Finding the Best North Carolina Individual Health Insurance

When you think of ways to provide for and protect your family in medical crisis and financial hardship, health insurance should be on the top of your list of priorities. For people who do not receive group health insurance through their employer, purchasing a North Carolina individual health insurance plan is often the best way to meet your health coverage needs.

The information below contains details regarding the laws and regulations impacting health insurance coverage in North Carolina.

How is eligibility for North Carolina health insurance determined?

People applying for affordable health insurance in North Carolina can expect their application to go through a review and underwriting process. During the review, the insurers will take into consideration factors including health status, lifestyle habits and age. Because the state of North Carolina does not have regulations guiding the process, an insurer may decline an application for any reason. The exception is if the applicant is choosing Blue Cross Blue Shield of North Carolina, as this provider has a guaranteed issue policy available to all NC residents although the premiums will likely be higher than the norm.

HIPPA's Group-to-Individual Portability Coverage regulations require insurers to offer at least two different health plan choices with the guaranteed issue to all consumers who are eligible for HIPPA. Plans falling under this category must include benefits and coverage similar to the plans available to consumers who are ineligible for HIPPA.

What are the Guaranteed Benefits and Pre-Existing Conditions in North Carolina?

Benefits of a North Carolina individual health insurance plan will vary depending on the plan type chosen. Because insurance providers in the state are able to choose which plans they wish to offer customers, they are not required to offer standardized policies. The state does, however, require that the insurers provide certain benefits to all residents who purchase health coverage. Benefits that must be a part of all plans include some cancer screenings, pap smears, and immunizations.

When it comes to pre-existing conditions, North Carolina has regulations and laws that come into play, including:

• An insurer has the right to review an applicant's medical history up to 12 months prior to the application and can enforce an exclusionary period (of up to 12 months) when they identify pre-existing conditions.
• Insurers may not impose exclusionary periods when the consumer is eligible for HIPPA
• Second, HIPPA-eligible consumers cannot have exclusionary periods imposed against them.
• North Carolina Insurers have the right to impose elimination riders on pre-existing conditions, excluding a condition or treatment for a certain body part from coverage for the life of the plan.
• Insurers also have the right to review the consumer's medical history for 12 months prior to the application when there is a claim filed regarding a certain condition within the first two years of coverage. If the insurer determines there was a pre-existing condition, it may deny coverage for the claim.

What to Expect from North Carolina Individual Health Insurance Premiums

Premium amounts for insurance in North Carolina are determined by the insurer. The state does not have guidelines to limit the costs of premiums. However, health insurance coverage in North Carolina is guaranteed renewable and may not be cancelled, even if medical claims increase over time. Insurers reserve the right to raise premium rates to cover the higher medical costs.

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