North Dakota Health Insurance

Affordable health insurance coverage is an inevitable necessity, especially if you are the sole earning member of a family. Health insurance from a private insurer can be expensive; you need to assess your finances and the potential risks associated with your family’s health. Approximately 47 million Americans do not have a proper health insurance in place. Majority of these uninsured people are the working families, who are exposed to the risk of crushing medical bills in the event of an illness or injury. Those families who are not covered by their employer’s group coverage can avail their state-sponsored low-cost health insurance programs.

North Dakota is the 12th healthiest state to live in and receive health care services, according to the United Health Foundation’s 2008 Health Rankings. However, the state fell four spots from its 8th position in 2007 and 2006. North Dakota’s health care system is robust, but, the state’s lawmakers need to tackle various issues including increasing public health funding, high prevalence of binge drinking and high geographic disparity within the state. The state of North Dakota, having the population of more than six hundred and twelve thousand residents, offers both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced health coverage to the uninsurable residents of North Dakota who meet specific eligibility requirements.

The North Dakota Insurance Department regulates all types of insurance sold in the state including health insurance policies offered by private-market health insurers or public health coverage programs. However, approximately 11.2% of the population remains uninsured, which is the top priority for the North Dakota government. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 34.6% of North Dakota residents under the above 200% FPL category continue to live in the state without any kind of health insurance.

Health insurance is important for the security of your health and finances. Therefore, your best interests remain in taking professional help from a licensed health insurance agent/broker to avail the benefits of appropriate health insurance coverage.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of North Dakota. These regulations apply to all insurance companies offering individual or family health insurance in North Dakota:

Medical Underwriting Yes
Pre-Existing Condition Exclusion Period 12 months
Look Back Period 6 months
Look Back Standard Objective
Mandatory Benefits Cancer screening for women including breast cancer screening, reconstructive surgery after mastectomy
Market Rate Restrictions Yes
Guaranteed Issue Options None

Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of North Dakota. These regulations apply to all insurance companies offering small group health insurance in North Dakota:

Small Group Size 2-50
Employee Qualifications Two employees must work for at least 6 months out of the year, and work 20 hours per week
Guaranteed Issue Yes
Premium Rating Factors Rate Bands
Rate Adjustment Factors 35%
Look-Back Period 6 months
Pre-existing condition exclusionary period 12 months
Mandatory Benefits Same as Individual

State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of North Dakota. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option Yes
Eligible Group Sizes 2-19
Extension of Benefits Period – Standard 39 weeks
Extension of Benefits Period – Disabled 39 weeks
Maximum Premium Increase 100%
State Legislation Reference
Additional Notes You must apply for the state continuation coverage within 10 days of losing your coverage or from the day you were notified about continuation coverage, whichever is later.

State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of North Dakota to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of North Dakota is summarized in the chart below:

Plan Name Comprehensive Health Association of North Dakota (CHAND)
Website http://www.chand.org/
Phone Number 800-737-0016
HIPPA Eligibility Required? Yes
Available Carriers Blue Cross Blue Shield of North Dakota
Pre-Existing Condition Waiting Period 6 months
Enrollment Periods Annual eligibility review
Premium Limits No more than 135% of standard rate
Lifetime Maximum Benefit $1 million
Special Notes To qualify for the coverage, individuals must be ineligible for health benefits under North Dakota’s medical assistance program, COBRA or certain other government programs

Children’s Health Insurance Program

Through shared funding from the federal government, the State of North Dakota provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name Healthy Steps
Website http://www.nd.gov/dhs/services/medicalserv/chip/
Phone Number 877-543-7669
Apply Online Yes
Age Limits Under 18
Insurance Carrier Blue Cross Blue Shield of North Dakota
Length of Coverage 12 months
Residency Requirements North Dakota residents and U.S. citizens, legal immigrants
Other Eligibility Requirements To be eligible, the child should not have any other insurance and should not be eligible for Medicaid
Pre-Existing Condition Exclusions None
Cost No monthly premiums are required. However, minimal co-payments include $5 per emergency room visit, $50 per hospitalization, $2 per prescription

Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of North Dakota:

Governing Agency North Dakota Department of Human Services
Website http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone Number 800-755-2604
Residency Requirements North Dakota resident
Federal Poverty Line Income Limits Pregnant women and Children ages 0-5: 133% FPL
Children ages 6-19: 100% FPL
Parents: 38% FPL
Medically Needy Individual: 66% FPL
Medically Needy Couple: 51% FPL

Additional Resources

North Dakota Health Care Options Matrix™ Guide

Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines North Dakota’s public and private health care choices for individuals and groups with various demographic profiles.

Family Health Insurance Guide by HealthInsuranceFinders.com

The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.

North Dakota: At-A-Glance

Provides exclusive health data of North Dakota. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, provides free, up-to-date, and easy-to-use health data on all 50 states.