SLS 11RS-350 ORIGINAL
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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, 2011
SENATE BILL NO. 173
BY SENATOR ADLEY
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
HEALTH/ACC INSURANCE. Provides for health insurance claims reform. (8/15/11)
AN ACT1
To enact R.S. 22:978(E), relative to group, family group, blanket, and association health and2
accident insurance; to provide with respect to notice required for certain premium3
increase, cancellation, or nonrenewal; to provide for the release of claims data, and4
to provide for related matters.5
Be it enacted by the Legislature of Louisiana:6
Section 1. R.S. 22:978(E) is hereby enacted to read as follows: 7
ยง978. Group, family group, blanket, and association health and accident insurance;8
notice required for certain premium increase, cancellation, or9
nonrenewal10
* * *11
E. (1) Not less than ninety days prior to the renewal of a policy, every12
health and accident insurance issuer shall release to each group policyholder13
claims data which shall include the following:14
(a) The net claims paid by month during the policy period.15
(b) The monthly enrollment by employee only, employee and spouse,16
employee and family during the policy period.17 SB NO. 173
SLS 11RS-350 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
(c) The amount of any claims reserve established by the insurance1
provider against future claims under the policy.2
(d) Claims over ten thousand dollars including claimant identifier, the3
date of occurrence, the amount of claims paid and those unpaid or outstanding,4
and claimant health condition or diagnosis.5
(e) A complete listing of all potential catastrophic diagnosis and6
prognosis involving persons covered under the policy provisions.7
(2) The provisions of this Subsection shall not be construed to authorize8
the disclosure of the identity of a particular employee covered under the group9
policy nor the disclosure of any individual employee's particular health10
insurance claim, condition, diagnosis, or prognosis which disclosure would11
violate federal or state law.12
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Horne.
DIGEST
Present law requires every insurer to notify the policyholder in writing at least forty-five
days before any increase of twenty percent or more in the policy rates or at least sixty days
before any cancellation or nonrenewal of a policy. Requires every health insurance issuer
providing coverage to an employer group comprising more than 100 enrollees to provide the
premium rate or amount to be paid to renew the group policy at least ninety days prior to the
date of renewal or termination.
Proposed law retains present law.
Proposed law requires every health insurance issuer to provide claims data not less than 90
days prior to the renewal of a policy. Provides for the claims data to include:
(1)net claims paid by month during the policy period.
(2)monthly enrollment by employee only, employee and spouse, employee and family
during the policy period.
(3)the amount of any claims reserve established by the insurance provider against future
claims.
(4)claims over $10,000 including claimant identifier, the date of occurrence, the amount
of claims paid and those unpaid or outstanding, and claimant health condition or
diagnosis.
(5)a complete listing of all potential catastrophic diagnosis and prognosis involving
persons covered by the policy. SB NO. 173
SLS 11RS-350 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Proposed law does not authorize disclosure of the identity of particular employees nor of
their particular health insurance claim, condition, diagnosis or prognosis if disclosure would
violate any federal or state law.
Effective August 15, 2011.
(Adds R.S. 22:978(E))