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North Carolina insurance law and regulation
News that affects your health insurance and planning
June 16, 2019 – Status of alternative non-ACA health plans: North Carolina does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, but does not permit insurers to sell non-compliant transitional policies in the individual market and does not limit the sale of short-term coverage more strictly than the federal government.
April 16, 2019 – North Carolina is considering an innovative new plan to provide coverage for up to half a million of the state’s lower income working class individuals who are currently uninsured or underinsured. House Bill 655 titled the “Health Care for Working Families Act” draws funding from various sources and requires participants to contribute 2% of their income toward the coverage. The plan is primarily financed by hospitals and the state’s major hospital networks have expressed support for the bill. Tax dollars will not be used t fund the bill. Lawmakers point out that the bill won’t directly contribute to the national debt. The bill enjoys support from Republicans, Democrats and Independents partly because it actively disassociates with Medicaid expansion plans.
March 29, 2019 – Small business health plans – Yesterday a federal court in the District of Columbia ruled in favor of states in striking down U.S. Treasury regulations that permitted the expansion of small business association health plans. Even before the court ruling, association health plans were not showing promise as cost-saving measures as was hoped. What this means to small businesses is that if they want a lower cost health plan then they must design it themselves independently from an insurance company. The problem is that most firms providing benefits services are primarily in the business of selling insurance rather than lowering costs. Freedom Benefits offers an affordable consultation to help small business owners design and document an alternate small business health plan without necessarily requiring the purchase of insurance.
November 28, 2018 – The North Carolina Restaurant & Lodging Association now offers association health plans to its member firms. Freedom Benefits specializes in referring North Carolina users in all industries and circumstances to a range of association health plans offered through the Association of United Internet Consumers on the Smart Insurance Marketplace.
The history of health care planning in North Carolina (Information is outdated and links may be expired)
6/8/2016 The recent proposal by North Carolina’s largest insurer to raise 2017 health insurance rates by more than 18% has sparked concern by individuals and small businesses that purchased Obamacare coverage. New York Times reports that similar health insurance cost hikes are proposed in many other states.
9/3/2015 Blue Cross and Blue Shield of North Carolina will no longer offer its broad network plans in Charlotte, Raleigh and Durham for 2016.
6/3/2015 The largest individual health insurance company in North Carolina proposed a 26% rate increase for next year after this year’s 13.5% increase. Blue Cross of North Carolina says that most of the rate increase is the result of high medical costs incurred in 2014 as newly covered consumers who qualified for Obamacare subsidies. New cancer and heart condition patients were the most expensive. If the state regulatory system does not approve the full amount of the requested increase then presumably the insurer will further restrict treatments and cut payments to providers.
10/27/2104 HealtheMed and HealtheFlex short-term medical plans, underwritten by HCC Life Insurance Company, will experience a geographic rate change on all new business submitted in North Carolina on or after November 7, 2014.
2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
7/26/2013 Affordable Smart Term Life Insurance is now available to most North Carolina residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
2/1/2013 Milliman Inc., a research firm hired by the state, estimates that about 40% of the total North Carolina residents who will use an Health Insurance Exchange to purchase cost-subsidized insurance are currently uninsured. Lawmakers point out that more than half, about 60% – of the expected insurance exchange users are already covered and would be using the exchange to find less expensive coverage or tap into taxpayer-paid subsidies. As a result, some North Carolina lawmakers have proposed stopping work on the state-run insurance exchange in order to let the federal government foot the bill for what they fear may be a budget-breaking expense. State Senator Tom Apodaca was quoted as saying “You never know what’s going to happen with the federal government. They’re with you one day and the next day they pull out and leave you holding the bills.”
2/15/2012 Concerns about health insurance consumer data and privacy issues about Health Insurance Smart NC navigator services are addressed on the Universal Health Insurance Blog. While the consumer data collection of Smart NC is clearly more invasive and beyond the scope of what would apparently be required to provide health insurance navigator services, the difference may be explained by the multiple function of this data collection form. We have no information on the custody and usage of personal data collected by the Smart NC program.
2/10/2012 North Carolina Department said that Well path Select, the state’s second largest individual health insurance issuer expects to lose more than 80 percent of its customers due to federal benefits ratio requirements that caused the company to reduce compensation to its agents. The department hopes to prevent other insurance companies from leaving the state entirely due to the same federal regulation.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Blue Cross and Blue Shield of North Carolina and UnitedHealthcare are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
1/12/2012 Value Access Guarantee is no longer available in North Carolina.
9/12/2011 The popular defined benefit medical expense insurance marketed under the brand name “Core Health Insurance” is no longer available in North Carolina. This coverage has been the fastest growing type of individual insurance throughout most of the United States. North Carolina residents may need to continue to use the older major medical type policies for now. Federal law may eventually make this limited type health insurance coverage available across state lines regardless of residence.
8/12/2011 Long term care partnership update – The NC Centers for Medicare and Medicaid Services have approved the amendment to the North Carolina Medicaid State Plan to allow for resource disregard at long-term care Medicaid eligibility determination and resource protection at estate recovery. This allows individuals the freedom to purchase insurance without worrying about the risk of losing coverage that might have been available through Medicaid. The new “Partnership Program” is offered through independent insurance agents in conjunction with Medicaid. Transamerica Life, Mutual of Omaha and Massachusetts Mutual are all participating in the insurance program.
5/29/2011 North Carolina lawmakers plan to cut spending for “optional” services provided by Medicaid. The affected services include items such as insulin, podiatry, chiropractic services, eye exams, dental care and at-home chemotherapy. These services account for about half of the spending of the 1.4 million residents currently covered by the state’s Medicaid programs. The cuts follow a national trend to trim benefits under Medicaid programs as enrollment and spending increases. It is unclear whether those affected by the benefit cutbacks will avoid these medical treatments or will try to afford their treatment through another means. The cutbacks are predicted to lead to an increase in more serious and more expensive medical conditions.
2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.
1/3/2011 Premium rates for Inclusive Health, the state’s high risk health insurance plan, dropped by 10% or more for 2011. For those 63 and over, premiums have decreased as much as 31 percent. The premium rate for a 64-year-old non-smoker drops from $592 per month to $412. The rate for applicants age 50 or younger drops from $346 to $315. The national average health insurance premium is now about $400 per month so these new premium rates for Inclusive Health plan are very competitive. A total of 513 North Carolina residents signed up for the plan in 2010 but it is not known how many policies were still in force for 2011. The premium reduction may help attract more previously uninsured members.
12/16/2010 North Carolina Department of Insurance officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, North Carolina said that it would: 1) Create an interagency group to work on the planning and establishing a foundation for the feasibility of the establishment of Exchange(s) in North Carolina. An advisory group has already been formed with eight different work groups to focus on different areas, 2) Build on the work of its SHAP grant to address the needs of the poor and near-poor, and 3) Determine if the implementation of NC Fast will have to be reexamined to function and/or interface with the Exchange. North Carolina has undertaken a multi-year program to streamline and combine the eligibility process for many of its income determined social programs.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in North Carolina is now available at Freedom Benefits.