North Carolina Health Insurance Risk Pool
What is Inclusive Health?
Inclusive Health, also known as the North Carolina Health Insurance Risk Pool (NCHIRP), provides affordable, individual health insurance coverage for North Carolinians who do not have access to an employer health plan and face higher premiums due to a pre-existing medical condition. It will also offer coverage to individuals who are federally defined HIPAA eligibles or qualify due to loss of employment due to the effects of international trade under the Health Coverage Tax Credit.
The North Carolina General Assembly created the North Carolina Health Insurance Risk Pool in 2007. It serves as North Carolina’s alternative mechanism for those who’ve exhausted their COBRA continuation coverage. Individuals with 18 months of prior continuous coverage may qualify for coverage under Inclusive Health and are not subject to Inclusive Health’s pre-existing condition waiting period.
Inclusive Health also provides coverage to individuals who have lost their jobs due to the effects of international trade and are eligible for the health coverage tax credit under the Trade Adjustment Assistance (TAA) program. This includes Department of Labor certified TAA or Alternative TAA eligibles. It also includes those who receive benefits from the Pension Benefit Guaranty Corporation and are at least 55 years old.
Who is Eligible
As its name implies, the idea behind Inclusive Health is to include as many people as possible. You may be eligible for Inclusive Health if you fit one of the following eligibility categories:
- You’ve received a notice of rejection or refusal to issue similar coverage for medical reasons.
- You’ve been offered coverage with conditional rider limiting coverage.
- You’ve been offered coverage at rates higher than Inclusive Health’s rates, or you have similar non-group coverage at a rate higher than Inclusive Health’s rate.
- You’ve been diagnosed with a condition from a list of high-risk conditions (for convenience – does not have to go through application/rejection).
- You are federally (HIPAA) eligible, or currently have HIPAA coverage.
- You are a resident eligible for federal Health Coverage Tax Credit (trade-displaced workers, PBGC recipients).
To further determine your eligibility, please complete the eligibility worksheet.
Who is not Eligible
An individual is not eligible for coverage under Inclusive Health if:
The individual is eligible for, has or gets health insurance coverage that is as good as, or better than, Inclusive Health, except that:
An individual may maintain other coverage for the period of time the individual is satisfying a pre-existing condition waiting period under Inclusive Health; and
An individual may maintain Inclusive Health coverage for the period of time the individual is satisfying a pre-existing condition waiting period under another health insurance policy to replace the Inclusive Health policy.
The individual is determined to be eligible for enrollment in Medicaid, SCHIP or Medicare, unless Inclusive Health offers Medicare supplemental insurance coverage.
The individual has previously terminated Inclusive Health coverage unless 12 months have lapsed since the termination, except that this shall not apply to an applicant who is a federally defined eligible individual or to an applicant eligible for or receiving benefits under the Trade Adjustment Assistance Program.
The individual is an inmate or resident of a public institution. This does not apply to an applicant who is a federally defined individual.
The individual’s premiums are paid for or reimbursed under any government-sponsored program or by any government agency or health care provider. This does not apply to an otherwise eligible full-time employee, or a dependent of a government agency or health care provider. This also does not apply for individuals receiving premium subsidies made available by the State based on individual income levels.
The individual has other insurance coverage in place on the date that Inclusive Health takes effect.