Eligibility

HIGH RISK POOL

HIPAA POOL

Premiums are 10% higher than the average of the top 5 health insurance carriers in the state of Louisiana

Premiums are 25% higher than the average of the top 5 health insurance carriers in the state of Louisiana

Must be a resident of the state of Louisiana for at least 6 consecutive months

Must be a resident of the state of Louisiana

Cannot be eligible for, or receiving, other major medical health insurance coverage.  This does NOT include hospital only, cancer policies or other limited benefit policies

Cannot be eligible for, or receiving, other major medical health insurance coverage.  This does NOT include hospital only, cancer policies or other limited benefit policies

Must have a written denial of coverage from a health insurance carrier dated within one year of the time of application.

Most recent coverage must have been under a group plan; or under an individual plan where the carrier has discontinued all health insurance coverage in the state of Louisiana

Must apply within 63 days of the last day of coverage

Must have a total of 18 months of “Creditable Coverage”

Must elect and EXHAUST all COBRA or continuation benefits

Most recent coverage must not have been terminated because of non-payment of premium, fraud or material misrepresentation

Cannot be eligible for Medicaid, Medicare or group coverage (including COBRA)

Cannot be eligible for Medicaid, Medicare or group coverage (including COBRA)

Cannot be an inmate of a public institution

Cannot be an inmate of a public institution

Cannot have been terminated for non-payment of premiums with Louisiana Health Plan or have been paid the maximum benefits with Louisiana Health Plan

Cannot have been terminated for non-payment of premiums with Louisiana Health Plan or have been paid the maximum benefits with Louisiana Health Plan

NOTE:  There is a 6-month waiting period in the High Risk Pool for pre-existing conditions

NOTE:  There is NO waiting period for pre-existing conditions

Policy is effective on the first day of the month following the postmark date of the application

If the application is postmarked prior to the ending of COBRA/continuation benefits, the LHP policy is effective the day after COBRA/continuation benefits end.  If the policy is postmarked within 63 days after COBRA /continuation benefits end, the LHP policy will be effective on the postmark date of the application

 

You may additionally be eligible if you have been notified that you are Trade Adjusted Assistance Act (TAA) or Pension Benefit Guaranty Corporation (PBGC) eligible

There is NO pre-existing condition for children, spouse who are “Special Enrollees” that enroll within 63 days of birth, adoption or placement for adoption

There is a 12-month pre-existing condition for other “Special Enrollees” such as a spouse or dependent child of an Eligible Enrollee (Eligible Enrollees are enrolled, or eligible to be enrolled, in the HIPAA Plan.)

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