SB 16: HEALTH/ACC INSURANCE: Provides relative to health stop-loss insurance. (8/1/25) (EN NO IMPACT See Note) - Louisiana

SB16 Original → SB16 Act 400 · 7 edits

MODERATE

This bill significantly expands protections for small employers by updating the definition of a 'large employer' to include those with at least five employees, rather than the previous 51. It mandates that health stop-loss insurance for small employers must have guaranteed rates for at least twelve months, limit premium increases to 50% unless actuarially justified, and align exclusions with the main health plan. The law also requires stop-loss policies to cover claims incurred during the contract period even if the plan terminates early and mandates a standardized disclosure form for employers to sign before purchasing coverage.

Scope change

The bill expands the scope of protection from 'large employers' (51+ employees) to 'small employers' (5+ employees) and introduces new mandatory requirements for stop-loss policies issued to these smaller groups.

ELIGIBILITY

Changed the definition of a large employer from 51 employees to 5 employees, extending stop-loss protections to smaller businesses.

REQUIREMENT

Requires health stop-loss policies for small employers to include guaranteed rates for at least twelve months without adjustment.

Limits premium rate increases to 50% of the medical care index unless the increase is actuarially justified.

Mandates that stop-loss plans align their benefit limitations and exclusions with the small employer's main health plan.

Requires stop-loss policies to cover eligible claims incurred during the contract period even if the plan terminates early.

Requires a separate disclosure form explaining coverage limits and risks, which the employer must sign before purchasing the policy.

TIMELINE

Establishes January 1, 2026, as the effective date for these new requirements.

SB16 Enrolled → SB16 Original · 4 edits

MODERATE

The bill was simplified from an enrolled version with multiple complex requirements to an original version with a single core change. The primary shift is a reversal in eligibility: the original bill restricts stop-loss insurance to large employers only, whereas the enrolled version contained broader rules for small employers and detailed disclosure mandates.

Scope change

The bill's scope narrowed significantly by removing provisions that regulated stop-loss insurance for small employers and eliminating specific requirements for disclosure forms and contract terms.

ELIGIBILITY

Removed detailed requirements for small employers, including rules on renewal rate increases, guaranteed contract terms, and specific attachment points.

Changed the rule so that health stop-loss insurance is now only issued to large employers, reversing the focus on small employers found in the enrolled text.

REQUIREMENT

Deleted mandates for a standardized disclosure form and requirements for employers to sign it before purchasing coverage.

TIMELINE

Removed specific effective dates tied to January 1, 2026, and provisions regarding policies in effect prior to that date.

SB16 Reengrossed → SB16 Enrolled · 3 edits · Jun 20, 2025

MINOR

This bill was finalized as an enrolled act after passing both legislative chambers and receiving the Governor's approval. The primary changes involve technical formatting updates, such as removing the Senate Legislative Services header and the detailed amendment history digest, while retaining the core policy provisions regarding health stop-loss insurance for small employers.

Scope change

The bill's substantive scope and applicability remain unchanged; it continues to regulate health stop-loss insurance for small employers in Louisiana.

TECHNICAL

Removed the 'REENGROSSED' header and the detailed digest of amendments that explained the legislative history of the bill.

Changed the document title from 'REENGROSSED' to 'ENROLLED' to reflect its final status as law.

Adjusted page numbering and footer text to reflect the final enrolled version rather than the working draft.

SB16 Engrossed → SB16 Reengrossed · 8 edits · Jun 8, 2025

MODERATE

The bill was reengrossed to expand its scope by adding a new subsection (I) that requires a separate disclosure form for stop-loss policies. It also increased the maximum allowed renewal rate increase from 15% to 50% and updated the effective date for new policies to January 1, 2026. Additionally, the bill removed previous restrictions limiting which insurance entities could issue these policies.

Scope change

The bill now applies to all licensed health insurance issuers, removing previous limitations that restricted issuance to specific entities like licensed insurers, health maintenance organizations, or third-party administrators.

REQUIREMENT

Added a new requirement (Subsection I) mandating a standardized disclosure form that explains coverage limits, employer risk, and potential renewal impacts, which the employer must sign before purchasing.

Increased the maximum allowable renewal rate increase from 15% above the medical care index to 50% above the medical care index.

Added a new condition requiring stop-loss plans to include both a specific attachment point and an aggregate attachment point in the contract.

Added a requirement that stop-loss plans must align their benefit limitations and exclusions with the small employer's main health plan.

Added a requirement that insurers must pay stop-loss claims incurred during the contract period within 48 months after the contract expires.

Added a requirement that stop-loss plans must include provisions to cover incurred and unpaid claims when the plan terminates.

TIMELINE

Changed the effective date for new policy conditions from August 1, 2025, to January 1, 2026.

ELIGIBILITY

Removed restrictions requiring policies to be issued by specific entities (licensed issuers, HMOs, or TPAs) and subject to specific state and federal laws.

HEALTH/ACC INSURANCE: Provides relative to health stop-loss insurance. (8/1/25) (EN NO IMPACT See Note)

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