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Rights – Laws


In Louisiana, all residents deserve to know what to expect when applying for health insurance, and their rights as a policyholder. Under the Affordable Care Act, consumers have many more rights than they used to, but several freedoms, namely plan design and pricing, are still in the hands of the insurer.

When owning a health insurance plan, you also may want to know how to file a complaint based on a denied claim or a dispute between yourself and your insurer. The best action to take is to contact your insurance company first, which can prove inconclusive at times. Find out how to exercise your rights and get a positive outcome whether you need to file an appeal or bring a civil issue to light. Get to know your plan, your rights, and your state health insurance laws a bit more deeply, and stay current with health care reform.

 

Guaranteed Renewal

Like most every state, Louisiana health insurance companies are required to follow the guaranteed renewability provision. This law gives policyholders the ability to keep their coverage even if they become sick, as insurers cannot cancel benefits due to factors other than fraud, lying on an application, or refusing to pay premiums. Part of the HIPAA law, the provision is in place to protect individuals from losing their coverage, and all companies on the private market are expected to comply. Insurers in Louisiana must also offer renew your plan for another term before your benefit year is over.

 

Guaranteed Issue

The health reform law known as Obamacare protects children and adults with health problems, as they must be accepted by any individual health insurer. Medical underwriters cannot consider health status when people apply for health plans under federal law. In the past, a Louisiana insurer followed the prudent person standard, and could decline an applicant based on any conditions they may have had in the last 12 months, even if they were untreated or undiagnosed.

 

Community Rating

The Affordable Care Act also requires insurers to practice nondiscrimination in determining premium rates, which means health plans cannot increase rates for health status, gender or occupation. Monthly premiums can only be determined by geographic location, age and tobacco use.

Formerly, if someone was diagnosed with a condition, they could apply for coverage but their premiums would increase, or they may be issued an unlimited exclusion period or an elimination rider. Louisiana insurers allowed credit for previous coverage, giving members with pre-existing conditions the ability to use a credit from their last health plan for care during the exclusion period.

 

Mandatory Benefits

Louisiana health insurance companies are required to pay for certain healthcare benefits under some insurance plans. Statewide provisions for covered care predate the ACA’s essential benefit provision, which requires insurers to cover ten groups of services in comprehensive individual and small group health plans.

Louisiana’s state laws for mandatory coverage include:

 

  • Ambulatory surgery
  • Bone marrow transplants
  • Breast reconstruction
  • Cancer treatment drugs
  • Dental anesthesia
  • Diabetes supplies and self-management
  • Emergency care
  • Hearing aids
  • HPV and cervical cancer screenings
  • Mammograms
  • Mastectomy and hospital stays
  • Medical foods
  • Mental health care and substance abuse treatment
  • Preventive immunizations
  • Prostate cancer screening
  • Rehabilitative services
  • Step therapy
  • Well-baby and well-child visits
  • Well-woman care

 

 

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