HLS 10RS-1032 ORIGINAL
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Regular Session, 2010
HOUSE BILL NO. 280
BY REPRESENTATIVE KLECKLEY
INSURANCE/HEALTH-ACCID: Provides for continued health insurance coverage for an
unmarried dependent student during a medically necessary leave of absence
AN ACT1
To enact R.S. 22:1003.1, relative to health insurance coverage for unmarried dependent2
students; to continue such coverage during a medically necessary leave of absence;3
to provide for terms and conditions; and to provide for related matters. 4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1003.1 is hereby enacted to read as follows: 6
§1003.1. Coverage of unmarried dependent students on medically necessary leave7
of absence8
A. The provisions of this Section shall apply to health insurance issuers,9
health maintenance organizations, and the Office of Group Benefits.10
B. In this Section, the term "medically necessary leave of absence" means11
a leave of absence of a dependent child from a postsecondary educational institution,12
including an institution of higher learning as defined in 20 USCA §1002, or any13
other change in enrollment of a dependent child at an institution that:14
(1) Commences while the dependent child is suffering from a serious illness15
or injury.16
(2) Is medically necessary.17
(3) Causes the dependent child to lose student status for purposes of18
coverage under the terms of the policy or subscriber agreement.19
C.(1) Insurance coverage shall not terminate for the dependent child under20
a policy or subscriber agreement due to a medically necessary leave of absence21
before the date that is the earlier of one of the following:22 HLS 10RS-1032 ORIGINAL
HB NO. 280
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(a) The date that is one year after the first day of the medically necessary1
leave of absence.2
(b) The date on which the coverage would otherwise terminate under the3
terms of the policy or subscriber agreement as required by state law.4
(2) A dependent child for purposes of this Section is an insured or enrollee5
under the policy or subscriber agreement who:6
(a) Is an unmarried dependent child of an insured or enrollee under the7
policy or subscriber agreement as required by state law.8
(b) Was enrolled in the policy or subscriber agreement on the basis of being9
a student at a postsecondary educational institution immediately before the first day10
of the medically necessary leave of absence involved.11
(3) The provisions of this Section shall apply only if the health insurance12
issuer, health maintenance organization, or Office of Group Benefits has received13
written certification by a treating physician of the dependent child which states that14
the child is suffering from a serious illness or injury and that the leave of absence or15
other change of enrollment status that causes the dependent child to lose student16
status is medically necessary.17
D. Every health insurance issuer, health maintenance organization, or Office18
of Group Benefits shall include, with any notice regarding a requirement for19
certification of student status for coverage under the policy or subscriber agreement,20
a description of the terms of this Section for continued coverage during medically21
necessary leaves of absence. The description shall be in language which is22
understandable to the typical insured or enrollee.23
E. A dependent child whose benefits are continued under this Section shall24
be entitled to the same benefits during the medically necessary leave of absence as25
if the child continued to be a covered student at the institution of higher education26
and was not on a medically necessary leave of absence.27
F. This Section shall provide for the continuation of coverage for a28
dependent child if coverage is changed during the remainder of the period of the29 HLS 10RS-1032 ORIGINAL
HB NO. 280
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dependent child's medically necessary leave of absence. The prior policy or1
subscriber agreement's coverage shall be applied in the same manner as it would if2
the changed coverage had been previous coverage if:3
(1) A dependent child of an insured or enrollee is in a period of coverage4
pursuant to a medically necessary leave of absence of the dependent child.5
(2) The manner in which the insured or enrollee is covered under the policy6
or subscriber agreement changes, whether through a change in health insurance7
coverage or health insurance issuer, a change between health insurance coverage and8
self-insured coverage, or otherwise.9
(3) The coverage as so changed continues to provide coverage of insureds10
or enrollees as dependent children.11
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. 280
Abstract: Continues health insurance coverage for unmarried students during medically
necessary leaves of absence under certain terms and conditions.
Present law generally requires that a child or grandchild be an unmarried dependent in order
to be eligible for dependent health insurance coverage up to the age of 21. Further provides
that unmarried full-time students are eligible for such coverage up to the age of 24.
Proposed law states that it is applicable to health insurance issuers, health maintenance
organizations, and the Office of Group Benefits and provides as follows:
(1)Defines a "medically necessary leave of absence" as a leave of absence of a
dependent child from a postsecondary educational institution, including an institution
of higher learning as defined in certain federal law, or any other change in
enrollment of a dependent child at an institution that:
(a)Commences while the dependent child is suffering from a serious illness or
injury.
(b)Is medically necessary.
(c)Causes the dependent child to lose student status for purposes of coverage
under the terms of the policy or subscriber agreement.
(2)Prohibits health insurance coverage from terminating for the dependent child due to
a medically necessary leave of absence before the date that is the earlier of one of the
following: HLS 10RS-1032 ORIGINAL
HB NO. 280
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are additions.
(a)The date that is one year after the first day of the medically necessary leave
of absence.
(b)The date on which the coverage would otherwise terminate under the terms
of the policy or subscriber agreement as required by present law.
(3)Further provides that for purposes of proposed law a dependent child must be an
insured or enrollee under the policy or subscriber agreement who:
(a)Is an unmarried dependent child of an insured or enrollee under the policy or
subscriber agreement as required by present law.
(b)Was enrolled in the policy or subscriber agreement on the basis of being a
student at a postsecondary educational institution immediately before the first
day of the medically necessary leave of absence involved.
(4)Provides that proposed law shall apply only if the health insurance issuer, health
maintenance organization, or Office of Group Benefits has received written
certification by a treating physician of the dependent child which states that the child
is suffering from a serious illness or injury and that the leave of absence or other
change of enrollment status that causes the dependent child to lose student status is
medically necessary.
(5)Requires every health insurance issuer, health maintenance organization, or Office
of Group Benefits to include, with any notice regarding a requirement for
certification of student status, a description of the terms of proposed law. Further
requires that such description be in language which is understandable to the typical
insured or enrollee.
(6)Provides that a dependent child whose benefits are continued under proposed law
shall be entitled to the same benefits during the medically necessary leave of absence
as if the child continued to be a covered student at the institution of higher education
and was not on a medically necessary leave of absence.
(7)Provides that proposed law shall provide for the continuation of coverage for a
dependent child if coverage is changed during the remainder of the period of the
dependent child's medically necessary leave of absence. Requires that the prior
policy or subscriber agreement's coverage shall be applied in the same manner as it
would if the changed coverage had been previous coverage if:
(a)A dependent child of an insured or enrollee is in a period of coverage
pursuant to a medically necessary leave of absence of the dependent child.
(b)The manner in which the insured or enrollee is covered under the policy or
subscriber agreement changes, whether through a change in health insurance
coverage or health insurance issuer, a change between health insurance
coverage and self-insured coverage, or otherwise.
(c)The coverage as so changed continues to provide coverage of insureds or
enrollees as dependent children.
(Adds R.S. 22:1003.1)