North Carolina Health Insurance

Looking for health insurance can be a long, complicated process, especially if you have a family or a preexisting health conditions. But don't be intimidated! We at Health-Insurance.org want to help make your search easier, by helping you to get insurance quotes and educating you about rules and regulations specific to North Carolina.

Request your free North Carolina health plan quote here!

North Carolina Individual Medical Plans (NC)

There are two types of policies available to you in North Carolina, group policies and individual policies. For a plan tailored to your needs, seek out an individual insurer. If you don't have as much money to spend, or are looking for general coverage, group networks, such as an HMO, PPO, POS, or HSA, may suit you.

North Carolina has several regulations unique to the state, so let us educate you about the regulations that will have an effect on the type of coverage you get.

• Blue Cross Blue Shield of North Carolina — NC residents have the right to obtain coverage from Blue Cross Blue Shield, regardless of any health problems.
• HIPAA-Eligible Individuals — If you are HIPAA-eligible, health carriers must offer you at least two plans without exclusion periods. However, there are no limits on the premiums you can be charged.
• Look-back period — The look-back period in North Carolina is 12 months. This means that insurers can check your medical records from the past year for preexisting conditions.
• Claims in First 24 Months — If you make a claim during the first two years of coverage, your health insurance company can examine your medical records for the one year before coverage started for any preexisting conditions related to the claim. If a health condition is found, the carrier is allowed to refuse the claim.

North Carolina Family Medical Coverage (NC)

Depending on your family's needs, you can choose to acquire an individual plan, or join a group network such as an HMO or PPO. If you have children or have just gotten married, certain North Carolina regulations may affect you:

• North Carolina law stipulates that if you have a disabled child, he or she may be able to receive coverage as a dependent child even after he or she exceeds the age of dependency.
• If your family is qualified for group medical coverage, you cannot be denied coverage or charged higher rates because of a health problem.
• If your family has recently gone through changes relating to marriage, job loss, or child birth/adoption, you may be given extra opportunities for coverage.
• Insurance companies in NC can check the past 6 months of your family's medical history for preexisting conditions. If any are found, you may have to wait out an exclusion period of up to 12 months.

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Pre-Existing Medical Conditions and Health Insurance in North Carolina

If you have a preexisting health condition, such as cancer or diabetes, acquiring health insurance could be a challenge in North Carolina, especially because the state currently does not have a high-risk pool.

There is legislature being reviewed that would allow the formation of a North Carolina Health Insurance High Risk Pool. This means that people who would otherwise go without treatment or medication can obtain health insurance through the state of North Carolina. This is good news for those people with preexisting or chronic conditions. More information is available online at the North Carolina Department of Insurance and is free to the public.

In the meantime, however, you may be given an exclusion period (max. 12 months) where you will not have benefits. You may also have to submit your medical records to the carrier for review. If you are having difficulties with private health carriers, consider inquiring about your state's Medicaid program.

New Health Plans in North Carolina

If you are a new North Carolina resident, or if you have left your job and will lose the coverage you had under your employer's group plan, you may need to switch medical plans. Depending on the situation you are in, you will have different options for coverage:

• Changing jobs? By exercising your federal COBRA rights, you may be able to maintain the health plan you had under your previous employer, thought the benefits may not be exactly the same.
• New to the state? Be aware that employers in North Carolina are not required to provide employees with medical insurance.
• Waiting for benefits to start? If your new job comes with an employee health plan, you may still have to wait a few months for your benefits to kick in, a time known as the waiting, or affiliation (for HMO plans) period.

Looking for a health plan in North Carolina? Request a health insurance quote!

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