North Carolina protects the interests of its residents regarding health insurance.
The North Carolina Department of Insurance helps its residents by governing and regulating the insurance industry. The department educate North Carolina consumers about insurance and handles their complaints. Any insurance sales business must be approved before they are granted a license and they must meet the standards and health insurance laws required by the state.
Basic Coverage Policy Laws
Insurance carriers that conduct business in the state of North Carolina must provide certain benefits in accordance with the state health insurance laws. Major medical health insurance plans have to contain a provision for emergency services that allows the injured person to be screened and stabilized without requiring prior authorization or an in-network emergency room. The health insurance laws also state that all policies must cover pap smears and mammograms, necessary treatment and services for diabetes patients, and coverage for reconstructive breast surgery. The law requires that a doctor can decide how long the patient should remain hospitalized after a mastectomy that was performed as treatment for cancer or breast disease. Insurance companies that offer group policies must include treatment and care for chemical dependency; if they offer prescription drug coverage, it must also include prescribed contraceptives.
Children's Coverage Policy Laws
Insurance carriers must abide by health insurance laws covering North Carolina children in their policies. The law requires immediate coverage for newborns, newly adopted and newly placed foster children as long as the health insurance policy is effective when the child is born or brought into the home. The company can not impose any exclusions for pre-existing health conditions or waiting periods unless the person's policy requires additional premium to cover the children. The policy holder can avoid exclusions and waiting periods by notifying the company within 30 days of the birth or placement of children. All health insurance companies operating in North Carolina must cover hearing screenings for newborns and they must adhere to lifting the age limitations for dependent mentally retarded and physically handicapped children.
Disclosure Laws
North Carolina health insurance laws also apply to the information that insurance companies provide about themselves and their products. They must give a clear description of their health insurance benefits as well as a complete list of services and conditions that are not covered under their health plan. The company has to provide the length of time you have to wait if your policy contains limitations on pre-existing health conditions. They also have to give an explanation of how they calculate their claim costs, your share of the costs and they have to provide an example showing how they make these calculations. North Carolina laws also state that insurance companies have to give their renewal terms, premium rate terms and all related provisions.
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