HLS 10RS-1132 ENGROSSED
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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. 824
BY REPRESENTATIVE ROY
INSURANCE/HEALTH-ACCID: Provides for coordination of health insurance benefits
with Medicare
AN ACT1
To amend and reenact R.S. 22:1836(A)(2)(b), relative to coordination of health insurance2
benefits; to provide for coordination of such benefits with Medicare; to require3
notification of affected individual insureds, subscribers, or enrollees; and to provide4
for related matters.5
Be it enacted by the Legislature of Louisiana:6
Section 1. R.S. 22:1836(A)(2)(b) is hereby amended and reenacted to read as7
follows: 8
ยง1836. Coordination of benefits9
A. Coordination of benefit requirements adopted by health insurance issuers10
shall, at a minimum, adhere to the following requirements:11
* * *12
(2) A coordination of benefit provision may not be used that permits a plan13
to reduce its benefits on the basis of any of the following:14
* * *15
(b) That a person is or could have been covered under another plan, except16
with respect to Part B of Medicare. a person who is covered by an individual health17
and accident policy or health maintenance organization subscriber agreement and,18
thereafter, becomes eligible for Medicare benefits. In the event that the individual19
health and accident policy or health maintenance organization subscriber agreement20 HLS 10RS-1132 ENGROSSED
HB NO. 824
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
provides for coordination of benefits, then the individual health and accident policy1
or health maintenance organization subscriber agreement shall coordinate its benefits2
to those primary benefits of Medicare. Each health insurance issuer or health3
maintenance organization shall mail a notice on a form prescribed by the4
commissioner of insurance to its individual insureds, subscribers, or enrollees no5
later than three months before the insured, subscriber, or enrollee reaches the age of6
sixty-five or no later than one month after receiving notice of the Social Security7
Administration's initial determination as to the entitlement of the insured, subscriber,8
or enrollee to receive Medicare benefits for disability or end-stage renal disease,9
explaining, in detail, the options available to them.10
* * *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)]
Roy HB No. 824
Abstract: Provides for coordination of benefits of health insurance benefits with Medicare,
including a requirement that each health insurance issuer and health maintenance
organization notify affected individual insureds, subscribers, or enrollees.
Present law requires that coordination of benefit requirements adopted by health insurance
issuers shall, at a minimum, adhere to certain requirements, including that a coordination of
benefit provision may not be used to permit a plan to reduce its benefits on the basis of
certain factors. Includes among such factors the fact that a person is or could have been
covered under another plan, except with respect to Part B of Medicare.
Proposed law instead provides that such factor be that a person is or could have been covered
under another plan, except with respect to a person who is covered by an individual health
and accident policy or health maintenance organization (HMO) subscriber agreement and,
thereafter, becomes eligible for Medicare benefits. Requires that in the event that the
individual health and accident policy or HMO subscriber agreement provides for
coordination of benefits, then the individual health and accident policy or HMO subscriber
agreement shall coordinate its benefits to those primary benefits of Medicare. Further
requires each health insurance issuer or HMO to mail a notice on a form prescribed by the
commissioner of insurance to its individual insureds, subscribers, or enrollees, no later than
three months before the insured, subscriber, or enrollee reaches the age of 65 or no later than
one month after receiving notice of the Social Security Administration's initial determination
as to the entitlement of the insured, subscriber, or enrollee to receive Medicare benefits for
disability or end-stage renal disease, explaining, in detail, the options available to them.
(Amends R.S. 22:1836(A)(2)(b))