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Regular Session, 2014
HOUSE BILL NO. 852
BY REPRESENTATIVE TALBOT
INSURANCE/GROUP: Provides relative to the disclosure of insurance claims data
AN ACT1
To amend and reenact R.S. 22:978(E)(1)(introductory paragraph), (a), (b), (d), and (e), (7),2
and (8) and to enact R.S. 22:978(G), relative to insurance claims data; to provide for3
the release of claims data to agents; to require the agent receiving the claims data to4
certify the limited use of the data; to provide that an insurer shall not be required to5
release information protected as confidential by federal law; and to provide for6
related matters.7
Be it enacted by the Legislature of Louisiana:8
Section 1. R.S. 22:978(E)(1)(introductory paragraph), (a), (b), (d), and (e), (7), and9
(8) are hereby amended and reenacted and R.S. 22:978(G) is enacted to read as follows: 10
ยง978. Group, family group, blanket, and association health and accident insurance;11
notice required for certain premium increase, cancellation, or nonrenewal12
* * *13
E.(1) Not less than ninety days prior to the renewal of a policy, every health14
Every health and accident insurance issuer, including a health maintenance15
organization, shall, upon request, release to each group policyholder or and agent of16
a policyholder claims data and shall provide this data within no more than fourteen17
business days of receipt of the request, which shall include the following items:18 HLS 14RS-1306 REENGROSSED
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(a) The net claims paid by month during the current and the two immediately1
preceding policy period periods.2
(b) The monthly enrollment by employee only, employee and spouse, and3
employee and family during the current and the two immediately preceding policy4
period periods.5
* * *6
(d) Claims over ten thousand dollars including claim identifier, the date of7
occurrence, the amount of claims paid and those unpaid or outstanding, and claimant8
health condition or diagnosis during the current and the two immediately preceding9
policy periods. The data shall provide a unique identifying number or code for the10
claimant.11
(e) A complete listing of all potential catastrophic diagnoses and prognoses12
involving persons covered under the policy provisions. The data shall provide a13
unique identifying number or code for the claimant.14
* * *15
(7) A plan sponsor is and the plan sponsor's agent are entitled to receive16
protected health information under this Section only after an appropriately17
authorized representative of the plan sponsor or agent makes to the health and18
accident insurer a certification substantially similar to the following certification:19
'I hereby certify and have demonstrated that the plan20
documents comply with the requirements of 45 C.F.R.21
Section 164.504(f)(2) and that the plan sponsor will safeguard22
and limit the use and disclosure of protected health23
information that the plan sponsor or agent may receive from24
the group health plan to perform the plan administration25
functions.'26
(8) A plan sponsor or agent that does not provide the certification required27
in Paragraph (7) of this Subsection is not entitled to receive the protected health28
information described in Subparagraphs (1)(d) and (e) of this Subsection, but is29 HLS 14RS-1306 REENGROSSED
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entitled to receive a report of claim information that includes the other information1
required by this Subsection.2
* * *3
G. Nothing in this Section shall be construed to require an insurer to provide4
information protected as confidential by the Health Insurance Portability and5
Accountability Act of 1996 or any other provision of federal law.6
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)]
Talbot HB No. 852
Abstract: Requires the release of claims data to the agent of a group policyholder, in
addition to the policyholder, within 90 days of renewal of the policy after the agent
certifies he will limit the use and disclosure of the claims data as provided by federal
regulation.
Present law provides for the release of claims data by a health and accident insurer within
90 days of renewal of the group policy to the group policyholder upon certification that the
policyholder will only use and disclose the data in compliance with federal regulation.
Proposed law retains present law but also provides for the release of the claims data to the
agent of the policyholder, and limits the claims data that must be released to the current and
two immediately preceding policy periods.
Proposed law provides that insurer shall not be required to release information protected as
confidential by federal law.
Proposed law requires that the data provide a unique identifying number or code for the
claimant.
(Amends R.S. 22:978(E)(1)(intro.para.), (a), (b), (d), and (e), (7), and (8); Adds R.S.
22:978(G))
Summary of Amendments Adopted by House
Committee Amendments Proposed by House Committee on Insurance to the original
bill.
1. Provided that an insurer shall not be required to release information protected as
confidential by federal law. HLS 14RS-1306 REENGROSSED
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House Floor Amendments to the engrossed bill.
1. Added provisions that the data provided must cover the current and two
immediately preceding policy periods regarding the monthly enrollment by the
employee, his spouse, and family, and that the data provided include a unique
identifying number or code for the claimant.
2. Made technical changes.