Louisiana (LA)
Individual Health Insurance Regulations

Learn more about Louisiana Individual Health Insurance

Individual health insurance under Louisiana law is not guaranteed issue, but rather medically underwritten. Medically underwritten health insurance policies allow the health insurance carrier to assess your past and current health status. They may take one of three actions when making a decision on your application for insurance: 1) Approve the application and offer full coverage under the terms of the health plan 2) approve the application with specific exclusions or limitations to medical coverage of pre-existing conditions or 3)deny coverage altogether. Health Insurance carriers are permitted to attach elimination eiders to the requested policy which would exclude coverage for specific health conditions. Louisiana insurance laws also provide the insurance carrier with a look back period and a 12 month exclusionary period limit for pre-existing conditions. The exclusionary period may not, under any circumstance, be longer than 12 months. Under this circumstance, credit for prior creditable coverage must be given. Monthly health insurance premiums may vary and are based on plan selection, age and health status.

Louisiana (LA)
Small Group Health Insurance Regulations

Louisiana insurance laws define a small group as between 3 – 35 employees. Group or employer sponsored health insurance is guarantee issue, which provides that no group can be declined health insurance coverage based on its health status. The employer may request a that each employee satisfy a waiting period prior to becoming eligible for health insurance coverage under the group plan. Health insurance carriers may place exclusions on pre-existing medical conditions for a specified period of time, but in any event no longer than 12 months. The insurance carrier is required to give credit for prior creditable coverage provided the prior coverage was continuous and without a lapse of more than 63 days. Group plan rates may medically underwritten and higher rates may be charged to "unhealthy" groups, but the maximum allowable rate may not be greater than 35 percent of the indexed rate.

Louisiana COBRA and Continuation Coverage

Employer groups of 20 or more employees are bound by federal COBRA regulations. Louisiana has a mini-COBRA law which for continuation of coverage under the group plan for up to 12 months. There are some restrictions that apply to Louisiana mini-COBRA laws, such as the eligible participant may not have access to other group health insurance coverage. Election of this right must be made in writing by the employee or member who is losing coverage and must be accompanied with the initial monthly premium. For those that have exhausted their COBRA benefits, HIPAA eligible guaranteed issue coverage is available under the state's high-risk health insurance pool.

(State Regulation 68 states that employers with 2-19 employees are required to offer COBRA for 12 months.)