HLS 14RS-1433 ORIGINAL
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Regular Session, 2014
HOUSE BILL NO. 711
BY REPRESENTATIVE GREENE
INSURANCE/HEALTH: Require health plans to collect co-insurance and deductibles
AN ACT1
To enact R.S. 22:1839, relative to health insurance; to provide for the collection of2
coinsurance and deductibles by health insurance issuers; to provide for definitions;3
to provide for exclusions; and to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1839 is hereby enacted to read as follows: 6
ยง1839. Health insurance issuer collection of coinsurance and deductibles7
A. As used in this Section, the following terms are defined as follows:8
(1) "Coinsurance" means a percentage of the allowed charge, after a9
copayment, if any, that an insured will pay for covered services received under the10
applicable health insurance coverage.11
(2) "Copayment" means a fixed dollar amount structured by the insurer that12
may be required to be paid by the insured to the healthcare provider at the time the13
patient receives covered services.14
(3) "Deductible" means an annual dollar amount that shall be paid by an15
insured for the provision of healthcare services that an insured uses before the health16
insurance issuer becomes obligated to pay for covered services; the term shall not17
include any portion of the premium paid by the insured.18
(4) "Health insurance coverage" or "coverage" means benefits consisting of19
healthcare services provided directly, through insurance or reimbursement, or20 HLS 14RS-1433 ORIGINAL
HB NO. 711
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otherwise and including items and services paid for as healthcare services under any1
hospital or medical service policy or certificate, hospital or medical service plan2
contract, preferred provider organization agreement, or health maintenance3
organization contract offered by a health insurance issuer. However, "health4
insurance coverage" or "coverage" shall not include benefits due under Chapter 105
of Title 23 of the Louisiana Revised Statutes of 1950 or limited benefit and6
supplemental health insurance policies, benefits provided under a separate policy,7
certificate, or contract of insurance for accidents, disability income, limited scope8
dental or vision benefits, or benefits for long-term care, nursing home care, home9
healthcare, or specific diseases or illnesses.10
(5) "Health insurance issuer" or "issuer" means any entity that offers health11
insurance coverage through a policy, contract, or certificate of insurance subject to12
state law that regulates the business of insurance. For purposes of this Subpart, a13
"health insurance issuer" or "issuer" shall include but not be limited to a health14
maintenance organization as defined and licensed pursuant to Subpart I of Part I of15
Chapter 2 of this Title. 16
B. A health insurance issuer shall not execute, amend, or renew any contract17
with a healthcare provider which requires the healthcare provider to collect any18
applicable coinsurance or deductible amount which may be the responsibility of the19
insured pursuant to the insured's contract for health insurance coverage. A health20
insurance insurer licensed pursuant to the provisions of this Title shall recover all21
co-insurance and deductible amounts due from patients for covered services as22
required under the health insurance insurer's health insurance coverage. Payment of23
claims submitted by healthcare providers shall not be dependent on the health24
insurance insurer recovering any applicable coinsurance and deductible amounts nor25
shall collection of any applicable coinsurance, deductible, and copayment amounts26
be required to be completed prior to processing and paying a claim made by a27
healthcare provider.28 HLS 14RS-1433 ORIGINAL
HB NO. 711
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C. The provisions of this Section shall not have any effect as to the collection1
of copayments.2
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)]
Greene HB No. 711
Abstract: Provides for collection by the insurer of applicable coinsurance or deductible
amounts owed by an insured under the policy.
Present law provides that healthcare providers are responsible for collecting the amount of
any coinsurance or deductibles applicable to a health insurance policy from the insured.
Proposed law provides that the healthcare insurer issuing a policy that requires coinsurance
or deductibles from the insured is responsible for collection of those amounts.
Proposed law defines certain terms.
(Adds R.S. 22:1839)