RS 976.1 - Fairness in enrollee cost-sharing
A. As used in this Section the following definitions shall apply:
(1) "Cost-sharing requirement" means any copayment, coinsurance, deductible, or annual limitation on cost-sharing including but not limited to a limitation subject to 42 U.S.C. 18022(c) and 300gg-6(b), required by or on behalf of an enrollee in order to receive a specific healthcare service, including a prescription drug, covered by a health benefit plan.
(2) "Enrollee" means an individual who is enrolled or insured by a health insurance issuer for healthcare services.
(3) "Health benefit plan" means healthcare services provided directly through insurance, reimbursement, or other means, and including items and services paid for as healthcare services under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization contract, or health maintenance organization contract offered by a health insurance issuer.
(4) "Health insurance issuer" means any entity that offers health insurance coverage through a health benefit plan, policy, or certificate of insurance subject to state law that regulates the business of insurance. "Health insurance issuer" includes a health maintenance organization as defined and licensed pursuant to Subpart I of Part I of Chapter 2 of this Title and the office of group benefits as created pursuant to Chapter 12 of Title 42 of the Louisiana Revised Statutes of 1950.
(5) "Healthcare services" means items or services furnished to any individual for the purpose of preventing, alleviating, curing, or healing human illness, injury, or a mental or physical disability.
(6) "Person" means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, not-for-profit corporation, unincorporated organization, government or governmental subdivision, or agency.
B. When calculating an enrollee's contribution to any applicable cost-sharing requirement, a health insurance issuer shall include any cost-sharing amounts paid by the enrollee or on behalf of the enrollee by another person.
C. In implementing the requirements of this Section, the state shall regulate a health insurance issuer only to the extent permissible under applicable law.
D. The commissioner of insurance may promulgate rules and regulations necessary to implement this Section.
Acts 2021, No. 431, §1, eff. June 21, 2021.