§ 135-48.57 – Payments for county or city ambulance service.
135-48.57. Payments for county or city ambulance service. Allowable payments for services provided by a county or city ambulance service shall be paid directly or shall be co-payable to the county or city ambulance service provider. As used in this subsection, "county or city ambulance service" means ambulance services provided by a county or county-franchised […]
§ 135-48.58 – Premiums for firefighters, rescue squad workers, and members of National Guard.
135-48.58. Premiums for firefighters, rescue squad workers, and members of National Guard. In setting premiums for firefighters, rescue squad workers, and members of the National Guard, and their eligible dependents, the Plan shall establish rates separate from those affecting other members of the Plan. These separate premium rates shall include rate factors for incurred but […]
§ 135-48.44 – Cessation of coverage.
135-48.44. Cessation of coverage. (a) Coverage under this Plan of an employee and his or her surviving spouse or eligible dependent children or of a retired employee and his or her surviving spouse or eligible dependent children shall cease on the earliest of the following dates: (1) The last day of the month in which […]
§ 135-48.45 – Conversion.
135-48.45. Conversion. (a) Upon a cessation of group coverage under the Plan and/or eligibility for group coverage under the Plan, an employee or dependent shall be entitled to a conversion to nongroup coverage without the necessity of a physical examination. Such conversion coverage shall include hospitalization, surgical, and medical benefits as contained in the major […]
§ 135-48.46 – Settlement agreements by employing units.
135-48.46. Settlement agreements by employing units. (a) No employing unit may enter into any settlement agreement with an employee or former employee regarding health benefits covered under the Plan unless the employing unit has received written authorization from the Plan’s Executive Administrator. (b) No settlement agreement between an employing unit and an employee or former […]
§ 135-48.47 – Participation in State Health Plan by local government employees and dependents.
135-48.47. Participation in State Health Plan by local government employees and dependents. (a) Eligibility. – The employees and dependents of employees of local government units are eligible to participate in the State Health Plan, as provided in this section. This section does not apply to employees of a charter school operated by a municipality. Employees […]
§ 135-48.49 – IRC Sections 6055 and 6056 regulatory reporting.
135-48.49. IRC Sections 6055 and 6056 regulatory reporting. The Plan shall be responsible for reporting coverage for retirees and coverage for direct bill members, except for individuals participating in Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage, as required by Section 6055 of the Internal Revenue Code. The Plan shall provide employing units with access to […]
§ 135-48.50 – Coverage mandates.
135-48.50. Coverage mandates. The Plan shall provide coverage subject to the following coverage mandates: (1) Abortion coverage. – The Plan shall not provide coverage for abortions for which State funds could not be used under G.S. 143C-6-5.5. The Plan shall, however, provide coverage for subsequent complications or related charges arising from an abortion not covered […]
§ 135-48.51 – Coverage and operational mandates related to Chapter 58 of the General Statutes.
135-48.51. Coverage and operational mandates related to Chapter 58 of the General Statutes. The following provisions of Chapter 58 of the General Statutes apply to the State Health Plan: (1) G.S. 58-3-191, Managed care reporting and disclosure requirements. (2) G.S. 58-3-221, Access to nonformulary and restricted access prescription drugs. (3) G.S. 58-3-223, Managed care access […]
§ 135-48.52 – General limitations and exclusions.
135-48.52. General limitations and exclusions. The Plan shall not provide coverage for or pay any benefits for any of the following: (1) Charges to the extent paid, or which the individual is entitled to have paid, or to obtain without cost, in accordance with any government laws or regulations except Medicare. If a charge is […]