North Dakota insurance law and regulation
News that affects your health insurance and planning
12/8/2018 – In June North Dakota joined a coalition of 20 states that argue that the Affordable Care Act is no longer constitutional after the 2017 federal tax law eliminated fines for not having health coverage. Today Attorney General Wayne Stenehjem won a court battle to keep the action alive over the objection of state lawmakers. It the lawsuit is successful, North Dakota residents would be free of the restrictions of Obamacare and the state could develop its own plans to protect residents with serious medical conditions.
The history of health care planning in North Dakota (Information is outdated and links may be expired)
12/23/2015 About 19,000 North Dakota residents enrolled for 2016 coverage through the federal insurance exchange. 80% of applicants received premium subsidies and most enrollees paid less than $75 for the coverage.
2/24/2015 The North Dakota legislature is scheduled to switch its health insurance provider from Blue Cross to a lower cost carrier this year after 37 years with Blue Cross. Some lawmakers are concerned that Sanford Health, the lower priced carrier, will not match the same level of benefits and service (a concern shared by employees of other organizations in a cost-driven health plan change). Freedom Benefits recommends the use of employee health plans with a choice of insurance carriers. Employer contribution can be based on the lower cost carrier and employees have the option to “buy up” to another plan of their choice. These are popular in large companies and small business health insurance exchanges and there is no practical reason why this is not a preferred solution for a government entity health plan.
12/22/2014 A major health care research organization reported that 75,000 North Dakotans live in “dental shortage areas,” and 2/3 of children on Medicaid did not receive any dental care in 2011. Many of the state’s dentists do not accept Medicaid patients because of low reimbursement or administrative hurdles. Most do accept private dental insurance as listed on this web site.
12/21/2014 About 11,000 North Dakota residents obtained insurance through the health insurance exchange system so far and most received help with the cost of the insurance premium according to a federal official.
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 Dakota 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.
2/21/2012 Comprehensive Health Association of North Dakota (CHAND) – health insurance to North Dakota residents who either are unable to find adequate health insurance coverage in the private market due to medical conditions or who have lost their employer-sponsored group health insurance. Insurance carriers licensed to do business in North Dakota must inform individuals denied health insurance coverage by their company about CHAND. CHAND covers major medical and prescription drug expenses, subject to benefit plan limitations and exclusions. An individual is eligible to receive $1,000,000 in benefits from CHAND during their lifetime. An individual who has received $1,000,000 in CHAND benefits from enrollment in any combination of benefit plans is not eligible to obtain new coverage through the association. Premiums may not to exceed 135% of premiums charged in the state of North Dakota for similar coverage. The balance is covered by assessments to companies that write $100,000 in annual premiums on behalf of residents of North Dakota. Additional dollars may also come through federal grants. Applicants are required to meet CHAND eligibility requirements to qualify. For more information, visit CHAND’s website at www.chand.org.
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 Blue Shield of North Dakota is the state’s largest health insurance provider and as such, earns the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
10/17/2011 State law H 1386 enacted 4/20/2011 establishes an “any willing provider” consumer freedom of choice for health care services providing that a health insurance plan may not prevent a beneficiary from selecting the health care service provider of their choice who is licensed in the state.
8/10/2011 North Dakota Insurance Commissioner Adam Hamm told the state’s legislators that the federal government should run the health insurance exchange. The state accepted a federal grant to explore the options for creating and operating an exchange and he now believes that the federal government could do a better job. While we agree that the commissioner’s assessment is absolutely accurate, is would seem politically unacceptable and impossible for the state’s lawmakers to give up this control and the additional funding that will be available from the federal government. The federal government wants state lawmakers to “buy into” the insurance exchange concept so that they will be more willing to fund their future funding gap when health care costs increase and federal aid decreases after 2014. However, federal laws says that the federal government will run the state’s insurance exchange if the state does not elect to do so by December by January 2013.
About half of the 50 states were previously expected to allow the federal government to run their health insurance exchange while the other half of the states will operate their own. Now other states may be reconsidering their reliance on the federal government to fund the launch of their insurance exchange especially in the wake of the federal deficit debt deal this month. Kansas Governor Sam Brownback announced that the state is giving a $31.5 million health insurance exchange “early innovator” grant back to the U.S. Department of Health and Human Services. Kansas does not believe that the federal government will follow through on its promise of funding health care reform through the insurance exchange.
2/7/2011 The state’s pre-existing condition insurance plan (PCIP) monthly premium rates (per person):
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods. PCIP applicants who are approved to participate in PCIP can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses. Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the amount the plan pays for your care. If you apply for PCIP coverage on the government Web site, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed. Note that your premium may increase if you age into a higher rate tier, or if PCIP adjusts its premiums to any changes in the commercial market.
12/16/2010 North Dakota 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 Dakota said that it would: 1) Estimate the potential design and operational details of Exchange as well as its cost, 2) Conduct a financial and structural forecast of technical needs for Exchange, 3) Implement necessary legislation that is not already in place and educate North Dakotans on changes, and 4) Convene stakeholders and experts to gather input.
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 Dakota is now available at Freedom Benefits.
3/23/2010 North Dakota and ten other states including Alabama, Florida, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah and Washington will make a joint legal challenge to the federal health reform bill on the basis that it improperly usurps state sovereignty over health insurance and that requiring health insurance is an illegal and improper government action.