North Carolina Individual Health Insurance

Health insurance is a valuable defense that will be there for you in the case of an accident or severe illness accompanied by costly medical expenses. If you are without group health insurance coverage, purchasing a North Carolina individual health insurance plan is a great option. As a North Carolina resident, you should educate yourself on the state laws and regulations that affect these individual health plans.

Eligibility: How Am I Evaluated?

Individual health insurance applicants in North Carolina are generally reviewed based on individual factors, such as age, health, and lifestyle choices. In most cases, private insurers in North Carolina are free to turn down any applicant for any reason and there are no regulations is North Carolina's insurance law that mandate who should and should not receive individual health insurance from private insurers. The only exception to all of this is if you receive your health coverage from Blue Cross and Blue Shield. This company does have a guaranteed issue policy that is available to everyone, but may be pricey.

In order to comply with HIPPA Group-to-Individual Portability Coverage regulations, North Carolina requires insurers to offer a minimum of 2 health plan choices with guaranteed acceptance to HIPPA eligible consumers. These plans must have benefits comparable to what is offered to non-HIPPA customers.

North Carolina Guaranteed Benefits & Pre-Existing Conditions

For the most part, your North Carolina individual health insurance policy will cover benefits depending on what type of plan you choose. Insurers in North Carolina are not required to carry any standardized policies and can decide which plans and benefits to offer to residents. However, there are a few benefits that must be offered to all residents who purchase health insurance, including mammograms, pap smears, and diabetes treatment.

In North Carolina, pre-existing conditions are handled in several ways:

• First, an insurer can impose an exclusionary period on suspected pre-existing conditions. They can look back into your medical history up to 12 months prior to your application date to find any pre-existing conditions. This exclusionary period can last up to 12 months.
• Second, HIPPA-eligible consumers cannot have exclusionary periods imposed against them.
• Third, the insurer can impose an elimination rider on any condition that it feels is pre-existing. This rider will exclude the condition(s) from your policy permanently.
• Lastly, if you file a claim regarding a specific condition within the first two years of your policy, your insurer can look back in your medical history up to 12 months prior to your application date to see if it is something that should have been listed as a pre-existing condition. If so, then your claim can be denied. The insurer no longer reserves this right after 2 years.

North Carolina Individual Health Insurance Premiums

To conclude, your North Carolina individual health insurance premiums will be determined by the insurer, according to their rules and regulations, and there are no state laws that limit what you can be charged for a policy. Your health insurance is guaranteed renewable and cannot be cancelled due to health status. On the other hand, the insurer can raise your premiums in order to protect themselves from these higher costs, so it is important to be prepared for that as well.