Louisiana maintains a high-risk pool, called the Louisiana Health Plan (LHP), to provide insurance for Louisiana residents with expensive health conditions, or others who meet certain requirements. The pool policies are sold through individual insurers. There are several ways you can qualify to buy individual health insurance from LHP. There are limits on what you can be charged. Rates are based on choice of plan, age, gender, where you live and whether you smoke. There are limits on pre-existing condition exclusion periods that can be imposed.

When am I eligible for LHP?

• There are four ways that you may be eligible to buy health insurance from the Louisiana Risk Pool.
  • First, if you are HIPAA eligible, you can buy health insurance from LHP.  See the box below - To be HIPAA eligible, you must meet certain criteria - to learn if you are eligible.
  • Second, if you had continuous major medical coverage and lose it involuntarily you can buy health insurance from LHP.  An example of involuntary coverage loss would be when an insurer cancels all policies because it ceases to do business in the state. 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 prior 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 two different insurance companies within one year, or offered private health insurance coverage for a premium at least twice the premium typically charged by the insurer for that policy.

    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.

  • Fourth, you also may be able to transfer to LHP from another state’s high-risk pool.  The other state pool would have to have entered into a reciprocal arrangement with LHP.  Contact LHP for more information.

To be HIPAA eligible, you must meet certain criteria

If you are HIPAA eligible you are guaranteed the right to buy individual health policy 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 HIPAA 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 HIPAA eligible.)
• You must apply for health insurance for which you are HIPAA eligible within 63 days of losing your prior coverage.

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

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, in addition to the deductible, for the different deductible options are $3500 and $4500.  There is a $500,000 lifetime cap and a $100,000 annual cap on covered benefits.  In addition, there is a $15,000 annual cap on prescription drug benefits per person.  LHP coverage includes physician services, inpatient and outpatient care, chemotherapy and radiation therapy, physical therapy, and prescription drugs.

What about coverage for my pre-existing condition?

• If you are HIPAA eligible, you will not be subject to a pre-existing condition exclusion period.
• If you are not HIPAA eligible, LHP will exclude coverage for your pre-existing condition for 6 months.  However, you may be able to credit prior coverage to reduce the LHP pre-existing condition exclusion period if you lost the prior coverage involuntarily and apply for LHP coverage within 63 days.

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% of the typical rate for individual coverage in Louisiana. For example, for coverage with a $1,000 deductible, a non-smoking 24-year old man in New Orleans would play $293 per month, while a non-smoking 64-year old man in New Orleans would pay $1,288 per month.   Contact LHP for more information about plan options and premiums.

How long does health insurance from LHP last?

• LHP polices are renewable as long as you pay your premiums, continue to reside in Louisiana and until you reach your lifetime cap on covered benefits.