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.
Effective August 1, 2020.
(Amends R.S. 42:808(F))