The national Group Health Insurance guide covers how group coverage works: master policies, certificates, eligibility, coordination of benefits, and federal COBRA and HIPAA. Louisiana adds:

• its own state continuation right for people not covered by COBRA (R.S. 22:1046)
• a separate continuation option for surviving spouses 50 and older (22:1045)
• notice rules for rate increases and nonrenewal (22:978)
• rules for disabled dependents and newborns

State continuation (R.S. 22:1046)

Who qualifies. An employee whose employment ends may continue group health coverage if they were continuously insured under the group policy, or one it replaced, for at least three consecutive months immediately before termination.

Who doesn't qualify:

• anyone eligible for federal COBRA, since the state law fills in where COBRA doesn't apply
• anyone covered under other coverage within 31 days
• anyone terminated for fraud or nonpayment

Cost. No more than the full group rate.

Duration. Up to 12 months after coverage would otherwise have ended.

Surviving spouse continuation (R.S. 22:1045)

• A surviving spouse 50 or older may continue group health coverage after the covered employee dies.
• The spouse has 90 days after the death to elect the option. Coverage can't be terminated during that time.
• The continued coverage may end for any of these reasons:
  • nonpayment
  • Medicare eligibility
  • eligibility for another group plan
  • remarriage

Notice of changes (R.S. 22:978)

• A group rate increase of 20% or more needs 45 days' written notice.
• Cancellation or nonrenewal of a group policy needs 60 days' written notice, except for nonpayment.

Dependents

• Newborns are covered from the date of birth, subject to any required premium and enrollment information (22:1075).
• Disabled children. A child who reaches the limiting age but can't support themselves because of a disability, and is chiefly dependent on the parent, stays covered if proof is given within 31 days of reaching that age (22:1001).

Related rules

• Every group, blanket and association health policy has a 30-day grace period (22:977).
• An insurer may not require a small employer to buy another product, such as business auto, to get a health plan. Selling group life with group health is not tying (22:1964(10)).
• Claims are paid within 30 days of proof, or the insurer owes double the benefits plus attorney fees (22:1821).

Common exam traps

• Louisiana state continuation requires three months of coverage and lasts 12 months, not 18. It is not available to anyone eligible for federal COBRA.
• A surviving spouse must be 50 or older, has 90 days to elect, and loses coverage on remarriage or Medicare eligibility.
• A rate increase of 20%+ needs 45 days' notice. Nonrenewal needs 60 days.
• Proof of a disabled child's dependency is due within 31 days.