2020 Regular Session ENROLLED
SENATE BILL NO. 174
BY SENATOR BERNARD
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,
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 Subsection shall not apply to limited benefit health insurance
21 policies or contracts, disability income, long-term care, nursing home care, home
22 health care, community based care, dental or vision benefits, Medicare supplement,
23 specified disease or illness, hospital indemnity or other fixed indemnity insurance,
24 workers' compensation or similar insurance.
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1 * * *
2 §1068. Guaranteed renewability of coverage for employers in the group market
3 * * *
4 B. A health insurance issuer may non-renew or discontinue health insurance
5 coverage offered in connection with a group health plan in the small or large group
6 market based only on one or more of the following:
7 * * *
8 (2) The plan sponsor has performed an act or practice that constitutes fraud
9 or made an intentional misrepresentation of material fact. Such health insurance
10 coverage may not be cancelled except with prior notice to the enrollee or insured,
11 and only as permitted by shall comply with any applicable federal law or regulation
12 pursuant to 42 U.S.C. A. Section 300gg-12, (Public Health Services Act). The
13 provisions of this Paragraph shall not apply to limited benefit health insurance
14 policies or contracts authorized to be issued in this state. The provisions of this
15 Subsection shall not apply to limited benefit health insurance policies or contracts,
16 disability income, long-term care, nursing home care, home health care, community
17 based care, dental or vision benefits, Medicare supplement, specified disease or
18 illness, hospital indemnity or other fixed indemnity insurance, workers'
19 compensation or similar insurance.
20 * * *
21 §1074. Guaranteed renewability of individual health insurance coverage
22 * * *
23 B. A health insurance issuer may non-renew or discontinue health insurance
24 coverage of an individual in the individual market based only on one or more of the
25 following:
26 * * *
27 (2) The individual has performed an act or practice that constitutes fraud or
28 made an intentional misrepresentation of material fact. Such health insurance
29 coverage may not be cancelled except with prior notice to the enrollee or insured,
30 and only as permitted by shall comply with any applicable federal law or regulation
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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 ENROLLED
1 pursuant to 42 U.S.C. Section 300gg-12, (Public Health Services Act). The
2 provisions of this Paragraph shall not apply to limited benefit health insurance
3 policies or contracts authorized to be issued in this state. The provisions of this
4 Subsection shall not apply to limited benefit health insurance policies or contracts,
5 disability income, long-term care, nursing home care, home health care, community
6 based care, dental or vision benefits, Medicare supplement, specified disease or
7 illness, hospital indemnity or other fixed indemnity insurance, workers'
8 compensation or similar insurance.
9 * * *
10 §1091. Health insurance plans subject to rate review
11 * * *
12 B. As used in this Subpart, the following terms shall have the meanings
13 ascribed to them in this Section:
14 * * *
15 (9) "Index rate" means the average rate resulting from the estimated
16 combined claims experience for all Essential Health Benefits, pursuant to 42 U.S.C.
17 18022, Section 1302(b) of the Patient Protection and Affordable Care Act, of all
18 nontransitional and nongrandfathered health plan coverage within a health insurance
19 issuer's single, statewide risk pool in the individual market and within a health
20 insurance issuer's single, statewide risk pool in the small group market, with a
21 separate index rate being calculated for each market. Health insurance issuers may
22 make any market-wide and plan- or product-specific adjustments to an index rate as
23 permitted or as required by federal law, rules, or regulations. In the event this rate
24 cannot be determined by reference to 42 U.S.C. 18022, Section 1302(b) of the
25 Patient Protection and Affordable Care Act, the commissioner of insurance
26 shall promulgate rules pursuant to the Administrative Procedure Act, R.S.
27 49:950 et seq., to define a substantially similar alternative.
28 * * *
29 §1092. Health insurance issuers; rate filings and rate increases
30 * * *
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1 I. For any rate increase that meets or exceeds the federal review threshold,
2 the department shall post a notice of final determination on its website and undertake
3 any other actions necessary pursuant to Section 2794 of the Public Health Service
4 Act federal law.
5 * * *
6 §2401. Requirements of federal laws and regulations; minimum requirements
7 Health insurance issuers shall implement effective processes for appeals of
8 coverage determinations and claims pursuant to Section 2719 of the Public Health
9 Service Act (42 U.S.C. 300gg-19) and any federal regulations promulgated pursuant
10 thereto by the United States Department of Labor and the United States Department
11 of Health and Human Services. The processes shall comply with any applicable
12 federal law or regulation. Under such processes, a health insurance issuer shall, at
13 a minimum:
14 * * *
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
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words in boldface type and underscored are additions.