feb 2014 lahap prese..

Report
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ADAP stands for AIDS Drug Assistance Program.
ADAP is a federal Ryan White funding source awarded
by the Health Resources and Services Administration
(HRSA).
ADAP funds can be used to provide medication and
insurance services to eligible individuals with a
positive HIV diagnosis.
The State STD/HIV Program (SHP) gets ADAP funding
from HRSA.
SHP uses ADAP funding to support medication and
insurance services through our programs called LDAP and HIP.
•
L-DAP - LOUISIANA DRUG ASSISTANCE PROGRAM
• covers drug costs for uninsured individuals only. Often
referred to as Traditional ADAP.
•
HIP -HEALTH INSURANCE PROGRAM
• covers insurance plan premiums as well as medical (nondrug) and drug copays, coinsurances, & deductibles
(known as cost shares) for insured individuals.
•
LA HAP processes L-DAP enrollment through SHP.
•
HIP processes HIP enrollment through HAART.
LA HAP
Manage LDAP & HIP Contracts
Process LDAP Enrollment
Louisiana Drug Assistance
Program
(LDAP)
•Drug costs for uninsured clients.
•Previously through 10 LSU Medical
Center Outpatient Pharmacies.
•Currently central distribution through
OPH Pharmacy.
Louisiana Health Insurance
Program (HIP) Services
& Enrollment
Insured plan premium
Drug cost share assistance
Medical cost share assistance
Participating HIP Pharmacies
To allow for better coordination of our programs you'll
see a few more changes with LDAP and HIP.
•L-DAP - LOUISIANA DRUG ASSISTANCE PROGRAM
•Will continue to cover drug costs for uninsured individuals
and will soon cover drug copays, coinsurances, & deductibles
(known as cost shares) for insured individuals.
•HIP -HEALTH INSURANCE PROGRAM
•Will continue to cover insurance plan premiums as well as
medical (non-drug) cost shares for insured individuals.
•LA HAP will soon process both L-DAP and HIP
enrollment through a single application.
LA HAP
Manage L-DAP & HIP Contracts
Process L-DAP & HIP
Enrollment
Louisiana Drug Assistance
Program (L-DAP)
•Drug costs for uninsured clients
•Drug cost shares for insured clients
Managed through Ramsell
Louisiana Health Insurance
Program (HIP) Services
Insured plan premium
Medical cost share assistance
Coordinated through HAART
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If you are uninsured and need assistance paying for your
HIV medications, apply to LDAP using the new LA HAP
application that was released in December 2013.
◦ LA HAP application is available on lahap.org
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If you have any type of health insurance and need
assistance with your premiums* and cost shares, apply
to HIP using the HIP application
◦ HIP application is available on haartinc.org under “services”  “HIP”
*If you need assistance paying for premiums, please double check that the
insurance plan you sign up with will accept premium payments from HIP.
•BOTH Race and Ethnicity must be marked. For the purposes of this
application, Hispanic is not considered a race.
•The pregnancy section MUST be filled out. Even if male, the “not applicable”
box can be checked.
•Carefully consider the definition of “household” for the purposes of this application.
People in the same household MUST be related by blood, state legal marriage and/or state
legal adoption.
•Live-in boyfriends/girlfriends and/or same sex partners* are NOT considered part of the
same household and should not be included in this section or included as contributing to
household income.
•Common law marriage is not recognized in Louisiana.
•Louisiana does not recognize people as being “separated” in a marriage until they are
legally divorced. However, LA HAP recognizes it is likely that if someone has been
separated from his/her spouse for greater than six months, it may difficult for that person
to obtain income documentation from his/her estranged spouse. Therefore, income
eligibility can be determined on the separated individual’s income alone. Contact LA HAP
at 504-568-7474 for more information.
*For the purposes of this application, only state legal marriages are considered. Therefore, even if a couple has a federally
recognized marriage or was married in another state, they are not considered married unless the state of Louisiana
recognizes their marriage.
•The client needs to provide proof of income for anyone listed in the
“household” section that is 18 years of age or older and receives any source
of income.
•If the client’s household member(s) does not have any source of income,
then the client needs to note that somewhere on the application. They can
make a note in the household section, cover letter, in the comments section
on page 3, etc.
All questions in this section need to be answered including the 4 subset
questions.
•If the client does not have Medicare, answer “no” to all the Medicare Part
D and LIS questions.
•If the client has SSDI, an SSDI start date is required.
•If you are a case manager/social worker/advocate helping a client
complete this application, please remember to sign your name above
“person obtaining consent” and date it.
•Also print your name, agency, and phone number in the appropriate boxes
so that LA HAP can help your agency track which referrals you have
submitted.
If the client checks that they have been diagnosed with CDC-defined
AIDS, then they need to put their HIV diagnosis date in addition to
their AIDS diagnosis date, even if they are on the same date.
•Lab values must be included and must have been drawn within 6 months of the day
the application is successfully submitted to LA HAP.
•The ARV regimen at time of labs needs to be filled out.
•To be approved for LA HAP, the client must be on or prescribed ARV and/or OI
medications on the LDAP formulary. If the client is not currently taking medications,
include the ARV and/or OI meds they will be prescribed.
•List all other medications that the client is taking.
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Must provide proof of residency that is dated within 6 months
of the day the application is successfully submitted to LA
HAP.
If the address on the proof of residency does not match the
address on the LA HAP application, make a note of why that
is the case and which address is correct.
Acceptable forms of proof of residency include:
◦ A copy of a valid, in-date (non-expired) LA driver’s license or LA
identification card
◦ A copy of a current check stub listing applicant’s name and
current address
◦ A copy of a current lease or mortgage in applicant’s name
◦ A copy of any current utility bill in the applicant’s name
◦ A copy of a legal affidavit stating applicant’s current address
◦ A copy of a legal document listing applicant’s name and current
address (i.e. Federal/State program award
◦ Letter (SSI, SSDI, Food Stamps, etc.), medical bill, a bank
statement, etc).
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Must provide proof of income for the individual applying for LA
HAP as well as all household member’s income.
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Acceptable forms of proof of income include:
◦ A copy of a current tax year document (i.e. Federal/State Tax Return, W2,
1099, etc.)
◦ A copy of the most recent pay stub indicating the time period covered by
the check (i.e. weekly, bi-weekly, monthly)
◦ A statement from the unemployment office verifying no record of
employment
◦ A copy of current award letter for SSI, SSDI, SNAP, VA, Workers
Compensation, unemployment, pension or other benefit
◦ A copy of current monthly benefit check from SSI, SSDI, VA, Workers
Compensation, unemployment, pension, or other benefit
◦ A bank statement showing a gross monthly direct deposit of current SSI,
SSDI, SNAP, VA, Workers Compensation, pension, unemployment, or
other benefit
◦ A legal document showing the current amount of child support or
alimony received in a routine basis
◦ A current legal affidavit declaring the amount of monthly cash income or
a client’s lack of income
◦ A current Certification of No Income
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Answer all of the questions on the application and send all required
documents.
If you are sending a follow up, include a coversheet stating that it is a
follow up. Unclear paperwork is filtered and set aside to be
researched.
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Use black ink. Colored ink does not fax well and results in
unreadable information that delays review.
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Write the client name on the top of each page of the application.
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Include a coversheet with the total number of pages you are sending.
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REVIEW THE APPLICATION WITH YOUR CLIENT BEFORE FAXING
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How do I know if LA HAP got everything? Turn on your fax machine’s
transmittal notice and only fax one application at a time. This will
give you a print out of how many pages were sent and if the
transmission was successful.
•The boxes next to the highlighted items are often not checked.
•The agency information is often not filled out
The information concerning pregnancy is often left blank or partially
blank. Make sure the client answers every question in this section.
•Make sure your client enters the entire household income for each section. For
example, if your client works and his/her spouse receives unemployment, then
the client’s salary/wages should be included in addition to the spouse’s
unemployment amount.
•Proof MUST be provided for all sources of income. In the above example, proof
of the client’s salary/wages in addition to proof of the spouse’s unemployment
amount must be sent in with the HIP application.
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This form is to
be used if a
client has a
group health
insurance policy,
such as an
insurance policy
through an
employer.
The client needs
to take this form
to his/her
employer’s HR
department to
have them
complete it.
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The client needs to
have his/her physician
fill out and sign this
form.
This form is often
referred to by HIP staff
as an APS (attending
physician’s statement).
Clients must complete a 12 month
recertification for HIP annually on their
month of birth. This requires them to fill
out an entire HIP application and check the
box on the HIP application.
Clients must also complete a 6 month
verification on the month that falls 6 months
after their birth month. This is a one page
document that can be found by clicking the
“6 month verification” link at haartinc.org
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The new 2014 FPL guidelines have been released and are
what LA HAP and HIP are currently using to determine income
eligibility for their services.
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In Louisiana, Ryan White ADAP funds (which are used to provide medication
and insurance services to individuals with an HIV positive diagnosis) contract
through HIP to assist clients with paying for their health insurance premiums
and cost shares (copay, coinsurance, deductible).
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Recently, some insurance companies in Louisiana decided NOT to accept
premium payments from HIP.
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Lambda Legal filed a lawsuit on 2/20/14, which resulted in a U.S. District
Court hearing on 3/10/14.
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As of 3/11/14:
 BCBSLA and HMO of LA decided to continue accepting Ryan White funds as
premium payments for individual policies for on-Marketplace and offMarketplace plans until 11/15/14.
 Louisiana Health Cooperative (LAHC) also confirmed that they will continue
accepting Ryan White funds as premium payments until 11/15/14. LAHC only
offers on-Marketplace plans.
 AAA Vantage will also continue accepting Ryan White funds as premium
payments until 11/15/14. AAA Vantage offers on-Marketplace and offMarketplace plans.
 Humana has been accepting Ryan White funds as premium payments and
confirmed they have no plan to change this stance. Humana has both onMarketplace and off-Marketplace plans. Humana on-Marketplace plans are
only available to persons who live in Jefferson Parish.
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On 3/14/14 CMS released an interim final rule
regarding third party payment. The rule went
into effect immediately but will remain open for
comment for 60 days.
The rule requires issuers of qualified health
plans (QHPs), including stand-alone dental
plans (SADPs), to accept premium and costsharing payments made on behalf of enrollees
by the Ryan White HIV/AIDS Program, other
Federal and State government programs that
provide premium and cost sharing support for
specific individuals, and Indian tribes, tribal
organizations, and urban Indian organizations.
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How do we know the insurance companies won’t change their minds and stop
taking payment again?
o
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BCBSLA, HMO of LA, LAHC, and AAA Vantage all individually consented on
record at the hearing that they would continue accepting premium payments
from third parties until 11/15/14.
If the insurers were to go back on their consent, they would receive heavy
sanctions.
CMS released an interim final rule on 3/14/14 requiring QHP insurers to accept
payments made on behalf of health plan enrollees by the Ryan White HIV/AIDS
Program.
CMS says a failure to accept third-party payments as outlined in the rule would
be considered substantial non-compliance with an exchange standard, and
could also be considered a practice that would have the effect of denying or
discouraging enrollment into a QHP by qualified individuals whose medical
history suggests the need for a significant amount of services.
Continue to accept premium payments? I thought BCBSLA and LAHC stopped
accepting premium payments from HIP.
◦ While BCBSLA and LAHC internally stopped accepting premium checks from HIP,
the only publicly produced written statements from either insurer stated they
would continue accepting third party premium payments until 3/31/14.
◦ As a result of this discrepancy, many clients dropped out of these plans or
switched to another plan.
◦ The bottom line: the most recent decision of these insurance companies gives
clients more options (next slide).
Pay premium
themselves
Enroll in a plan
and
apply for HIP
Ryan White funded programs, including HIP, are not entitlement or required programs. If
financially capable, individuals can choose to pay their own insurance premiums and/or cost
shares. It may be helpful for these individuals to lower the metal level of their plan (e.g.
from a platinum level to a bronze level) potentially making their premium costs more
affordable.
Individuals have until 3/31/14 to enroll in a Marketplace plan for 2014. If they cannot
afford the premium and/or cost share costs themselves and have a household income <
300% FPL, they can apply for assistance through HIP.
With the 2014 Marketplace Open Enrollment period ending 3/31/14, providers are
encouraged to assist clients in signing up for the Marketplace plan that best suits
their needs.
HIP has received approval from SHP to resume issuing checks to BCBS and LAHC for the
payment of premiums.
Switch Plans
If a client switched to another plan and would like to switch back to the plan they originally
enrolled in, the client needs to check with the insurance company to find out if the plan has
been effectuated yet. A plan can be effectuated whether or not payment was received.
Client can choose to become / remain uninsured with the understanding of the
consequences of being uninsured, such as:
Be uninsured
-Penalty for not obtaining health insurance*
-Being reliant on LDAP and the public health medical care system
-LDAP open enrollment is dependant on the availability of funding and is subject to the
possibility of restricted access, such as waiting lists.
*The penalty in 2014 is calculated in 1 of 2 ways. You’ll pay whichever of these amounts is higher:
1. 1% of your yearly household income. The maximum penalty is the national average yearly premium for a bronze plan.
2. $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.
The fee increases every year. In 2015, it’s 2% of income or $325 per person. In 2016, and later years it’s 2.5% of income or $695 per person. After that, it is adjusted for inflation.
If you would have qualified for expanded Medicaid (0%-138% FPL), you’re exempt from the law’s requirements to buy coverage because Louisiana declined expansion.
Therefore, you won’t pay a penalty this year for not buying it. HOWEVER, this exemption must be applied for and a Medicaid denial letter is required for application.
138% FPL = $15, 856 for a single person household.
More information on penalty exemptions are available at www.healthcare.gov/exemptions
Effectuated is a term used by insurance companies
that means a plan has become active or gone into
effect.
o If an individual’s plan has already been effectuated, or gone
into effect, they do not have the option to switch plans until
2015 open enrollment unless they are eligible for a Special
Enrollment Period (SEP).
o If an individual’s plan has not yet been effectuated, they can
terminate their coverage with their current insurer and switch to
another plan.
o The only way to know if a plan is effectuated is to contact the
insurer directly.
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While SHP will do our best to update you with
new information, be on the look out for
upcoming items:
◦ On 3/6/14, a new CMS regulation entitled “Patient Protection
and Affordable Care Act; Third Party Payment of Qualified
Health Plan (QHP) Premiums (CMS-9943-IFC)” was submitted
for final review. The final regulation is expected to be released
on 3/14/14.
◦ Louisiana representative Regina Barrow has proposed
legislation that would require all Louisiana insurers to accept
third party premium payments past the date of 11/15/14.
◦ Legislation could be posed to bypass the governor and expand
Louisiana Medicaid. If passed, Louisiana voters would decide
whether to expand Medicaid on next November's election day
ballot.
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Learn and educate other about the benefits of Medicaid Expansion for Louisiana.
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VOTE and help you clients register to vote - www.geauxvote.com
Contact your representatives - www.house.gov/representatives/find/
Contact LAAN and CHANGE
Pay attention to and get involved in Louisiana’s legislative session – www.legis.la.gov
Talk to the plans about expanding their prescription drug formularies to include
medications that benefit people living with HIV/AIDS. (NASTAD Sample Letter)
Learn the process for requesting off-formulary drugs through clients’ plans.
Educate medical providers on how and why they should sign up with the plans that
best support your local community.
Identify and reach out to organizations both locally and nationally, that are already
advocating around these topics, such as LAAN, CHANGE, and NASTAD .
◦
NASTAD – National Alliance of State and Territorial AIDS Directors
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LAAN – Louisiana AIDS Advocacy Network
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Created a sample letter that anyone can use to send to insurance carriers
LAAN Chair – Joshua Holmes ([email protected])
CHANGE – Coalition of HIV/AIDS Nonprofits & Governmental Entities
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Contact information: [email protected]
A PDF version of this letter is available at hivhealthreform.org
Direct link: http://www.hivhealthreform.org/2013/12/09/hiv-advocates-continue-to-push-feds-for-effectiveimplementation-of-the-aca/
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Each insurance plan has a process for how to make an off-formulary request. Below are the
processes for Louisiana Marketplace plans.
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Blue Cross Blue Shield/HMO of Louisiana
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Louisiana Health Cooperative:
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Contact LAHC. For more details use this link:
http://www.mylahc.org/Files/Repository/LAHC2014Formulary.pdf.
If approved, the drug will be covered at a “pre-determined cost-sharing level” and you will not be able
to ask LAHC for a lower cost-sharing level.
Providers must complete a Coverage Determination Request Form and fax it to the Pharmacy
Department available when providers log on to mylahc.org.
AAA Vantage Health Plan:
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Call Express Scripts at 1-866-781-7533 to make an off-formulary request
File an “exception request” by calling AAA Vantage’s Member Service department at (318) 361-0900 or
(888) 823-1910.
The insured and the physician must request the formulary exception.
Humana:
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Off-formulary requests can be made by phone, mail, or fax.
Phone: The patient, provider, or appointed representative should call Humana Clinical Pharmacy Review
(HCPR) at 1-800-555-CLIN (2546), TTY: 711, Monday through Friday, 8 a.m. to 6 p.m. in your local
time zone.
Mail/Fax form “Prior Authorization Request Form: Administrative Product – Nonformulary” available
electronically - http://apps.humana.com/marketing/documents.asp?file=1312909
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Medicare: HCPR, Attn: Medicare Coverage Determination, P.O. Box 33008, Louisville, KY 40232
Commercial: HCPR, Attn: Prior Authorizations, P.O. Box 33008, Louisville, KY 40232
Fax: 1-877-486-2621
Highlighed items are not covered on the listed plan's formulary
Listing of HIV Medicine on Louisiana Marketplace Plans
Louisiana Health Cooperative
Blue Cross Blue Shield & HMO of Louisiana
AAA Vantage *
Humana
Generic Name
Brand Name
Generic Name
Brand Name
Generic Name
Brand Name
Generic Name
Brand Name
Efavirenz/Emtricitabine/Tenofovir
Atripla (Sustiva/Truvada)
Efavirenz/Emtricitabine/Tenofovir
Atripla (Sustiva/Truvada)
Efavirenz/Emtricitabine/Tenofovir
Atripla (Sustiva/Truvada)
Efavirenz/Emtricitabine/Tenofovir
Atripla (Sustiva/Truvada)
Rilpivirine/Tenofovir/Emtricitabine
Complera
(Edurant/Viread/Emtriva)
Rilpivirine/Tenofovir/Emtricitabine
Complera
(Edurant/Viread/Emtriva)
Rilpivirine/Tenofovir/Emtricitabine
Complera
(Edurant/Viread/Emtriva)
Rilpivirine/Tenofovir/Emtricitabine
Complera
(Edurant/Viread/Emtriva)
Elvitegravir/Cobicistat/Emtricitabine/Tenofovi
r
Stribild
Elvitegravir/Cobicistat/Emtricitabine/Tenofov
ir
Stribild
Elvitegravir/Cobicistat/Emtricitabine/Tenofovi
r
Stribild
Elvitegravir/Cobicistat/Emtricitabine/Tenofov
ir
Stribild
Maraviroc
Selzentry
Maraviroc
Selzentry
Maraviroc
Selzentry
Maraviroc
Selzentry
Raltegravir
Isentress
Raltegravir
Isentress
Raltegravir
Isentress
Raltegravir
Isentress
Dolutegravir
Tivicay
Dolutegravir
Tivicay
Dolutegravir
Tivicay
Dolutegravir
Tivicay
Zidovudine/Lamivudine
Combivir
Zidovudine/Lamivudine
Combivir
Zidovudine/Lamivudine
Combivir
Zidovudine/Lamivudine
Combivir
Emtricitabine
Emtriva
Emtricitabine
Emtriva
Emtricitabine
Emtriva
Emtricitabine
Emtriva
Lamivudine (3TC)
Epivir
Lamivudine (3TC)
Epivir
Lamivudine (3TC)
Epivir
Lamivudine (3TC)
Epivir
Lamivudine/Abacavir
Epzicom
Lamivudine/Abacavir
Epzicom
Lamivudine/Abacavir
Epzicom
Lamivudine/Abacavir
Epzicom
Zalcitabine/Dideoxycytidine (ddC)
Hivid
Zalcitabine/Dideoxycytidine (ddC)
Hivid
Zalcitabine/Dideoxycytidine (ddC)
Hivid
Zalcitabine/Dideoxycytidine (ddC)
Hivid
Zidovudine (AZT)
Retrovir
Zidovudine (AZT)
Retrovir
Zidovudine (AZT)
Retrovir
Zidovudine (AZT)
Retrovir
Abacavir/Zidovudine/Lamivudine
Trizivir
Abacavir/Zidovudine/Lamivudine
Trizivir
Abacavir/Zidovudine/Lamivudine
Trizivir
Abacavir/Zidovudine/Lamivudine
Trizivir
Emtricitabine/Tenofovir
Truvada
Emtricitabine/Tenofovir
Truvada
Emtricitabine/Tenofovir
Truvada
Emtricitabine/Tenofovir
Truvada
Didanosine (ddI)
Videx / Videx EC
Didanosine (ddI)
Videx / Videx EC
Didanosine (ddI)
Videx / Videx EC
Didanosine (ddI)
Videx / Videx EC
Tenofovir
Viread
Tenofovir
Viread
Tenofovir
Viread
Tenofovir
Viread
Stavudine (d4T)
Zerit
Stavudine (d4T)
Zerit
Stavudine (d4T)
Zerit
Stavudine (d4T)
Zerit
Abacavir Sulfate
Ziagen
Abacavir Sulfate
Ziagen
Abacavir Sulfate
Ziagen (only as solution, not
tablet)
Abacavir Sulfate
Ziagen
Tipranavir
Aptivus
Tipranavir
Aptivus
Tipranavir
Aptivus
Tipranavir
Aptivus
Amprenavir
Agenerase
Amprenavir
Agenerase
Amprenavir
Agenerase
Amprenavir
Agenerase
Indinavir
Crixivan
Indinavir
Crixivan
Indinavir
Crixivan
Indinavir
Crixivan
Saquinavir
Fortovase
Saquinavir
Fortovase
Saquinavir
Fortovase
Saquinavir
Fortovase
Saquinavir Mesylate
Invirase
Saquinavir Mesylate
Invirase
Saquinavir Mesylate
Invirase
Saquinavir Mesylate
Invirase
Lopinavir/Ritonavir
Kaletra
Lopinavir/Ritonavir
Kaletra
Lopinavir/Ritonavir
Kaletra
Lopinavir/Ritonavir
Kaletra
Fosamprinavir
Lexiva
Fosamprinavir
Lexiva
Fosamprinavir
Lexiva
Fosamprinavir
Lexiva
Ritonavir
Norvir
Ritonavir
Norvir
Ritonavir
Norvir
Ritonavir
Norvir
Darunavir
Prezista
Darunavir
Prezista
Darunavir
Prezista
Darunavir
Prezista
Atazanvir
Reyataz
Atazanvir
Reyataz
Atazanvir
Reyataz
Atazanvir
Reyataz
Nelfinavir
Viracept
Nelfinavir
Viracept
Nelfinavir
Viracept
Nelfinavir
Viracept
Enfuvirtude
Fuzeon
Enfuvirtude
Fuzeon
Enfuvirtude
Fuzeon
Enfuvirtude
Fuzeon
Rilpivirine
Edurant
Rilpivirine
Edurant
Rilpivirine
Edurant
Rilpivirine
Edurant
Etravirine
Intelence
Etravirine
Intelence
Etravirine
Intelence
Etravirine
Intelence
Delavirdine
Rescriptor
Delavirdine
Rescriptor
Delavirdine
Rescriptor
Delavirdine
Rescriptor
Efavirenz
Sustiva
Efavirenz
Sustiva
Efavirenz
Sustiva
Efavirenz
Sustiva
Nevirapine
Viramune/Viramune XR
Nevirapine
Viramune/Viramune XR
Nevirapine
Viramune/Viramune XR
Nevirapine
Viramune XR
 Atripla is not covered as a single tablet, but its components are available
for a split treatment regimen

All HIV medicine listed is in Tier 5
 Complera is not covered as a single tablet, but its component are available
for a split treatment regimen

All HIV medicine listed is in Tier 5

All HIV medicine listed requires Prior Authorization
This information is available on lahap.org
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This is not a comprehensive comparison of all
dental plans in Louisiana, but it is a good starting
point.
HIP can assist with premium payments, but
currently CANNOT assist with cost shares (copay,
coinsurance, deductible).
Currently, the client is responsible for paying their
own cost shares for their dental insurance.

Annual Maximum – the maximum amount that a dental plan
will pay for services in a plan year.

Diagnostic and Preventive Care – routine dental care, such
as cleanings and X-rays.

Basic Dental Work – minor restorative services and surgeries,
such as fillings and extractions.


Major Dental Work – complex dental services and surgeries,
such as crowns, bridgework, root canals, and denture
repair/adjustments.
Waiting Period – a time period in which the dental plan will
not pay for services, leaving the client responsible for 100%
of any costs during this time period. This is a one-time wait
period occurring when someone first signs up with a plan.
Louisiana Marketplace Dental Plan Comparison
Plan
AllStar Family Dental Plan - Low
Dental Smart Choice
Blue Dental Essential
Blue Dental Preferred
One Plus Ultimate Max (OFF EXCHANGE)*
AllStar Family Dental Plan - High
PPO Children's Plan 70 + Basic for Adults
PPO Plan 70 for Children + Basic for Adults
BESTOne Dental Basic - Silver
BESTOne Dental Plus - Silver
BESTOne Dental Plus - Gold
PPO Plan 85 for Children + Preferred for Adults
PPO Children's Plan 85 + Preferred for Adults
BESTOne Dental Advantage - Gold
*This dental plan is not offered on the
health insurance marketplace, but was
included in the comparison.
**The percentages listed are how much the
insurance carrier is paying. For example, if it
says 70%, that means that the insurance
carrier is paying 70% of the costs of care
and the client would be responsible for the
remaining 30% of those costs.
Carrier
AlwaysCare Benefits
Humana
BCBSLA
BCBSLA
AlwaysCare Benefits
AlwaysCare Benefits
Dentegra Insurance
Delta Dental Ins. Co
BEST Life
BEST Life
BEST Life
Delta Dental Ins. Co
Dentegra Insurance
Best Life
Basic
Major
Annual
Annual
Preventive Dental
Dental Basic Dental Work Major Dental Work Monthly
Deductible Maximum
Care
Work** Work**
Waiting Period
Waiting Period
Premium
$100
$1,000
100%
50%
0%
0 Months Major not covered
$14.61
$100
$1,000
100%
50%
50%
6 Months
0 Months
$16.20
$75
$1,000
100%
50%
50%
6 Months
12 Months
$17.17
$50
$1,000
100%
80%
50%
6 Months
12 Months
$21.11
$50
$2,000
100%
70%
40%
0 Months
12 Months
$22.98
$15
$1,000
100%
80%
50%
0 Months
12 Months
$25.02
$50
$1,000
100%
80%
0%
0 Months
12 Months
$25.49
$50
$1,000
100%
80%
0%
0 Months
12 Months
$26.70
$50
$1,000
100%
50%
30%
0 Months
No waiting period
$28.20
$50
$1,500
100%
70%
40%
0 Months
12 Months
$37.65
$50
$1,500
100%
70%
40%
0 Months
12 Months
$37.65
$25
$1,000
100%
80%
50%
0 Months
12 Months
$41.94
$50
$1,000
100%
80%
50%
0 Months
12 Months
$43.50
$0
$1,500
100%
90%
50%
0 Months
12 Months
$45.27


My Contact Information:
◦ Julia Frisk, Public Health Associate, 504-568-8387, [email protected]
HIP: 225-927-1269
For assistance completing a HIP application ask for:
Brandy Davis (ext. 144)
For application status updates ask for:
◦ Regions 1, 2, 3 new & recertification - Vena Lewis ext. 147 ([email protected])
◦ Regions 4, 5, 6, 8 new & recertification – Tanya Brown ext. 135 ([email protected])
◦ Regions 7, 9 new & recertification AND 6 month verification for all regions - Kne-Kole
Gibson ext. 126 ([email protected])
◦ ACA application for all Regions - Heather Faris ext 124 ([email protected])

LAHAP – for application status updates, the CSS are usually the easiest to
contact.
◦ Jennifer Carlos Gomez, ADAP Coordinator
 504-568-5448
◦ Rosaline Morgan, Client Services Specialist (CSS)
 504-568-8746
◦ Markham Bradburn, Client Services Specialist (CSS)
 504-568-3623
◦ Heather Weaver, TAB Coordinator
 504-568-5489

This presentation is available on lahap.org  “Links”  “Technical Assistance
Resources” or the direct link at http://lahap.org/information_links/default.html

Lahap.org

Haartinc.org under “services”

Healthcare.gov

HIV411.org

Cms.gov

Hivhealthreform.org

Enrollment Assistance:
Enroll Louisiana Inc. (www.enrolllouisianainc.com)
4664 Jamestown Ave, Suite 125
Baton Rouge, LA 70808
Office: 225-228-1515
Fax: 225-612-6395
Email: [email protected]

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