11 NCAC 12 .0331. HEALTH INSURANCE RISK POOL NOTICE LANGUAGE REQUIREMENTS

(a)  The definitions contained in G.S. 58-3-276 are incorporated by reference.

(b)  As of the effective date of this Rule, notices required under G.S. 58-3-276 shall be provided by the insurer to the applicant by:

(1)           first-class mail or other nationally recognized carrier to the applicant's address as provided in the application, or

(2)           by electronic mail as may be elected by the applicant to receive communications from the insurer, or

(3)           electronically through or as part of the online application process, or

(4)           by hand delivery by an agent or other insurer designated courier. 

(c)  The notice in Paragraph (b) shall be in Times New Roman 10‑point font or other equivalent font and contain the following wording:

"In response to your application for individual health insurance coverage, you have received from [INSERT INSURER'S NAME] (i) a notice of a denial of coverage or (ii) an offer of coverage with a conditional rider that limits the coverage.  We are therefore required to inform you that you may be eligible for health insurance coverage through the North Carolina Health Insurance Risk Pool, known as "Inclusive Health." 

Inclusive Health is a state subsidized health insurance coverage option for individuals with pre-existing medical conditions who either are unable to qualify for or cannot find more affordable individual health insurance coverage.  Inclusive Health's premiums are not based on specific medical conditions and are capped by law.  You cannot be rejected by Inclusive Health because of health conditions. You may contact the North Carolina Health Insurance Risk Pool for information on specific eligibility criteria and the type of benefit plans available at:

North Carolina Health Insurance Risk Pool, dba Inclusive Health

P.O. Box 30909

Raleigh, NC 27622

[phone]

www.inclusivehealth.org

The Consumer Services Division of the North Carolina Department of Insurance is available to assist you with your questions about health insurance.  You may contact the Consumer Services Division at:

North Carolina Department of Insurance – Consumer Services Division

1201 Mail Service Center

Raleigh, NC 27699-1201

800-546-5664 - in North Carolina only

919-807-6750 - outside North Carolina"

(d)  The notice required under this Rule may be delivered to an applicant along with the notice required by G.S. 58-39-55 relating to the adverse underwriting decision described in G.S. 58-50-195(a)(1) and G.S. 58-50-195(a)(2) when the adverse underwriting decision notice is provided in writing.

 

History Note:        Authority G.S. 58-2-40; 58-3-27;

Eff. February 1, 2010.