Southeast Insurance Solutions, Inc.
Southeast Insurance Solutions, Inc.
2137 Chatham Avenue
Charlotte, NC 28205
Phone: 704-560-8972
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North Carolina Health Plans

Let’s look at some of the advantages, disadvantages and differences between Individual North Carolina health plans and Group North Carolina health plans.
Individual North Carolina Health Plans
These plans are purchased by individuals or families that may not have coverage offered through their current employer, are self employed, want other options that aren’t available through their employer’s plans, or their employer only covers the employee’s premium and to add the family on the employer plan you would be responsible for the entire premium (much more costly). 
Advantages of having individual health insurance:
  1. You are in control of your NC health insurance.  Because you are in control you get to choose the carrier you want, the deductible you want, and to some extent how much you want to pay for your health insurance. This keeps you from paying more for benefits that may not be beneficial for you situation. 
  2. You own your coverage not your employer. If you voluntarily or involuntarily leave your employer your individual health insurance NC stays in force.  If you have a preexisting condition this is a huge benefit (and the most important in our opinion) as you don’t have to worry about getting coverage.
  3. Premiums are based on your health history (also, your spouse and family if coverage is purchased for them) at the time of application.  Your premiums never go up due to medical claims. Therefore, if you are rated Preferred you will always stay at Preferred as long as you stay on that plan.
 Disadvantages of having individual health insurance:
  1. With individual health insurance in North Carolina, you are responsible for the entire premium.  There is no subsidy from your employer.
  2. There is usually a 12 month waiting period for pre-existing health conditions (however this will usually be waived if you had prior creditable coverage for the previous 12 months without a lapse of 63 days). 
  3. If you have major health issues at the time of application, premiums may be charged at a higher rate, condition specific exclusions can be placed on the plan (this will be carrier dependent), or you may be declined coverage.
Group North Carolina Health Plans
These plans are offered by employers and are available to most full time workers at that particular business.

Advantages of having group health insurance:
  1. In North Carolina, by law, employers must pay at least 50% of the employee only premium.  Some employers (usually large employers) even pay for your spouse and dependents but this is starting to decrease as an option.
  2. For persons with major health issues (cancer, diabetes, stroke, etc) a group North Carolina health insurance plan may be their only option for affordable coverage, because they are not eligible for individual health insurance.  Group health insurance North Carolina is guaranteed issue (however you still may have waiting periods depending on when you last had coverage).
Disadvantages of having group health insurance North Carolina:
  1. If you are diagnosed with a major health issue (cancer, heart disease, diabetes, mental disorders, etc) while on a group plan you may not qualify for individual coverage. If your employer cancels group coverage or you are terminated for any reason your options for affordable health care are limited or nonexistent.
  2. Group health insurance rates are based on claims and conditions. Therefore if you are in a small group and one of the members has huge medical bills due cancer, then the group rate will be adjusted accordingly at renewal causing all members rates to be higher. The employers typically pass these costs onto their workers or even drop health insurance coverage altogether! Remember, the employer can change coverage and benefits at any time.
  3. Your options are limited to only the plan that is offered by the employer. What if your employer is only offering an HDHP plan with an HSA and you prefer to have a copay plan and are willing to pay more for it?
Southeast Insurance Solutions, Inc.
2137 Chatham Avenue
Charlotte, NC 28205