The debut of North Carolina’s new high risk insurance pool is almost here. Starting January 2009, the North Carolina Health Insurance Risk Pool (NCHIRP), also known as Inclusive Health, will officially begin offering coverage to eligible North Carolinians. The program is aimed at select groups, but focuses mainly on individuals who don’t have access to an employer health plan, yet face high individual premiums due to a pre-existing medical condition. Individuals with 18 months of prior continuous insurance coverage may be eligible for coverage under NCHIRP, without being subject to the pre-existing condition waiting period. The program will also offer coverage to individuals who are federally defined HIPAA eligibles, or to individuals who have lost their jobs due to international trade and are eligible for the health care tax credit under the Trade Adjustment Assistance (TAA) program.

To be eligible for coverage with Inclusive Health, you must meet all of the following criteria:

• You are a legal resident of the United States
• You are a resident of the State of North Carolina
• You do not have access to group coverage as an employee or as a dependent of an employee
• You do not qualify for a government program such as Medicare or Medicaid

Additionally, you must meet at least one of the following criteria:

• You have been refused coverage by an insurer for similar coverage for medical reasons
• You have been offered coverage by an insurer but with conditional rider limiting coverage
• You have been refused coverage unless you pay a higher premium rate than Inclusive Health offers
• You have similar coverage, but at a single rate higher than Inclusive Health
• You have a diagnosed medical condition, as detailed by Inclusive Health, which allows automatic enrollment into the program
• You are a federally-qualified,  HIPAA-eligible individual, including those who currently have this coverage through an insurer
• You are a resident eligible for the Federal Health Coverage Tax Credit (trade-displaced workers, PBGC recipients)
• You are an eligible individual with other non-group coverage in place; you can move to Inclusive Health at any time

Like traditional insurance plans, Inclusive Health provides coverage for a broad range of services, including preventive care, urgent care, outpatient services, and prescription drug benefits. There are several plan options available, so individuals should be able to find a plan that best meets their needs and lifestyle.

There are three different plans options available, with various deductibles and benefits. Inclusive Health provides a detailed description of the plans in a downloadable PDF document. This document is an extremely useful tool if you are eligible for the plan, but are trying to compare the costs between NCHIRP and a private health insurance plan.

Premium costs are based on age, gender, smoker/non-smoker status, and your plan choice. Premium rates are updated for all enrollees once a year, on January 1^st. Their website provides a useful premium calculator to estimate your expected monthly premium.

The North Carolina Health Insurance Risk Pool was created by the North Carolina General Assembly in 2007. They began accepting enrollment applications in the fall of 2008. Although the program is not part of the state government, it still operates under the supervision and control of the Board. Inclusive Health is governed by a 12-member board, including the North Carolina Commissioner of Insurance.

Inclusive Health provides a pretty detailed “FAQ” section that answers several questions regarding the program. We recommend you check it out for additional information on Inclusive Health.