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Regular Session, 2012
HOUSE BILL NO. 1196 (Substitute for House Bill No. 868 by Representative Pearson)
BY REPRESENTATIVE PEARSON
INSURANCE/HEALTH: Provides relative to continuation of coverage for spouses and
dependents
AN ACT1
To amend and reenact R.S. 22:1046(B), (C), (F), and (G)(3) and (4) and to repeal R.S.2
22:1046(E), relative to group health plans; to provide for continuation of group3
health plans; and to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1046(B), (C), (F), and (G)(3) and (4) are hereby amended and6
reenacted to read as follows: 7
ยง1046. Group health insurance continuation8
* * *9
B. A group policy delivered or issued for delivery in this state which insures10
employees or members, and their eligible dependents, if they have elected to include11
them, for hospital, surgical or major medical insurance on an expense incurred or12
service basis, other than for specific diseases or for accidental injuries only, shall13
provide that employees or members whose insurance for these types of coverage14
under the group policy would otherwise terminate because of termination of active15
employment or membership, or termination of membership in the eligible class or16
classes under the policy death or divorce of the employee or member shall be entitled17
to continue their hospital, surgical, and medical insurance under that group policy,18
for themselves and or their eligible dependents with respect to whom they who were19
insured on the date of termination, subject to all of the group policy's terms and20
conditions applicable to those forms of insurance and to the conditions specified in21
this Section. The terms and conditions set forth in this Section are intended as22
minimum requirements and shall not be construed to impose additional or different23 HLS 12RS-2561 REENGROSSED
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requirements upon those group hospital, surgical, or major medical plans already in1
force, or hereafter placed into effect, that provide continuation benefits equal to or2
better than those required in this Section.3
C. Continuation shall only be available to an under this Section if the4
employee or member who has been continuously insured under the group policy, or5
for similar benefits under any other group policy that it replaced, during the period6
of three consecutive months immediately prior to the date of termination. The7
continued policy must cover all dependents covered under the group policy.8
* * *9
F. An employee or member electing continuation shall pay to the group10
policyholder or his employer, in advance, the amount of contribution required by the11
policyholder or employer, but not more than the full group rate for the insurance12
applicable to the employee or member under the group policy on the due date of each13
payment. The employee or member shall not be required to pay the amount of the14
contribution less often than monthly. In order to be eligible for continuation of15
coverage, the employee or member shall make a written election of continuation, on16
a form provided by the group policyholder, and pay the first contribution, in advance,17
to the policyholder or employer on or before the date on which the employee's or18
member's insurance would otherwise terminate. no later than the end of the month19
following the month in which the event that made the employer or member eligible20
for coverage under this Section occurs. Such form shall be as prescribed in this21
Section. If the dependent is eligible due to divorce, the event shall be deemed to have22
occurred on the date of the judgment of divorce.23
G. Continuation of insurance under the group policy for any person shall24
terminate on the earliest of the following dates:25
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(3) The date the employee or member becomes or is eligible to become27
covered for similar benefits under any arrangement of coverage for individuals in a28
group, whether insured or uninsured self-insured.29 HLS 12RS-2561 REENGROSSED
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(4) The date on which the group policy is terminated or, in the case of a1
multiple employer plan, the date his employer terminates participation under the2
group master policy. When this occurs the employee or member shall have a3
conversion privilege if the date of termination precedes that on which his actual4
continuation of insurance under that policy would have terminated. The insurer that5
insured the group prior to the date of termination shall make a converted policy6
available to the employee or member.7
* * *8
Section 2. R.S. 22:1046(E) is hereby repealed in its entirety.9
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)]
Pearson HB No. 1196
Abstract: Provides for the continuation of group health plans.
Present law provides the option of continuation of group health, blanket, and association
services for surviving spouses age 50 or older in the event of death of the spouse who is the
primary policyholder. Further provides that the spouse will be able to continue coverage by
paying a premium price which shall be no more than it was during the life of the decedent
spouse who was the employee-member and that coverage shall continue unless and until the
surviving spouse no longer makes timely payments, becomes eligible for Medicare, becomes
eligible for another health plan, or remarries.
Proposed law retains present law.
Proposed law requires an insured who wishes to continue coverage to elect continuation on
a form provided by the insurer and to pay the first month's premium in advance of the end
of the month following the month in which the event that made employee or member eligible
for coverage.
Proposed law provides that if the dependent is eligible due to divorce, the event shall be
deemed to have occurred on the date of the judgement of divorce.
(Amends R.S. 22:1046(B), (C), (F), and (G)(3) and (4); Repeals R.S. 22:1046(E))
Summary of Amendments Adopted by House
House Floor Amendments to the engrossed bill.
1. Removed provisions that would have made proposed law applicable to vision
and dental plans.
2. Restored provision in present law that requires an employee or member electing
continuation, upon their election to continue coverage, to pay their first HLS 12RS-2561 REENGROSSED
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contribution in advance of the date on which that employe e's or member's
insurance would otherwise terminate.
3. Relative to continuation of coverage, changed the date by which the first
contribution must be made from on or before the date on which the employee's
or member's insurance would otherwise terminate to no later than the end of the
month following the month in which the event that made employee or member
eligible for coverage.
4. Clarified that when the dependent is eligible for continuation due to divorce, the
qualifying event shall be deemed to have occurred on the date of the judgment
of divorce.
5. Removed provisions of proposed law that would mirror the Consolidated
Omnibus Budget Reconciliation Act. Further removed exceptions to proposed
law.