North Carolina Health Insurance


North Carolina (NC)

Individual Health Insurance Regulations

Medical insurance is an essential aspect of an individual's life. As a head of the family, your main priority should be safeguarding your family against unpredicted events of illness and injury. Suitable health coverage requires a detailed assessment of your family's healthcare needs and your finances. If you reside in North Carolina, you can choose from various product alternatives. The North Carolina Department of Insurance supervises the legislature under which the North Carolina health insurers can sell private health plans to individuals and families.

All insurance companies offering individual/family health plans in North Carolina may medically underwrite new applications for insurance. The underwriting process allows the health plans company an opportunity to review your past and current health history. Based upon information provided to the insurance carrier during the application process, the insurance company may opt to deny coverage based on medical history; or approve coverage with an exclusionary period of up to 12 months; or approve the application and offer full coverage. North Carolina insurance laws provide the insurance carrier to impose a 12 month look back period and 12-month exclusionary period limit for pre-existing conditions. Credit for prior coverage is not required for individual medical insurance policies. North Carolina state permits the insurers to impose an elimination rider to exclude pre-existing health conditions. Prior creditable coverage must be applied to this exclusionary period. Individual health plans in North Carolina is guaranteed renewable, which means that the insurance company may not cancel your coverage is your health status worsens.

Search for plans and the costs associated with them using the search box above. We provide individual, family, Medicare supplemental, group and student health plan quotes for you to compare on all states and zip codes. Remember that having coverage leads to a healthier lifestyle as you are able to get regular doctor checkups and therefore a low-cost premium.


North Carolina (NC)

Small Group Health Insurance Regulations

Any company with 1-50 employees may qualify for small group health coverage in North Carolina. For groups of 1-50, coverage is guaranteed issue and the group may not be turned down due to health status when applying for new coverage. Self-employed persons that qualify as a group of 1 may be turned down on all plans except for the 2 standardized plans that must be offered by every insurance company offering small group health insurance. These standardized plans are state mandated and they all have the same level of benefits, regardless of the insurance company. All group health plans in North Carolina are non-discrimination, so an individual employee may not be denied coverage under the group plan because of health status. Insurance carriers may impose a 12-month exclusionary period for pre-existing conditions on all applicants who do not have prior creditable coverage. The look-back period is limited to 6 months. For prior creditable coverage to be accepted there may not be a break in coverage of more than 63 days.

Insurance companies may medically underwrite small group applications, but only for the purpose of determining the premium to charge. Rates can be modified based on health status and demographics, but are limited to a 1.20 rate adjustment factor. Groups in the highest risk level may not be charged more than 20% of the standard rate. To qualify for a small group health plan, a self-employed group of one may be required to provide proof of business ownership.


North Carolina COBRA and Continuation Coverage

Federal COBRA regulations apply to all groups with more than 20 employees. For groups of 19 or less, North Carolina has a mini-COBRA law which is similar to federal COBRA. Continuation of coverage under the group plan must be available for 18 months. Some qualified dependents are able to remain on COBRA for up to 36 months. Under mini-COBRA law, an employee must have been insured on the group plan for at least 3 months and must accept their COBRA coverage within 31 days of the termination date of employment. Any person accepting COBRA coverage is fully responsible for payment of premium and there will be a 2% administration fee in addition to the monthly premium. For persons that have exhausted their COBRA coverage, or are unable to obtain individual health insurance, Inclusive Health, the North Carolina Health Insurance Risk Pool, provides coverage to the medically-uninsurable residents. For those that have exhausted their COBRA, and apply for this coverage within 63 days, there are no pre-existing condition exclusionary periods or elimination riders.