Group and Individual North Carolina Health Insurance

North Carolina health insurance companies are required to comply with a variety of rules and regulations imposed upon them through the state legislature. These laws are meant to even the playing field between the North Carolina health insurance companies and those that they insure. These North Carolina health insurance rules differ depending on whether a person has an individual or a group North Carolina health insurance plan.

For an individual to qualify for a group North Carolina health insurance plan, he or she must work for an employer who supplies benefits to eligible employees. If this is the case, an applicant to a North Carolina health insurance group plan cannot be denied a policy due to his or her age or health status. However, with individual North Carolina health insurance policies, individuals can be denied access to policies based on their ages, health conditions or other factors that label them as high risk.

Group North Carolina health insurance policies have flat rates for the different plans available. These flat rates apply to all of the North Carolina health insurance policyholders in the group. A North Carolina health insurance company is not allowed raise just one individual’s policy premium if he or she is a member of a North Carolina health insurance group policy. However, North Carolina health insurance companies can raise the premiums for the entire group at the end of a term if there has been a general increase in the number of claims filed. With individual North Carolina health insurance policies, North Carolina health insurance companies can increase an individual’s premium at the end of every term based on his or her age or health status.

Pre-existing condition laws also differ among individual and group North Carolina health insurance policies. Group North Carolina health insurance plans define pre-existing conditions as any condition or illness that was diagnosed and treated during the six months prior to the individual’s obtaining of the new North Carolina health insurance policy. North Carolina health insurance group providers can exclude these conditions from coverage for up to one year.

With individual North Carolina health insurance policies, pre-existing conditions are defined as treatments or diagnoses that were made within the last twelve months prior to obtaining a North Carolina health insurance policy. Individual health insurance policies are allowed to exclude pre-existing conditions for up to twelve months, and North Carolina health insurance companies are allowed to insert elimination riders into individual policies to permanently eliminate the North Carolina health insurance company’s obligation to pay on certain pre-existing conditions.

Both individual and group North Carolina health insurance policies are required to cover newborns and adopted children for the first thirty-one days. Within this time period, North Carolina health insurance policyholders are required to fill out the required paperwork in order to extend dependent coverage beyond that time. North Carolina health insurance companies are also required to extend dependent coverage beyond the usual age limit if dependents involved are physically or mentally disabled and are reliant solely on their parents for income and care.

Group and Individual North Carolina Health Insurance

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