HLS 12RS-1020 ORIGINAL
Page 1 of 3
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Regular Session, 2012
HOUSE BILL NO. 868
BY REPRESENTATIVE PEARSON
INSURANCE/HEALTH: Provides relative to continuation of coverage for spouses and
dependents
AN ACT1
To amend and reenact R.S. 22:1045(B) and (C) and to enact R.S. 22:1045(D), relative to2
group, blanket, and association policies; to provide for continuation of group,3
blanket, and association coverage; and to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1045(B) and (C) are hereby amended and reenacted and R.S.6
22:1045(D) is hereby enacted to read as follows: 7
ยง1045. Group, blanket, and association health and accident insurance; continuation8
of coverage9
* * *10
B. Each group, blanket, or association insurance policy that is sponsored by11
an employer who employs twenty or more employees and contains provisions for12
payment by the insurer of benefits for expenses incurred for hospital, nursing,13
medical, or surgical services, issued or renewed in this state on or after September14
30, 2012, shall include within its provisions the following:15
(1) An option for all surviving spouses, who have not reached fifty years of16
age, of deceased employees covered by the group plan by virtue of their family17
relationship to a group member to continue as a member of the group plan when their18
eligibility for group coverage ceases due to the death of the employee-member.19 HLS 12RS-1020 ORIGINAL
HB NO. 868
Page 2 of 3
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
(2) An option for spouses covered by the group plan by virtue of their1
marital relationship, upon the severance of the marital relationship to the employee-2
member, to continue as a member of the group plan.3
(3) An option for dependent children covered by virtue of their family4
relationship to a group member to continue as a member of the group plan when their5
eligibility for group coverage ceases due to the death of the employee-member, the6
severance of the family relationship, or upon the loss of dependent child status under7
the plan rules.8
(4) The continuation option provided for above shall not be conditioned upon9
any physical examination.10
(5) The continuation option shall entitle the surviving or former spouse or11
dependent to coverage identical in scope to that provided for under the group plan.12
(6) The policyholder shall be responsible for billing and collection of the13
premium; however, the premium amount shall not exceed the premium assessed for14
each group member under the group insurance policy. The premium shall be based15
upon the community costs of the pool of members of the group insurance policy,16
family members, or dependents covered under the group policy.17
(7) The surviving or former spouse or dependent shall have ninety days after18
the date of death to notify the insurer that the continuation option will be exercised.19
Coverage under the group insurance plan shall not be terminated during the ninety20
day notification period. No probationary or waiting period shall be required.21
(8) If the continuation option is exercised, coverage of the surviving or22
former spouse or dependent under the group plan shall continue without interruption23
and may not be terminated for a period of one year, unless one of the following24
occurs:25
(a) The insured fails to make timely payment of the required premium26
amount.27
(b) The insured becomes eligible to participate in another group health plan28
and accident insurance plan.29 HLS 12RS-1020 ORIGINAL
HB NO. 868
Page 3 of 3
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
B. C. If the insurer has been furnished with the home address of the1
surviving or former spouse or dependent and has been notified of the death of the2
employee by the policy owner, the insurer shall notify the surviving spouse of the3
right to the continuation option.4
C. D. This Section shall not be construed to interfere with or diminish any5
protection already provided pursuant to collective bargaining agreements and6
employer-sponsored plans that are more favorable to the surviving spouses benefited7
thereby than the protection offered by this Section.8
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. 868
Abstract: Provides for the temporary continuation of group health, blanket, and association
services for surviving spouses of all ages, former spouses, and dependents.
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 extends the option for continuation to surviving spouses under the age of 50,
as well as to divorcing spouses and dependents who were members of a health plan as a
result of a familial relationship. Dependents shall have the right of continuation in the event
of death of the policyholder, the severance of the family relationship, or upon the loss of
dependent status under the terms of the plan. Proposed law provides that people who fit into
this category of continuation of benefits shall be able to continue on the plan for a 12 month
period.
Proposed law provides that an individual who exercises the option to continue group
coverage shall not be required to take and pass a physical examination as a condition to
continuing coverage.
Present law provides that if an insurer has been furnished with the home address of the
surviving spouse, it shall notify the surviving spouse of the continuation option.
Proposed law retains present law and further extends the notification requirement to former
spouses and dependents.
(Amends R.S. 22:1045(B) and (C); Adds R.S. 22:1045(D))