Louisiana Risk Pool - Health Insurance for the Uninsurable

Risk Pool Name / Acronym
Louisiana Health Plan / LHP

Insurance Regulation Establishing Risk Pool
Louisiana Health Insurance Association

Louisiana Health Plan (LHP)

If a Louisiana resident cannot find health coverage because of a pre-existing health condition, the state provides coverage through the Louisiana Health Plan, state's high-risk pool. To be eligible for this program, individuals must have high risk health condition, or during the 12 months prior to applying for coverage from the LHP have been rejected by a health insurer. Individuals would qualify for LHP if the most recent coverage was under a group health plan; who 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. The Louisiana Health Plan provides coverage to the residents who are eligible under the Health Coverage Tax Credit federal program as well as HIPAA-eligible individuals who have exhausted their coverage options in the group market.

Funding

The Louisiana Health Plan is funded partially by the premiums collected by plan members, state general revenues, the Louisiana mandated service charge and assessments.

Plans Offered

There are four medical insurance plans offered through the Louisiana Health Plan: Plan A, Plan B, Plan C and Plan D. The plans offered under the HIPAA pool are Plan J, Plan K, Plan L and Plan M.

Plan Benefits

Plans A and J have a $1,000 annual deductible and a 25% coinsurance up to an annual out-pocket maximum of $3,500, not including plan deductible. Plans B and K have a $2,000 annual deductible and a 25% coinsurance up to an annual out-pocket maximum of $4,500, not including plan deductible. Plans C and L have a $3,500 annual deductible and a 25% coinsurance up to an annual out-pocket maximum of $4,500, not including plan deductible. Plans D and K have a $5,000 annual deductible and a 25% coinsurance up to an annual out-pocket maximum of $4,500, not including plan deductible.

Louisiana Health Plan High Risk Pool Brochure
Lousiiana Health Plan HIPAA Pool Brochure

Maximum Benefit Limits

The annual maximum payable benefit for all Louisiana Health Plan options is $100,000 and the lifetime maximum is $500,000.

Eligibility

The eligibility requirements of the standard high risk pool are different from those offered under the HIPAA pool

High Risk Pool Eligibility

You must be a resident of Louisiana for at least 6 months
You must not be eligible or covered under any other medical insurance plan, including Medicare and Medicaid
You must provide a letter of declination from two health insurance companies from whom you attempted to obtain health insurance within the past 12 months of submitting your application to LHP
Or, have an existing health insurance plan that has a premium that is more than 200% of the premium for a high risk health plan of similar coverage

HIPAA Pool Eligibility

You must be a resident of Louisiana
You must have 18 months of creditable health insurance coverage, most recently under a group health plan, an individual health plan that stop operating in Louisiana. If your recent coverage was under a discontinued individual plan, you must have had all 18 months of coverage in Louisiana
You must not be eligible for other health insurance, Medicare or Medicaid or any other medical insurance policy
Your most recent coverage could not have been terminated for non-payment of premium or fraud

Enrollment Periods

The Louisiana Health Plan has limitations on the number of members that can be enrolled on the medical plan at any given time. Applications are accepted at anytime but there may be a waiting list. At time of application, you will be informed of the approximated wait time you can expect before becoming enrolled on the plan. The HIPAA pool is always open for enrollment without a waiting list.

Premium Payments

Premiums for LHP are based on age, gender, geographic location and whether or not you are a smoker.

Premium Calculations

Louisiana Health Plan premiums range from 150% to 200% of the standard risk rate for similar type health insurance coverage available to Louisiana residents that qualify for standard issue individual health insurance. The rate is currently set at 150% to make it more accessible

Pre-Existing Condition Waiting Periods

There is a 6 month exclusionary period unless you are eligible for coverage under the HIPAA plan, in which case there is no pre-existing condition waiting period.

Louisiana Health Plan Contact Information

Louisiana Health Plan
P.O. Drawer 83880
Baton Rouge, LA 70884-3880
Phone: 800-736-0947

LHP Website

* Please refer to our legal terms and conditions for disclaimers pertaining to the content on this page.