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Louisiana Health Insurance
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: |
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 | |
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 (LaCHIP) |
Website | |
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. |
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 | |
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 |
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.
