§1063. Prohibiting discrimination against individual participants and beneficiaries based on
health status
A.
(1)Subject to Paragraph (2) of this Subsection, a group health plan, and a health
insurance issuer offering group health insurance coverage in connection with a group health
plan, may not establish rules for eligibility, including continued eligibility, of any individual
to enroll under the terms of the plan based on any of the following health status-related
factors in relation to the individual or a dependent of the individual:
(b)Medical condition, including both physical and mental illnesses.
(d)Receipt of health care.
(g)Evidence of insurability, including conditions arising out of acts
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§1063. Prohibiting discrimination against individual participants and beneficiaries based on
health status
A.(1) Subject to Paragraph (2) of this Subsection, a group health plan, and a health
insurance issuer offering group health insurance coverage in connection with a group health
plan, may not establish rules for eligibility, including continued eligibility, of any individual
to enroll under the terms of the plan based on any of the following health status-related
factors in relation to the individual or a dependent of the individual:
(a) Health status.
(b) Medical condition, including both physical and mental illnesses.
(c) Claims experience.
(d) Receipt of health care.
(e) Medical history.
(f) Genetic information.
(g) Evidence of insurability, including conditions arising out of acts of domestic
violence.
(h) Disability.
(2) To the extent consistent with R.S. 22:1062, Paragraph (1) of this Subsection shall
not be construed to do the following:
(a) To require a group health plan, or group health insurance coverage, to provide
particular benefits other than those provided under the terms of such plan or coverage.
(b) To prevent such a plan or coverage from establishing limitations or restrictions
on the amount, level, extent, or nature of the benefits or coverage for similarly situated
individuals enrolled in the plan or coverage.
(3) For purposes of Paragraph (1) of this Subsection, rules for eligibility to enroll
under a plan include rules defining any applicable waiting periods for such enrollment.
B.(1) A group health plan, and a health insurance issuer offering health insurance
coverage in connection with a group health plan, may not require any individual, as a
condition of enrollment or continued enrollment under the plan, to pay a premium or
contribution which is greater than such premium or contribution for a similarly situated
individual enrolled in the plan on the basis of any health status-related factor in relation to
the individual or to an individual enrolled under the plan as a dependent of the individual.
(2) Nothing in Paragraph (1) of this Subsection shall be construed to do the
following:
(a) To restrict the amount that an employer may be charged for coverage under a
group health plan.
(b) To prevent a group health plan, and a health insurance issuer offering group
health insurance coverage, from establishing premium discounts or rebates or modifying
otherwise applicable copayments or deductibles in return for adherence to programs of health
promotion and disease prevention.
C. A health insurance issuer offering group health insurance coverage shall not
rescind such coverage with respect to an enrollee or insured once the enrollee or insured is
covered under such coverage involved, except that this Subsection shall not apply to an
enrollee or insured who has performed an act or practice that constitutes fraud or makes an
intentional misrepresentation of material fact. Such coverage may not be cancelled except
with prior notice to the enrollee or insured, and shall comply with any applicable federal law
or regulation. The provisions of this Subsection shall not apply to limited benefit health
insurance policies or contracts, disability income, long-term care, nursing home care, home
health care, community based care, dental or vision benefits, Medicare supplement, specified
disease or illness, hospital indemnity or other fixed indemnity insurance, workers'
compensation or similar insurance.