Louisiana Health Insurance Guide
Louisiana Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a Louisiana resident you have a variety of private health insurance plans to choose from including individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Louisiana State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Louisiana is not a guarantee issue state. That means private insurance companies are not required to sell you an individual health insurance policy if do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health, gender, age and lifestyle habits. If you are accepted, the insurer has the right to impose an exclusionary period up to 12 months for any pre-existing conditions, however you must be given credit for prior creditable coverage. Louisiana also allows insurance companies to a 12-month look-back period. If you are considered a health risk, you can be charged a higher premium. Louisiana law also allows health insurance companies to add elimination riders to your individual health insurance policy.
Louisiana is a guarantee issue state for group health plans issued to small businesses. If your Louisiana health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. However, a 12-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of prior creditable coverage. Credit for creditable coverage is also required if there was no break in coverage of more than 63 days. Louisiana allows group health insurance issuers to medically underwrite policies to determine the premium they will charge the entire group, although the highest premium cannot be 35% more than the standard rate.
Louisiana is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status.
Louisiana Mandated Health Benefits
Louisiana laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Ambulatory Surgery
- Ambulance Services
- Bone Marrow Transplants
- Breast Reconstruction
- Cancer Medications
- Cervical Cancer and HPV Screening
- Dental Anesthesia
- Diabetes Supplies and Self Management
- Emergency Services
- Hearing Aids
- Mammography
- Mastectomy and Mastectomy Stays
- Maternity Stays
- General and Parity Mental Health
- PKU/Formula
- Prostate Cancer Screening
- Rehabilitation Services
- Well-Child Care
- Coverage for newborns under parent's policy
- Coverage for adopted children under parent's policy
- Coverage for handicapped and continuation/dependents under parent's policy
- Coverage for continuation/employees
- Coverage for conversion to non-groups
Types Health Insurance Plans Available in Louisiana
The following major medical health insurance plans are generally available in Louisiana. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Louisiana
Louisiana Health Plan (LHP)
LPH is the state-sponsored program that enables health insurance companies to sell individual policies to eligible applicants who have been denied coverage due to a pre-existing condition. You must have lived in Louisiana for at least six months, have a high-risk health condition or have been rejected by a health insurer during the year prior to applying for LHP, and meet other eligibility requirements. There are four different medical insurance plans to choose from with varying annual deductibles and coinsurance based on 25% of varying out-of-pocket maximums per plan. Annual maximum payable benefits are $100,000. Lifetime maximum is capped at $500,000. Premiums are based on age, sex, geographic location and use of tobacco, but cannot exceed 150% to 200% of the standard risk rate for similar individual health insurance in Louisiana. Enrollment is open, but there may be a wait period.
Louisiana Children’s Health Insurance Program (LaCHIP)
LaCHIP is the state-sponsored program providing health insurance for eligible resident children up to age 19 who do not have other coverage and cannot afford Medicare. Eligibility is based on family size and income. A similar plan, LaCHIP Affordable, provides low-cost care for children whose families exceed the income level for LaCHIP. There is no waiting period. Coverage is comprehensive. There are no premiums, deductibles or co-pays under LaCHIP; LaCHIP affordable requires modest co-payments an $50 monthly premiums to cover all children in a household. Enrollment must be renewed every 12 months.
Regulating Agency
The Louisiana Department of Insurance is responsible for regulating Louisiana’s health insurance industry.
Get access to Louisiana health insurance quotes from http://www.einsurance.com/health-insurance.
Louisiana Department of Insurance
1702 N 3rd St
Baton Rouge, LA 70802
(255) 342-5900 or (800) 259-5300
http://www.ldi.la.gov
Louisiana Health Plan
PO Box 83880
Baton Rouge, LA 70884-3880
(255) 926-6245 or (800) 736-0947
http://www.lahealthplan.org/index-noflash.html
Louisiana Children’s Health Insurance Program (LaCHIP)
Louisiana Department of Health and Hospitals
628 N 4th St
Baton Rouge, LA 70802
(877) 2-LACHIP ((877) 252-2447)
http://bhsfweb.dhh.lousisiana.gov/LaCHIP/
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/