Health Insurance Plans in North Carolina

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Eligibility Requirements

You are eligible for coverage under this EOC if, at the time of application:

• You are a citizen or national of the United States, or a non-citizen who is lawfully present in the United States, and are reasonably expected to be a citizen, national, or a non-citizen who is lawfully present for the entire period for which enrollment is sought; and
• You are a resident of the state of North Carolina; and
• You live in the Service Area in which You are applying, and intend to continue living there for the entire period for which enrollment is sought; and
• You are not incarcerated other than incarceration pending the disposition of charges; and
• You do not reside in an Institution; and
• You have submitted a completed and signed application for coverage and have been accepted in writing by Us.

The Subscriber must notify Us of all changes that may affect any Member's eligibility under this EOC.

Other Members may include the following Family Member(s):

• Your lawful spouse or domestic partner who lives in the Service Area.
• Your children until the end of the plan Year in which the child reaches age 26.

Your own, or Your spouse's or domestic partner’s Newborn children are automatically covered for the first 31 days of life. To continue coverage past that time, You must enroll the child as a Family Member by applying for his or her enrollment as a Family Member within 60 days of the date of birth, and pay any additional Premium. Coverage for a newborn dependent child enrolled within 60 days of birth will be retroactive to the date of the child’s birth. If no additional premium is required You must enroll the child, but no prior notification is required. Coverage would then be effective on the date of the child’s birth, or the first date of coverage under this EOC whichever is later.

An adopted child, including a child who is placed with You for adoption, is automatically covered for 31 days from the date of the adopted child’s placement for adoption or initiation of a suit of adoption. To continue coverage past that time, You must enroll the child as a Family Member by applying for his or her enrollment as a Family Member within 60 days of the date of adoption, and pay any additional Premium. Coverage for an adopted dependent child enrolled within 60 days of adoption will be retroactive to the date of the child’s placement for adoption or initiation of a suit of adoption. If no additional premium is required You must enroll the child, but no prior notification is required. Coverage would then be effective on the date of the child’s birth, or the first date of coverage under this EOC whichever is later.

A child who is placed with You for foster care is automatically covered for 31 days from the date of the foster child's placement. To continue coverage past that time, You must enroll the child as a Family Member by applying for his or her enrollment as a dependent within 60 days of the date the child is placed with You for foster care, and pay any additional premium. If no additional premium is required You must enroll the child, but no prior notification is required. Coverage would then be effective on the date of the child’s placement for foster care, or the first date of coverage under this EOC, whichever is later.

If a court has ordered a Subscriber to provide coverage for an eligible child (as defined above) coverage will be automatic for the first 31 days following the date on which the court order is issued. To continue coverage past that time, You must enroll the child as a Family Member by applying for his or her enrollment as a Family Member within 60 days of the court order date, and paying any additional Premium. Court-ordered coverage for a dependent child enrolled within 60 days of the court order will be retroactive to the date of the court order.

• Your stepchildren until the end of the plan Year in which the stepchild reaches age 26.
• Your own, or Your spouse's or domestic partner’s children, regardless of age, enrolled prior to age 26, who are incapable of self-support due to medically certified continuing intellectual or physical disability, and are chiefly dependent upon the Member for support and maintenance. Cigna Healthcare may require written proof of such disability and dependency within 31 days prior to the end of the Year in which the child reaches age 26.

NOTE: A child enrolled as a Family Member under this EOC is entitled to receive, while outside the Service Area, only Emergency Services for Emergency Medical Conditions.