ENROLLED
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ACT No. 217
Regular Session, 2012
HOUSE BILL NO. 989
BY REPRESENTATIVES HUVAL, PIERRE, REYNOLDS, RITCHIE, TALBOT, AND
THIBAUT
AN ACT1
To enact R.S. 22:978(E) and (F), relative to group, family group, blanket, and association2
health and accident insurance and health maintenance organizations; to provide with3
respect to notice required for certain premium increase, cancellation, or nonrenewal;4
to provide for the release of claims data; to provide with respect to civil immunity5
and certifications; and to provide for related matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. R.S. 22:978(E) and (F) are hereby enacted to read as follows: 8
ยง978. Group, family group, blanket, and association health and accident insurance;9
notice required for certain premium increase, cancellation, or nonrenewal10
* * *11
E.(1) Not less than ninety days prior to the renewal of a policy, every health12
and accident insurance issuer, including a health maintenance organization, shall,13
upon request, release to each group policyholder or agent of a policyholder claims14
data and shall provide this data within no more than fourteen business days of receipt15
of the request, which shall include the following items:16
(a) The net claims paid by month during the policy period.17
(b) The monthly enrollment by employee only, employee and spouse, and18
employee and family during the policy period.19
(c) The amount of any claims reserve established by the insurance provider20
against future claims under the policy.21
(d) Claims over ten thousand dollars including claim identifier, the date of22
occurrence, the amount of claims paid and those unpaid or outstanding, and claimant23
health condition or diagnosis.24 ENROLLEDHB NO. 989
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(e) A complete listing of all potential catastrophic diagnoses and prognoses1
involving persons covered under the policy provisions.2
(2) A health and accident insurer that discloses data or information in3
compliance with the provisions of this Section may condition any such disclosure4
upon the execution of an agreement for immunity from civil liability.5
(3) A health and accident insurer that provides data or information in6
compliance with the provisions of this Section shall be immune from civil liability7
for any acts or omissions of any person's subsequent use of such data or information.8
(4) The provisions of this Subsection shall not be construed to authorize the9
disclosure of the identity of a particular employee covered under the group policy,10
nor the disclosure of any individual employee's particular health insurance claim,11
condition, diagnosis, or prognosis, which would violate federal or state law.12
(5) For purposes of this Subsection, "claim identifier" shall be defined as13
data that reflects a number designation including but not limited to an alphabetic or14
alphanumeric designation which shall not be a name identifier of an employee,15
employee's spouse, or employee's dependent.16
(6) The provisions of this Subsection shall not apply to limited benefit17
insurance, as defined by R.S. 22:47(2)(c).18
(7) A plan sponsor is entitled to receive protected health information under19
this Section only after an appropriately authorized representative of the plan sponsor20
makes to the health and accident insurer a certification substantially similar to the21
following certification:22
'I hereby certify and have demonstrated that the plan23
documents comply with the requirements of 45 C.F.R.24
Section 164.504(f)(2) and that the plan sponsor will safeguard25
and limit the use and disclosure of protected health26
information that the plan sponsor may receive from the group27
health plan to perform the plan administration functions.'28
(8) A plan sponsor that does not provide the certification required in29
Paragraph (7) of this Subsection is not entitled to receive the protected health30 ENROLLEDHB NO. 989
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information described in Subparagraphs (1)(d) and (e) of this Subsection, but is1
entitled to receive a report of claim information that includes the other information2
required by this Subsection.3
F. For purposes of this Section, the term "health and accident insurer" or4
"health and accident insurance issuer" shall include a health maintenance5
organization, the term "policy" shall include a subscriber agreement, and the term6
"policyholder" shall include an enrollee or subscriber of a health maintenance7
organization.8
Section 2. This Act shall become effective on January 1, 2013.9
SPEAKER OF THE HOUSE OF REPRESENTATI VES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: