North Carolina Risk Pool - Health Insurance for the Uninsurable

Risk Pool Name / Acronym
North Carolina Health Insurance Risk Pool / NCHIRP OR Inclusive Health

Insurance Regulation Establishing Risk Pool
North Carolina Legislature - 2007
SESSION LAW 2007-532, HOUSE BILL 265

North Carolina Health Insurance Risk Pool (NCHIRP) OR Inclusive Health

North Carolina Health Insurance Risk Pool (NCHIRP) also known as Inclusive Health provides health insurance coverage for North Carolinians who do not have access to an employer health plan and face higher premiums due to a pre-existing medical condition. It also offers coverage to individuals who are federally defined HIPAA eligible or qualify due to loss of employment due to the effects of international trade under the Health Coverage Tax Credit.

Funding

NCHIRP is funded by the premiums collected from plan members and assessments to health insurance companies.

Plans Offered

Inclusive Health offers Plan A with $1,000 deductible, Plan B with $2,500 deductible and Plan C, the high deductible plan, with $5,000 deductible.

Plan Benefits

• Plan A has an annual deductible of $1,000.00. For most in-patient covered medical services, there is a 20% coinsurance. For most outpatient services, the coinsurance is 50%. The maximum out-of-pocket limit is $2,000.00, which includes the annual deductible.
• Plan B has an annual deductible of $2,500.00. For most in-patient covered medical services, there is a 20% coinsurance. For most outpatient services, the coinsurance is 50%. The maximum out-of-pocket limit is $4,000.00, which includes the annual deductible.
• Plan C, the high deductible health plan, has an annual deductible of $5,000.00. For most in-patient and outpatient covered medical services, there is a 100% coinsurance after the deductible has been met. The maximum out-of-pocket limit is $5,000.00, which includes the annual deductible.

Inclusive Health Plan Brochure
NCHIRP Plan Brochure

Maximum Benefit Limits
Inclusive Health coverage offers a lifetime maximum of $1,000,000 for all the plans.

Eligibility

To be eligible for Inclusive Health coverage, you must meet all of the following criteria:

 

• You are a legal resident of the United States and a resident of the State of North Carolina.
• You do not have access to group coverage as an employee or as a dependent of an employee and you do not qualify for a government program such as Medicare or Medicaid.
• You have been rejected or refused by an insurer for similar coverage for medical reasons.
• You have been offered coverage by an insurer but with conditional rider limiting coverage.
• You have been refused coverage except at a higher premium rate than Inclusive Health.
• You have similar coverage, but at a single rate higher than Inclusive Health.
• You have a diagnosed medical condition, outlined by Inclusive Health, which allows automatic enrollment into Inclusive Health.
• You are a resident eligible for the Federal Health Coverage Tax Credit (trade displaced workers, PBGC recipients). (See below description of HCTC)
• You are an eligible individual with other non-group coverage in place; you can move to Inclusive Health at any time.

 

Portability Eligibility

You are considered HIPAA-eligible if:

 

• You have a total of 18 months of creditable coverage.
• You have avoided a significant break in health coverage of 63 or more full days in a row. A significant break in coverage results in the individual losing credit for the coverage before the break.
• You do not have any medical coverage, other than that which will soon be exhausted;
• If COBRA, state continuation coverage, or Federal Temporary Continuation Coverage was offered, you must have accepted and exhausted it. Although an individual may apply for HIPAA coverage before the termination of COBRA, COBRA must be exhausted and then the new coverage will start.
• You must not be eligible for any other employment related group health coverage, Medicare or Medicaid.
• Your last coverage must have been through an employer or union plan (COBRA, State and Federal continuation coverage also meet this requirement) or a church plan (as defined under section 3(33) of the Employee Retirement Income Security Act of 1974.
• You must not have lost your last coverage through fraud or nonpayment of premiums.
• Generally, you must not have accepted, after losing employer group coverage, a conversion policy or policy of limited duration because they are both forms of individual coverage and will terminate your HIPAA portability rights.

 

Enrollment Periods

Coverage begins on the first day of the following month if your applicant is received and processed by the 15th of the month.

Premium Payments

Premiums for Inclusive Health are based on your plan selection, age, gender and whether you smoke or not.

Premium Calculations
Premiums are based on the standard risk rate for similar type coverage available to North Carolinas residents. The Inclusive Health rates are capped between 150% and 200% of the average amount charged for standard coverage in the state.

Pre-Existing Condition Waiting Periods

There is a 12-month waiting period for preexisting conditions, which is waived if the applicant had continuous coverage under another health policy immediately proceeding or the individual is HIPAA eligible.

North Carolina Health Insurance Risk Pool (NCHIRP) OR Inclusive Health

The Inclusive Health Customer Service Department
Phone: 866-665-2117
Inclusive Health Website

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