HLS 10RS-1420 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. 568
BY REPRESENTATIVE ABRAMSON
INSURANCE/HEALTH-ACCID: Permits the application of reduced health insurance
copayments for primary care services
AN ACT1
To enact R.S. 22:1014, relative to health and accident insurance; to provide for definitions;2
to provide with respect to reduced health insurance copayments for primary care3
services; and to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1014 is hereby enacted to read as follows: 6
ยง1014. Reduced copayments for primary care services; purpose; definitions7
A. The legislature recognizes that the state's primary care physicians provide8
an invaluable service such that they are called upon to play key roles in critical9
aspects of the health care system. The legislature is in accord with the widely held10
premise that access to primary care physicians should be encouraged so that patients11
can derive the greatest benefit from the patient education, preventive care,12
comprehensive care, and coordination of care that these physicians offer. The13
provisions of this Section are not intended to discriminate against any types of14
specialty physicians but rather are meant to encourage the use of primary care15
services.16
B. As used in this Section, the following terms shall have the following17
meanings unless the context clearly indicates otherwise:18 HLS 10RS-1420 ORIGINAL
HB NO. 568
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(1) "Copayment" means a specific dollar amount that is the responsibility of1
an insured or enrollee of a health insurance plan, usually paid at the time services are2
rendered.3
(2) "Health insurance issuer" or "issuer" means any entity that offers health4
insurance coverage through a policy, contract, or certificate of insurance subject to5
state law that regulates the business of insurance. For purposes of this Section, a6
"health insurance issuer" shall include but not be limited to a health maintenance7
organization as defined and licensed pursuant to Subpart I of Part I of Chapter 2 of8
this Title.9
(3) "Primary care physician" or "PCP" means a physician trained and licensed10
to provide comprehensive and preventative health care services not limited by11
problem origin or organ system and whose role also includes education of patients12
and coordination of their health care. Types of physicians considered primary care13
physicians shall include general practitioners, family practitioners, general internists,14
and pediatricians. The term may also mean, at a health insurance issuer's option, a15
physician other than these types of physicians who is assigned by the issuer to16
provide comprehensive and preventative health care services and to coordinate care.17
C. A health insurance issuer may establish and maintain benefit plans for18
group and individual insureds or enrollees that apply lower insured or enrollee19
copayments for services provided by primary care physicians than for services20
provided by other types of physicians.21
D. A health insurance issuer that provides for the application of lower insured22
or enrollee copayments for the services of a primary care physician than for services23
of other types of physicians shall state clearly such differences in its policies and24
materials.25
Section 2. This Act shall become effective on July 1, 2010; if vetoed by the governor26
and subsequently approved by the legislature, this Act shall become effective on July 1,27
2010, or on the day following such approval by the legislature, whichever is later.28 HLS 10RS-1420 ORIGINAL
HB NO. 568
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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)]
Abramson HB No. 568
Abstract: Permits the application of reduced health insurance copayments for primary care
services by health insurance issuers.
Proposed law defines a "primary care physician" or "PCP" as a physician trained and
licensed to provide comprehensive and preventative health care services not limited by
problem origin or organ system and whose role also includes education of patients and
coordination of their health care. Specifies that types of physicians considered primary care
physicians shall include general practitioners, family practitioners, general internists, and
pediatricians. Further provides that the term may also mean, at a health insurance issuer's
option, a physician other than these types of physicians who is assigned by the issuer to
provide comprehensive and preventative health care services and to coordinate care.
Proposed law authorizes a health insurance issuer to establish and maintain benefit plans for
group and individual insureds or enrollees that apply lower insured or enrollee copayments
for services provided by primary care physicians than for services provided by other types
of physicians.
Proposed law further requires that a health insurance issuer that provides for the application
of lower insured or enrollee copayments for the services of a primary care physician than for
services of other types of physicians state clearly such differences in its policies and
materials.
Effective July 1, 2010.
(Adds R.S. 22:1014)