Health Insurance Carriers in North Carolina (NC)
In North Carolina, like every state, there are specific guidelines that all health insurance providers must follow. To make your research easier, we have compiled a list of recommended providers complete with links to more information about each one. Below that you will find details on some of North Carolina’s health insurance laws.
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Health Insurance Carriers in North Carolina
American Medical Security
Assurant Health (Formerly Fortis)
Blue Cross and Blue Shield of North Carolina
Celtic
Health Plan Administrators, Inc.
Group Health Insurance in North Carolina
- If eligible for coverage, an applicant may not be denied or charged more due to health problems.
- Extra opportunities may be available for life changes involving children, marriage, family problems or job loss.
- Special considerations are offered to dependent and disabled children.
- A new employer may withhold coverage for a certain period.
- A new HMO may require an ‘affiliation period’.
- Insurance providers may review medical records on a pre-existing condition for the six months immediately preceding intended coverage start date.
- A pre-existing condition may be excluded from coverage for up to12 months.
- Creditable coverage applies when a pre-existing condition was covered continuously without a break longer than 63 days.
Small Business Health Insurance in North Carolina
- Small businesses with fewer than 50 employees may not be denied small group health insurance
- Coverage may not be cancelled because of sickness within the employee group.
- Small business employers are protected from widely varying premium prices.
- Small businesses may apply for standardized plans.
- Small businesses with fewer than 50 employees may join a statewide purchasing pool for group health insurance.
- Contact the North Carolina Department of Insurance for more information.
North Carolina Department of Insurance
P.O. Box 26387
Raleigh, NC 27611
(919) 733-2032
www.ncdoi.com
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Self-Employed Health Insurance in North Carolina
- The self-employed may purchase small group health insurance with proof sole proprietorship.
- Providers must offer standard or basic insurance to those requesting it on behalf of a household employee, although other types of group coverage may be denied.
Individual Health Insurance in North Carolina
- Individual health insurance may be denied based on health problems of all individual insurers except Blue Cross Blue Shield of North Carolina which must guarantee individual coverage.
- For those eligible under HIPAA, insurance companies must offer two plans with good benefits and may not exclude coverage for any length of time. There are no limitations set on prices of premiums.
- Providers may attach elimination riders in reference to pre-existing conditions.
- Providers may exclude coverage for up to 12 months.
- Any claims made within the first 24 months of coverage allows the provider to review to the 12 months immediately prior to coverage for pre-existing conditions related to the claim. Should a pre-existing condition be found through objective standards, providers may refuse to pay the claim.
- There are no premium price limitations for an individual policy or a renewal.
- Coverage may not be cancelled due to illness
North Carolina Health Care Programs
Medicaid, Health Choice for Children, and Breast and Cervical Cancer Control Program are assistance programs available in North Carolina.
