Buying a short-term plan in Louisiana
- Louisiana state regulations restrict insurers’ exclusion of coverage for pre-existing conditions.
- Short-term plans are not subject to the restrictions, as long as they have terms of no more than six months.
- Some insurers offer longer short-term plans, with durations of 11 to 12 months, but their pre-existing condition lookback period cannot exceed 12 months.
- The majority of Louisiana’s short-term insurers have longer pre-existing condition lookback periods, so they cannot offer policies with terms longer than six months.
- At least nine insurers offer short-term plans in Louisiana.
Duration of short-term health plans is limited in Louisiana if the insurer looks back more than 12 months for pre-existing conditions
Until October 2, 2018, federal regulations limited short-term health plans to no more than three months in duration, and prohibited renewals. But the Trump Administration relaxed those rules, allowing for much longer short-term plans, unless states impose their own requirements.
Louisiana insurance regulations (see Title 22, Section 1072) place restrictions on how insurers can exclude coverage for pre-existing conditions. But the regulations stipulate that in short-term health insurance plans are not subject to the restrictions, as long as they have terms of no more than six months.
Other health plans — including plans with terms of more than six months — can only define pre-existing conditions as those for which treatment was provided in the past 12 months (or which would have caused a prudent person to seek treatment in the past 12 months), and current pregnancy.
Specifically, this is the portion of Title 22, Section 1072 that applies here:
The provisions of this Section shall not apply to limited benefit health
insurance policies and short-term policies or contracts of a duration of six
months or less. Any policy, contract, or plan subject to the provisions of
this Section shall not contain a definition of a preexisting condition more
restrictive than the following:
(1) A condition that would have caused an ordinary prudent person to seek
medical advice, diagnosis, care, or treatment during the twelve months
immediately preceding the effective date of coverage.
(2) A condition for which medical advice, diagnosis, care or treatment was
recommended or received during the twelve months immediately preceding the
effective date of coverage.
(3) A pregnancy existing on the effective date of coverage.
Short-term health plans typically look back more than 12 months when considering whether an enrollee’s condition was pre-existing, but to do that in Louisiana, according to the terms of the statute, the plan must have a term of six months or less.
Elsewhere in Title 22, Section 1072, the statute refers to the federal definition of short-term health insurance plans. So the six-month limit on the initial term only applies if the insurer wants to define pre-existing conditions as things that were diagnosed, treated, or symptomatic more than 12 months before the application is submitted.
Insurers that offer longer short-term plans
As of April 2019, there are at least four insurers offering short-term plans with initial terms longer than six months in Louisiana: Blue Cross Blue Shield of Louisiana (available with a term of up to 11 months), Standard Life, National General, and Vantage (plans offered by Vantage can continue until the end of the calendar year or for 364 days, whichever comes first).
For reference, National General’s brochure confirms that the pre-existing condition lookback period is 12 months, which is also the case for Vantage short-term plans.
Standard Life previously limited their plans to six-month terms, but they are offering 12-month plans as of 2019. However, Standard Life’s brochure still indicates that they classify pre-existing conditions as anything that was treated, diagnosed, symptomatic, etc. in the 60 months prior to enrollment in the short-term plan. We have contacted the Louisiana Department of Insurance for clarification on this apparent discrepancy, and will update this page if and when more information becomes available.
Most insurers have longer pre-existing condition lookback periods, so their plans are limited to six-month terms
At least five insurers are limiting their short-term plans to no more than six months: Companion Life, Everest Prime, Independence American Insurance Company, LifeShield, and UnitedHealthcare.
For reference, the policy exclusion details for Independence American Insurance Company, Companion Life, LifeShield, and Everest Prime note that the pre-existing condition lookback period is five years (this is also the case for Standard Life, although their plans are available for online purchase with terms up to 12 months). And for UnitedHealthcare, it’s 24 months.
Effect of Trump Administration’s new regulations
The Trump Administration’s new regulations allow short-term plans to have initial terms of up to 364 days, and total duration, including renewals, of 36 months. But the regulations are clear in noting that states may continue to have more restrictive rules.
So short-term plans in Louisiana are limited to initial terms of six months if the insurer has a pre-existing condition lookback period in excess of 12 months. But if the insurer only looks at the applicant’s past 12 months of medical history, the plans can have durations in line with the new federal rules.
Louisiana does not limit or prohibit renewals or subsequent purchases of additional short-term coverage, so people can purchase a new plan when their short-term coverage expires, as long as they can pass the medical underwriting for a new policy. LifeShield is marketing six consecutive six-month policies as of 2019, which would provide a total coverage duration of 36 months.
Which insurers offer short-term plans in Louisiana?
- Blue Cross Blue Shield of Louisiana (HMO Louisiana, plan is sold as Bridge Blue)
- Companion Life
- Everest Prime
- Independence American Insurance Company
- National General
- Standard Life
- UnitedHealthcare (Golden Rule)
In most states, it’s fairly rare to see the insurers that offer ACA-compliant plans also offering short-term health plans. But both insurers that offer ACA-compliant plans in Louisiana (BCBSLA and Vantage) have also started offering short-term plans. BCBSLA began offering short-term plans as of late 2018, and Vantage’s short-term plans became available as of January 2019.
The short-term plans offered by Vantage and by Blue Cross Blue Shield of Louisiana include full coverage for certain preventive and wellness services, and BCBSLA’s short-term plans also include coverage for prescription drugs. Coverage for preventive care and prescription drugs is somewhat rare for short-term plans (note that the preventive care and prescription coverage is not as extensive as it would be with an ACA compliant plan though — for example, contraceptives are not covered at all under BCBSLA’s short-term plans).
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.