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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, 2012
SENATE BILL NO. 283
BY SENATOR ADLEY
HEALTH/ACC INSURANCE. Provides for release of certain group information to the
group policyholder or his agent prior to renewal of a group policy. (8/1/12)
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, upon request, release to each group13
policyholder or agent of a policyholder claims data 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. 283
SLS 12RS-713 ORIGINAL
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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, and1
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 claim identifier, the date5
of occurrence, the amount of claims paid and those unpaid or outstanding, and6
claimant health condition or diagnosis.7
(e) A complete listing of all potential catastrophic diagnoses and8
prognoses 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
alphabetic or alphanumeric designation which shall not be a name identifier of17
an employee, employee's spouse, or employee's dependent.18
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 45 days
before any increase of 20% or more in the policy rates or at least 60 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 90 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 14 business days of receipt
of the request. Provides that the data shall include:
1. Net claims paid by month during the policy period. SB NO. 283
SLS 12RS-713 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
2. Monthly enrollment by employee only, employee and spouse, and 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 claim 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 diagnoses and prognoses 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 "claim identifier" as data that reflects a number designation, including
but not limited to, an alphabetic or alphanumeric designation which shall not be a name
identifier of an employee, employee's spouse, or employee's dependent.
Effective August 1, 2012.
(Adds R.S. 22:978(E))