Prepaid Health Plans

Prepaid Health Plans

The North Carolina Department of Insurance is the North Carolina agency responsible for the licensing and financial regulation of a Prepaid Health Plan (“PHP”) under Chapter 58, Article 93 of the North Carolina General Statutes (The Prepaid Health Plan Licensing Act).

Filing an Application for a North Carolina PHP License

New companies wishing to be licensed as a PHP in North Carolina must apply for a license.

To apply for a PHP license, a new company must use the following:

• Application for PHP License
• Financial Forecast Template

Licensed Health Organization Request for a North Carolina PHP License

Insurers already licensed in North Carolina that meet the definition of a Licensed Health Organization (“LHO”) in North Carolina General Statute 58-93-2(7) are not required to file a PHP application. A LHO will be recognized as a PHP and shall be issued a PHP license upon the LHO’s demonstration of compliance with the Prepaid Health Plan Licensing Act.

To request a PHP License, a LHO must use the following:

• LHO Request to Add PHP License
• Financial Forecast Template

Please be advised that the Application for PHP License and the LHO Request to Add PHP License above contain lists of information to be provided by applicants or LHOs. The lists are intended to be used as guides and are not all-inclusive. As such, it is recommended that interested persons refer to Chapter 58, Article 93 of the North Carolina General Statutes when applying for or requesting a PHP license.

Applications and Requests for PHP licenses will be reviewed by the Company Admissions Section and the Actuarial Services Division. Pursuant to North Carolina General Statute 58-93-4, the Commissioner will contract with consultants and other professionals to expedite and complete the review process, the cost of which shall be reimbursed by the applicant or the LHO. Applicants and LHOs requesting a PHP license are requested to complete the following Agreement and submit it with their application or request to ensure an expedited review:

• Agreement to Pay

Reference Materials

• Chapter 58, Article 93 of the North Carolina General Statutes, as passed in House Bill 156

Contact Information

Questions about obtaining a PHP license can be directed to:

Jessica Price
Chief Financial Analyst
919-807-6169
jessica.price@ncdoi.gov