SLS 15RS-387 ORIGINAL
2015 Regular Session
SENATE BILL NO. 108
BY SENATOR BUFFINGTON
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
HEALTH/ACC INSURANCE. Provides for the collection of co-insurance and deductibles
by health insurance issuers. (8/1/15)
1 AN ACT
2 To enact R.S. 22:1839, relative to health insurance; to provide for the collection of co-
3 insurance and deductibles by health insurance issuers; to provide for exclusions; and
4 to provide for related matters.
5 Be it enacted by the Legislature of Louisiana:
6 Section 1. R.S. 22:1839 is hereby enacted to read as follows:
7 ยง1839. Health insurance issuer collection of co-insurance and deductibles
8 A. As used in this Section, the following terms are defined as follows:
9 (1) "Co-insurance" means a percentage of the allowed charge, after a
10 copayment, if any, that an insured will pay for covered services received under
11 the applicable health insurance coverage.
12 (2) "Copayment" means a fixed dollar amount structured by the insurer
13 that may be required to be paid by the insured to the healthcare provider at the
14 time the patient receives covered services.
15 (3) "Deductible" means an annual dollar amount that shall be paid by
16 an insured for the provision of healthcare services that an insured uses before
17 the health insurance issuer becomes obligated to pay for covered services; the
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 108
SLS 15RS-387 ORIGINAL
1 term shall not include any portion of the premium paid by the insured.
2 (4) "Health insurance coverage" or "coverage" means benefits consisting
3 of healthcare services provided directly, through insurance or reimbursement,
4 or otherwise and including items and services paid for as healthcare services
5 under any hospital or medical service policy or certificate, hospital or medical
6 service plan contract, preferred provider organization agreement, or health
7 maintenance organization contract offered by a health insurance issuer.
8 However, "health insurance coverage" or "coverage" shall not include benefits
9 due under Chapter 10 of Title 23 of the Louisiana Revised Statutes of 1950 or
10 limited benefit and supplemental health insurance policies, benefits provided
11 under a separate policy, certificate, or contract of insurance for accidents,
12 disability income, limited scope dental or vision benefits, or benefits for long-
13 term care, nursing home care, home healthcare, or specific diseases or illnesses.
14 (5) "Health insurance issuer" or "issuer" means any entity that offers
15 health insurance coverage through a policy, contract, or certificate of insurance
16 subject to state law that regulates the business of insurance. For purposes of
17 this Subpart, a "health insurance issuer" or "issuer" shall include but not be
18 limited to a health maintenance organization as defined and licensed pursuant
19 to Subpart I of Part I of Chapter 2 of this Title.
20 (6) "High deductible" means a deductible which is set at a dollar value
21 of one thousand dollars or greater.
22 B. A health insurance issuer shall not execute, amend, or renew any
23 contract with a healthcare provider which requires the healthcare provider to
24 collect any applicable co-insurance or deductible amount which may be the
25 responsibility of the insured pursuant to the insured's contract for health
26 insurance coverage when the insured's contract for health insurance includes
27 a high deductible. A health insurance insurer licensed pursuant to the
28 provisions of the Title shall recover all co-insurance and deductible amounts
29 due from patients for covered services as required under the health insurance
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 108
SLS 15RS-387 ORIGINAL
1 insurer's health insurance coverage. Payment of claims submitted by healthcare
2 providers shall not be dependent on the health insurance insurer recovering any
3 applicable co-insurance and deductible amounts nor shall collection of any
4 applicable co-insurance, deductible, and copayment amounts be required to be
5 completed prior to processing and paying a claim made by a healthcare
6 provider.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Horne.
DIGEST
SB 108 Original 2015 Regular Session Buffington
Proposed law defines "co-insurance", "copayment", "deductible", "health insurance
coverage", "health insurance issuer", and "high deductible" as used in proposed law.
Proposed law prohibits a health insurance issuer from contracting with a healthcare provider
which requires the healthcare provider to collect any applicable co-insurance or deductible
amount which may be the responsibility of the insured when the insured's contract for health
insurance includes a high deductible.
Proposed law requires a health insurance insurer to recover all co-insurance and deductible
amounts due from patients for covered services as required under the insurer's coverage.
Proposed law prohibits payment of claims submitted by healthcare providers which are
dependent on the health insurance insurer recovering any applicable co-insurance and
deductible amounts. Further prohibits collection of any applicable co-insurance, deductible,
and copayment amounts to be required to be completed prior to processing and paying a
claim.
Effective August 1, 2015.
(Adds R.S. 22:1839)
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.