SLS 20RS-128 ORIGINAL
2020 Regular Session
SENATE BILL NO. 122
BY SENATOR CARTER
GROUP BENEFITS PROGRAM. Provides relative to notice and appeal rights for over-age
dependent coverage by any health plan offered under the purview of the Office of Group
Benefits. (8/1/20)
1 AN ACT
2 To amend and reenact R.S. 42:808(F), relative to the Office of Group Benefits; to provide
3 for the coverage of certain dependents; to provide for notice to certain parents and
4 grandparents; to provide for the right to appeal to an appeal review panel in certain
5 circumstances; to provide relative to the authority of appeal review panels; and to
6 provide for related matters.
7 Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 42:808(F) is hereby amended and reenacted to read as follows:
9 ยง808. Eligibility in group programs
10 * * *
11 F.(1) Attainment of the respective limiting age of a child or grandchild shall
12 not operate to terminate the coverage of such child or grandchild if the child or
13 grandchild became incapable of self-sustaining employment by reason of physical
14 or mental disability prior to attaining the respective limiting age, provided that no
15 later than eight months before the child or grandchild reaches the limiting age, the
16 office shall send a notice notifying the parent or grandparent that the coverage
17 shall expire unless but no earlier than six months prior thereto, an application for
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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. 122
SLS 20RS-128 ORIGINAL
1 continued coverage is filed with the office on a form designated by the office, and
2 the application is subsequently approved. The notice shall provide that if the
3 application for continued coverage is not filed prior to the date the child or
4 grandchild reaches the respective limiting age, the child or grandchild shall lose
5 coverage. The notice shall explain the right of the parent or grandparent to
6 appeal to an appeal review panel if the documentation is not submitted timely.
7 This application shall be submitted no earlier than six months prior to the child
8 or grandchild attaining the respective limiting age and shall be accompanied by
9 an attestation from the dependent's attending physician setting forth the specific
10 physical or mental disability and certifying that the child or grandchild is incapable
11 of self-sustaining employment by reason of that disability. The office may require
12 additional medical or other supporting documentation regarding the disability to
13 process the application.
14 (2) After the initial approval, the office may require the submission of
15 additional medical or other supporting documentation substantiating the continuance
16 of the disability, but not more frequently than annually, as a precondition to
17 continued coverage. If continued coverage is denied due to the failure of the
18 parent or grandparent to obtain the additional documentation, upon submitting
19 the documentation, the parent or grandparent may appeal to an appeal review
20 panel to reinstate the coverage. For good cause shown and after considering the
21 totality of the circumstances, the appeal review panel may decide to reinstate
22 coverage for the child or grandchild.
23 (3) The parent or grandparent who fails to submit the application for
24 continued coverage prior to the date the child or grandchild reaches the
25 respective limiting age, may appeal the denial of coverage to an appeal review
26 panel. The parent or grandparent shall explain the reasons for the untimely
27 filing. For good cause shown and after considering the totality of the
28 circumstances, the appeal review panel may decide to continue coverage for the
29 child or grandchild.
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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. 122
SLS 20RS-128 ORIGINAL
1 (4) The provisions of this Subsection shall apply to any health plan
2 under the purview of the Office of Group Benefits.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Martha S. Hess.
DIGEST
SB 122 Original 2020 Regular Session Carter
Present law provides for eligibility in programs sponsored by the Office of Group Benefits,
subject to certain limitations.
Present law provides that the respective limiting age of a child or grandchild of an enrollee
shall not terminate the coverage of the child or grandchild if they are incapable of self-
sustaining employment by reason of physical or mental disability prior to attaining the
respective limiting age.
Present law further provides that before the child or grandchild reaches the limiting age, but
no earlier than six months before, an application for continued coverage is filed and
subsequently approved.
Present law stipulates the application shall be accompanied by an attestation from the
dependent's attending physician specifying the physical or mental disability and certifying
that the child or grandchild is incapable of self-sustaining employment by reason of that
disability. The office may require additional medical or other supporting documentation
regarding the disability to process the application.
Present law also provides that after the initial approval, the office may require the
submission of additional medical or other supporting documentation substantiating
continued disability, but not more frequently than annually, as a precondition to continued
coverage.
Proposed law provides that no later than eight months before the child or grandchild reaches
limiting age, the office shall send notice to the parent or grandparent that coverage expires
unless an application for continued coverage is filed. Proposed law stipulates that the notice
specify that if the application for continued coverage is not filed prior to the date the child
or grandchild reaches the respective limiting age, the child or grandchild shall lose coverage.
Proposed law requires that the notice contain an explanation of the right of the parent or
grandparent to appeal to a review panel if the documentation is not submitted timely.
Proposed law requires that the application be submitted no earlier than six months prior to
the child or grandchild attaining the respective limiting age.
Proposed law provides that if continued coverage is denied due to failure to obtain the
additional required documentation, upon submitting documentation, the parent or
grandparent shall have the right to appeal to reinstate the coverage. The appeal review panel
may decide, after consideration of the totality of circumstances and for good cause, to
reinstate coverage.
Proposed law further provides that if the parent or grandparent does not submit the
application for continued coverage prior to the date the child or grandchild reaches the
respective limiting age, they shall have the right to appeal and to explain the reasons for
untimely filing. Authorizes the appeal review panel to decide, after consideration of the
totality of circumstances and for good cause, to reinstate coverage.
Proposed law applies to any health plan under the purview of the Office of Group Benefits.
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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. 122
SLS 20RS-128 ORIGINAL
Effective August 1, 2020.
(Amends R.S. 42:808(F))
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.