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 and/or treated more than 12 months before the application is submitted.
Insurers that offer longer short-term plans
As of November 2018, there are at least two insurers offering short-term plans with initial terms longer than six months in Louisiana: Blue Cross Blue Shield of Louisiana, and National General. And Vantage will be offering longer short-term plans as of 2019.
For reference, National General’s brochure confirms that the pre-existing condition lookback period is 12 months. Vantage does not yet have their plans available for purchase as of November, but their page says that plans will be allowed to have terms of up to 364 days. Blue Cross Blue Shield’s short-term plan is available with a term of up to 11 months.
Most insurers have longer pre-existing condition lookback periods, so their plans are limited to six-month terms
At least six insurers are limiting their short-term plans to no more than six months: Companion Life, Everest Prime, Independence American Life, LifeShield, Standard Life, and UnitedHealthcare. For reference, the policy exclusion details for Standard Life, Independence American Life, Companion Life, LifeShield, and Everest Prime note that the pre-existing condition lookback period is five years. 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.
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 Life
- National General
- Standard Life
- UnitedHealthcare (Golden Rule)
- Vantage (plans available with effective dates starting January 1, 2019)
In May 2018, Michael Bertaut, a healthcare economist and HealthCare.gov exchange coordinator for Blue Cross Blue Shield of Louisiana, addressed the then-proposed federal regulations to expand access to short-term plans. In answer to the question about whether a person will be able to buy a short-term health plan from BCBSLA, Bertaut’s article clarifies that the insurer is “very closely monitoring the evolving rules on STLD health insurance, both at the state and federal level.” So it’s possible that the list of insurers that offer short-term plans in Louisiana could change after the new federal rules take effect.
As of early October, BCBSLA was still working out the details, but by November, Bridge Blue plans were available for purchase statewide in Louisiana (and they include full coverage for certain preventive and wellness services, as well as prescription drug coverage, both of which are 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). Vantage, the state’s other insurer that offers ACA-compliant plans, has also gotten into the short-term market with effective dates starting in January 2019.
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.