Short-term health insurance in North Dakota

State regulations limit short-term plans to no more than 185 days, and allows only one renewal (which insurers are required to offer)

Buying a short-term health plan in North Dakota

ND short-term plans limited to 185 days

Long-standing North Dakota regulations limit short-term health insurance plans to durations of no more than 185 days. Although the Trump administration changed the rules as of late 2018 to allow short-term plans to last longer, state regulations still apply if they’re stricter than the federal rules.

Only one renewal allowed, for a total plan duration of up to 12 months

The North Dakota Insurance Department published a bulletin in September 2018, clarifying the state’s position in terms of the new federal rules for short-term plans. In addition to longer initial terms, the new federal rules allow for renewals and much longer total plan durations, including renewals. But North Dakota clarified that only one renewal is permitted, so the total duration of a plan, including renewal, cannot exceed 12 months (the renewal process cannot include medical underwriting).

2019 legislation requires insurers to offer a renewal, but still caps total plan duration at 12 months

ND 2118 was signed into law in North Dakota in March 2019, following nearly unanimous support in both chambers of the state’s legislature. The new law clarifies some of the state’s existing rules, including the initial term limit of six months. But the legislation also requires short-term health insurers to allow a member to renew their coverage, although the total duration of the plan, including renewal, cannot exceed 12 months.

This is an important provision, as it differs from the federal rules and most other states’ rules. While the new federal rules for short-term plans allow insurers to offer renewal, at their discretion, North Dakota’s new law leaves it to the insured’s discretion — the insurer is required to allow the renewal, with no additional underwriting, if the insured wants to renew their coverage.

ND 2118 requires that all short-term plans sold in the state must be sold by a licensed insurance producer, which is in line with existing rules in North Dakota. But another provision of the state’s new law goes well beyond most states’ requirements: The initial marketing call that an insurance producer makes to a potential client about a short-term policy must be recorded and maintained on file by the insurance producer or the insurance company, for at least a year after the policy terminates.

Other state requirements for short-term plans

North Dakota requires short-term plan applications to ask the consumer whether they have comprehensive major medical coverage in force, whether they understand that the short-term plan is NOT a comprehensive major medical policy, and why they are purchasing the short-term plan.

Short-term plans in the state are also required to have a loss ratio (claim amounts divided by premium amounts) of at least 55 percent.

The North Dakota Insurance Department clarified that insurers offering short-term plans must refile updated plans with the Department in order to continue marketing short-term products under the new rules.

The North Dakota Insurance Department published a document in 2017 to warn consumers about the drawbacks of short-term plans, limited benefit plans, and discount medical plans. In terms of when a consumer should purchase short-term coverage, the ND Insurance Department said “almost never.”

Which insurers offer short-term plans in North Dakota?

  • National General (according to this brochure, which was revised in 2020, National General does sell short-term plans in North Dakota)

As of October 2018, there were several other insurers offering short-term plans in North Dakota. But plan availability had dwindled considerably by 2019, and very few plans appear to be available as of 2020.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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