§ 22:978 — Group, family group, blanket, and association health and accident insurance; notice

§978. Group, family group, blanket, and association health and accident insurance; notice
required for certain premium increase, cancellation, or nonrenewal
A.(1) Notwithstanding the provisions of R.S. 22:887(A) through (D), every insurer,
including any trust subject to the provisions of R.S. 22:401 et seq., whether domestic or
foreign, issuing a policy of group, family group, blanket, or association health and accident
insurance under the provisions of this Subpart to any group composed of one or more
members shall notify the policyholder in writing at least forty-five days before any increase
of twenty percent or more in the policy rates or at least sixty days before any cancellation or
nonrenewal of such policy. Such cancellation or nonrenewal shall comply with the
provisions of R.S. 22:887(F).
(2) The notice required by Paragraph (1) of this Subsection may be waived for a
policy of group, family group, blanket, or association health and accident insurance that
covers one hundred or more persons, provided a provision for such waiver is made part of
the policy agreed upon by the insurer and the policyholder.
B. Nothing in this Section shall be construed to grant to the insurer any additional
authorization in relation to cancellation, nonrenewal, or other termination of policies and all
provisions of this Subpart that regulate such events shall apply. No policy shall be cancelled,
nonrenewed, or otherwise terminated because the insurer failed to meet the notice provisions
of this Section.
C. The notice provisions of this Section shall not apply to cancellations due to
nonpayment of premiums.
D.(1) At least ninety days prior to the date on which a group policy is to be renewed
or terminated, every health insurance issuer providing coverage to a large employer group,
as defined in R.S. 22:1061, shall provide the employer group with, or make available
electronically, information as to the premium rate or amount to be paid to renew the group
policy for the next policy year. The health insurance issuer shall make the information
available to the employer group or to the employer group's appointed insurance agent or
broker.
(2) The group insurance issuer shall make available on a monthly basis the currently
available utilization data and aggregate paid claims and premium data accumulated for the
period of the current policy year. This data shall be made available to both the employer
group and the employer group's appointed insurance agent or broker. Upon request by the
employer group or its agent or broker, the health insurance issuer shall provide this data to
the employer group or the agent or broker within fourteen business days of receipt of the
initial request and monthly thereafter.
E.(1) Every health and accident insurance issuer, including a health maintenance
organization, shall, upon request, release to each group policyholder and agent of a
policyholder claims data and shall provide this data within no more than fourteen business
days of receipt of the request, which shall include the following items:
(a) The net claims paid by month during the current and the two immediately
preceding policy periods.
(b) The monthly enrollment by employee only, employee and spouse, and employee
and family during the current and the two immediately preceding policy periods.
(c) The amount of any claims reserve established by the insurance provider against
future claims under the policy.
(d) Claims over ten thousand dollars including claim identifier, the date of
occurrence, the amount of claims paid and those unpaid or outstanding, and claimant health
condition or diagnosis during the current and the two immediately preceding policy periods.
The data shall provide a unique identifying number or code for the claimant.
(e) A complete listing of all potential catastrophic diagnoses and prognoses
involving persons covered under the policy provisions. The data shall provide a unique
identifying number or code for the claimant.
(2) A health and accident insurer that discloses data or information in compliance
with the provisions of this Section may condition any such disclosure upon the execution of
an agreement for immunity from civil liability.
(3) A health and accident insurer that provides data or information in compliance
with the provisions of this Section shall be immune from civil liability for any acts or
omissions of any person's subsequent use of such data or information.
(4) The provisions of this Subsection shall not be construed to authorize the
disclosure of the identity of a particular employee covered under the group policy, nor the
disclosure of any individual employee's particular health insurance claim, condition,
diagnosis, or prognosis, which would violate federal or state law.
(5) For purposes of this Subsection, "claim identifier" shall be defined as data that
reflects a number designation including but not limited to an alphabetic or alphanumeric
designation which shall not be a name identifier of an employee, employee's spouse, or
employee's dependent.
(6) The provisions of this Subsection shall not apply to limited benefit insurance, as
defined by R.S. 22:47(2)(c).
(7) A plan sponsor and the plan sponsor's agent are entitled to receive protected
health information under this Section only after an appropriately authorized representative
of the plan sponsor or agent makes to the health and accident insurer a certification
substantially similar to the following certification:
'I hereby certify and have demonstrated that the plan
documents comply with the requirements of 45 C.F.R.
Section 164.504(f)(2) and that the plan sponsor will safeguard
and limit the use and disclosure of protected health
information that the plan sponsor or agent may receive from
the group health plan to perform the plan administration
functions.'
(8) A plan sponsor or agent that does not provide the certification required in
Paragraph (7) of this Subsection is not entitled to receive the protected health information
described in Subparagraphs (1)(d) and (e) of this Subsection, but is entitled to receive a
report of claim information that includes the other information required by this Subsection.
F. For purposes of this Section, the term "health and accident insurer" or "health and
accident insurance issuer" shall include a health maintenance organization, the term "policy"
shall include a subscriber agreement, and the term "policyholder" shall include an enrollee
or subscriber of a health maintenance organization.
G. Nothing in this Section shall be construed to require an insurer to provide
information protected as confidential by the Health Insurance Portability and Accountability
Act of 1996 or any other provision of federal law.

Legislative History

Acts 1990, No. 538, §1; Acts 1991, No. 933, §1; Acts 1993, No. 57, §1; Acts 2003, No. 129, §1, eff. May 28, 2003; Redesignated from R.S. 22:215.9 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011; Acts 2010, No. 997, §1; Acts 2012, No. 217, §1, eff. Jan. 1, 2013; Acts 2014, No. 558, §1; Acts 2019, No. 112, §1.