Author Archives: jtdickerson


25 Jun , 2015,
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Great news for hard working North Carolina residents who purchased insurance through the Marketplace!

Per the AP: “The Supreme Court on Thursday upheld the nationwide tax subsidies under President Barack Obama’s health care overhaul, in a ruling that preserves health insurance for millions of Americans.”

BCBC-NC 26% rate increase filed for 2016 marketplace plans!

10 Jun , 2015,
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The biggest health insurance news in North Carolina this week is the recent press around Bluecross Blueshield of North Carolina filing a BCBS-NC 26% rate increase for 2016 ACA plans. A detailed overview of these filings can be viewed at at or by clicking here.

Who will this affect? These rate increases will likely affect all North Carolina residents who have an ACA compliant plan purchased on or off the marketplace.

BCBS-NC rate increase 2016

Rate increase got you down? Click to compare plans!

However, it is important to note that the “26% rate increase headline number” is simply an average increase across all areas. Some areas may see increases that are lower or possibly higher. In addition, it is important to note that the Blue Select products are only anticipating a 17.72% rate increase, on average, for 2016. It is also important to note that these rate increases have NOT YET been approved. CMS and the NC Department of Insurance will need to review and approve these filings before they take effect on January 1st, 2016.

How do these 2016 BCBS-NC rate increases compare to the competition?

Aetna (the parent company of Coventry) have filed increases on their various ACA compliant plans ranging from 17.23% to 25.78%.

United Healthcare has filed for a 2016 rate increase of 12.48%.

In addition, as previously reported by, Humana is expected to enter the North Carolina health insurance marketplace for 2015. This additional competition could be great news for many North Carolina residents!

Stay tuned to for the latest North Carolina health insurance news! Need to get enrolled? We can help!



Humana files to sell plans on North Carolina marketplace in 2016!

7 May , 2015,
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Great news for residents of North Carolina! Based on filings available from the North Carolina Department Of Insurance, Humana has filed to sell individual health insurance plans ON (and off) the North Carolina health insurance marketplace for 2016! This is great news for North Carolina residents looking for additional health insurance options. Based on the limited information available in the filing, it appears Humana will offer a PPO network in North Carolina. In addition, it appears the current on exchange insurers in North Carolina have also filed for 2016. At this time, we do not have detailed information on plans, pricing or availability by county, but stay tuned to for more breaking news!


North Carolina Democrats file bill to expand Medicaid

25 Mar , 2015,
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On Tuesday, Democrat lawmakers in the North Carolina House and Senate filed bills to expand Medicaid to meet parameters set by the Affordable Care Act, the federal healthcare reform bill that became law on March 23, 2010. The Affordable Care Act aimed to reduce the number of uninsured by providing access to a health insurance marketplace for middle income Americans, and by expanding Medicaid to help with those American below 133% of the Federal Poverty Level.

According to Indy Week “At a press conference, Buncombe County Sen. Terry van Duyn and Reps. Gale Adcock, Wake, and Carla Cunningham, Mecklenburg, emphasized the economic benefits to the state of Medicaid expansion. ”

It has been estimated by various sources that expansion of Medicaid in North Carolina would provide low to no cost health coverage to an additional 500,000 residents, most of which are presumed currently uninsured.

As reported by the Charlotte Observer in January, 2015, Governor McCrory has stated that he would be open to a waiver requiring a job or job training for Medicaid expansion beneficiaries.

As always, is your leading source for North Carolina Health Plan information. Stay tuned for more news!

Update on United Healthcare / Carolinas Medical Centers negotiations

6 Mar , 2015,
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The following message comes from Garland Scott, CEO of UnitedHealthcare of the Carolinas.


United Healthcare and Carolinas Healthcare network negotiations – 2015

4 Feb , 2015,
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As reported recently by the Charlotte Observer, the contract between United Healthcare (UHC) and Carolinas Healthcare system (CHC) is set to expire on February 28, 2015. CHC owns 12 hospitals and employs thousands of doctors and other medical professionals in the greater Charlotte metro area, and surrounding counties. These negotiations could impact approximately 80,000 North Carolina residents insured by United Healthcare in the Charlotte metro area, and thousands more residents in rural areas who may seek care at CHC.

Our take on the issue? These contract negotiations frequently get wrapped up at the last minute possible, as both sides play games of brinksmanship to achieve the desire outcome. Stay tuned to for updates!

Looking for United Healthcare insurance quotes? CLICK HERE



United Healthcare Compass Network

12 Nov , 2014,
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United Healthcare Compass Network North Carolina

Over the last few days since 2015 health insurance rates were made available for North Carolina, we have been excited to see how the new kid on the block, United Healthcare, stacks up to other insurers offering coverage on the North Carolina marketplace.

For 2015, the United Healthcare Compass network will be used for North Carolina residents purchasing coverage on the health insurance marketplace. The Compass network is new for 2015, so we have been very curious to see how it stacks up against other networks in North Carolina, including Bluecross Blueshield of NC and Coventry Healthcare of the Carolinas (an Aetna company). If you wish to search for providers in the North Carolina Compass Network, you can do so by CLICKING HERE. And PLEASE NOTE, networks do change from time to time – always check the network directory to ensure your providers participate in a plan before you enroll. We are always happy to help with the process!

So far, we have been impressed by the results! Lets start with hospitals: In the Wilmington/Cape Fear area, we are pleased to see New Hanover Regional Medical Center and Cape Fear Hospital listed as “In Network”. In addition, a quick search reveals 257 Primary Care Provider listings within 20 miles of the Wilmington Area. This includes 152 UnitedHealth

United Healthcare Compass network North Carolina

Need to compare prices for United Healthcare North Carolina Plans? Click here!

Premium® Tier 1 Providers in the Compass Network within 20 miles of Wilmington North Carolina! The UnitedHealth Premium® physician designation program uses evidence-based, medical society, and national industry standards to recognize physicians for providing quality and cost efficient care!

Switching gears to the far west high country of North Carolina, we are happy to see a variety of providers in Watauga and Avery counties, including Boone and Blowing Rock, including 25 Unitedhealth Premium primary care providers, and a total of 63 primary care providers within 20 miles of Boone!

In the Charlotte area, we are pleased to see that Carolinas Medical Center listed as “In Network”. UPDATE: Carolinas HealthCare is NO LONGER in the United Healthcare Compass Network. Click here for more details. In the Charlotte metro area, Novant is now the primary In Network hospital system. And of course, in central North Carolina, Duke, WakeMed, Wake Forest Baptist, and The University of North Carolina hospital systems all appear to be “In network” status as well! As always, we will post more updates as we see them. Stay tuned!

Need help searching for providers? Call us directly at 843.882.7062, or email us at We can HELP!




5 Nov , 2014,
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Breaking News out of DC! We have just learned that the Department of Health and Human Services has released preliminary guidance on Self Funded Large group plans that exclude hospitalization coverage, yet still meet Minimum Value criteria due to flaws in the MV calculator. This subject has recently made big news in the large group health insurance sector.MV calculator flaw

According to various sources, DHHS intended to act fast to remedy this situation, and based on guidance released today, they certainly did, releasing Notice 2014-69! In order to provide as much info as possible (it’s been a long day helping Carolina residents here at NChealthconnector!) we are going to cut to the chase and provide the text of the guidance we received below. Please pardon the formatting – the original document we received had some odd formatting!

Notice 2014-69
The Department of Health and Human Services (HHS) and the Department of
the Treasury (including the Internal Revenue Service) (collectively, the Departments)
have become aware that certain group health plan benefit designs that do not provide
coverage for in-patient hospitalization services are being promoted to employers. A
plan that fails to provide substantial coverage for these services would fail to offer
fundamental benefits that are nearly universally covered, and historically have been
considered integral to coverage, under typical employer-sponsored group health plans.
Promoters of these plans contend that the plans satisfy minimum value within the
meaning of the Affordable Care Act (including section 36B(c)(2)(C)(ii)of the Internal
Revenue Code (Code) and final HHS regulations under section1302(d)(2)(C) of the
Affordable Care Act (referred to in this notice as minimum value or MV)), as determined
through use of the on-line MV Calculator referred to in final HHS regulations and
proposed Treasury regulations.

Questions have been raised as to whether plans that fail to provide substantial
coverage for in-patient hospitalization services should satisfy the requirements for
providing minimum value. Concerns have been raised as to whether the continuance
tables underlying the MV Calculator (and thus the MV Calculator) produce valid
actuarial results for unconventional plan designs that exclude substantial coverage for
in-patient hospitalization services. These concerns include that the standard population
and other underlying assumptions used in developing the MV Calculator and associated
continuance tables are based on typical self-insured employer-sponsored plans,
essentially all of which historically have included coverage for these services, and that
designing a plan to exclude such coverage could substantially affect the composition of
the population covered by discouraging enrollment by employees who have, or
anticipate that they might have, significant health issues. It has been suggested that
these and other effects resulting from excluding substantial coverage of in-patient
hospitalization services may not be adequately taken into account by the MV Calculator
and its underlying continuance tables. Similar concerns have been raised regarding the
possibility of using the MV calculator to demonstrate that an unconventional plan design
that excludes substantial coverage of physician services provides minimum value.
The Departments believe that plans that fail to provide substantial coverage for
in-patient hospitalization services or for physician services (or for both) (referred to in
this notice as Non-Hospital/Non-Physician Services Plans) do not provide the minimum
value intended by the minimum value requirement and will shortly propose regulations
to this effect with a view to being in a position to finalize such regulations during 2015
and make them applicable upon finalization. Accordingly, employers should consider
the consequences of the inability to rely solely on the MV Calculator (or any actuarial certification or valuation) to demonstrate that a Non-Hospital/Non-Physician Services
Plan provides minimum value for any portion of any taxable year ending on or after
January 1, 2015, that follows finalization of such regulations. However, solely in the
case of an employer that has entered into a binding written commitment to adopt, or has
begun enrolling employees in, a Non-Hospital/Non-Physician Services Plan prior to
November 4, 2014 based on the employer’s reliance on the results of use of the MV
Calculator (a Pre-November 4, 2014 Non-Hospital/Non-Physician Services Plan), the
Departments anticipate that final regulations, when issued, will not be applicable for
purposes of Code section 4980H with respect to the plan before the end of the plan
year (as in effect under the terms of the plan on November 3, 2014) if that plan year
begins no later than March 1, 2015.
Pending issuance of final regulations, an employee will not be required to treat a
Non-Hospital/Non-Physician Services Plan as providing minimum value for purposes of
an employee’s eligibility for a premium tax credit under Code section 36B, regardless of
whether the plan is a Pre-November 4, 2014 Non-Hospital/Non-Physician Services

An employee or family member who is offered coverage under an eligible
employer-sponsored plan that offers affordable MV coverage for the employee may not
receive premium tax credit assistance under Code section 36B for coverage in a
qualified health plan. An applicable large employer (as defined in Code section
4980H(c)(2)) may be liable for a section 4980H assessable payment if one or more of
its full-time employees receives a premium tax credit.

Under Code section 36B(c)(2)(C)(ii), a plan provides MV if the plan’s share of the
total allowed costs of benefits provided under the plan is at least 60 percent of the
costs. Section 1302(d)(2)(C) of the Affordable Care Act provides that in determining the
percentage of the total allowed costs of benefits provided by a group health plan or
health insurance coverage under the Code, as well as under the Public Health Service
Act (PHSA), regulations promulgated by the Secretary of HHS under section 1302(d)(2),
addressing actuarial value, apply.
HHS published final regulations under section 1302(d)(2) on February 25, 2013
(78 FR 12834), effective on April 26, 2013. For plans required to cover the essential
health benefits (EHB), the HHS regulations define the percentage of the total allowed
costs of benefits as (1) the anticipated covered medical spending for EHB (as defined in
45 CFR 156.110(a)) paid by a health plan for a standard population, (2) computed in
accordance with the plan’s cost-sharing, and (3) divided by the total anticipated allowed
charges for EHB coverage provided to a standard population. 45 CFR 156.20.

The preamble also states that MV is measured based on the provision of EHBs to a
standard population based on typical self-insured group health plans and that, in
determining MV, plans may take into account those benefits covered by the employer
that are covered in any one of the state EHB-benchmark plans. See 45 CFR
Proposed regulations under Code section 36B on MV published by Treasury and
the IRS on May 3, 2013 (78 FR 25909), apply these rules in defining the standard
population for MV purposes and the MV percentage. The proposed Code section 36B
regulations provide that the MV percentage is determined by dividing the plan’s
anticipated spending (based on the plan’s cost-sharing) for EHB under any one state
benchmark plan by the total cost of EHBs for the standard population and converting
the result to a percentage. Proposed 26 CFR 1.36B-6(c). Neither the final HHS
regulations nor the proposed Code section 36B regulations require employer-sponsored
self-insured and insured large group plans to cover every EHB category or conform their
plans to an EHB benchmark that applies to individual and small group market plans.

The HHS regulations allow MV to be determined using an MV Calculator
(available at or a safe harbor
established by HHS and the IRS. Under the regulations, plans with “nonstandard”
features that are incompatible with the MV Calculator or a safe harbor may determine
MV through an actuarial certification from a member of the American Academy of
Actuaries. A plan in the small group market provides MV if it meets the requirements for
any of the levels of metal coverage defined at 45 CFR 156.140(b) (bronze, silver, gold,
or platinum).
The proposed Code section 36B regulations require plans to determine MV by
using either a safe harbor or the MV Calculator. Employers using the MV Calculator
may, however, supplement the MV Calculator by obtaining actuarial valuation of a
plan’s nonstandard features.

A. Proposed Amendments to Regulations Relating to Minimum Value
HHS intends to promptly propose amending 45 CFR 156.145 to provide that a
plan will not provide minimum value if it excludes substantial coverage for in-patient
hospitalization services or physician services (or both). Treasury and the IRS intend to
issue proposed regulations that apply these proposed HHS regulations under Code
section 36B. Accordingly, under the HHS and Treasury regulations, an employer will
not be permitted to use the MV Calculator (or any actuarial certification or valuation) to
demonstrate that a Non-Hospital/Non-Physician Services Plan provides minimum value.
It is anticipated that the proposed changes to regulations will be finalized in 2015
and will apply to plans other than Pre-November 4, 2014 Non-Hospital/Non-Physician
Services Plans on the date they become final rather than being delayed to the end of
2015 or the end of the 2015 plan year. As a result, a Non-Hospital/Non-Physician Services Plan (other than a Pre-November 4, 2014 Non-Hospital/Non-Physician
Services Plan) should not be adopted for the 2015 plan year. (As noted above, it is
anticipated that the proposed changes to regulations, when finalized, will not apply to
Pre-November 4, 2014 Non-Hospital/Non-Physician Services Plans until after the end of
the plan year beginning no later than March 1, 2015. The Departments anticipate that
final rulemaking will be completed on or about that date.)
Pending issuance of final regulations, in no event will an employee be required to
treat a Non-Hospital/Non-Physician Services Plan as providing MV for purposes of an
employee’s eligibility for a premium tax credit under Code section 36B, regardless of
whether the plan is a Pre-November 4, 2014 Non-Hospital/Non-Physician Services
B. Employer Duty to Inform Employees

An employer that offers a Non-Hospital/Non-Physician Services Plan (including
a Pre-November 4, 2014 Non-Hospital/Non-Physician Services Plan) to an employee
(1) must not state or imply in any disclosure that the offer of coverage under the Non-Hospital /Non-Physician Services Plan precludes an employee from obtaining a premium tax credit, if otherwise eligible, and (2) must timely correct any prior disclosures that stated or implied that the offer of the Non-Hospital/Non-Physician Services Plan would preclude an otherwise tax-credit-eligible employee from obtaining a premium tax credit. Without such a corrective disclosure, a statement (for example, in a summary of benefits and coverage) that a Non-Hospital/Non-Physician Services Plan provides minimum value will be considered to imply that the offer of such a plan precludes employees from obtaining a premium tax credit. However, an employer that also offers an employee another plan that is not a Non-Hospital/Non/-Physician Services Plan and that is affordable and provides MV is permitted to advise the employee that the offer of this other plan will or may preclude the employee from obtaining a premium tax credit.


The Departments have coordinated on the guidance and other information
contained in this notice, and HHS is concurrently issuing parallel guidance. Questions
concerning the information contained in this notice may be directed to HHS at 301-492-
5153 or the IRS at 202-317-7006. Additional information for employers regarding the
Affordable Care Act is available at,, and

Did you receive an incorrect BCBS NC rate increase?

4 Nov , 2014,
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The following post comes directly from Blue Cross Blue shield of North Carolina:

This week, many BCBSNC individual customers received letters telling them how much their health plans will cost in 2015. About 42,000 customers received notices that contained an incorrect premium amount. We’re very sorry about this mistake and we will be sending corrected rate notices to those customers.  In the meantime, we know you have questions about whether the rate notice you received is correct.

How do I know if my rate notice is correct?

The error affected only customers who are grandfathered and have a Blue Advantage health plan with a $15 co-pay for primary care office visits (Plan A).

Here’s what to look for:

  1. Does the rate notice you received contain the following language:  “Good news: your health plan is grandfathered…”GoodNews

  2. Is your co-pay for Primary Care Physician office visits $15?IDCard

If you answer “yes” to both of these questions, then the rate you received the week of Oct. 27 is incorrect.

So, when will I know how much my health plan will cost?

We have corrected the mistake and are printing new rate notices as we speak. Customers should begin receiving them the week of Nov. 3. If you’d like to know sooner, you can call the customer service number listed in your rate notice starting 10/31/2014. Our Customer Service Professionals have the correct information and can tell you how much your health plan will cost in 2015.

What if my letter does not say I’m grandfathered and/or my Primary Care co-pay is something other than $15?

If that’s the case, then the rate notice you received is correct and your rate was affected by the factors we discussed in our previous blog post about 2015 rates.

How did this happen?

We’re human and sometimes we make mistakes. We regret that it happened and we’re working to fix it.

Can I expect my rate to be less than what my letter shows?

In most cases, yes. About 38,000 customers received a rate that is too high. About 4,000 customers received  rates that are lower than what they should be. Again, all customers who were affected by the error will get a corrected rate notice the week of Nov. 3.

Bluecross Blueshield North Carolina 2015 ACA rates.

23 Oct , 2014,
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Bluecross Blueshield North Carolina 2015 ACA rates.

According to various sources around the web, Bluecross Blue Shield North Carolina on Wednesday released some limited rate information or 2015 marketplace health insurance plans.

The headline number for this story is that rates will rise “more than 13 percent on average”. Of course, that does not tell the entire story. As we recently saw in South Carolina , rate increases for ACA plans offered on the exchange will fluctuate quite a bit between different regions. We do not expect every Bluecross Blueshield customer to receive a 13% increase. Rates will vary across regions, as North Carolina has 16 distinct rating regions, each with differing rate increases. In addition, different types of plans will receive different increases:

Bluecross Blueshield of North Carolina 2015 ACA rate increase

Rate increase got you down? Click here to shop for a lower price!

Bluecross yesterday provided only one scenario of how rates would increase next year. For a 45-year old nonsmoker, the monthly premium rate would increase 15.6 percent – from $364.39 to $421.32 – on one of the most popular individual plans Blue Cross sold in Raleigh through the federal marketplace – a Silver plan.

Keep in mind, however, rate increases for Bronze and Gold plans will change by different amounts. We have also been told certain plans in specific areas may actually decrease a bit – stay tuned for more!

Of course, most North Carolina residents will also be able to choose a marketplace plan from Unitedhealthcare for 2015, as well as Coventry Healthcare in certain areas!

Our takeaway? If you need the most robust network options for North Carolina in 2015, Bluecross Blueshield of North Carolina may be your best bet. However, if you are willing to change doctors to accept an HMO or Tiered network structure, you may be able to save some money.

Beginning November 15, North Carolina residents can view 2015 rates and apply online from our frontpage (click the Blue button!).