Louisiana Small Business
Health Insurance Plans 2023

The average price of a standard Louisiana small business health insurance policy ranges from around $583 to over $1706 per employee per month based on; single or family, location, coverages offered, deductibles and more.

As in all US states, there are laws that pertain to small business health insurance in Louisiana. Furthermore, as with all US states, small business insurance plans offered in Kentucky must adhere to the mandates that have been established by the Affordable Care Act.

In Louisiana, all health insurance companies are legally required to sell small business health insurance to all small businesses. Qualifying small businesses in the state have to be offered the same health insurance policies that are offered to ever other Louisiana small business.

In order to be eligible to purchase insurance policies, small businesses must employ more than 2 but fewer than 50 employees.

Additionally, employees are required to meet a minimum participation level in order to qualify for small business health insurance, and that participation level is determined by the health insurance company. If the required percentage of employees do not purchase the policy offered, the health insurance company can terminate the policy.

In addition, depending on the insurance company, employers may be required to contribute a specific amount toward their employees' premiums. Should these requirements be met, health insurance companies must sell Louisiana small business health insurance plans to any small business that applies.

It should be noted that small business health insurance in Louisiana is slightly limited, meaning that the price of small business insurance can fluctuate as a result of the risk of the group, but those fluctuations must be reasonable. Lastly, it is illegal for health insurance companies to terminate small group health insurance policies if someone in the group falls ill.

According to the Louisiana Division of Administration, The ACA was passed in 2010, and created a variety of new provisions and requirements for individuals, employers, employees and insurers.

Beginning in 2015, LaGov HCM paid agencies are subject to the Employer Shared Responsibility Provisions that require applicable large employers to offer affordable minimum essential health coverage that provides minimum value to their full-time employees (defined as employees who average 30 hours or more of service per week).

If appropriate health coverage is not offered, employers may be subject to penalties if an employee purchases health coverage through the Health Insurance Marketplace and receives a premium tax credit.

In 2010, the Affordable Care Act (ACA or "ObamaCare") was passed by the United States Congress and was signed into law by Obama. Following its passage, provisions of the law have continued to be phased in, and as of January 1, 2014, the majority of American citizens and legal residents of the United States are required, by law, to have qualifying health care coverage.

If they fail to have coverage, they are responsible for paying an annual tax penalty for each month they aren't insured, which is known as the "individual mandate".

The cost of the penalty for failure to have qualifying coverage is $95 per adult and $47.50 per child, or 1% of your total taxable income; whichever amount is higher - as much as $285 per family. In 2017, the penalty increased, and has continued to increase thereafter.

Qualifying Exemptions For The Individual Mandate

Individuals who meet one of the following are exempt from the individual mandate and the associated tax penalties in LA:

• Illegal aliens
• Jailed individuals
• Religious objections
• The cost of health insurance coverage is higher than 8% of your household income
• Those who aren't covered for less than three months during the calendar year
• Those who have hardship waivers
• Your income level is blow the 100% poverty level

If you're a small business owner in Louisiana, you must provide your employees with insurance. This is a requirement that was put into place by the Affordable Care Act.

Referred to as the Employer Shared Responsibility provision, all employers must offer their employees at least one of the ACA-compliant Louisiana small business health insurance plans, otherwise then can face fines of up to $2,000 per employee.

Louisiana small business owners can purchase coverage for their employees through the state's Small Health Option Program (SHOP) exchange, or from a private insurance agent or broker.

Affordable Care Act Standardized Essential Health Benefits

As per the ACA, all qualifying health insurance plans must offer 10 standardized essential benefits.

Depending on the state, additional benefits may also be required. The 10 ACA standardized essential benefits are as follows:

1. Ambulatory patient services (medical care that is offered without being admitted to a hospital)
2. Emergency services
3. Hospitalizations, such as overnight stays and surgical procedures
4. Lab services
5. Mental health and substance abuse disorder services, including behavioral health treatments, such as psychotherapy and counseling
6. Pediatric health care services, including vision and oral care; however, adult vision and dental coverage aren't essential health benefits under ACA
7. Pregnancy, maternity, and newborn care, including before and after birth
8. Prescription pharmaceuticals
9. Preventative and wellness services, as well as management for chronic diseases
10. Rehabilitative and habilitative services and devices, including services and devices for injuries, disabilities, and chronic health conditions

Additional Health Benefits Mandated In Louisiana

In the State of Louisiana, not only do health insurance policies have to offer coverage for the 10 essential standardized benefits that are outlined by the ACA, but they must include additional benefits that have been mandated by Kentucky law. These additional benefits include the following:

• Attention deficit disorder treatments
• Breast reconstruction surgery
• Clinical trials for cancer, excluding phase 1
• Congenital anomaly cleft lip and palate care
• Diabetes care management, including diabetic supplies, equipment, outpatient self-management training and education
• Durable medical equipment, including prosthetic devices and services
• Emergency transportation/ambulance services for ill or injured newborns and their momentarily disabled mother
• Hearing aids for minors
• Prescription pharmaceutical drugs for the use and services of cancer

Standardized Louisiana Small Business Health Insurance Plans

In order to make it easier to compare costs and benefits, the Affordable Care Act has designated all qualifying Louisiana small business health insurance plans to be one of four metal colors, including Bronze, Silver, Gold, and Platinum.

Each of these designations is based on the average amount of health care costs that the plan will cover, which is illustrates at percentages of how much the insurance company will cover for health care, as well as the amount the insured will have to pay out-of-pocket.

All insurance companies that are participating in the federal or state health care exchange program must offer at least the Silver and Gold Louisiana small business health insurance plans.

All four of the metal plans have a shared maximum out-of-pocked amount that the insured can be charged during any calendar year. The following table illustrates this information:

Guaranteed Issue

As per the ACA, individuals cannot be denied coverage or charged higher premiums because of their past health history, or their gender.

Additionally, look-back and waiting periods cannot be imposed. Additionally, policies are effective when they are issued and all coverage is renewable if the individual chooses to renew the policy.

However, plans can be canceled if the individual fails to pay their premiums or commits fraud.

A premium is the amount the insured must pay out-of-pocket in order to maintain their health insurance policy. The premiums that are charged for any of the qualifying metal plans can be based on the following:

• Age of the individual
• Whether or not the individual uses tobacco
• Where the individual lives, based on a rating area
• The number of family members who will be enrolling

While there are several types of health insurance plans to choose from, the following plans are the most popular among LA small business owners:

Health Maintenance Organization - Simply known as an "HMO", this type of plan offers a variety of health-related services via a network of health care providers and hospitals that exclusively contract with the HMO, or who agree to offer their services to members of the HMO. Employees who participate in this type of plan usually have to choose a primary care physician (PCP), and receive most of their care from this physician. If a specialist is needed, the PCP will recommend one that is affiliated with the HMO.

Preferred Provider Organization - More commonly referred to simply as "PPO", this type of health insurance plan is the most common among Louisiana small business owners. The insurance company provides a preferred list of health care providers, and employees must receive their medical care from the doctors and hospitals on that list for their claims to be paid at the highest level possible - but they also have the flexibility to see any other provider anywhere in or out of state.

Point-of-Service Plan - Known as a (POS), this type of health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. Members can access care from in-network or out-of-network providers and facilities, but coverage is better when you stay in-network. POS plans may vary, but generally, plans are considered a blend of HMO and PPO plans - offering more flexibility than HMOs, but less than PPOs.

Health Savings Account - A health savings account (HSA) is a special type of bank account that allows participants in the insurance plan to save money that can be used specifically for the medical care they require in the future. HSA-qualified health insurance plans are usually PPO plans that are specifically designed to be used with an HSA.

Indemnity Health Insurance - This type of health insurance plan allows members to control their own health care and to visit any doctor or hospital they choose. The insurance company would then pay a pre-determined percentage of the total charges for the services that were rendered. Employees may have to pay for some types of services up-front and then they can submit a request for reimbursement with the insurance company.