SLS 12RS-1014 ORIGINAL
Page 1 of 4
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. 636
BY SENATOR DORSEY-COLOMB
HEALTH/ACC INSURANCE. Requires insurance plans to provide coverage for a
minimum forty-eight hour time period in a hospital after a mastectomy. (8/1/12)
AN ACT1
To enact R.S. 22:1076.1, relative to required health insurance coverage for hospitalization2
after a mastectomy; and to provide for related matters.3
Be it enacted by the Legislature of Louisiana:4
Section 1. R.S. 22:1076.1 is hereby enacted to read as follows: 5
ยง1076.1. Required coverage for hospitalization following mastectomies6
A. A group health plan, a health insurance insurer providing health7
insurance coverage in connection with a group health plan, or health insurance8
coverage offered by a health insurance insurer in the individual market that9
provides medical and surgical benefits with respect to a mastectomy shall10
provide, in the case of a participant or beneficiary who is receiving benefits in11
connection with a mastectomy, coverage for a minimum of forty-eight hours of12
hospitalization after all states of mastectomy, including lymphedemas. The13
coverage to be provided shall be determined in consultation with the attending14
physician and the patient. The coverage required by this Section may be subject15
to annual deductibles, coinsurance, and copayment provisions which are16
deemed appropriate and are consistent with those established for other benefits17 SB NO. 636
SLS 12RS-1014 ORIGINAL
Page 2 of 4
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
under the plan or coverage. Written notice of the coverage required by this1
Section shall be delivered to the participant upon enrollment and annually2
thereafter as approved by the commissioner of insurance.3
B.(1) A group health plan, a health insurance insurer providing health4
insurance coverage in connection with a group health plan, or health insurance5
coverage offered by a health insurance insurer in the individual market shall6
provide notice to each participant and beneficiary under such plan regarding7
the coverage provided as required by this Section in accordance with8
regulations adopted by the department. This notice shall be in writing and9
prominently positioned in any literature or correspondence made available or10
distributed by the plan or issuer and shall be transmitted in one of the following11
ways, whichever is earlier:12
(a) In the next mailing made by the plan or insurer to the participant or13
beneficiary.14
(b) As part of any yearly informational packet sent to the participant or15
beneficiary.16
(2) In no case shall the notice required pursuant to this Subsection17
provided to current participants or beneficiaries be mailed, sent, or otherwise18
distributed later than January 1, 2013.19
C. A group health plan, a health insurance insurer offering group health20
insurance coverage in connection with a group health plan, or health insurance21
coverage offered by a health insurance insurer in the individual market shall22
not do either of the following:23
(1) Deny to a patient eligibility, or continued eligibility, to enroll or to24
renew coverage under the terms of the plan solely for the purpose of avoiding25
the requirements of this Section.26
(2) Penalize or otherwise reduce or limit the reimbursement of an27
attending provider, or provide monetary or nonmonetary incentives to an28
attending provider, to induce such provider to provide care to an individual29 SB NO. 636
SLS 12RS-1014 ORIGINAL
Page 3 of 4
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
participant or beneficiary in a manner inconsistent with this Section.1
D. In the case of a group health plan maintained pursuant to one or more2
collective bargaining agreements between employee representatives and one or3
more employers, any amendment to the group health plan made pursuant to a4
collective bargaining agreement for the sole purpose of conforming with5
requirements imposed pursuant to this Section shall not be treated as a6
termination of the collective bargaining agreement.7
E. A group health plan, a health insurance insurer providing health8
insurance coverage in connection with a group health plan, or health insurance9
coverage offered by a health insurance insurer in the individual market that10
provides medical and surgical benefits with respect to a mastectomy is not11
required to comply with the requirements of this Section if the patient and the12
attending physician determine that a shorter period of hospitalization care is13
appropriate.14
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Horne.
DIGEST
Proposed law requires a group health plan, a health insurance insurer providing health
insurance in connection with a group health plan, or health insurance coverage offered by
a health insurance insurer in the individual market that provides medical and surgical
benefits with respect to a mastectomy shall provide coverage for a minimum of 48 hours
hospitalization after all states of a mastectomy, including lymphedemas.
Proposed law requires written notice of such coverage to be delivered to the participant upon
enrollment and annually thereafter as approved by the commissioner. Further requires notice
to each participant and beneficiary under a plan regarding the coverage required in proposed
law to be transmitted in one of the following ways, whichever is earlier:
1. In the next mailing made by the plan or insurer to the participant or beneficiary.
2. As part of any yearly informational packet sent to the participant or beneficiary.
Further provides that the notice required by proposed law shall be distributed to current plan
participants not later than January 1, 2013.
Proposed law prohibits an insurer from either of the following:
1. Denying to a patient eligibility, or continued eligibility, to enroll or to renew
coverage under the terms of the plan solely for the purpose of avoiding the
requirements in proposed law. SB NO. 636
SLS 12RS-1014 ORIGINAL
Page 4 of 4
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
2. Penalizing or otherwise reducing or limiting the reimbursement of an attending
provider, or provide monetary or nonmonetary incentives to an attending provider,
to induce such provider to provide care to an insured in a manner inconsistent with
proposed law.
Proposed law provides that in the case of a group health plan maintained pursuant to one or
more collective bargaining agreements between employee representatives and one or more
employers, any amendment to the group health plan made pursuant to a collective bargaining
agreement amending the plan solely to conform to proposed law shall not be treated as a
termination of the agreement.
Proposed law exempts an insurer from the requirements in proposed law if the insured and
the insured's attending physician determine that a shorter period of hospitalization is
appropriate.
Effective August 1, 2012.
(Adds R.S. 22:1076.1)