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2020 Regular Session
SENATE BILL NO. 174
BY SENATOR BERNARD
HEALTH/ACC INSURANCE. Provides relative to health insurance. (8/1/20)
1 AN ACT
2 To amend and reenact R.S. 22:1063(C), 1068(B)(2), 1074(B)(2), 1091(B)(9), 1092(I), and
3 the introductory paragraph of R.S. 22:2401, relative to health insurance; to make
4 technical changes in references to federal law; and to provide for related matters.
5 Be it enacted by the Legislature of Louisiana:
6 Section 1. R.S. 22:1063(C), 1068(B)(2), 1074(B)(2), 1091(B)(9), 1092(I), and the
7 introductory paragraph of R.S. 22:2401 are hereby amended and reenacted to read as
8 follows:
9 §1063. Prohibiting discrimination against individual participants and beneficiaries
10 based on health status
11 * * *
12 C. A health insurance issuer offering group health insurance coverage shall
13 not rescind such coverage with respect to an enrollee or insured once the enrollee or
14 insured is covered under such coverage involved, except that this Subsection shall
15 not apply to an enrollee or insured who has performed an act or practice that
16 constitutes fraud or makes an intentional misrepresentation of material fact. Such
17 coverage may not be cancelled except with prior notice to the enrollee or insured,
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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. 174
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1 and only as permitted by shall comply with any applicable federal law or regulation
2 pursuant to 42 U.S.C.A. Section 300gg-12, (Public Health Services Act). The
3 provisions of this Subsection shall not apply to limited benefit health insurance
4 policies or contracts, disability income, long-term care, nursing home care, home
5 health care, community based care, dental or vision benefits, Medicare supplement,
6 specified disease or illness, hospital indemnity or other fixed indemnity insurance,
7 workers' compensation or similar insurance.
8 * * *
9 §1068. Guaranteed renewability of coverage for employers in the group market
10 * * *
11 B. A health insurance issuer may non-renew or discontinue health insurance
12 coverage offered in connection with a group health plan in the small or large group
13 market based only on one or more of the following:
14 * * *
15 (2) The plan sponsor has performed an act or practice that constitutes fraud
16 or made an intentional misrepresentation of material fact. Such health insurance
17 coverage may not be cancelled except with prior notice to the enrollee or insured,
18 and only as permitted by shall comply with any applicable federal law or regulation
19 pursuant to 42 U.S.C. A. Section 300gg-12, (Public Health Services Act). The
20 provisions of this Paragraph shall not apply to limited benefit health insurance
21 policies or contracts authorized to be issued in this state. The provisions of this
22 Subsection shall not apply to limited benefit health insurance policies or contracts,
23 disability income, long-term care, nursing home care, home health care, community
24 based care, dental or vision benefits, Medicare supplement, specified disease or
25 illness, hospital indemnity or other fixed indemnity insurance, workers'
26 compensation or similar insurance.
27 * * *
28 §1074. Guaranteed renewability of individual health insurance coverage
29 * * *
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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. 174
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1 B. A health insurance issuer may non-renew or discontinue health insurance
2 coverage of an individual in the individual market based only on one or more of the
3 following:
4 * * *
5 (2) The individual has performed an act or practice that constitutes fraud or
6 made an intentional misrepresentation of material fact. Such health insurance
7 coverage may not be cancelled except with prior notice to the enrollee or insured,
8 and only as permitted by shall comply with any applicable federal law or regulation
9 pursuant to 42 U.S.C. Section 300gg-12, (Public Health Services Act). The
10 provisions of this Paragraph shall not apply to limited benefit health insurance
11 policies or contracts authorized to be issued in this state. The provisions of this
12 Subsection shall not apply to limited benefit health insurance policies or contracts,
13 disability income, long-term care, nursing home care, home health care, community
14 based care, dental or vision benefits, Medicare supplement, specified disease or
15 illness, hospital indemnity or other fixed indemnity insurance, workers'
16 compensation or similar insurance.
17 * * *
18 §1091. Health insurance plans subject to rate review
19 * * *
20 B. As used in this Subpart, the following terms shall have the meanings
21 ascribed to them in this Section:
22 * * *
23 (9) "Index rate" means the average rate resulting from the estimated
24 combined claims experience for all Essential Health Benefits, pursuant to 42 U.S.C.
25 18022, Section 1302(b) of the Patient Protection and Affordable Care Act, of all
26 nontransitional and nongrandfathered health plan coverage within a health insurance
27 issuer's single, statewide risk pool in the individual market and within a health
28 insurance issuer's single, statewide risk pool in the small group market, with a
29 separate index rate being calculated for each market. Health insurance issuers may
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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. 174
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1 make any market-wide and plan- or product-specific adjustments to an index rate as
2 permitted or as required by federal law, rules, or regulations. In the event this rate
3 cannot be determined by reference to 42 U.S.C. 18022, Section 1302(b) of the
4 Patient Protection and Affordable Care Act, the commissioner of insurance
5 shall promulgate rules pursuant to the Administrative Procedure Act, R.S.
6 49:950 et seq., to define a substantially similar alternative.
7 * * *
8 §1092. Health insurance issuers; rate filings and rate increases
9 * * *
10 I. For any rate increase that meets or exceeds the federal review threshold,
11 the department shall post a notice of final determination on its website and undertake
12 any other actions necessary pursuant to Section 2794 of the Public Health Service
13 Act federal law.
14 * * *
15 §2401. Requirements of federal laws and regulations; minimum requirements
16 Health insurance issuers shall implement effective processes for appeals of
17 coverage determinations and claims pursuant to Section 2719 of the Public Health
18 Service Act (42 U.S.C. 300gg-19) and any federal regulations promulgated pursuant
19 thereto by the United States Department of Labor and the United States Department
20 of Health and Human Services. The processes shall comply with any applicable
21 federal law or regulation. Under such processes, a health insurance issuer shall, at
22 a minimum:
23 * * *
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by LG Sullivan.
DIGEST
SB 174 Engrossed 2020 Regular Session Bernard
Present law contains various specific references to federal health insurance law.
Proposed law retains present law and changes specific references to general requirement to
comply with applicable federal laws and regulations.
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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. 174
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Effective August 1, 2020.
(Amends R.S. 22:1063(C), 1068(B)(2), 1074(B)(2), 1091(B)(9), 1092(I), and
2401(intro para))
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.