RÉSUMÉ DIGEST
ACT 112 (SB 122) 2020 Regular Session Carter
Prior law provided for eligibility in programs sponsored by the Office of Group Benefits,
subject to certain limitations.
Prior law authorized the Office of Group Benefits to procure private contracts of policies of
group health, accident, accidental death and dismemberment, and hospital, surgical, or
medical expense benefits and to contract for all or a portion of the administration, operation,
or both of a self-funded program for that purpose.
Prior law provided 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.
Prior law further provided 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.
Prior law stipulated 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.
Prior law also provided 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.
New law provides that no later than seven months before the child or grandchild reaches
limiting age, the health plan 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 shall 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.
New law requires that the notice contain an explanation of the right of the parent or
grandparent to appeal for an administrative review if the documentation is not submitted
timely. New law requires that the application be submitted no earlier than six months prior
to the child or grandchild attaining the respective limiting age.
New 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 for an administrative review to reinstate the coverage. The
administrative review panel may decide, after consideration of the totality of circumstances
and for good cause, to reinstate coverage.
New 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 for an administrative review and to explain
the reasons for untimely filing. Authorizes the administrative review panel to decide, after
consideration of the totality of circumstances and for good cause, to reinstate coverage.
New law applies to any health plan under the purview of prior law.
New law provides that new law may be referred to or cited as "Arielle's Law".
Effective August 1, 2020.
(Amends R.S. 42:808(F))