§1023.1. Prohibited discrimination; potential organ transplant recipients with disabilities
A. For purposes of this Section, the following terms have the meaning ascribed to
them in this Subsection:
(1)"Anatomical gift" means a donation of all or part of a human body that takes
effect after the death of the donor for the purpose of transplantation or transfusion.
(2)"Covered person" means a policyholder, subscriber, enrollee, member, or
individual covered by a health benefit plan.
(3)"Disability" has the meaning ascribed in 42 U.S.C. 12102. (4)"Health benefit plan" means a policy, contract, certificate, or agreement entered
into, offered, or issued by a health insurance issuer to provide, deliver, arrange for, pay for,
or reimburse any of the costs of healthcare services. "Health benef
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§1023.1. Prohibited discrimination; potential organ transplant recipients with disabilities
A. For purposes of this Section, the following terms have the meaning ascribed to
them in this Subsection:
(1) "Anatomical gift" means a donation of all or part of a human body that takes
effect after the death of the donor for the purpose of transplantation or transfusion.
(2) "Covered person" means a policyholder, subscriber, enrollee, member, or
individual covered by a health benefit plan.
(3) "Disability" has the meaning ascribed in 42 U.S.C. 12102.
(4) "Health benefit plan" means a policy, contract, certificate, or agreement entered
into, offered, or issued by a health insurance issuer to provide, deliver, arrange for, pay for,
or reimburse any of the costs of healthcare services. "Health benefit plan" shall not include
a plan that provides coverage for excepted benefits as defined in R.S. 22:1061 or short-term
policies that have a term of less than twelve months.
(5) "Health insurance issuer" means an entity subject to the insurance laws and
regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or
offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of
healthcare services, including through a health benefit plan as defined in this Subsection, and
shall include a sickness and accident insurance company, a health maintenance organization,
a preferred provider organization or any similar entity, or any other entity providing a plan
of health insurance or health benefits.
(6) "Organ transplant" means the transplantation or transfusion of a part of a human
body into the body of another for the purpose of treating or curing a medical condition.
B. A health insurance issuer that provides coverage for anatomical gifts, organ
transplants, or related treatment and services shall not do any of the following:
(1) Deny coverage to a covered person solely on the basis of the person having a
disability.
(2) Deny to a patient eligibility, or continued eligibility, to enroll or to renew
coverage under the terms of the health benefit plan, solely for the purpose of avoiding the
requirements of this Section.
(3) Penalize or otherwise reduce or limit the reimbursement of an attending provider,
or provide monetary or nonmonetary incentives to an attending provider, to induce such
provider to furnish care to an insured or enrollee in a manner inconsistent with this Section.
(4) Reduce or limit coverage benefits to a patient for the medical services or other
services related to organ transplantation performed pursuant to this Section as determined
in consultation with the attending physician and patient.
C. In the case of a health benefit plan maintained pursuant to one or more collective
bargaining agreements between employee representatives and one or more employers, any
plan amendment made pursuant to a collective bargaining agreement relating to the plan
which amends the plan solely to conform to any requirement imposed pursuant to this
Section shall not be treated as a termination of the collective bargaining agreement.
D. Nothing in this Section shall be construed as requiring a health insurance issuer
to provide coverage for a medically inappropriate organ transplant.