§ 22:1074 — Guaranteed renewability of individual health insurance coverage

Louisiana § 22:1074

• Jurisdiction: Louisiana
• Title 22: Insurance

Text

§1074. Guaranteed renewability of individual health insurance coverage
A. Except as provided in this Section, a health insurance issuer that provides
individual health insurance coverage to an individual shall renew or continue in force such
coverage at the option of the individual.
B. A health insurance issuer may non-renew or discontinue health insurance
coverage of an individual in the individual market based only on one or more of the
following:
(1) The individual has failed to pay premiums or contributions in accordance with
the terms of the health insurance coverage or the issuer has not received timely premium
payments.
(2) The individual has performed an act or practice that constitutes fraud or made an
intentional misrepresentation of material fact. Such health insurance 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 Paragraph shall not apply to
limited benefit health insurance policies or contracts authorized to be issued in this state. 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.
(3) The issuer is ceasing to offer coverage in the individual market in accordance
with Subsection C of this Section and applicable state law.
(4) In the case of a health insurance issuer that offers health insurance coverage in
the market through a network plan, the individual no longer resides, lives, or works in the
service area, or in an area for which the issuer is authorized to do business, but only if such
coverage is terminated under this Paragraph uniformly without regard to any health
status-related factor of covered individuals.
(5) In the case of health insurance coverage that is made available in the individual
market only through one or more bona fide associations, the membership of the individual
in the association, on the basis of which the coverage is provided, ceases but only if such
coverage is terminated under this Paragraph uniformly without regard to any health
status-related factor of covered individuals.
C.(1) In any case in which an issuer decides to discontinue offering a particular type
of health insurance coverage offered in the individual market, coverage of such type may be
discontinued by the issuer only if:
(a) The issuer provides notice to each covered individual provided coverage of this
type in such market of such discontinuation at least ninety days prior to the date of the
discontinuation of such coverage.
(b) The issuer offers to each individual in the individual market provided coverage
of this type, the option to purchase any other individual health insurance coverage currently
being offered by the issuer for individuals in such market.
(c) In exercising the option to discontinue coverage of this type and in offering the
option of coverage under Subparagraph (b) of this Paragraph, the issuer acts uniformly
without regard to any health status-related factor of enrolled individuals or individuals who
may become eligible for such coverage.
(d) Prior to providing the notice required by Subparagraph (a) of this Paragraph, the
issuer files such notice and the insurance product being discontinued with the commissioner
of insurance.
(2)(a) Subject to Subparagraph (b) of this Paragraph, in any case in which a health
insurance issuer elects to discontinue offering all health insurance coverage in the individual
market in a state, health insurance coverage may be discontinued by the issuer only if:
(i) The issuer provides notice to the applicable state authority and to each individual
of such discontinuation at least one hundred eighty days prior to the date of the expiration
of such coverage.
(ii) All health insurance issued or delivered for issuance in the state in such market
are discontinued and coverage under such health insurance coverage in such market is not
renewed.
(iii) Prior to providing the notice required by Item (i) of this Subparagraph, the issuer
files with the commissioner of insurance the notice and the insurance product being
discontinued for certification that the notice is in compliance with this Section. Notice shall
not be issued to the insureds or enrollees until the expiration of twenty days after the notice
and insurance product being discontinued have been filed unless the commissioner of
insurance gives his written approval prior to that time.
(b) In the case of a discontinuation in the individual market under Subparagraph (a)
of this Paragraph, any individual's policy or coverage that is not subject to renewal during
the minimum one-hundred-eighty-day notice period shall remain in force until the
termination date upon which the contracted period of coverage ends. Any individual's policy
or coverage whose renewal date falls within the minimum one-hundred-eighty-day notice
period shall remain in force for one hundred eighty days from the date that the notice of
discontinuation was issued.
(c) In the case of a discontinuation under Subparagraph (a) of this Paragraph in the
individual market, the issuer may not provide for the issuance of any health insurance
coverage in the market and state involved during the five-year period beginning on the date
of the discontinuation of the last health insurance coverage not so renewed.
(3) No health insurance issuer shall not renew any policy or contract of coverage in
the individual market prior to the end of the last period of coverage as stated in such policy
or contract.
(4) This Subsection shall apply to a discontinuation resulting from any federal
statutory change or federal court ruling repealing or otherwise rendering unenforceable the
Patient Protection and Affordable Care Act, P.L. 111-148.
D. A health insurance issuer may modify the health insurance coverage for a policy
form offered to individuals in the individual market if each of the following conditions is
met:
(1) The modification occurs at the time of coverage renewal.
(2) The modification is approved by the commissioner, is consistent with state law,
and is effective on a uniform basis among all the individuals with that policy form.
However, for purposes of this Section, modifications affecting drug coverage shall not
require approval by the commissioner.
(3) The issuer notifies, on a form approved by the Department of Insurance, each
affected individual of the modification, including modification of coverage of a particular
product or modification of drug coverage, not later than the sixtieth day before the date the
modification is effective. Notwithstanding the requirements of Paragraph (1) of this
Subsection, modification of drug coverage for any drug increasing over three hundred dollars
per prescription or refill with an increase in the wholesale acquisition cost of at least
twenty-five percent in the prior three hundred sixty-five days may occur at any time provided
that thirty-day notice of the modification of coverage is given. The thirty-day notice of
modification of coverage shall include information on the issuer's process for an enrollee's
physician to request an exception from the issuer's modification of drug coverage for
purposes of continuity of care of the patient.
E. In applying this Section in the case of health insurance coverage that is made
available by a health insurance issuer in the individual market to individuals only through
one or more associations, a reference to an "individual" is deemed to include a reference to
such an association, of which the individual is a member.
F. The Department of Insurance shall have the authority, pursuant to the
Administrative Procedure Act, to promulgate and adopt rules and regulations necessary to
implement the provisions of this Section.
NOTE: Former R.S. 22:1074 redesignated as R.S. 22:794 by Acts 2008, No.
415, §1, eff. Jan. 1, 2009.

Legislative History

Acts 1997, No. 1138, §1, eff. July 14, 1997; Acts 1999, No. 127, §1, eff. June 9, 1999; Redesignated from R.S. 22:250.13 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 484, §1, eff. Sept. 23, 2010; Acts 2010, No. 595, §1; Acts 2011, No. 350, §1, eff. Jan. 1, 2012; Acts 2012, No. 316, §1, eff. May 25, 2012; Acts 2019, No. 212, §1; Acts 2020, No. 36, §1; Acts 2021, No. 217, §1.