Finding and keeping an affordable health insurance plan can be difficult for people in the U.S. who have pre-existing conditions. As of 2010, more than 30 states have organized their own high-risk insurance programs, which allow residents to buy insurance even though they have had previous health problems. North Carolina's pool is named Inclusive Health and went into effect on January 1, 2009.
Eligibility
To be eligible for Inclusive Health, you must have been a resident of North Carolina for a minimum of 30 days. You must also meet one or more additional eligibility criteria: you must have received a rejection or refusal notice from an insurance company for a medical reason; you are eligible for or currently have HIPAA group health insurance coverage; you are eligible for the federal health coverage tax credit; you've been diagnosed with a high-risk condition, regardless of whether or not you have been rejected yet by an insurance company; or you've been offered health insurance at rates higher than those offered by the program. People who have already had at least 18 months of prior continuous health insurance coverage can join the North Carolina Health Insurance Risk Pool without going through a waiting period, even if they have a pre-existing condition.
Premiums
Premiums for NCHIRP are based on household income, age, gender and whether or not you use tobacco. The program has a premium cap of 175 percent, which means you cannot be charged more than 175 percent of what a healthy person would be charged by an insurance company. Monthly premiums also depend on what kind of deductible you choose. High-deductible plans generally result in lower monthly premiums.
Benefits
All NCHIRP policies are PPO plans and feature benefits for inpatient and outpatient hospital services, chiropractic care, office visits, prescription drug benefits, nicotine replacement therapy, surgery and vaccinations. Routine dental care is not covered, although removal of impacted teeth may qualify as a covered health service. All plans cover 80 percent of treatment received inside the PPO network and 50 percent of those gained outside, except for the high-deductible HDHP 5000 plan, which cover 100 percent of both in-network and out-of-network services.
Renewability
Inclusive Health plans are renewable for as long as you continue to pay your monthly premiums. However, if you stop paying and the policy is cancelled, you have to wait at least 12 months before you are eligible to rejoin.
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