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Louisiana Risk Pool - Health Insurance Provided for the Uninsurable

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Acronym or name of the risk pool: Louisiana health plan or LHP.

Regulation establishing risk pool: Louisiana Health Insurance Association.

Funding: The funding received is mainly generated from premiums paid by members. It is also derived from state general revenues and mandated charges.

Plans offered: Four medical Insurance plans are offered through the Louisiana health plan. These are plans A, B, C and D. Plans J, K, L and M are offered under the HIPAA pool.

Plan benefit: Plans A and J have a deductible of $1000 and a coinsurance rate of 25%. The annual out of pocket limit is $3500. This does not include plan deductibles. Plans B and K have annual deductibles of $2000 and a coinsurance rate of 25% till a maximum out of pocket limit of $4500. Plans C and L have deductibles of $3500 and 25% coinsurance till a maximum of $4500.

Louisiana Health Plan High Risk Pool Details: http://www.lahealthplan.org/

Louisiana Health Plan HIPAA Pool Details: http://www.lahealthplan.org/

Maximum benefit limits: The annual maximum level payable is $100000 for all health plans. The lifetime maximum is $500000.

Eligibility: Eligibility conditions are different for the two sectors - HIPAA eligible and the high risk pool.

Eligibility for high risk pool: (a) The person must be a resident of Louisiana for at least 6 months. (b) The person may not be eligible for Medicare or Medicaid. (c) The person must have received a notice rejecting his application for insurance from an admitted company in the state within the last 12 months. (d) The person has a health insurance plan with a premium more than 200% that of a high risk health plan providing similar coverage.

Eligibility for HIPAA pool: (a) The person must be a resident of Louisiana for at least 6 months. (b) The person may not be eligible for Medicare or Medicaid. (c) The person must have at least 18 months of insurance coverage, most recently for a group insurance. (d) The last payment should not have been terminated because of non-payment of premium.

Enrollment periods: The Louisiana health plan imposes limitations on enrolments in the medical plan at a specific time. Applications are accepted throughout the year but there may be a wait list. You are informed about the approximate waiting period at the time of enrollment. However, the HIPAA pool does not have a wait list and enrollments are taken at all times.

Premium payments: Premiums are dependent on the health plan you select. It is also determined by your age, sex and whether you are a smoker.

Premium calculations: The rate cannot exceed 200% of the standard risk rate. This refers to benefits that people in Louisiana can obtain from other private health insurance providers. The minimum rate is 125%. Currently, the rate is fixed at 150%.

Pre existing condition waiting period: The preexisting condition exclusion period is of 6 months unless the applicant is eligible for coverage on HIPAA. In case of eligibility under HIPAA, there is no exclusion period.

Contact information: Louisiana health plan. PO Drawer 83880, Baton Rouge, LA 700884 3880. Ph: 800 736 0947. LHP Website.

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