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North Carolina-Rate Review Law

If you buy health insurance on the individual market, without help from an employer, you may want to know what North Carolina is doing to protect you from unfair and unnecessary premium rate increases.  Here’s a summary of the North Carolina laws that govern rate increases.  Caution: the laws and regulations on the books don’t always reflect what actually happens in practice.  Contact your state’s insurance agency for further information.

  • North Carolina does require insurers to obtain state approval of rate increases before they go into effect.
  • For individual accident and health plans, insurers must file rate increase requests with the Department of Insurance, and regulators have 90 days approve or disapprove the proposed revised rates or rates will be deemed approved after expiration of 90 days.  Rates may be disapproved if benefits are unreasonable in realtion to the premium charged. N.C. GEN. STAT. § 58-51-95.
  • For non-profit insurers, regulators have a right to approve, modify, or notice a hearing on the rate increases within 60 days after the filing. N.C. GEN. STAT. § 58-65-40′ 58-65-45.  The Insurance Commissioner may refuse approval if rates are excessive, inadequate, or unfairly discriminatory, or unreasonable in relation to benefits provided.
  • For HMOs, the approval period is 45 days, and rates are deemed approved if regulators take no action within the 45-day period. N.C. GEN. STAT. § 58-67-50(c).  HMO premiums must be in accord with actuarial priniciples and amy not be excessive, inadequate or unfairly discriminatory, and shall be resaonable to the benefits provided.  N.C. GEN. STAT. § 58-67-50(b).
  • Regulators may disapprove of rate increases if “benefits are found to be unreasonable in relation to premiums.” Insurers must file an actuarial memorandum to support the proposed increase.
  • The Department of Insurance makes rate filings publicly available online in a searchable database at http://infoportal.ncdoi.net/filelookup.jsp?divtype=3, although portions of filings are considered confidential and therefore not disclosed.

Information is based on review of state statutes and regulations and, in some cases, interviews or emails with state insurance departments.