Louisiana
Insurance Guide

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Open Enrollment Period (OEP)

November 1, 2015 - January 31, 2016

Coverage Can Start

January 1, 2016

Individuals may qualify for Special Enrollment Periods (SEP) outside of Open Enrollment Periods (OEP) if they experience a Qualifying Life Event.

Carriers in Louisiana

H
Humana
UH
United Healthcare

Your State's Health Insurance Marketplace

Qualifying Life Events

If you don’t experience a Qualifying Life Event but still need insurance, Short-Term Health Insurance is an option until Open Enrollment.

Marriage, Divorce, Legal Separation
Loss of Coverage
Moved to a new Location
Birth or Adopton of a child
OtherGaining or losing a dependent, death, change in disability status, certain changes to income, release from incarceration, gaining eligible immigration status

ACA Standardized Benefits

Ambulatory Patient Care
Emergency Services
Hospitalization
Mental Health Services
Rehabilitative & Habilitative Services
Prescription Drugs
Preventative & Wellness Care
Pediatric Care
Lab Services
Maternity & Newborn Care

Marketplace Coverage Plans

Coverage plans are comprised of 5 categories. Percentages are based on the total costs of an average persons' care. The actual percentage you pay will depend on the services administered during the year.

Metal Plan	Carrier Pays	You Pay
Bronze	60%	40%
Silver	70%	30%
Gold	80%	20%
Platinum	90%	10%

Catastrophic: Plans pay less than 60% of the total average cost of care on average. They’re available only to people who are under 30 yrs. old or experience a hardship.

Plan Types

Health Maintenance Organization(HMO)	Preferred Provider Organization(PPO)
Primary Care Physician (PCP) Required Referral Required No coverage for out-of-network doctors Generally Lower Premiums	Primary Care Physician (PCP) Not Required Referral Not Required Choose the doctor or specialist Generally Higher Premiums

Exclusive Provider Organization(EPO)	Point of Service(POS)
No coverage for out-of-network doctors Generally Lower premiums than HMO & PPO	Mix between HMO & PPO Primary Care Physician (PCP) Required Referral Required May use out-of-network providers

Exemptions From Health Insurance and the Tax Penalty

Religious Objections
Incarcerated
Illegal Immigrant
Cost of healthcare exceeds 8.05% income
Uninsured for no more than 2 months in a year
Experienced a hardshipHomeless, evicted in the past 6 months, received a shut off notice from a utility company, recently experienced domestic violence, recently experienced death of a close family member, fire or flood causing substantial damage to your property, filed for bankruptcy in the past 6 months, medical expenses you couldn’t pay in the last 24 months, plan was canceled, ineligible for Medicaid