before March 23, 2010, only, the provisions26
of this Section shall apply only if the child is not eligible to enroll in an eligible27
employer-sponsored health plan. The provisions of this Subsection shall not apply28
for plan years beginning after January 1, 2014.29 ENROLLEDHB NO. 244
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C. The provisions of this Section shall apply to all policies or subscriber1
agreements issued or renewed or issued for delivery in this state after September 23,2
2010.3
SPEAKER OF THE HOUSE OF REPRESENTATI VES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: