Currently, no state law exists requiring employers to offer health insurance to employees, but many employers provide this benefit. If insurance is offered, employers must follow North Carolina and South Carolina state laws mandating that policies cover specific benefits while giving employees the right to convert to individual policies or use group coverage.
While states are not permitted to regular self-insured plans, North Carolina's and South Carolina’s mandated benefits, conversion, and continuation provisions do not apply to health plans where the employer pays all benefits. Employers offering a health plan are self-insured when the risk of paying claims is not on the insurance company but the employer. Self-insured plans can contract with third-party administrators, like insurance companies, to process all claims. The third-party company pays the claims then the employer reimburses the cost.
While the self-insured plans vary based on the need of the individual, some plans offer the option to buy “stop-loss” insurance, which covers broad claims. The purchase of this type of insurance does not cause the loss of self-insured status or state regulation exemption. Under the Affordable Care Act (ACA), the government required the creation of healthcare exchanges for small employers with access to affordable coverage and individuals. North Carolina and South Carolina have the flexibility to plan and operate exchanges that meet their needs while still adhering to the ACA regulatory standards.
Many self-insured North Carolina and South Carolina residents opt for short term health insurance plans which provide coverage for up to 12-months with the option to renew for up to 36-months. This is an excellent solution for those between jobs, who need an affordable option, or are waiting for group coverage to start. One of the most significant advantages of short-term coverage is cost. Since the benefits focus more on emergency care, those who do not require frequent doctor visits will save money.
To make more sense of North Carolina's and South Carolina’s regulations, and to find a plan that best fits your needs, contact The Pentagon Group today! Our professionals at The Pentagon Group are standing by ready to answer all your questions and meet your specific needs!