§ 42:808 — Eligibility in group programs

§808. Eligibility in group programs
A. For the purposes of participating in life, health, or other programs sponsored by
the Office of Group Benefits, an employee is defined as:
(1) A classified or unclassified state civil service employee.
(2) A retiree as defined by the rules and regulations of the Office of Group Benefits.
(3) A full-time employee of a school board, if the school board elects to pay at least
one-half of the insurance premium for the employee; however, if the school board makes
such an election, the school board shall pay the same proportion of any increase in premiums
as compared to the proportion of premiums paid by the state on behalf of state employees.
(4) A district supervisor or a district employee or a retired district supervisor or a
retired district employee of a soil and water conservation district.
(5) Any parish judge paid in part or in full by the state.
(6) Notwithstanding any provision of this Chapter to the contrary, any employee of
the New Orleans City Park Improvement Association, which is within the Department of
Culture, Recreation and Tourism pursuant to the provisions of R.S. 36:209(C), who is a
participant in a program or programs administered by the Office of Group Benefits and who
is transferred to a nonprofit corporation recognized as a 501(c)(3) entity under the Internal
Revenue Code of 1954, as amended, which transfer is made pursuant to a cooperative
endeavor agreement which provides for the nonprofit corporation to provide certain
maintenance, administration, and operating functions on behalf of the New Orleans City Park
Improvement Association.
(7) Notwithstanding any other provision of law to the contrary, any active or retired
employee of the Louisiana Naval War Memorial Commission as provided by R.S. 25:1000
et seq. Nothing in this Paragraph shall be construed to extend eligibility under this
Subsection to any current or past member of the commission.
(8) The district attorney or district attorney office active employees of New Orleans.
(9) Notwithstanding any other provision of law to the contrary, any active or retired
member of the Louisiana National Guard, provided such active or retired member agrees to
pay one hundred percent of the premium and certifies that other coverage is not available
through the member's employment or the member is not eligible for Medicare.
(10) Notwithstanding any other provision of law to the contrary, any official holding
an appointed position with the West Jefferson Levee District for more than eight years prior
to January 1, 2007.
(11)(a) Notwithstanding any provision of law to the contrary, persons who are state
employees who have completed not less than ten years of continuous full-time state
employment and who are terminated without cause or who resign, and persons who have
completed not less than ten years of continuous service as state elected officials who are
either ineligible to run for reelection, fail to be reelected, or resign from elected office, and
persons who have completed not less than ten years of continuous service as state appointed
officials and who are removed from office without cause or who resign are deemed to be a
special group for eligibility for programs sponsored by the Office of Group Benefits. Such
group shall not be subject to the provisions of Paragraph (3) of this Subsection, R.S.
42:851(E) and (H)(5), or other limitations or restrictions of law that require vesting or a
duration of continuous membership in the programs for eligibility for maximum premium
contributions, or that authorize or require the premium rates for such group to be increased
as a result of eligibility being authorized without prior participation as an active employee,
or that limit participation to either actively employed or retired persons.
(b) For the purposes of this Paragraph and R.S. 42:851(R):
(i) "State employee" means any person who, as an active employee, was a member
of the Louisiana State Employees' Retirement System or the Teachers' Retirement System
of Louisiana.
(ii) "State elected official" means any person elected to a statewide office, to the
legislature, to the Public Service Commission, to the State Board of Elementary and
Secondary Education, to the state courts of appeal, or to the Louisiana Supreme Court.
(iii) "State appointed official" means any person who is appointed by a state elected
official to serve on a board or commission with statewide jurisdiction which exists by law
and which service may be compensated or not.
B. No individual may participate in a program sponsored by the Office of Group
Benefits unless the school board, state agency, or political subdivision through which the
individual is actively employed or retired from participates in the program as a group.
C. Notwithstanding any other provision of this Chapter to the contrary, the
provisions of this Section shall not affect the eligibility of any state agency, local school
board, political subdivision, or other entity or any individuals eligible to participate in the
program on June 29, 2001.
D.(1) Notwithstanding any provision of law to the contrary, no person employed in
a position in an unclassified health care professional employee pool established pursuant to
R.S. 17:1519.16 shall be considered an employee for purposes of this Section nor shall any
such person be eligible to participate in any health, life, or other programs sponsored by the
Office of Group Benefits.
(2) The appointing authority shall notify each person being employed in a position
in an unclassified health care professional employee pool of his ineligibility for participation
in any programs of the Office of Group Benefits. Each person employed in a position in an
unclassified health care professional employee pool shall sign an affidavit acknowledging
his ineligibility for participation in any programs of the Office of Group Benefits.
E. Notwithstanding any provision of law to the contrary, and in particular the
provisions of R.S. 22:1001, 1003, and 1003.1, the Office of Group Benefits is authorized to
offer group insurance coverage to the following dependents of an enrollee:
(1) The spouse of the enrollee, as defined by the office.
(2) A child of the enrollee, until the end of the month the child attains the age of
twenty-six, unless coverage is terminated earlier as provided in this Section.
(3) For purposes of this Section, "child" means:
(a) The issue of a marriage of the enrollee.
(b) A natural child of the enrollee.
(c) A legally adopted child of the enrollee or a child placed for adoption with the
enrollee.
(d) The child of a male enrollee, if a court of competent jurisdiction has issued an
order of filiation declaring the paternity of the enrollee for the child or the enrollee has
formally acknowledged the child.
(e) The issue of a previous marriage or a natural or legally adopted child of the
enrollee's legal spouse, hereinafter "stepchild", which stepchild has not been adopted by the
enrollee and for whom the enrollee does not have court-ordered legal custody, until the
earliest of:
(i) The end of the month the enrollee is no longer married to the stepchild's parent.
(ii) The end of the month of the death of the enrollee's spouse who is the stepchild's
parent.
(iii) The end of the month the stepchild attains the age of twenty-six.
(f) A grandchild in the court-ordered legal custody of and residing with the
grandparent enrollee, until the end of the month the grandchild attains the age of twenty-six.
For purposes of this Section, "grandchild" means a child of a child of the enrollee.
(g) A dependent for whom the enrollee has court-ordered legal custody or court-ordered legal guardianship but who is not a child or grandchild of the enrollee until the end
of the month the custody or guardianship order expires or the end of the month the dependent
attains the age of eighteen, whichever is earlier.
F.(1) Attainment of the respective limiting age of a child or grandchild shall not
operate to terminate the coverage of such child or grandchild if the child or grandchild
became incapable of self-sustaining employment by reason of physical or mental disability
prior to attaining the respective limiting age, provided that no later than seven months before
the child or grandchild reaches the limiting age, the health plan authorized by R.S. 42:851(A)
shall send a notice notifying the parent or grandparent that the coverage shall expire unless
an application for continued coverage is filed with the office on a form designated by the
office, and the application is subsequently approved. The notice shall provide that if the
application for continued coverage is not filed prior to the date the child or grandchild
reaches the respective limiting age, the child or grandchild shall lose coverage. The notice
shall explain the right of the parent or grandparent to appeal for an administrative review if
the documentation is not submitted timely. This application shall be submitted no earlier
than six months prior to the child or grandchild attaining the respective limiting age and shall
be accompanied by an attestation from the dependent's attending physician setting forth the
specific physical or mental disability and certifying that the child or grandchild is incapable
of self-sustaining employment by reason of that disability. The office may require additional
medical or other supporting documentation regarding the disability to process the application.
(2) After the initial approval, the office may require the submission of additional
medical or other supporting documentation substantiating the continuance of the disability,
but not more frequently than annually, as a precondition to continued coverage. If continued
coverage is denied due to the failure of the parent or grandparent to obtain the additional
documentation, upon submitting the documentation, the parent or grandparent may appeal
for an administrative review to reinstate the coverage. For good cause shown and after
considering the totality of the circumstances, the administrative review panel may decide to
reinstate coverage for the child or grandchild.
(3) The parent or grandparent who fails to submit the application for continued
coverage prior to the date the child or grandchild reaches the respective limiting age, may
appeal for an administrative review of the denial of coverage. The parent or grandparent
shall explain the reasons for the untimely filing. For good cause shown and after considering
the totality of the circumstances, the administrative review panel may decide to continue
coverage for the child or grandchild.
(4) The provisions of this Subsection shall apply to any health plan authorized by
R.S. 42:851(A).

Legislative History

Acts 2001, No. 767, §2, eff. June 26, 2001; Acts 2001, No. 1178, §5, eff. June 29, 2001; Acts 2004, No. 779, §1, eff. July 1, 2004; Acts 2004, No. 870, §1, eff. July 1, 2004; Acts 2005, No. 223, §3, eff. July 1, 2005; Acts 2005, No. 505, §2; Acts 2006, 1st Ex. Sess., No. 1, §2, eff. Jan. 1, 2007; Acts 2007, No. 366, §1, eff. July 10, 2007; Acts 2008, No. 414, §1, eff. June 21, 2008; Acts 2011, No. 129, §1, eff. June 24, 2011; Acts 2014, No. 811, §23, eff. June 23, 2014; Acts 2018, No. 603, §1; Acts 2018, No. 676, §1; Acts 2020, No. 112, §1; Acts 2021, No. 20, §6.