Louisiana Administrative Code
Title 32 - EMPLOYEE BENEFITS
Part I - General Provisions
Chapter 3 - Uniform Provisions-Participation in the Office of Group Benefits
Section I-319 - Continued Coverage
Universal Citation: LA Admin Code I-319
Current through Register Vol. 50, No. 9, September 20, 2024
A. Leave of Absence. If an enrollee is allowed an approved leave of absence by his/her participating employer, the enrollee may retain the coverage for up to one year if the premium is paid. Failure to pay the premium will result in cancellation of coverage. The enrollee and/or the participating employer shall notify OGB within 30 days of the effective date of the leave of absence.
1. Leave of Absence without Pay, Employer
Contributions to Premiums
a. An enrollee who
is granted leave of absence without pay due to a service related injury may
continue coverage and the participating employer shall continue to pay its
portion of health plan premiums for up to 12 months.
b. An enrollee who suffers a service related
injury that meets the definition of a total and permanent disability under the
workers' compensation laws of Louisiana may continue coverage and the
participating employer shall continue to pay its portion of the premiums until
the enrollee becomes gainfully employed or is placed on state disability
retirement.
c. An enrollee who is
granted leave of absence without pay in accordance with the federal Family and
Medical Leave Act (F.M.L.A.) may continue coverage during the time of such
leave and the participating employer shall continue to pay its portion of
premiums if the enrollee continues his/her coverage.
2. Leave of Absence without Pay; No Employer
Contributions to Premiums. An enrollee granted leave of absence without pay for
reasons other than those stated in Paragraph A.1, may continue to participate
in an OGB plan for a period up to 12 months upon the enrollee's payment of the
full premiums due.
B. Disability. Enrollees who have been granted a waiver of premium for basic or supplemental life insurance prior to July 1, 1984, may continue OGB plan coverage for the duration of the waiver if the enrollee pays the total contribution to the participating employer. Disability waivers were discontinued effective July 1, 1984.
C. Surviving Dependents/Spouse
1. Benefits under an OGB plan of benefits for
covered dependents of a deceased enrollee will terminate on the last day of the
month in which the enrollee's death occurred unless the surviving covered
dependents elect to continue coverage.
a. The
surviving legal spouse of an enrollee may continue coverage unless or until the
surviving spouse is or becomes eligible for coverage in a group health plan
other than Medicare.
b. The
surviving dependent child of an enrollee may continue coverage unless or until
such dependent child is or becomes eligible for coverage under a group health
plan other than Medicare or until attainment of the termination age for
children, whichever occurs first.
c. Surviving dependents will be entitled to
receive the same participating employer premium contributions as enrollees,
subject to the provisions of Louisiana Revised Statutes, title
42, section 851 and rules promulgated pursuant thereto by OGB.
d. Coverage provided by the Civilian Health
and Medical Program for the Uniformed Service (CHAMPUS/TRICARE) or successor
program will not be sufficient to terminate the coverage of an otherwise
eligible surviving legal spouse or dependent child.
2. A surviving spouse or dependent child
cannot add new dependents to continued coverage other than a child of the
deceased enrollee born after the enrollee's death.
3. Participating Employer/Dependent
Responsibilities
a. To continue coverage, it
is the responsibility of the participating employer and surviving covered
dependent to notify OGB within 60 days of the death of the enrollee.
b. OGB will notify the surviving dependents
of their right to continue coverage.
c. Application for continued coverage shall
be made in writing to OGB within 60 days of receipt of notification. Premiums
for continued coverage shall be paid within 45 days of the coverage application
date for the coverage to be effective on the date coverage would have otherwise
terminated.
d. Coverage for the
surviving spouse under this section will continue until the earliest of the
following:
i. failure to pay the applicable
premium timely; or
ii. eligibility
of the surviving spouse for coverage under a group health plan other than
Medicare.
e. Coverage
for a surviving dependent child under this Section will continue until the
earliest of the following events:
i. failure
to pay the applicable premium timely;
ii. eligibility of the surviving dependent
child for coverage under any group health plan other than Medicare;
or
iii. the attainment of the
termination age for children.
4. The provisions of Paragraphs 1 through 3
of this Subsection are applicable to surviving dependents who, on or after July
1, 1999, elect to continue coverage following the death of an enrollee.
Continued coverage for surviving dependents who made such election before July
1, 1999, shall be governed by the rules in effect at the time.
D. Over-Age Dependents. If a dependent child who is the natural or adopted child of the enrollee is incapable of self-sustaining employment by reason of mental or physical incapacity and became incapable prior to attainment of age 26, the coverage for that dependent child may be continued for the duration of incapacity
1. Prior to such dependent child's attainment
of age 26, an application for continued coverage is required to be submitted to
OGB together with current medical information from the dependent child's
attending physician to establish eligibility for continued coverage.
2. OGB may require additional medical
documentation regarding the dependent child's incapacity upon receipt of the
application for continued coverage and as often as it may deem necessary
thereafter.
3. The incapacity
determination shall be a medical determination subject to the appeal procedures
of the enrollee's plan of benefits.
E. Military Service. Members of the National Guard or of the United States military reserves who are called to active military duty and who are OGB enrollees or covered dependents will have access to continued coverage under OGB's health and life plans of benefits.
1. Health Plan Participation. When called to
active military duty, enrollees and covered dependents may:
a. continue participation in any OGB
self-funded plan during the period of active military service and the
participating employer may continue to pay its portion of premiums;
or
b. cancel participation in any
OGB self-funded plan during the period of active military service and apply for
reinstatement of OGB coverage within 30 days of:
i. the date of the enrollee's reemployment
with a participating employer;
ii.
the dependent's date of discharge from active military duty; or
iii. the date of termination of extended
health coverage provided as a benefit of active military duty, such as TRICARE
Reserve Select.
2. Plan participants who elect this option
and timely apply for reinstatement of OGB coverage will not experience any
adverse consequences with respect to the participation schedule set forth in
R.S.
42:851(E) and the
corresponding rules promulgated by OGB.
3. Life Insurance. When called to active
military duty, enrollees with OGB life insurance coverage may:
a. continue participation in OGB life
insurance during the period of active military service, but the accidental
death and dismemberment coverage will not be in effect during the period of
active military duty; or
b. cancel
participation in OGB life insurance during the period of active military
service and the enrollee may apply for reinstatement of OGB life insurance
within 30 days of the date of the enrollee's reemployment with a participating
employer; enrollees who elect this option and timely apply for reinstatement of
OGB life insurance will not be required to provide evidence of
insurability.
AUTHORITY NOTE: Promulgated in accordance with R.S. 42:801(C) and 802(B)(1).
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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