North Carolina Health Insurance

Record numbers of recent graduates and retirees are now moving to North Carolina and the demands on the state’s healthcare system are growing. The good news is that health coverage availability is expanding to meet the needs of new patient populations in this state. The Simple Dollar has compiled statistics and resources to help consumers demystify North Carolina’s latest health coverage options, eligibility and processes.

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Stats in Your State

The facts and figures below are provided to help readers in North Carolina compare their insurance quotes with those found elsewhere in the country, and determine whether or not they are paying too much for health coverage.

Chip Medicaid

In terms of residents covered under Medicaid or the Children's Health Insurance Program (CHIP) coverage, North Carolina ranked second in the South Atlantic states behind Florida. The number of North Carolina children enrolled in Medicaid and CHIP rose by roughly 200,000 between 2009 and 2010.

Individual Health Insurance Premiums

In terms of employer-based health plans, the average North Carolina worker paid $1,061 per year — $31 lower than the national average for coverage. However, North Carolina employers also paid $4,169 into their employees annual health plans — about $30 more than employers contributed on average nationally. North Carolina had the second lowest average employee contribution rate among South Atlantic states.

Family Health Insurance Premiums

In 2011, the average North Carolina family covered under an employer-based insurance plan paid an annual premium of $4,854. This was roughly $620 more than the national average. Employees paid more in just one other South Atlantic state — in South Carolina employees paid about $150 more on average per year. Families of workers in Florida, Georgia, Virginia and West Virginia, on the other hand, paid less than those in North Carolina.

SAHIE Health Insurance Uninsured

In 2010, 1,549,918 North Carolina residents (or roughly 19.1 percent of the state's population) did not possess health insurance coverage. North Carolina has the sixth largest population of uninsured persons in the nation. However, in terms of statewide percentages of people without health coverage, 16 states had higher rates of uninsurance.

Rules in Your State

In order to understand your insurance rates as dictated by the state of North Carolina, you should thoroughly research this state's insurance laws. Please consult the following resources for more information.

Life and Health Insurance Guaranty Association Act

Every licensed insurance provider in North Carolina must participate as a member in the state’s guarantry association. The association then guarantees a certain amount of protection to North Carolina residents who purchase life insurance, accident and health insurance from any state insurer that goes bankrupt and is liquidated.

North Carolina House Bill 247

This bill, recently passed by the North Carolina Senate, increases competition among health insurance providers by limiting their ability to privilege certain health care providers in rate negotiations. Explore the bill to see how this expands patient healthcare options and increases transparency between insurance companies and their policyholders.

North Carolina Rules: Alcohol & Your Health Insurance

North Carolina’s insurance laws mandate that insurance providers must maintain coverage for individuals who struggle with alcoholism or other forms of substance abuse.

Losses Due to Intoxication
Health Insurance Parity for Alcohol-Related Treatment
North Carolina law prohibits health insurance providers from distinguishing between substance abuse and other forms of mental illness.
North Carolina law requires health insurers to cover treatment for alcohol-related disorders with the same level of benefits as provided for individuals who suffer from a physical illness or condition.

Representatives & Resources in Your State

If you have any insurance related question or complaint to file against a provider NCDIC Consumer Services is the best place to start. Below you’ll find more resources and contact information from agencies dedicated to helping North Carolina residents navigate health insurance claims and policies.

Health Insurance Smart NC
The NCDI launched Health Insurance Smart to help North Carolina state residents to navigate disputes with their insurers, compare licensed providers and better understand the major ways in which the new healthcare law will affect their care and coverage options.

Seniors’ Health Insurance Information Program SHIIP is devoted to help North Carolina seniors with issues related to Medicare, Medicare supplements and long-term care insurance.
11 South Boylan Avenue
Raleigh, NC 27063
Nationwide Toll Free Line: 1-800-443-9354
Main Number: 919-807-6900
This site is dedicated to connecting North Carolina residents with free and reduced cost healthcare services and insurance providers. You can filter searches of the site’s healthcare directory by county, medical office hours, types of insurance accepted and services provided.

Depending on the type of plan you have you may need to contact the proper regulatory agency. These are the complaint offices for major types of health plans that the NCDOI does not regulate:
State Health Plans for Teachers and State Employees
State Health Benefits Office
4901 Glenwood Ave., Suite 300
Raleigh, NC 27612-3820
Get Directions
(919) 881-2300

Self-Funded Employee Benefit Plans
U.S. Department of Labor, Employee Benefits and Security Administration
Atlanta Federal Center
61 Forsyth St. SW; Suite 7B54
Atlanta, GA 30303
Get Directions
(866) 444-3272

Federal Employees’ Health Plans
U.S. Office of Personnel Management
Employee Review Retirement & Insurance Group
P.O. Box 436
Washington, DC 2004

Part A Claims & Provider Problems
Palmetto GBA – Medicare Part A
800 S. Duke St.
P.O. Box 3824
Durham, North Carolina

Part B Claims & Provider Problems
CIGNA – Medicare Part B
4135 Mendenhall Oaks Parkway, Suite 101
Attn: Public Relations
High Point, NC 27265
(336) 882-4562

North Carolina Division of Medical Assistance
1985 Umstead Drive
Raleigh, NC 27603-2001
Get Directions
(919) 733-4261 or 1-800-662-7030

Workers Compensation Claims Questions
North Carolina Industrial Commission
4335 Mail Service Center
Raleigh, NC 27699-4335
(919) 807-2500