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Regular Session, 2010
SENATE BILL NO. 668
BY SENATOR HEBERT
HEALTH/ACC INSURANCE. Provides for increasing the termination age for children
under health and accident policies to age 26. (8/15/10)
AN ACT1
To amend and reenact R.S. 22:1000(A)(1)(a)(vi) and (2) and 1003; to enact R.S. 22:1003.12
and to repeal R.S. 22:1002, relative to dependent health insurance coverage; to3
provide with respect to coverage up to the age of twenty-six; to set premium4
requirements; and to provide for related matters.5
Be it enacted by the Legislature of Louisiana:6
Section 1. R.S. 22:1000(A)(1)(a)(vi) and (2) and 1003 are hereby amended and7
reenacted and R.S. 22:1003.1 is hereby enacted to read as follows:8
§1000. Group, family group, blanket, and association health and accident insurance9
A. Any insurer authorized to write health and accident insurance in this state10
shall have power to issue policies described in this Section.11
(1) Group health and accident insurance is any policy of health and accident12
insurance, or similar coverage issued by a health maintenance organization, covering13
more than one person, except family group, and blanket policies hereinafter14
specifically provided for, which shall conform to the following requirements:15
(a)(i) * * *16
(vi) The policy may be issued to an employer, association, or to the trustees17 SB NO. 668
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of a fund established by two or more employers in the same industry or by one or1
more labor unions, or by one or more employers and one or more labor unions, or to2
a multiple employer trust established by an insurer on behalf of participating3
employers, provided all participating employers and employees have the same4
statutory protections that would apply if such policy was purchased by the employer5
directly from the insurer, which trustees shall be deemed the policyholder, to insure6
with or without any eligible family members including spouse, unmarried children7
under twenty-one twenty-six years of age, and unmarried grandchildren who are in8
the legal custody of and residing with the grandparent under twenty-one twenty-six9
years of age pursuant to R.S. 22:1003 and 1003.1, employees of the employers or10
members of the association or of the unions for the benefit of persons other than the11
employers or the unions.12
* * *13
(2)(a) Except as provided in Subparagraph (b) of this Paragraph, family14
Family group health and accident insurance or similar coverage issued by a health15
maintenance organization is an individual policy covering any one person, with or16
without any eligible members, including spouse and unmarried children under17
twenty-one years of age or, in the case of full-time students, unmarried children18
under the age of twenty-four twenty-six, and unmarried grandchildren under twenty-19
one years of age in the legal custody of and residing with the grandparent or, in the20
case of full-time students, unmarried grandchildren under the age of twenty-four21
twenty-six who are in the legal custody of and residing with the grandparent22
pursuant to R.S. 22:1003 and 1003.1, except that the policy may provide for23
continuing coverage for any unmarried child or grandchild in the legal custody of24
and residing with the grandparent who is incapable of self-sustaining employment25
by reason of mental retardation or physical handicap, who became so incapable prior26
to attainment of age twenty-one twenty-six, and any other person dependent upon27
the policyholder, written under a master policy issued to the head of such family. The28
policy shall contain a provision that the policy, and the application of the head of the29 SB NO. 668
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family if attached thereto, shall constitute the entire contract between the parties.1
(b) Every family group health and accident insurance policy or health2
maintenance organization subscriber agreement which provides coverage, pursuant3
to Subparagraph (a) of this Paragraph, to a policyholder's unmarried children under4
the age of twenty-four who are full-time students or the policyholder's unmarried5
grandchildren in the legal custody of and residing with the policyholder who are full-6
time students under the age of twenty-four shall continue coverage under such policy7
if such child or grandchild develops a mental or nervous condition, problem, or8
disorder which, in the opinion of a qualified psychiatrist, subject, if deemed9
necessary by the insurer or health maintenance organization, to a second opinion,10
prevents the unmarried child or grandchild from attending school as a full-time11
student and from holding self-sustaining employment provided the child or12
grandchild is under the age of twenty-four.13
* * *14
§1003. Coverage of unmarried students children for group and individual health15
and accident insurance16
A.(1) Except as provided in Paragraph (2) of this Subsection, students who17
are unmarried Unmarried children and unmarried grandchildren in the legal18
custody of and residing with the grandparent who have not yet attained the age19
of twenty-four twenty-six and who are enrolled as full-time students at an accredited20
college or university, or at a vocational, technical, vocational-technical or trade21
school or institute, or secondary school, and who are dependent upon the primary22
insured under any group health and accident or association health and accident23
insurance policy or health maintenance organization subscriber agreement issued in24
this state for their support, shall be considered as dependents of the primary insured25
or enrollee under the provisions of said policy. any family group health and26
accident insurance policy, group health and accident insurance policy or similar27
coverage issued by a health maintenance organization in this state.28
(2) Every unmarried child under the age of twenty-four who is enrolled as a29 SB NO. 668
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full-time student at an accredited college or university, or a vocational, technical,1
vocational-technical, or trade school or institute, or secondary school and who is2
dependent for their support on the primary insured under any group health and3
accident or association health and accident insurance policy issued in this state shall4
continue to be considered a dependent under the provisions of such policy if the5
unmarried child develops a mental or nervous condition, problem, or disorder which6
renders the unmarried child, in the opinion of a qualified psychiatrist, subject, if7
deemed necessary by the insurer or health maintenance organization, to a second8
opinion, unable to attend school as a full-time student and from holding self-9
sustaining employment until the student reaches the age of twenty-four.10
B. The provisions of this Section shall apply to all policies issued or renewed11
or issued for delivery in this state after September 1, 1997 2010. Any insurer who,12
on September 1, 1997 2010, has health and accident insurance policies or health13
maintenance organization subscriber agreements in force in this state shall have until14
September 1, 1998 2011, to convert such existing policies to conform to the15
provisions of this Section.16
* * *17
§ 1003.1. Unmarried children; premiums, portability, enrollment18
A. In reference to R.S. 22:1003, the following shall apply:19
(1) The premium for coverage under any family group health and20
accident insurance policy, group health and accident insurance policy or similar21
coverage issued by a health maintenance organization in this state shall not22
increase on the basis of the addition of unmarried children or unmarried23
grandchildren under the age of twenty-six unless there are no dependents24
covered under the policy prior to the addition of such unmarried children or25
unmarried grandchildren. The health insurance issuer or health maintenance26
organization shall apply portability rights in reference to pre-existing conditions27
to the newly added unmarried children or unmarried grandchildren as28
described in R.S. 22:1062(A) and (B) . The pre-existing condition waiting period29 SB NO. 668
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applicable to such unmarried children or unmarried grandchildren shall be1
applied to the unmarried children or unmarried grandchildren in the same2
manner as any other dependent.3
(2) The health insurance issuer or health maintenance organization shall4
offer to all insureds or enrollees a special enrollment period of not less than5
thirty days upon request of the insured or enrollee to include unmarried6
children or unmarried grandchildren under the age of twenty-six as a new7
entrant covered under the policy or subscriber agreement. It is solely the8
insured or enrollee's decision whether to add such unmarried children or9
unmarried grandchildren to the policy or subscriber agreement.10
(3) The health insurance issuer or health maintenance organization may11
not limit or otherwise restrict the offer of coverage to unmarried children or12
unmarried grandchildren under the age of twenty-six by requiring any of the13
following:14
(a) That the unmarried children or unmarried grandchildren had to15
have been previously covered as a dependent;16
(b) That the unmarried children or unmarried grandchildren reside in17
this state;18
(c) That the unmarried children or unmarried grandchildren19
demonstrate that he or she had previous creditable coverage; or20
(d) That the enrollee or insured requested coverage for the unmarried21
children or unmarried grandchildren the first time such children or22
grandchildren were eligible for coverage.23
(4) The health insurance issuer or health maintenance organization may24
not deny coverage to unmarried children or unmarried grandchildren under25
the age of twenty-six when the enrollee or insured requests coverage.26
(5) The health insurance issuer or health maintenance organization shall27
offer coverage for an enrollee or insured's unmarried children or unmarried28
grandchildren under the age of twenty-six as new entrants through special29 SB NO. 668
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enrollment and shall annually provide at least a thirty day enrollment period.1
The health insurance issuer or health maintenance organization may request2
documentation of such unmarried children or unmarried grandchildren's3
creditable coverage to determine portability.4
B. The provisions of this Section shall apply to all policies or subscriber5
agreements issued or renewed or issued for delivery in this state after6
September 1, 2010. Any insurer who, on September 1, 2010, has health and7
accident insurance policies or health maintenance organization subscriber8
agreements in force in this state shall have until September 1, 2011, to convert9
such existing policies to conform to the provisions of this Section.10
Section 2. R.S. 22:1002 is hereby repealed in its entirety.11
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Horne.
DIGEST
Proposed law provides as follows:
Present law, with respect to group, family group, blanket, and association health and
accident insurance, allows dependent coverage of unmarried 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 retains present law and increases the age for such dependent coverage from
21 to 26 years of age.
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, 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 21 and any other
person dependent upon the policyholder.
Proposed law retains present law but increases the age for dependent coverage to 26 years
of age and deletes the requirement that unmarried grandchildren under 21 years of age be
in the legal custody of and residing with the grandparent. Provides for coverage of one with
a mental or physical handicap who became incapable prior to age 26.
Present law provides for dependent coverage if any described dependent 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 SB NO. 668
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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 to 26 years of age and deletes the requirement for full-time student
status.
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 unmarried children includes unmarried grandchildren in the
legal custody of and residing with a grandparent, deletes the requirement for full-time
student status, and increases the age for dependent coverage to the age of 26.
Present law provides for dependent coverage if any described dependent 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 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 to 26 years
of age and deletes the requirement for full-time student status.
Proposed law further provides that the premium for coverage under any family group health
and accident insurance policy, group health and accident insurance policy, or similar
coverage issued by a HMO shall not increase on the basis of the addition of unmarried
children or unmarried grandchildren under 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 pre-existing conditions to the newly
added unmarried children or unmarried grandchildren as described in present law relative
to such conditions. Specifies that the pre-existing condition waiting period applicable to
such child shall be applied to that child in the same manner as any other dependent.
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 unmarried children or unmarried grandchildren under 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.
Proposed law additionally prohibits the health insurance issuer or HMO from limiting or
otherwise restricting the offer of coverage to unmarried children or unmarried grandchildren
under 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.
Proposed law further prohibits the health insurance issuer or HMO from denying coverage
to unmarried children or unmarried grandchildren under the age of 26 when the enrollee or
insured requests coverage. SB NO. 668
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Proposed law further requires that the health insurance issuer or HMO offer coverage for an
enrollee's or insured's unmarried children or unmarried grandchildren under 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.
Proposed law provides that it shall apply to all policies issued or renewed in this state after
September 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 September 1,
2011, to convert such existing policies or agreements to conform to proposed law.
Proposed law repeals the provision requiring children attending vocational, technical or trade
schools or institutes in Louisiana on a full-time basis to be considered as full-time students
for purposes of coverage by family group health and accident insurance policies.
Effective 8/15/10.
(Amends R.S. 22:1000(A)(1)(a)(vi) and (2) and 1003; adds R.S. 22:1003.1; repeals R.S.
22:1002)