The original instrument and the following digest, which constitutes no part of the
legislative instrument, were prepared by Cheryl Horne.
DIGEST
Gary Smith (SB 328)
Proposed law requires the commissioner of insurance to collect a $100 fee for new rate filings for
insurance issuers and $150 for rate changes.
Present law provides for approval and disapproval of health and accident insurance forms and
policies by the commissioner of insurance.
Proposed law retains present law and increases the time for the use of forms from 45 days to 60
days after filing. Requires written notification to be provided to the health insurance issuer
specifying the reasons a policy form or subscriber agreement does not comply with the provisions
of proposed law. Provides that it shall be unlawful for any health insurance issuer to issue any
form not previously submitted to and approved by the department.
Present law provides rate limitations for health benefit plans for small employers and individuals.
Provides for rating factors and sets allowable percentages of annual increases. Requires each
small group and individual health and accident insurer to make reasonable disclosure of rates to
small employers and provides required content of each disclosure. Provides that when a rate
increase occurs, the insurer shall provide a reasonable explanation of the increase. Also requires
each insurer to maintain records of its rating practices and to certify to the commissioner that it is
in compliance with the rating requirements. Prohibits health and accident insurers from
increasing their premiums except as provided in present law. Excludes group and individual
high deductible health plans from the rate limitations and requirements.
Proposed law makes rate review and approval requirements applicable to health benefit plans
which provide coverage in the small group and individual markets. Requires each health benefit
plan to file a copy of its rates with all insurance policy forms. Provides that the commissioner
shall review rates and may only disapprove proposed rate increases that meet the statutory
definition of unreasonable in proposed law. Provides for risk pools. Limits variations on health
insurance premiums to variations based on whether the insured is an individual or member of a
family group, the age of the insured, geographic region, and whether the insured uses tobacco
products. Prohibits insurers from using the health status of the insured in the calculation of rates.
Provides for fees for proposed rate filings and rate changes. Lists and identifies those benefits
not subject to the requirements. Additionally, subjects HMOs and any entity that offers health
insurance coverage through a policy, certificate, or subscriber agreement to proposed rating law.
Requires rate filings with the department, made under certain time lines, subject to certain filing
fees, and containing required information in prescribed, standardized formats. Requires any such
filings containing rate increases beyond a specific threshold to be published for public comment.
Exempts certain information submitted in required filings from the Public Records Law. Proposed law exempts limited benefits plans from proposed law rating restrictions.
Proposed law requires the rating practices and rating methods, and the rating restrictions imposed
by law upon grandfathered health coverage in the individual market and small group market that
exist when proposed law takes effect, including the restrictions on rate increases and required
notices for such increases, to remain binding upon such grandfathered health coverage.
Present law allows health insurers to create and maintain separate risk pools through closed
blocks of business or classes of business.
Proposed law prohibits the maintenance of separate risk pools. Requires all health insurance
issuers to maintain a single, state-wide risk pool in each of the following markets: small group,
individual, and student health plans.
Proposed law provides that the commissioner may issue penalties or cease-and-desist orders if he
determines that any health insurance issuer is not in compliance with the rate review provisions.
Provides monetary penalties for violations of cease-and-desist orders. Authorizes the
commissioner to revoke, suspend, or nonrenew a certificate of authority of any health insurance
issuer for noncompliance. Permits any aggrieved health insurance issuer the opportunity to seek
judicial review of certain decisions by the commissioner.
Proposed law, beginning January 1, 2015, requires every individual health insurance policy or
plan year to be for a period of one year, and to commence on January first of that year. Prohibits
any rate increases in the individual market during the course of the policy or plan year. Requires
health insurance issuers to file an actuarial certification that such issuers use actuarially sound
methods and are in compliance with applicable laws.
Present law prohibits unfair discrimination in rates or failure to provide life, life annuity, or
disability coverage because of severe disability or sickle cell trait.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Amends R.S. 22:972 and 1091 through 1097 and R.S. 44:4.1(B)(11); adds R.S. 22:821(B)(36),
1092.1,1098, and 1099)