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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 release of certain group information to the
group policyholder or his agent prior to renewal of a group policy. (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 policyholder or13
agent of a policyholder claims data upon request and shall provide this data14
within no more than fourteen business days of receipt of the request, which shall15
include the following items:16
(a) The net claims paid by month during the policy period.17 SB NO. 173
SLS 11RS-350 REENGROSSED
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
(b) The monthly enrollment by employee only, employee and spouse,1
employee and family during the policy period.2
(c) The amount of any claims reserve established by the insurance3
provider against future claims under the policy.4
(d) Claims over ten thousand dollars including claimant identifier, the5
date of occurrence, the amount of claims paid and those unpaid or outstanding,6
and claimant health condition or diagnosis.7
(e) A complete listing of all potential catastrophic diagnosis and8
prognosis involving persons covered under the policy provisions.9
(2) The provisions of this Subsection shall not be construed to authorize10
the disclosure of the identity of a particular employee covered under the group11
policy nor the disclosure of any individual employee's particular health12
insurance claim, condition, diagnosis, or prognosis which disclosure would13
violate federal or state law.14
(3) For purposes of this Subsection, "claim identifier" shall be defined15
as data that reflects a number designation, including but not limited to, an16
alpha or numeric designation which shall not be a name identifier of an17
employee, employee's spouse, or employee's dependent.18
The original instrument was prepared by Cheryl Horne. The following digest,
which does not constitute a part of the legislative instrument, was prepared
by Christopher D. Adams.
DIGEST
Adley (SB 173)
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, not less than 90 days prior to the
renewal of a policy, to release to each group policyholder or agent of a policyholder, claims
data upon request and shall provide this data within no more than fourteen business days of
receipt of the request. Provides that the data shall include: SB NO. 173
SLS 11RS-350 REENGROSSED
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
(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. 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.
Proposed law defines claims identifier as data that reflects a number designation, including
but not limited to, an alpha or numeric designation which shall not be a name identifier of
an employee, employee's spouse, or employee's dependent.
Effective August 15, 2011.
(Adds R.S. 22:978(E))
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original
bill.
1. Requires release of claims data to an agent of a policyholder upon request no
more than 14 business days of receipt of the request.
2. Defines claim identifier.
Senate Floor Amendments to engrossed bill.
1. Legislative Bureau technical amendment.