For more information call 
Health Insurance and Portability Act
1-800-736-0947 / 225-926-6245
 Louisiana Health Insurance Association

Louisiana maintains a high risk pool, called the Louisiana Health Plan (LHP), to provide insurance for people with expensive health conditions, or others who meet certain requirements. While LHP offers the same benefit plan options to all its enrollees, you may be charged a different premium and may be placed on a waiting list for LHP coverage, depending upon the reason you are eligible for LHP. You can buy self-only or, if federally eligible, family coverage from LHP.

When am I eligible for LHP?

•        There are 3 ways you can be eligible for coverage through LHP.

•        First, if you are federally eligible, you can buy health insurance from LHP without pre-existing condition exclusion periods. In addition, you will not be subject to any waiting list that might apply to other people in LHP. You must apply within 63 days of becoming federally eligible. Your premium will be higher than for others in LHP who are not either federally eligible or eligible for a conversion policy.

To be federally eligible, you must meet certain criteria

If you are federally eligible you are guaranteed the right to buy some type of individual health coverage in every state and are exempted from pre-existing condition exclusion periods. In Louisiana, you are guaranteed the right to buy coverage from LHP.

To be federally eligible, you must meet all of the following:

•         You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.

•         You also must have used up any COBRA or state continuation coverage for which you were eligible.

•         You must not be eligible for Medicare, Medicaid or a group health plan.

•         You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be federally eligible.)

•         You must apply for health insurance for which you are federally eligible within 63 days of losing your prior coverage.

Federal eligibility ends when you enroll in an individual plan, because the last day of your continuous health coverage must have been in a group plan. You can become federally eligible again by maintaining continuous coverage and rejoining a group health plan.

•        Second, if you had continuous major medical coverage and lose it involuntarily, you can buy health insurance from LHP. You will not have a pre-existing condition exclusion period, but you will be subject to any waiting list that might apply to other people in LHP. To qualify for LHP this way, you must apply to LHP within 63 days after your group or continuation coverage ends.

•        Third, you can buy LHP coverage if you have lived in Louisiana for at least 6 consecutive months and can demonstrate proof of uninsurability. You are considered uninsurable if you have been turned down for coverage by 2 different insurance companies within one year, or are unable to find private health insurance coverage for less than twice the premium typically charged for individual health insurance.

If you qualify for LHP as uninsurable, you might have a pre-existing condition exclusion period. You will get credit for any prior coverage that was involuntarily terminated and that was not interrupted by a break of 63 or more days.

You also might be subject to a waiting list if state funds are insufficient to let you enroll right away.

Your premium will be lower than that charged for people who are federally eligible.

•        You also may be eligible for LHP if you recently moved from another state where you were covered under that state’s high risk pool and that state has entered into a reciprocal arrangement with LHP. Contact LHP for more information.

What does LHP cover?

•        LHP offers coverage with a choice of annual deductibles ($1000, $2000, $3500 or $5000). After the deductible is met, LHP will pay 75% of the claims until your out-of-pocket limit for the plan is met. The maximum out of pocket limits for the different deductible options are $1500, $3000, $3500, and $4500, respectively. There is a $500,000 lifetime cap and a $100,000 annual cap on benefits per person.

What about coverage for my pre-existing condition?

•        If you are federally eligible or lose continuous coverage involuntarily, you will not be subject to a pre-existing condition exclusion period.

•        LHP will exclude coverage for your pre-existing condition for 6 months if you had a condition for which you actually received a diagnosis or treatment. However, if you had at least 6 months of prior coverage and apply for LHP coverage within 63 days of losing your prior coverage, you will not have a pre-existing condition exclusion period.

How much can I be charged for LHP coverage?

•        Premiums vary based on the type of plan you choose, where you live, your gender, your age, and whether you smoke. Premiums are generally between 150 and 200 percent of the typical rate for individual coverage in Louisiana. For example, for coverage with a $1000 deductible, a non-smoking 24-year old man in New Orleans would play $157.07 per month, while a non-smoking 64-year old man in New Orleans would pay $520.64 per month. Contact LHP for more information about plan options and premiums.

Can my LHP coverage be cancelled?

•        You can remain enrolled in LHP as long as you pay your premium.

For more information call 
Health Insurance and Portability Act
1-800-736-0947 / 225-926-6245
Louisiana Health Insurance Associatio

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