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Posted by on Aug 14, 2013 in North Carolina | 0 comments

North Carolina


Health Insurance Exchange

On November 15, 2012, Governor Beverly Perdue (D) declared the state’s intent to establish a state-federal partnership health insurance exchange. However, on February 12, 2013, newly-elected Governor Pat McCrory (R) issued a statement indicating that North Carolina would default to the federal government to operate the exchange.North Carolina’s health insurance consumers will use the federally facilitated exchange,, to compare plans and enroll in health insurance coverage.

Which companies will be offering plans through the exchange?

On July 30, 2013, the North Carolina Department of Insurance approved rates for three insurance carriers. The carriers are Coventry Health Care of the Carolinas, FirstCarolinaCare Insurance Company, and BlueCross BlueShield of North Carolina. Carriers now must gain certification from the federal government to offer plans on the health benefit exchange or health insurance marketplace. All three carriers have submitted to offer individual plans, however, the offering will be more limited for small groups, with only BCBS offering small group plans through Small Business Health Options Program or SHOP.

How do the rates in North Carolina compare to those in other states?

While health insurance filings have been submitted and approved, the majority of the contents of the filings is confidential because the rates and details were filed as trade secrets. Actual rates have not been publicly released. Furthermore, the areas each company will serve are also trade secret and have not been publically released.

What information is there regarding the companies that have indicated their intent to offer plans through the health exchange?

BlueCross BlueShield of North Carolina has submitted 26 plans for state and federal approval for the individual exchange and SHOP. Of the three insurance carriers, only BCBS is offering exchange plans statewide, that is all 100 counties in North Carolina.

Current BCBSNC options include: BlueAdvantage; BlueOptions traditional PPO; BlueSelect, BCBSNC’s new tiered benefit PPO plan; and the BlueValue POS product, a type of HMO with a limited network. BlueSelect and BlueValue products seem to be the most promising exchange options given the trend towards limited and tiered product designs.

BlueCross BlueShield also recently implemented the company’s fourth Accountable Care Organization agreement. In April of 2013, BCBSNC announced a collaboration with Cornerstone Health Care, a patient-centered medical home network, to launch an Accountable Care Organization affecting customers and patients in 11 central North Carolina counties.

Coventry Health Care of the Carolinas, a subsidiary of Coventry Health Care, has submitted about 25 individual plans. CHC Carolinas current products include POS, PPO, and HMO plans. The company will not be offering plans statewide; here is a look at the company’s current coverage area.


FirstCarolinaCare Insurance Company, a subsidiary of the FirstHealth of the Carolinas health system, is entering the individual health insurance market in North Carolina. The company is looking to sell individual policies in its 6 county primary service area which includes: Moore, Hoke, Richmond, Montgomery, Scotland, and Lee counties. FirstCarolinaCare submitted 16 individual plans; the individual FirstCarolinaCare HMO product will only be sold on the exchange.


Will coverage and premiums be the same statewide?

The state of North Carolina is broken up into groups of counties or geographic rating areas that are used to determine rates. In North Carolina, there are 16 rating areas and there may be variations in premiums across the different areas. Insurance carriers do not have to offer plans in all the counties in a geographic area. Here are the rating areas in North Carolina:



1 Avery, Buncombe, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, McDowell, Macon, Madison, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey
2 Alexander, Burke, Caldwell, Iredell, Catawba
3 Alleghany, Ashe, Watauga, Wilkes
4 Anson, Cabarrus, Mecklenburg, Rowan, Stanly, Union
5 Cleveland, Gaston, Lincoln
6 Davidson, Davie, Forsyth, Stokes, Surry, Yadkin
7 Guilford, Randolph, Rockingham
8 Montgomery, Moore
9 Bladen, Cumberland, Harnett, Hoke, Richmond, Robeson, Sampson, Scotland
10 Granville, Vance
11 Alamance, Caswell, Chatham, Durham, Lee, Orange, Person
12 Bertie, Camden, Chowan, Currituck, Gates, Halifax, Hertford, Martin, Northampton, Pasquotank, Perquimans

New information is being released every day. Follow this blog to receive updates as new information is released in North Carolina.

Jillian Carlile
Research Analyst & Health Exchange know-it-all

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