Health Maintenance Organizations

Health Maintenance Organizations

The North Carolina Department of Insurance is the North Carolina agency responsible for the licensing and regulation of a Health Maintenance Organization (“HMO”) under Chapter 58, Article 67 of the North Carolina General Statutes (Health Maintenance Organization Act).

The following Divisions and Sections of the North Carolina Department of Insurance assist in the review of HMO applications:

Financial Analysis Section (“FAS”)

• Reviews the financial solvency, including the financial feasibility plan, insolvency protection plan, and financial statements for all HMO applicants, and determines the required levels of working capital and appropriateness of reserves.

• Coordinates the review for Medicare only HMOs.

Actuarial Services Division

• Assists FAS with the review of the financial feasibility plan.

Life & Health Division

• Coordinates the review for non-Medicare HMOs, reviewing non-financial and operational policies and procedures.

Filing an Application for a Medicare Only HMO License

To apply for a Medicare only HMO license, applicants must use the following:

• Application for Medicare Only HMO License 
• Financial Forecast Template

Filing an Application for a Non-Medicare HMO License

Non-Medicare HMO applicants are requested to comply with the filing requirements of the Life & Health Division as follows:

• HMO Initial License Requirements

Annual License Renewal

Every licensed HMO must submit a license update form and pay a nonrefundable renewal fee by March 1 each year in order to retain its license.

Listing of HMOs

• List of HMOs licensed in North Carolina