North Dakota Health Insurance Guide
North Dakota Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
When you live in North Dakota you can choose from a variety of private health insurance plans including plans for individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for North Dakota State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
North Dakota is not a guarantee issue state. By law, private insurance companies that sell individual policies must medically underwrite them and are required to sell you an individual health insurance policy if you do not meet their criteria. You can be turned down for any number of reasons including your past or current health and lifestyle habits. In North Dakota, insurers are permitted a 12-month exclusionary period and a six-month look-back period for pre-existing conditions. North Dakota does require an insurer to give you credit for prior creditable coverage. North Dakota also permits health insurance providers to issue Elimination Riders that exclude coverage for specific health conditions. Premiums, which are not regulated by the state, can be based on your health, your age and lifestyle factors. North Dakota requires insurers to offer two standardized policies for individuals.
North Dakota is a guarantee issue state for group health plans issued to small businesses. If your North Dakota health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. The insurer can impose a 12-month exclusionary period and a six-month look-back period for pre-existing medical conditions, but must give credit for prior creditable coverage. HMOs may impose a two-month waiting period, but you will not be required to pay premiums during that time. Your employer may impose a waiting period for eligibility for new hires, but it must be applied equally to all new hires. Premiums for small group health insurance may be underwritten and the insurer can charge a premium not to exceed 35% of its index rate if your group has a history of unfavorable health.
North Dakota is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status. Your policy can be canceled if your insurer discontinues a plan or no longer sells insurance in the state.
North Dakota Mandated Health Benefits
North Dakota laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Breast Reconstruction
- Colorectal Cancer Screening
- Dental Anesthesia
- Emergency Services
- Hearing Aids
- Mammography
- Maternity Stays
- General and Parity Mental Health
- Off Label Drug Use
- PKU/Formula
- Prostate Cancer Screening
- TMJ Disorders
- Coverage for newborns under their parent’s policy
- Coverage for adopted under their parent’s policy
- Coverage for non-custodial children under their parent’s policy
- Coverage for handicapped dependants under their parent’s policy
- Coverage for continuation/dependents under their parent’s policy
- Coverage for dependent students under their parent’s policy
- Coverage for conversion to non-group
- Coverage for continuation/employees
Types Health Insurance Plans Available in North Dakota
The following major medical health insurance plans are generally available in North Dakota. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in North Dakota
Comprehensive Health Association of North Dakota
CHAND is the state-sponsored high-risk pool that offers health insurance to state residents who have been unable to secure coverage from private insurers because of a pre-existing condition or certain other qualifiers. There are three eligibility categories: Standard, HIPAA and TAARA. You can choose from two PPO plans. Deductibles, co-pays and coinsurance will vary based on the plan you choose, but maximum out-of-pocket for both plans is $3,000, including the annual deductible. Premiums are based on the plan you select and you age, but are capped at 135% of the average rate charged for similar coverage in North Dakota. NCHIRP enrollment is open. There is a 180-day exclusionary period for pre-existing conditions, but it can be waived if you can show proof of continuous creditable coverage or if you are HIPAA-eligible.
North Dakota Healthy Steps
This program provides comprehensive free or low-cost health care for resident children up to age 18, whose families meet income requirements and other eligibility requirements. One plan is available with assignment based on family income. No premiums are charged but there are modest co-pays for prescription drugs, emergency room visits and hospital admissions. There may be a waiting period but it can be waived in certain circumstances. are no waiting periods for most applicants. Enrollment is open but is subject to review and renewal every 12 months.
Regulating Agency
The North Dakota Insurance Department is responsible for regulating North Dakota’s health insurance industry.
Get access to North Dakota health insurance quotes from http://www.einsurance.com/health-insurance.
North Dakota Insurance Department
State Capitol, fifth floor
600 E Boulevard Ave
Bismarck, ND 58505-0320
(701) 328-2440 or (800) 247-0560
http://www.nd.gov.ndins/
Comprehensive Health Association of North Dakota
4510 13th Avenue South
Fargo, ND 58121
(701) 277-2271 or (800) 737-0016
http://www.chand.org
North Dakota Healthy Steps
Children’s Health Insurance Program (CHIP)
Department of Human Services
600 E Boulevard Avenue, Dept. 325
Bismarck, ND 58505-0250
(877) KIDSNOW ((877) 543-7669)
http://www.nd.gov/dhs/services/medicalserv/chip
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/