Applicants

In order to be eligible for coverage through Inclusive Health, all of the following must apply:

In order to process your application, you will be asked to provide a photocopy of your Social Security card, birth certificate, passport, naturalization/citizenship certificate, unexpired Visa, unexpired I-94 card or green card. If your green card is pending, you will need to supply a photocopy of your Employment Authorization Document (EAD) and Advance Parole (temporary travel document).

I am a legal resident of the US and currently reside in North Carolina. I have been a continuous resident of North Carolina for at least 30 days.

I do not have access to group coverage as an employee or as a dependent of an employee.

In order to be eligible for coverage through Inclusive Health, one of the following must apply:

I have been rejected or refused by an insurer for similar coverage due to medical reasons.

In order to process your application, you will be asked to provide a photocopy of a written notice from an insurance company from which you recently applied for coverage stating they will not provide you with health insurance coverage. The date of the denial letter cannot exceed six months prior to the date of this application.

I have been offered coverage by an insurer but with a conditional rider limiting coverage.

In order to process your application, you will be asked to provide a photocopy of a written notice from the insurance company stating that you have been approved, but with a conditional rider thus limiting your coverage. The date of the letter cannot exceed six months prior to the date of this application.

I have been refused coverage except at a higher premium rate than that offered through Inclusive Health.

In order to process your application, you will be asked to provide a photocopy of a written notice from the insurance company stating that you have been approved, but at a premium rate higher than that of Inclusive Health. The date of the letter cannot exceed six months prior to the date of this application.

I currently have similar health insurance coverage but at a single rate higher than that offered through Inclusive Health.

In order to process your application, you will be asked to provide a photocopy of the premium billing statement from your current health insurance provider. The statement date cannot exceed sixty days from the original effective date of the policy and does not include renewals.

I have been diagnosed with a medical condition that is outlined by Inclusive Health allowing automatic enrollment into Inclusive Health.

In order to process your application, you will be asked to provide a medical condition verification letter from your physician including your physician's name, address, specialty, and license number. A signed prescription form with your name and exact diagnosis may also be accepted.

This also includes those who currently have coverage through an insurer. You are considered HIPAA-eligible if:

You have exhausted COBRA coverage before Inclusive Health coverage will start.
Your most recent coverage was not terminated as a result of non-payment of premium or fraud.
If offered, you elected and exhausted any continuation coverage with the most recent coverage under COBRA or a similar state or federal program.
You did not enroll in an individual insurance policy or accept a conversion policy of limited duration after losing group coverage or health insurance plan.
You have 18 months of recent credible coverage under a health plan with your most recent coverage under an employer sponsored, government, union or church plan.
You have no more than a 63 day break in coverage since the last coverage terminated.

You will be asked to provide a Certificate of Creditable Coverage or otherwise provide evidence in writing for the periods of health coverage totaling 18 months. If COBRA or other continuation coverage has been offered by a state or the Federal government, please indicate the date such coverage began and the date it was exhausted. Note: if you move out of the service area of a plan and are not offered alternative coverage that will pay benefits in your new location, you have exhausted your continuation coverage.

I am eligible for the Health Coverage Tax Credit under the Trade Adjustment Assistance Act (TAA), Alternate Trade Adjustment Assistance (ATAA) or the Pension Benefit Guaranty Corporation (PBGC).

You are considered potentially HCTC eligible if:

You are a PBGC Pension Benefits, TAA or ATAA (Alternate Trade Adjustment Assistance) recipient.

In addition:

You are not entitled to Medicare benefits
You are not entitled to health coverage through the military health system (CHAMPUS/TRICARE). This does not include health coverage received as a Veterans Affairs (VA) benefit
You are not in prison
You cannot be claimed as a dependent on someone else's federal tax return

You will be asked to provide a copy of your approval letter from the government stating your TAA, ATAA or PBGC status.

Applicants

Applicants

Pre-Existing Condition Exclusions and Waivers

Effective Date of Coverage