HLS 19RS-165 ORIGINAL
2019 Regular Session
HOUSE BILL NO. 237
BY REPRESENTATIVE CHAD BROWN
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE/HEALTH: Prohibits preexisting condition exclusions or other discrimination
based on health status
1 AN ACT
2To enact Chapter 21 of Title 22 of the Louisiana Revised Statutes of 1950, to be comprised
3 of R.S. 22:2481 through 2488, relative to prohibitions against discrimination by
4 health insurance issuers based on health status; to require coverage for certain health
5 benefits; to prohibit preexisting condition exclusions; to prohibit discrimination
6 based on health status; to prohibit lifetime or annual limits; to require insurers to
7 accept all applicants; to prohibit excessive waiting periods; to provide for
8 applicability; to provide for an effective date; and to provide for related matters.
9Be it enacted by the Legislature of Louisiana:
10 Section 1. Chapter 21 of Title 22 of the Louisiana Revised Statutes of 1950,
11comprised of R.S. 22:2481 through 2488, is hereby enacted to read as follows:
12 CHAPTER 21. PROHIBITIONS AGAINST DISCRIMINATION
13 BY HEALTH INSURANCE ISSUERS BASED ON HEALTH STATUS
14 §2481. Increased portability through prohibition on preexisting condition exclusions
15 A group health plan or a health insurance issuer offering group or individual
16 health insurance coverage shall not impose any preexisting condition exclusion with
17 respect to the plan or coverage.
18 §2482. Guaranteed availability of coverage in the individual and group market
19 A. Subject to the provisions of Subsections B through D of this Section, each
20 health insurance issuer that offers health insurance coverage in the individual or
Page 1 of 11
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 19RS-165 ORIGINAL
HB NO. 237
1 group market in Louisiana shall accept every employer and individual in the state
2 that applies for coverage.
3 B.(1) A health insurance issuer may restrict enrollment in coverage to open
4 or special enrollment periods pursuant to rules and regulations promulgated by the
5 commissioner of insurance as required by this Subsection.
6 (2) A health insurance issuer shall establish special enrollment periods for
7 qualifying events as defined in Section 603 of the federal Employee Retirement
8 Income Security Act of 1974.
9 (3) The commissioner of insurance shall promulgate regulations with respect
10 to enrollment periods pursuant to this Subsection.
11 C.(1) In the case of a health insurance issuer that offers health insurance
12 coverage in the group or individual market through a network plan, the issuer may
13 do any of the following:
14 (a) Limit the employers that may apply for coverage to those with eligible
15 individuals who live, work, or reside in the service area for the network plan.
16 (b) Within the service area of the plan, deny coverage to employers or
17 individuals if the issuer has demonstrated to the commissioner of insurance both of
18 the following:
19 (i) It will not have the capacity to deliver services adequately to enrollees of
20 any additional groups or any additional individuals because of its obligations to
21 existing group contract holders and enrollees.
22 (ii) It is applying this Paragraph uniformly to all employers and individuals
23 without regard to the claims experience of those individuals, employers and their
24 employees, and their dependents, or any health status-related factor relating to the
25 individuals, employees, and dependents.
26 (2) An issuer, upon denying health insurance coverage in any service area
27 in accordance with Subparagraph (1)(b) of this Subsection, shall not offer coverage
28 in the group or individual market within the service area for a period of one hundred
29 eighty days after the date coverage is denied.
Page 2 of 11
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 19RS-165 ORIGINAL
HB NO. 237
1 D.(1) A health insurance issuer may deny health insurance coverage in the
2 group or individual market if the issuer has demonstrated, if required, to the
3 commissioner of insurance each of the following:
4 (a) It does not have the financial reserves necessary to underwrite additional
5 coverage.
6 (b) It is applying this Paragraph uniformly to all employers and individuals
7 in the group or individual market in the state consistent with applicable state law and
8 without regard to the claims experience of those individuals, employers and their
9 employees, and their dependents, or any health status-related factor relating to the
10 individuals, employees, and dependents.
11 (2)(a) A health insurance issuer, upon denying health insurance coverage in
12 connection with group health plans in accordance with Paragraph (1) of this
13 Subsection in this state, shall not offer coverage in connection with group health
14 plans in the group or individual market in this state for a period of one hundred
15 eighty days after the date coverage is denied or until the issuer has demonstrated to
16 the commissioner of insurance, that the issuer has sufficient financial reserves to
17 underwrite additional coverage, whichever is later.
18 (b) The commissioner of insurance may issue reasonable regulations for the
19 application of this Paragraph on a service-area-specific basis.
20 §2483. Guaranteed renewability of coverage
21 A. Except as provided in Subsection B of this Section, if a health insurance
22 issuer offers health insurance coverage in the individual or group market, the issuer
23 shall renew or continue in force the coverage at the option of the plan sponsor or the
24 individual, as applicable.
25 B. A health insurance issuer may nonrenew or discontinue health insurance
26 coverage offered in connection with a health insurance coverage offered in the group
27 or individual market based only on one or more of the following:
Page 3 of 11
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 19RS-165 ORIGINAL
HB NO. 237
1 (1) The plan sponsor, or individual, as applicable, has failed to pay premiums
2 or contributions in accordance with the terms of the health insurance coverage or the
3 issuer has not received timely premium payments.
4 (2) The plan sponsor, or individual, as applicable, has performed an act or
5 practice that constitutes fraud or made an intentional misrepresentation of material
6 fact under the terms of the coverage.
7 (3) In the case of a group health plan, the plan sponsor has failed to comply
8 with a material plan provision relating to employer contribution or group
9 participation rules, pursuant to applicable state law.
10 (4) The issuer is ceasing to offer coverage in the market in accordance with
11 Subsection C of this Section and applicable state law.
12 (5) In the case of a health insurance issuer that offers health insurance
13 coverage in the market through a network plan, there is no longer any enrollee in
14 connection with the plan who lives, resides, or works in the service area of the issuer
15 or in the area for which the issuer is authorized to do business and, in the case of the
16 small group market, the issuer would deny enrollment with respect to the plan
17 pursuant to R.S. 22:2482(C)(1)(a).
18 (6) In the case of health insurance coverage that is made available in the
19 small or large group market only through one or more bona fide associations, the
20 membership of an employer in the association, on the basis of which the coverage
21 is provided, ceases but only if the coverage is terminated pursuant to this Paragraph
22 uniformly without regard to any health status-related factor relating to any covered
23 individual.
24 C.(1) If an issuer decides to discontinue offering a particular type of group
25 or individual health insurance coverage, the coverage may be discontinued by the
26 issuer in accordance with applicable state law in that market only if all of the
27 following conditions are met:
28 (a) The issuer provides notice to each plan sponsor or individual, as
29 applicable, provided coverage of this type in the market, and participants and
Page 4 of 11
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 19RS-165 ORIGINAL
HB NO. 237
1 beneficiaries covered under the coverage, of the discontinuation at least ninety days
2 prior to the date of the discontinuation of the coverage.
3 (b) The issuer offers to each plan sponsor or individual, as applicable,
4 provided coverage of this type in the market, the option to purchase all or, in the case
5 of the large group market, any other health insurance coverage currently being
6 offered by the issuer to a group health plan or individual health insurance coverage
7 in the market.
8 (c) In exercising the option to discontinue coverage of this type and in
9 offering the option of coverage pursuant to Subparagraph (b) of this Paragraph, the
10 issuer acts uniformly without regard to the claims experience of those sponsors or
11 individuals, as applicable, or any health status-related factor relating to any
12 participants or beneficiaries covered or new participants or beneficiaries who may
13 become eligible for coverage.
14 (d) Prior to providing the notice required by Subparagraph (a) of this
15 Paragraph, the issuer files the notice and the insurance product being discontinued
16 with the commissioner of insurance.
17 (2)(a) If a health insurance issuer elects to discontinue offering all health
18 insurance coverage in the individual or group market, or all markets, in Louisiana,
19 health insurance coverage may be discontinued by the issuer only in accordance with
20 applicable state law and if all of the following conditions are met:
21 (i) The issuer provides notice to the commissioner of insurance and to each
22 plan sponsor or individual, as applicable, and participants and beneficiaries covered
23 under the coverage, of the discontinuation at least one hundred eighty days prior to
24 the date of the discontinuation of the coverage.
25 (ii) All health insurance issued or delivered for issuance in Louisiana in the
26 market or markets are discontinued and coverage under the health insurance
27 coverage in the market or markets is not renewed.
28 (iii) Prior to providing the notice required by Item (i) of this Subparagraph,
29 the issuer files with the commissioner of insurance the notice and the insurance
Page 5 of 11
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 19RS-165 ORIGINAL
HB NO. 237
1 product being discontinued for certification that the notice is in compliance with this
2 Section. Notice shall not be issued to the insureds or enrollees until the expiration
3 of twenty days after the notice and insurance product being discontinued have been
4 filed unless the commissioner of insurance gives his written approval prior to that
5 time.
6 (b) In the case of a discontinuation pursuant to Subparagraph (a) of this
7 Paragraph in a market, the issuer shall not issue any health insurance coverage in the
8 market and state during the five-year period beginning on the date of the
9 discontinuation of the last health insurance coverage not renewed.
10 D. At the time of coverage renewal, a health insurance issuer may modify
11 the health insurance coverage for a product offered to a group health plan in the
12 small or large group market if, for coverage that is available in the market other than
13 only through one or more bona fide associations, the modification is consistent with
14 state law and effective on a uniform basis among group health plans with that
15 product.
16 E. For the purposes of this Section, with respect to health insurance coverage
17 that is made available by a health insurance issuer in the small or large group market
18 to employers only through one or more associations and is provided to an employer
19 member of the association, "plan sponsor" shall include the employer.
20 §2484. Prohibiting discrimination against individual participants and beneficiaries
21 based on health status
22 A. A group health plan and a health insurance issuer offering group or
23 individual health insurance coverage shall not establish rules for eligibility, including
24 continued eligibility, of any individual to enroll under the terms of the plan based on
25 any of the following health status-related factors in relation to the individual or a
26 dependent of the individual:
27 (1) Health status.
28 (2) Medical condition, including both physical and mental illnesses.
29 (3) Claims experience.
Page 6 of 11
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 19RS-165 ORIGINAL
HB NO. 237
1 (4) Receipt of health care.
2 (5) Medical history.
3 (6) Genetic information.
4 (7) Evidence of insurability, including conditions arising out of acts of
5 domestic violence.
6 (8) Disability.
7 (9) Any other health status-related factor determined appropriate by the
8 commissioner of insurance.
9 B.(1) A group health plan, and a health insurance issuer offering individual
10 or group health insurance coverage in connection with a group health plan, shall not
11 require any individual, as a condition of enrollment or continued enrollment under
12 the plan, to pay a premium or contribution which is greater than the premium or
13 contribution for a similarly situated individual enrolled in the plan on the basis of
14 any health status-related factor in relation to the individual or to an individual
15 enrolled under the plan as a dependent of the individual.
16 (2) Nothing in Paragraph (1) of this Subsection shall be construed to do any
17 of the following:
18 (a) Restrict the amount that an employer or individual may be charged for
19 coverage under a group health plan or individual health coverage.
20 (b) Prevent a group health plan, and a health insurance issuer offering group
21 health insurance coverage, from establishing premium discounts or rebates or
22 modifying otherwise applicable copayments or deductibles in return for adherence
23 to programs of health promotion and disease prevention.
24 §2485. Comprehensive health insurance coverage; coverage for essential health
25 benefits
26 A health insurance issuer that offers health insurance coverage in the
27 individual or small group market shall ensure that the coverage includes all of the
28 following essential health benefits:
29 (1) Ambulatory patient services.
Page 7 of 11
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 19RS-165 ORIGINAL
HB NO. 237
1 (2) Emergency services.
2 (3) Hospitalization.
3 (4) Maternity and newborn care.
4 (5) Mental health and substance use disorder services, including behavioral
5 health treatment.
6 (6) Prescription drugs.
7 (7) Rehabilitative and habilitative services and devices.
8 (8) Laboratory services.
9 (9) Preventive and wellness services and chronic disease management.
10 (10) Pediatric services including oral and vision care.
11 §2486. Prohibition on excessive waiting periods
12 A group health plan and a health insurance issuer offering group or individual
13 health insurance coverage shall not apply to any waiting period that exceeds ninety
14 days.
15 §2487. Prohibition on lifetime or annual limits; exceptions
16 A.(1) A group health plan and a health insurance issuer offering group or
17 individual health insurance coverage in Louisiana shall not establish either of the
18 following:
19 (a) Lifetime limits on the dollar value of benefits for any participant or
20 beneficiary.
21 (b) Except as provided in Paragraph (2) of this Subsection, annual limits on
22 the dollar value of benefits for any participant or beneficiary.
23 (2)(a) With respect to plan years beginning prior to January 1, 2014, a group
24 health plan and a health insurance issuer offering group or individual health
25 insurance coverage shall only establish a restricted annual limit on the dollar value
26 of benefits for any participant or beneficiary with respect to the scope of benefits that
27 are essential health benefits pursuant to R.S. 22:2485.
Page 8 of 11
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 19RS-165 ORIGINAL
HB NO. 237
1 (b) The commissioner of insurance shall promulgate regulations to define the
2 term "restricted annual limit" for purposes of this Subsection and shall ensure that
3 access to needed services is made available with a minimal impact on premiums.
4 C. Subsection A of this Section shall not be construed to prevent a group
5 health plan or health insurance coverage from placing annual or lifetime per
6 beneficiary limits on specific covered benefits that are not essential health benefits
7 pursuant to R.S. 22:2485, to the extent that the limits are otherwise permitted by
8 federal or state law.
9 §2488. Applicability; exemptions; conflict of laws
10 A.(1) This Chapter shall not apply to any grandfathered health plan
11 coverage.
12 (2) For the purposes of this Chapter, "grandfathered health plan coverage"
13 has the same meaning as that term in 45 C.F.R. 147.140 or other subsequently
14 adopted federal law, rule, regulation, directive, or guidance.
15 B. The provisions of this Chapter shall not apply to limited benefit health
16 insurance policies or contracts, as defined by R.S. 22:47.
17 C. In the event of a conflict between any provision of this Chapter and any
18 other provision of this Title, including but not limited to R.S. 22:1062, 1063, 1067,
19 and 1072 , with respect to any health plan subject to the provisions of this Chapter,
20 the provisions of this Chapter shall supersede and control.
21 Section 2. This Act shall become effective upon signature by the governor or, if not
22signed by the governor, upon expiration of the time for bills to become law without signature
23by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
24vetoed by the governor and subsequently approved by the legislature, this Act shall become
25effective on the day following such approval.
Page 9 of 11
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 19RS-165 ORIGINAL
HB NO. 237
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)]
HB 237 Original 2019 Regular Session Chad Brown
Abstract: Prohibits discrimination by health insurance issuers in the individual market and
small and large group market based on health status.
Proposed law prohibits a group health plan or a health insurance issuer offering group or
individual health insurance coverage from imposing any preexisting condition exclusion
with respect to the plan or coverage.
Proposed law requires each health insurance issuer that offers health insurance coverage in
the individual or group market in La. to accept every employer and individual in the state
that applies for coverage, except that an issuer may restrict enrollment in coverage to open
or special enrollment periods pursuant to rules and regulations promulgated by the
commissioner of insurance.
Proposed law authorizes a health insurance issuer that offers health insurance coverage in
the group or individual market through a network plan to do any of the following:
(1)Limit the employers that may apply for coverage to those with eligible individuals
who live, work, or reside in the service area for the network plan.
(2)Within the service area of the plan, deny coverage to employers or individuals if the
issuer has demonstrated to the commissioner of insurance that it will not have the
capacity to deliver services adequately and is applying proposed law uniformly to all
employers and individuals.
Proposed law requires a health insurance issuer offering health insurance coverage in the
individual or group market to renew or continue in force the coverage at the option of the
plan sponsor or the individual, as applicable, except that the issuer may nonrenew or
discontinue health insurance coverage based only on a failure to pay premiums or
contributions, an act or practice that constitutes fraud or an intentional misrepresentation of
material fact under the terms of the coverage, or the issuer is ceasing to offer coverage in the
market.
Proposed law prohibits a group health plan and a health insurance issuer offering group or
individual health insurance coverage from establishing rules for eligibility, including
continued eligibility, of any individual to enroll under the terms of the plan based on any of
the following health status-related factors in relation to the individual or a dependent of the
individual:
(1)Health status.
(2)Medical condition, including both physical and mental illnesses.
(3)Claims experience.
(4)Receipt of health care.
(5)Medical history.
(6)Genetic information.
Page 10 of 11
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 19RS-165 ORIGINAL
HB NO. 237
(7)Evidence of insurability, including conditions arising out of acts of domestic
violence.
(8)Disability.
(9)Any other health status-related factor determined appropriate by the commissioner
of insurance.
Proposed law requires a health insurance issuer that offers health insurance coverage in the
individual or small group market to ensure that the coverage includes all of the following
essential health benefits:
(1)Ambulatory patient services.
(2)Emergency services.
(3)Hospitalization.
(4)Maternity and newborn care.
(5)Mental health and substance use disorder services, including behavioral health
treatment.
(6)Prescription drugs.
(7)Rehabilitative and habilitative services and devices.
(8)Laboratory services.
(9)Preventive and wellness services and chronic disease management.
(10)Pediatric services including oral and vision care.
Proposed law prohibits a group health plan and a health insurance issuer offering group or
individual health insurance coverage from applying any waiting period that exceeds 90 days.
Proposed law prohibits a group health plan and a health insurance issuer offering group or
individual health insurance coverage in La. from establishing either of the following:
(1)Lifetime limits on the dollar value of benefits for any participant or beneficiary.
(2)Annual limits on the dollar value of benefits for any participant or beneficiary,
except with respect to plan years beginning prior to Jan. 1, 2014, an issuer shall only
establish a restricted annual limit on the dollar value of benefits for any participant
or beneficiary with respect to the scope of benefits that are essential health benefits.
Proposed law does not apply to any grandfathered health plan coverage or limited benefit
health insurance policies or contracts.
In the event of a conflict between proposed law and any other provision of the La. Insurance
Code, the provisions of proposed law shall supersede and control.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 22:2481-2488)
Page 11 of 11
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.