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Louisiana Health Cooperative (LAHC) overview

On September 28, 2012, Louisiana Health Cooperative (LAHC) was selected by the United States Department of Health and Human Services (HHS) to receive loans to create and operate a Consumer Oriented and Operated Plan, or “CO-OP”. Since that time, LAHC officials have been working with the Louisiana Department of Insurance to obtain approval to operate as an insurer statewide with open enrollment beginning on October 1, 2013 and coverage starting on January 1, 2014. Once operational, LAHC will intensely pursue those individuals and small employers (2-50 employees) who want health insurance coverage, but are not eligible for public assistance in other forms.

Based in Louisiana, LAHC is sponsored by a coalition of health care providers and business leaders who plan to improve health outcomes by providing better access to high quality care at an affordable price. LAHC’s mission is to promote community health and well-being by engaging the members and providers it serves in the valued delivery of high quality, integrated health care services.

CO-OPs, like LAHC, are non-profit, member-owned and member-governed health insurance companies with a focus on developing programs intended to improve the quality of health care delivered to members

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Louisiana Health Cooperative (LAHC) overview

  1. 1. Louisiana Health Cooperative, Inc. (LAHC) OVERVIEW HealthCare.gov mylahc.org
  2. 2. What is a Health CO-OP? Consumer Oriented and Operated Health Plans or “CO- OPs” are non-profit, member-owned and member- governed health insurance companies. The CO-OPs were created by the Affordable Care Act and will operate in several states across the nation. The application for the Louisiana Health Cooperative (LAHC) was selected by the United States Department of Health and Human Services (HHS) to receive loans to create and operate a CO-OP in the state of Louisiana. HealthCare.gov1/30/2013 mylahc.org 2
  3. 3. What are CO-OPs?CO-OPs focus on developing programs intended to improve thequality of health care delivered to members, such as:• preventive programs offered with early health screenings;• focusing on health outcomes based on sound clinical evidence;• ongoing measurement and comparison of performance to clinical quality standards;• a comprehensive medical network;• coordinated care programs;• opportunities for members to participate in their care. HealthCare.gov1/30/2013 mylahc.org 3
  4. 4. What is the Affordable Care Act?The development of health insurance Exchanges and CO-OPs likeLouisiana Health Cooperative (LAHC) are a direct result of thePatient Protection and Affordable Care Act (PPACA) – also knownas the Affordable Care Act (ACA).The ACA is the landmark health reform legislation passed byCongress and signed into law by the President in March 2010. HealthCare.gov1/30/2013 mylahc.org 4
  5. 5. What is the Affordable Care Act?ACA legislation includes a long list of health-related provisionsthat are intended to:• extend coverage to millions of uninsured Americans,• implement measures that will lower health care costs and improve system efficiency, and• eliminate industry practices that are harmful to patients, such as rescission and denial of coverage due to pre-existing conditions. HealthCare.gov1/30/2013 mylahc.org 5
  6. 6. What is LAHC? LAHC is currently working with the Louisiana Department of Insurance to obtain approval to operate as an insurer statewide with open enrollment beginning on October 1, 2013 and coverage starting on January 1, 2014. Once operational, LAHC will intensely pursue those individuals and small employers (2-50 employees) who want affordable health insurance coverage, and are not eligible for public assistance in other forms. HealthCare.gov1/30/2013 mylahc.org 6
  7. 7. LAHC Mission Louisiana Health Cooperative (LAHC) exists to promote community health and well being by engaging the members and providers it serves in the valued delivery of high quality, integrated health care services. HealthCare.gov1/30/2013 mylahc.org 7
  8. 8. What are health insurance Exchanges?Exchanges are organized marketplaces authorized by theAffordable Care Act where individuals and small employers canpurchase health insurance.• An Exchange is a set of government-regulated and standardized health care plans.• Low and moderate income individuals can receive premium and cost-sharing subsidies that will only be available through Exchanges.• Exchanges will make insurance markets more transparent, facilitate consumer choice and encourage competition among insurers. HealthCare.gov1/30/2013 mylahc.org 8
  9. 9. What are health insurance Exchanges?Within the Exchange markets, you can one-stop shop for a healthcare plan, compare benefits and prices, and choose the planthats best for you.• None of these plans will deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs.• All plans must cover preventive care without any out of pocket expense.• Under federal law, all Exchanges must be fully certified and operational by January 1, 2014. HealthCare.gov1/30/2013 mylahc.org 9
  10. 10. What are health insurance Exchanges?Major requirements affecting insurers in the individualExchanges include:• guaranteed issue - insurers will not be permitted to refuse to insure any individuals• plans will be offered in four comparable tiers, covering the same basic benefits so you can compare them easily.• You get to choose your level of out of pocket expense• strict regulations on rescission or the retroactive cancellation of a health insurance policy• elimination of lifetime and annual limits on claims payments HealthCare.gov1/30/2013 mylahc.org 10
  11. 11. LAHC Provider NetworkLAHC intends to contract with physicians, hospitals and otherhealth care providers in markets throughout Louisiana to serveas participating providers for the health plan.Based in Louisiana, LAHC plans to partner with providers thatshare in its mission of promoting community health and well-being and providing high quality, integrated health care services. HealthCare.gov1/30/2013 mylahc.org 11
  12. 12. Who will regulate LAHC?The federal Department of Health and Human Services providesinitial loan funding and monitoring.The Louisiana Commissioner of Insurance will provide allinsurance-related supervision.LAHC will be governed by a community board composed of:  Members of LAHC  Providers  Employers  Individuals providing particular expertise to LAHC Eventually all directors will be elected by the members HealthCare.gov1/30/2013 mylahc.org 12
  13. 13. More information:For additional information about the Louisiana HealthCooperative (LAHC) visit www.myLAHC.org or call toll-free:1-888-517-3802.For additional information about the Affordable Care Act, healthinsurance Exchanges and CO-OPs visit www.Health care.gov. HealthCare.gov1/30/2013 mylahc.org 13

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