New North Carolina Program Expands Health Insurance Options for Small Businesses

Starting this month, small businesses in North Carolina have access to a new way to offer health insurance to employees through the launch of Carolina HealthWorks. The program was made possible by a legislative change last year that updated the state’s insurance regulations.

Collaboration Between the N.C. Chamber and Blue Cross Blue Shield

The N.C. Chamber is partnering with Blue Cross Blue Shield of North Carolina (BCBSNC) to offer the new health plans. The initiative is designed to help small businesses—often burdened by high insurance costs—gain access to more affordable coverage.

North Carolina Insurance Commissioner Mike Causey described the program as a major opportunity for small employers. “Any small business that’s a member of a local chamber (of commerce) or the North Carolina Chamber can now participate in that group health insurance, from anywhere from two employees to 50 employees,” Causey said during a recent Council of State meeting. He also noted that his agency expedited regulatory approvals to help launch the program.

Expanded Access Through Chamber Membership

To qualify, business owners must have between two and 50 employees and belong to either the N.C. Chamber or one of 82 affiliated local chambers of commerce. Eligible businesses can work with Blue Cross Blue Shield agents to establish coverage for their employees.

Under the program’s structure, businesses will join together through a multiple employer welfare arrangement (MEWA)—a model that allows smaller companies to combine their resources to secure group health insurance benefits typically available to larger employers.

Legislative Background and Small Business Impact

Previously, North Carolina law permitted MEWAs only for specific industry trade groups. However, a bill passed in December 2024 expanded that authority to chamber of commerce organizations, paving the way for Carolina HealthWorks.

Gary Salamido, CEO of the N.C. Chamber, said small businesses have long sought relief from rising health insurance costs. “When it comes to health coverage, small employers have faced some of the toughest challenges: higher costs, fewer choices and less control,” Salamido said. “Carolina HealthWorks changes that. It allows small businesses to band together under a multiple employer welfare arrangement, pooling resources to access the same kinds of benefits and advantages larger companies enjoy.”

By combining their employees and dependents into one pool, participating companies can collectively manage risk and potentially achieve more competitive rates in the insurance marketplace.

Launch Timing and Market Context

The introduction of Carolina HealthWorks comes at a time when Affordable Care Act (ACA) insurance premiums are expected to rise, affecting individuals whose employers do not offer coverage. Many small business owners have cited affordability as the main reason they have been unable to provide health insurance to employees.

With the rollout of this new option, small businesses across North Carolina now have an additional pathway to offer health coverage and attract and retain employees in a competitive job market.