Small businesses are vital to our economy, and the heartbeat of our communities. Over the last 25 years, small businesses have created two-thirds of the state’s net new jobs.¹ Entrepreneurs make up 99% of all businesses in North Carolina, serving as a driving force behind local innovation and job creation. These very small businesses strengthen communities across the state and provide nearly half of all jobs-underscoring the essential role they play in supporting North Carolina’s workforce.²

Rising health care costs make it increasingly difficult for small businesses and their employees to access the care they need. Only about 49% of US workers at companies with fewer than 50 employees work at establishments that offer employer-sponsored health insurance.³

North Carolina is already the most expensive state in the country for health care,⁴ and national data indicates costs will continue to rise at alarming rates. PwC projects medical cost trend in the employer group market to be 8.5% in 2026, just as it was in 2024 and 2025.⁵ Facing a third year of elevated cost growth, another survey found more than half of employers are likely to shift more cost to employees in 2026.⁶

Those who do receive coverage through small businesses often shoulder a greater financial burden. On average, employees at small firms contribute more toward family premiums than workers at larger firms and face significantly higher annual deductibles – with family deductibles at small firms more than 40% higher than those at large firms.³

In the face of such headwinds, new solutions are needed. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is working with partners across the state to find new tools to make health care more affordable.

For example, Blue Cross NC has partnered with the NC Chamber to administer their new health plan, Carolina HealthWorks, to help small businesses access affordable health care. This plan brings together more than 170 years of combined experience supporting North Carolinians and their communities. Carolina HealthWorks is an exclusive offering only available to members of the NC Chamber and its participating local chambers. 

Carolina HealthWorks allows companies with as few as two employees to get access to rates and benefits typically only affordable to large groups. It’s a great alternative to Small Group Affordable Care Act (ACA) plans and can lead to significant savings. Plus, it opens the door to more plan options without adding administrative complexity to busy employers.

In addition to its core offerings, Blue Cross NC partners with several Multiple Employer Welfare Arrangements (MEWAs) designed to serve specific professional communities. These include the NC Bar Association Health Benefit Trust, the NC Center for Nonprofits, and the NC Home Builders Association plan. Eligibility for these health plans is limited to members of the respective trade or professional associations, providing tailored coverage options for their industries.

Beyond these association-based solutions, Blue Cross NC also offers other flexible options to help small businesses manage costs and coverage, including Balanced Funding and Fully Insured health plans. Each option is designed to meet different employer needs. 

Balanced Funding is a health plan funding option for employers with at least 12 eligible employees. It combines the potential advantages of a Self-Funded plan with the financial protection and predictable monthly payments of a Fully Insured plan. Key benefits include:

• Potential savings of Self-Funding  
• Predictable monthly rates, similar to a Fully Insured plan
• Integrated stop-loss coverage 
• Money-back opportunities 

Fully Insured health plans are another distinct option for small businesses seeking simplicity and stability. With this approach, we underwrite the employers’ medical expenses and provide full administrative services. Key benefits include:

• A single monthly premium
• Predictable and stable health care costs for the plan year 
• Peace of mind, ease, and convenience – we handle the details 
• Health benefits without claims cost risk to the employer 

Health care is complex. Positive, lasting change is difficult to achieve. But it can and must be done. The stakes are simply too high. From the NC Chamber to hospital systems, Blue Cross NC will continue working with collaborative partners to make health care better for all. 

If you’re interested in learning more, please reach out to your authorized Blue Cross NC representative, or visit our Employers page.