Health insurance is the key to insuring your financial future and basic medical care needs. Protecting your family against the occurrence of illness or injury is difficult; however a suitable health policy can relieve your financial burden caused by these events. When purchasing health coverage, your top priority should be evaluation of all potential risks and its influence on your finances. In the U.S., approximately 47 million people are uninsured, majority of whom are working families. These families, especially children, are often victims of high financial costs due to the absence of proper health insurance. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to these individuals.
Unfortunately, Louisiana comes on the last spot in the healthiest states list according to United Health Foundation’s 2008 Health Rankings. In 2007, the state climbed one spot to the 49th position still holding the rank of the least healthy states to live in. Despite strong public health funding, the Louisiana continues to stay in the bottom spot due to less number of insured people, high percentage of children in poverty and high crime rate. The state of Louisiana, with a population of more than 4 million residents, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced coverage to the uninsurable residents of Louisiana who meet specific eligibility requirements of age and income.
The Louisiana Department of Insurance manages and supervises all kinds of insurance sold through private-market health insurers as well as public health coverage programs. The state has the highest uninsured population, i.e. approximately 20.2%. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 31.9% of Louisiana’s uninsured residents come under the above 200% FPL category.
Overall, the Health Care in the Louisiana state needs to be revamped to provide adequate health coverage accessibility to its citizens. Buying health coverage is not easy and requires the help of a licensed health insurance agent/broker to choose a proper health insurance plan with benefits that are ideal for your family.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Louisiana. These regulations apply to all insurance companies offering individual or family health insurance in Louisiana:
Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
12 months
Look Back Period
12 months
Look Back Standard
Prudent person
Mandatory Benefits
Cancer screening for women including breast cancer screening and cervical cancer screening, reconstructive surgery after mastectomy, osteoporosis screening, direct access to OB/GYNs, OB/GYNs as Primary Care Providers
Market Rate Restrictions
Yes
Guaranteed Issue Options
None
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Louisiana. These regulations apply to all insurance companies offering small group health insurance in Louisiana:
Small Group Size
2-50
Employee Qualifications
Two employees must work for at least 6 months out of the year, and work 20 hours per week
Guaranteed Issue
Yes
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
35%
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Louisiana. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
Mini-Cobra Option
Yes
Eligible Group Sizes
2-19
Extension of Benefits Period – Standard
12 months
Extension of Benefits Period – Disabled
12 months
Maximum Premium Increase
100%
State Legislation Reference
Louisiana Revised Statute 22:215.13
Additional Notes
To be eligible:
• You must have been covered for 3 months before your insurance ended
• You should not be eligible for another group insurance or government health plan like Medicare or Medicaid
• Your insurance coverage didn’t end because you committed fraud or didn’t pay your part of the premiums.
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Louisiana to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Louisiana is summarized in the chart below:
Plan Name
Louisiana Health Plan
Website
://www.lahealthplan.org
Phone Number
800-736-0947
HIPPA Eligibility Required?
Yes
Available Carriers
Beechstreet Provider Network
Pre-Existing Condition Waiting Period
6 months
Enrollment Periods
Open to new enrollment
Premium Limits
Between 150% and 200% of standard risk
Lifetime Maximum Benefit
$500,000
Special Notes
Individuals who have had at least 18 months of continuous health insurance coverage; who has exhausted any available COBRA coverage; whose most recent coverage was not terminated due to nonpayment of premiums or fraud; who does not have other health insurance coverage; and who is not eligible for other coverage are eligible for coverage.
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Louisiana provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
Program Name
Louisiana Children’s Health Insurance Plan (5LaCHIP)
Website
://www.dhh.louisiana.gov/offices/?ID=119
Phone Number
877-252-2447
Apply Online
Yes
Age Limits
Under 19
Insurance Carrier
Medicaid Provider Network
Length of Coverage
12 months
Residency Requirements
Louisiana residents and able to document either U.S. citizenship or meet residency requirements
Other Eligibility Requirements
Children must not covered by any other health insurance. Family income cannot be more than 250% of the FPL
Pre-Existing Condition Exclusions
None
Cost
No premiums, deductibles or co-payments required for LaCHIP.
$0-$50 monthly premiums for LaCHIP AffordablePlan.
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Louisiana:
Governing Agency
Louisiana Department of Health and Hospitals
Website
://www.lamedicaid.com/provweb1/default.htm
Phone Number
888-342-6207
Residency Requirements
Legal Louisiana residents
Federal Poverty Line Income Limits
Pregnant women & Children 0-19 Income up to 200% FPL
Supplemental Security Income Recipients: 74% FPL
Non-Working Parents: 13% FPL
Medically Needy Couples and Working Parents: 20% FPL
Medically Needy Individual: 14% FPL
Additional Resources
Louisiana Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Louisiana’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Louisiana: At-A-Glance
Provides exclusive health data of Louisiana. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.