North Carolina North Carolina Health Choice (NCHC) Application Information

North Carolina Health Choice program (NCHC) supports families whose income level is above Medicaid limit but still cannot afford to raise insurance premiums for their children. The NCHC program administration and guidelines are unique to the state of North Carolina. Members are privileged to receive reduced health insurance cost coverage. The main objective of NCHC is to ensure that uninsured children who do not qualify for Medicaid are able to receive the medical care needed not only to treat illness or injury but also to promote general well being. Enhancing or maintaining good health in children is essential so that they may become effective both in school and work related activities.

North Carolina Children Health Insurance Program is funded by both federal and North Carolina governments. Depending on the income level of the household, NCHC provides children under the age of 19 who are not covered by Medicaid with reduced health insurance benefits. Program eligibility is determined by social service and county health departments. Children may be provided with free or reduced rates for comprehensive health care including:

  • Hospitalization
  • Outpatient's care
  • Hospice care
  • Prescription drugs
  • Doctor's visits
  • Surgical services
  • Laboratory tests
  • Radiology services
  • Vision
  • Dental
  • Physical therapy

Children with special needs are eligible to receive additional services as demanded by their various conditions and are deemed medically necessary.

Before North Carolina residents apply for the Health Choice program, they should first enquire if they are eligible for Medicaid. If they are not, they can then go ahead and pursue for NCHC coverage. However, it is important to know that some medical services mentioned below are not included in the program. Uncovered services include:

  • Maternity care
  • Unnecessary medical procedures
  • Dental braces
  • Experimental treatments
  • Hospital transportation expenses

Eligibility Requirements

For your children to be covered under Health Choice, they must be:

  • North Carolina residents between the ages of 6 and 1.8
  • House hold income not exceeding 200 % of the Federal Poverty Level (FPL)<./li>
  • If your family's monthly income is slightly above the income limits listed below, your children may still be eligible. This is made possible by including deductions for child care and a $90 work-related expense deduction for each family member who works to bring your family's income level to 200%.

f your family economic condition rises above 200% FPL after your children have been covered by NCHC plan and you still want your children to continue with the program, you may be allowed to purchase the plan at full premium for one year.

Enrollment Fees

  • If your monthly household income is above the specified 200% Federal Poverty Level, there is an enrollment fee of $50 for one child or $100 for more children.
  • If your monthly income is at or below the 200% Federal Poverty Level, then the enrollment fee does not apply.

Co-Payments

  • If your monthly income is above the 200% Federal Poverty Level, below co-payments apply:
    • $25 per non-emergency room hospital visit.
    • $5 per physician or dental visit.
    • Prescription drugs: $1 for a generic drug, $1 for any original drug for which no generic is available, and $10 for original drug for which there is a generic available.
  • If your monthly income is 200% of poverty and below, the copayments involved include:
    • $10 for any non-emergency room visit
    • Prescription drugs: $1 for a generic drug, $1 per original drug for which no generic is available, and $3 for original drug for which there is a generic available.

North Carolina Health Choice Application Instructions

Families interested in applying for the North Carolina Health Choice program have two options. They can apply either in-person at their local Department of Social Services or mail in a printed application available at the Division of Medical Assistance website.

Applying in person/ Mail application

  1. Download, print and mail a completed NCHC application form.  Click here to download the application in the county where you reside.
  2. Call your local Department of Social Service Office (DSS) and ask a representative to mail an application form to you. The State of North Carolina has 100 counties and each county has a local Department of Social Services Office. Click here and select the county which phone numbers, physical addresses, and mailing addresses you would like to view. Email addresses and agency web site addresses are also included.
  3. Some health facilities have application forms available and are willing assist you in completing them.
  4. For people with special needs, a county representative may be able to assist them with the application procedures during a home visit.

The Division of Medical Assistance requires applicants to furnish them with several types of documentation to verify a family's financial status. These documents include:

  • Current Bank Statements
  • Current Payroll Stubs
  • List of assets such as real estate and vehicles owned by any household member.
  • Identification documents for children applying for NCHC such as genuine birth certificates and proof of citizenship or immigration status
  • Social Security Cards for each applicant
  • Copies of any other insurance or medical policy
  • Recent statements from any other source of income e.g. child support, pensions and retirement benefits