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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Regular Session, 2010 ENROLLED
SENATE BILL NO. 705
BY SENATOR DONAHUE
AN ACT1
To amend and reenact R.S. 22:1000(A)(1) and (B), relative to health and accident insurance;2
to provide for group policies issued to trusts for multiple associations; to provide for3
coverage involving such associations and their members and employees; to provide4
for definition of "participating association"; and to provide for related matters.5
Be it enacted by the Legislature of Louisiana:6
Section 1. R.S. 22:1000(A)(1) and (B) are hereby amended and reenacted to read as7
follows: 8
ยง1000. 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) The policy shall be issued to an employer or association, or trustees of16
a fund established by an employer , or association, or a trust for multiple17
associations who shall be deemed the policyholder, covering one or more employees18
of such employer or one or more members or employees of members of such19
association or multiple associations, for the benefit of persons other than the20
employer, or the association, or the multiple associations, as well as their its21
officers or trustees, upon some plan which will preclude individual selection.22
(ii) The premium may be paid by the employer , or association or multiple23
associations, by the employees , or members or employees of members, or by the24
ACT No. 896 SB NO. 705 ENROLLED
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words in boldface type and underscored are additions.
two parties jointly. An insurer may but shall not be required to establish a percentage1
of eligible employees who are required to enroll and participate in a group health and2
accident policy if the entire premium is not paid by the employer , or association or3
multiple associations.4
(iii) If the policy is issued to any employer, any class or classes of employees5
eligible for coverage must be determined by conditions pertaining to their6
employment or age.7
(iv) No such policy issued under individual certificates and considered as8
individual insurance coverage for purposes of this Subpart and R.S. 22:984, 10619
through 1079, and 2247 may be issued to an association or trust for multiple10
associations unless such association or each participating association in the11
multiple associations, having had an active existence for at least five years, has a12
constitution and bylaws and has been organized and is maintained in good faith for13
purposes other than those of obtaining insurance, does not condition membership14
in the association or multiple associations on any health status-related factor15
relating to an individual, including an employee of an employer or a dependent16
of an employee, and does not make health insurance coverage offered through17
the association or multiple associations available other than in connection with18
a member of the association or multiple associations. No such policy, issued and19
considered as group health insurance, as defined under R.S. 22:1061(2)(c), may be20
issued to an association, trust for an association, or multiple associations unless21
it is a bona fide association as defined under R.S. 22:1061(5)(b) it or each22
participating association has been actively in existence for at least five years, has23
been formed and maintained in good faith for purposes other than obtaining24
insurance, does not condition membership in the association or multiple25
associations on any health status-related factor relating to an individual,26
including an employee of an employer or a dependent of an employee, and does27
not make health insurance coverage offered through the association or multiple28
associations available other than in connection with a member of the29
association. Such individual or group policy may be issued to a trust established30 SB NO. 705 ENROLLED
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
by an association or associations to allow multiple associations to participate.1
(v) The insurer shall issue to the employer , or association, or the multiple2
associations for delivery to each employee or member insured under such group3
policy, an individual certificate containing a statement as to the insurance protection4
to which he is entitled and to whom payable.5
(vi) The policy may be issued to an employer, association, a trust for6
multiple associations or to the trustees of a fund established by two or more7
employers in the same industry or by one or more labor unions, or by one or more8
employers and one or more labor unions or by an association, or multiple9
associations, or to a multiple employer trust or multiple association trust10
established by an insurer on behalf of participating employers or participating11
associations, in the multiple associations, provided all participating employers and12
employees or members, or employees of members of one of the multiple13
participating associations have the same statutory protections that would apply if14
such policy was purchased by the employer, association or multiple associations15
directly from the insurer, which trustees shall be deemed the policyholder, to insure16
with or without any eligible family members including spouse, unmarried children17
under twenty-o ne years of age, and unmarried grandchildren who are in the legal18
custody of and residing with the grandparent under twenty-one years of age,19
employees of the employers , or members of the association or employees of20
members of a multiple association, or of the unions for the benefit of persons other21
than the employers or the unions.22
(b) The benefits payable under any policy or contract of group health and23
accident insurance shall be payable to the employee , or members or employees of24
members of multiple associations or to some beneficiary or beneficiaries25
designated by him, other than the employer or association or multiple associations,26
but if there is no designated beneficiary as to all or any part of the insurance at the27
death of the employee , or member or employee of members, then the amount of28
insurance payable for which there is no designated beneficiary shall be payable to29
the estate of the employee , or member or employee of members, except that the30 SB NO. 705 ENROLLED
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insurer may in such case, at its option, pay such insurance to any one or more of the1
following surviving relatives of the employee , or member or employee of members:2
wife, husband, mother, father, child, or children, brothers or sisters; and except that3
payment of benefits for expenses incurred on account of hospitalization or medical4
or surgical aid, may be made by the insurer to the hospital or other person or persons5
furnishing such aid. Payment so made shall discharge the insurer's obligations with6
respect to the amount of insurance so paid.7
(d) (c) Except as may otherwise be provided in the policy or contract of8
group health and accident insurance or by R.S. 22:1012, the policyholder and the9
insurer may agree to modify, amend, or cancel the group policy, and such agreement10
shall be binding upon the employee , or member, or employee of members insured11
under the group policy, provided that the modification, amendment, or cancellation12
shall be without prejudice to any claim for benefits accrued, or for expenses incurred13
for services rendered, prior to such modification, amendment, or cancellation.14
Benefits and expenses incurred shall be as defined and limited by the terms of the15
policy; however, upon cancellation by the insurer, the insurer shall only be liable for16
any claim for benefits accrued, or for expenses incurred for services rendered,17
subsequent to the cancellation date if the subsequent claim is for an illness or18
condition which was the basis of any claim prior to cancellation and for which the19
insurer had notice. Any cancellation pursuant to this Paragraph shall also comply20
with the provisions of R.S. 22:887(F).21
(e) (d) Except as may otherwise be provided in the policy or contract of22
group health and accident insurance, the insurer shall not be liable for benefits23
accrued, or for expenses incurred for services rendered, subsequent to the24
termination date where the policy of insurance terminates for failure of the group25
policyholder to pay premiums or where the employee's , or member's, or member's26
employee's coverage terminated for failure of the employee , or member, or27
employee of members to maintain eligibility as provided in the policy or contract28
of group health and accident insurance.29
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B.(1) The term "employees" as used in this Section shall be deemed to1
include, for the purposes of insurance hereunder, as employees of a single employer,2
the officers, managers, and employees of the employer and of subsidiary or affiliated3
corporations of a corporation employer, and the individual proprietors, partners, and4
employees of individuals and firms of which the business is controlled by the insured5
employer through stock ownership, contract or otherwise. The term "employer" as6
used herein may be deemed to include any governmental corporation, unit, agency7
or department thereof, or the proper officers, as such, of any unincorporated8
governmental organization.9
(2) As used in this Section, "participating association" shall mean an10
association that has, by virtue of an affirmative vote, consensus, or similar11
decision in accordance with the association's bylaws or conventions, acted12
overtly through its staff or elected leaders, acting within the scope of their13
authority, to enter into an agreement with one or more other associations to be14
a partner in a multiple association trust on terms mutually agreeable to all15
associations participating in the multiple association trust.16
* * *17
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: