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North Carolina

North Carolina Health Insurance

North Carolina has fewer health insurance regulations than most states. It is still important to familiarize yourself with them so you're more confident and knowledgeable in your health insurance purchase.

This guide:

  • Describes North Carolina health insurance policy regulations

  • Lists rules North Carolina health insurance companies must follow

Health insurance policies are regulated by each state's own health insurance laws. North Carolina health insurance companies and policyholders alike must abide by established insurance laws.

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Do You Qualify For A Subsidy?


Find out if you qualify for a government subsidy under Obamacare. Millions of Americans will have their insurance rates reduced under the new health care law. Learn how much you could save with our simple calculator.

North Carolina health insurance policy provisions

Some of the most important North Carolina health insurance laws are the ones that influence the health insurance policy specifically.

One of the more universal policy provisions is the guaranteed renewability provision. In North Carolina this clause, stating that a policyholder has the right to renew an existing health insurance policy as long as no part of the contract was violated, is a required element in all North Carolina health insurance policys, and is in place for your protection.

A second important provision of North Carolina health insurance policies that is allowed, but not required, to be included is a "pre-existing condition exclusion period" clause. This states that certain pre-existing conditions, which are specified in the clause, are not going to be treated for a certain time, known as the "exclusion period." Exclusion periods can last for up to 12 months, but are often 3 or 6 months, depending on the condition.

Medical conditions are considered to be pre-existing if you received medical treatment for, or were diagnosed with, them in the time equal to the "exclusion period" (e.g. 3 months, 6 months, 12 months) before the beginning of your health insurance plan.

In situations where you switch your North Carolina health insurance from one company or policy to another, make certain you have continuous coverage (no lapses in your health insurance coverage). This is very important as state laws allow your old coverage to be used to credit the pre-existing condition period of your new North Carolina health insurance plan. This means that if you have satisfied the exclusion period for a particular illness with one policy, then, if you have no lapse in your coverage between policies, you will have no exclusion period for that sickness in the new policy. Likewise, if, under your old policy, your policy was in effect for 5 months, the maximum exclusion period under your new plan, would be 7 months, not 12.

Finally, under North Carolina health insurance laws, newborns and adopted children are covered by their parent's insurance policy if the policy already provides coverage for dependents. The coverage then ends 31 days after birth or adoption and the policy needs to be amended to include these dependents.

Regulating North Carolina health insurance companies

The other area of importance in regards to health insurance laws is the degree of influence your health insurance company has over your policy and its price.

The general rule is that any North Carolina health insurance company, except Blue Cross Blue Shield, is free to refuse you coverage. You can be denied health insurance or can be charged different premiums for health insurance on the basis of your health.

Also, your North Carolina health insurance premiums can increase due to age and and health.

However, since North Carolina health insurance companies can't refuse to renew your existing health insurance policy, not even on the grounds of illness, it is advisable to buy health insurance now to guarantee that you will have a comprehensive health insurance policy when you will need it most. If you already need medical treatment, North Carolina health insurance companies may deny your application for health insurance. At the very least, the compant

Temporary North Carolina health insurance

If you are seeking temporary North Carolina health insurance, then conversion policies are a good choice. Such policies are available to individuals who have recently left a fully insured group policy.

Although the price may be higher and the coverage less than your old North Carolina health insurance policy, conversion policies offer adequate insurance in times when you have breaks in between your long-term coverage. These also allow you to maintain you coverage continuously. Lapses in your coverage can make your relationship with your new company complicated regarding your new policy, potentially losing you some vital medical treatments and care for a renew exclusion period of up to 12 months!

In North Carolina, you must be given at least two different policies to choose from when buying a conversion policy. These policies will not require a new pre-existing condition exclusion period and will never be canceled because you fall ill.

Temporary insurance, for those that do not qualify for a conversion policy, can also be obtained in North Carolina.

More NC health insurance help

If you want more help getting a good health insurance policy, take our free health insurance internet course.

Also see our guide to North Carolina small business health insurance.


To find out more about NC health insurance laws and regulations, visit the official website of the North Carolina Department of Insurance.





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This internet site provides information of a general nature for educational purposes only and is not intended to be legal advice. We make no guarantees as to the validity of the information presented. Your particular facts and circumstances, and changes in the law, must be considered when applying insurance law. You should always consult with a competent insurance professional licensed in your state with respect to your particular situation.