ENROLLED
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ACT No. 558
Regular Session, 2014
HOUSE BILL NO. 852
BY REPRESENTATIVE TALBOT
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
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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
(a) The net claims paid by month during the current and the two immediately19
preceding policy period periods.20
(b) The monthly enrollment by employee only, employee and spouse, and21
employee and family during the current and the two immediately preceding policy22
period periods.23
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(d) Claims over ten thousand dollars including claim identifier, the date of1
occurrence, the amount of claims paid and those unpaid or outstanding, and claimant2
health condition or diagnosis during the current and the two immediately preceding3
policy periods. The data shall provide a unique identifying number or code for the4
claimant.5
(e) A complete listing of all potential catastrophic diagnoses and prognoses6
involving persons covered under the policy provisions. The data shall provide a7
unique identifying number or code for the claimant.8
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(7) A plan sponsor is and the plan sponsor's agent are entitled to receive10
protected health information under this Section only after an appropriately11
authorized representative of the plan sponsor or agent makes to the health and12
accident insurer a certification substantially similar to the following certification:13
'I hereby certify and have demonstrated that the plan14
documents comply with the requirements of 45 C.F.R.15
Section 164.504(f)(2) and that the plan sponsor will safeguard16
and limit the use and disclosure of protected health17
information that the plan sponsor or agent may receive from18
the group health plan to perform the plan administration19
functions.'20
(8) A plan sponsor or agent that does not provide the certification required21
in Paragraph (7) of this Subsection is not entitled to receive the protected health22
information described in Subparagraphs (1)(d) and (e) of this Subsection, but is23
entitled to receive a report of claim information that includes the other information24
required by this Subsection.25
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G. Nothing in this Section shall be construed to require an insurer to provide1
information protected as confidential by the Health Insurance Portability and2
Accountability Act of 1996 or any other provision of federal law.3
SPEAKER OF THE HOUSE OF REPRESENTATI VES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: