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:
- 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.
- 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.
- 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:
- With individual health insurance in North Carolina, you are responsible for the entire premium. There is no subsidy from your employer.
- 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).
- 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:
- 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.
- 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:
- 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.
- 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.
- 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?
Important tips when buying North Carolina Health Plans
- Do not buy a discount or limited benefit plan. Make sure you are buying a major medical insurance policy.
You may see plans advertised for a low monthly fee that covers doctor office visits, prescription and surgical benefits. Many of these plans have limited coverage like $1,000 max surgery benefit (what if your surgery costs $18,000) or $200/day hospital allowance (average stay in hospital room is $800/day…what if you had to stay 8 days)…I think you see where we are going with this. These plans are NOT health insurance and are sold to unsuspecting persons who do not realize what they have bought until they find out they have no real coverage. Avoid at all costs or you could find yourself bankrupt! You CAN find affordable health insurance that is still a major medical policy that will not leave you bankrupt!
- Watch for "association plans".
They are sold to persons on the basis that you are part of a "group" that can negotiate lower premiums. These plans are NOT group insurance and do not have the same rights and protections of group policies. Some of these plans are limited benefit plans sold by unscrupulous agents with little knowledge and are represented as major medical plans. Get information on the specific health insurance plan and not just the association.
- You are probably dealing with a bad product or agent if you encounter any of the following:
- Agents who use high pressure or will not let you compare plans from other companies.
- The agent cannot leave you a summary of benefits for the plan they are showing you.
- If an agent tells you this is a "special offer" or "discount rate" good only for today.
- When you see the words "health plan" without the word "insurance" anywhere in the literature.
- Agents who tell you that the plan is guaranteed issue to everyone regardless of health. This usually means the plan has very limited benefits.
- Make sure that the agent you are talking to is licensed with the North Carolina Department of Insurance.
You can easily check an agent’s license by visiting the North Carolina Department of Insurance (NCDOI) website at www.ncdoi.com. If they are not listed here you are not buying insurance…it is a limited benefit plan that is not regulated by the NCDOI.
- If an agent tells you he can get you better rates than another agent.
Rates are always determined by the carrier once the application has gone through underwriting. An agent or broker can NEVER have an effect on final rates. An agent may “quote” you a preferred rate all the time knowing you won’t get this rate (say your height/weight are out of the preferred range). This is a trick used by unethical agents to get you to submit an application they will deal with the rate up after you have been approved. When you are consulting with us directly, we will quote you the rates based on our experience that we feel you should receive from the North Carolina health plans you have chosen.
