58-50-1. Waiver by insurer. The acknowledgment by any insurer of the receipt of notice given under any policy covered by Articles 49, 50 through 55, 65, or 67 of this Chapter, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim under the […]
58-50-100. Title and reference. This section and G.S. 58-50-105 through G.S. 58-50-156 are known and may be cited as the North Carolina Small Employer Group Health Coverage Reform Act, referred to in those sections as "this Act". (1991, c. 630, s. 1; 2006-105, s. 1.9.)
58-50-105. Purpose and intent. The purpose and intent of this Act is to promote the availability of accident and health insurance coverage to small employers, to prevent abusive rating practices, to require disclosure of rating practices to purchasers, to establish rules for continuity of coverage for employers and covered individuals, and to improve the efficiency […]
58-50-110. Definitions. As used in this Act: (1) Repealed by Session Laws 2001-334, s. 12.1, effective August 3, 2001. (1a) "Actuarial certification" means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the Commissioner that a small employer carrier is in compliance with the provisions of G.S. […]
58-50-112. Affiliated companies; HMOs. For the purposes of this Act, companies that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one carrier except that any insurance company, hospital service plan, or medical service plan that is an affiliate of an HMO located in North Carolina or […]
58-50-115. Health benefit plans subject to Act. (a) A health benefit plan is subject to this Act if it provides health benefits for small employers and if any of the following conditions are met: (1) Any part of the premiums or benefits is paid by a small employer or any covered individual is reimbursed, whether […]
58-50-125. Health care plans; formation; approval; offerings. (a), (a1) Repealed by Session Laws 2013-357, s. 2(e), effective January 1, 2015. (b) Repealed by Session Laws 2006-154, s. 9, effective July 23, 2006. (c) Except as provided under Article 68 of this Chapter, the plans developed under this section are not required to provide coverage that […]
58-50-130. Required health care plan provisions. (a) Health benefit plans covering small employers are subject to the following provisions: (1) to (4) Repealed by Session Laws 1997-259, s. 5, effective July 14, 1997. (4a) A carrier may continue to enforce reasonable employer participation and contribution requirements on small employers applying for coverage; however, participation and […]
58-50-131. Premium rates for health benefit plans; approval authority; hearing. (a) No schedule of premium rates for coverage for a health benefit plan subject to this act, or any amendment to the schedule, shall be used in conjunction with any such health benefit plan until a copy of the schedule of premium rates or premium […]
58-50-149. Limit on cessions to the Reinsurance Pool. In addition to any individual or group previously reinsured in accordance with G.S. 58-50-150(g)(1), the Pool shall only reinsure a health benefit plan issued or delivered for original issue by a reinsuring carrier on or after October 1, 1995, if the health benefit plan provides coverage to […]
58-50-15. Conforming to statute. (a) Other Policy Provisions. – No policy provision which is not subject to G.S. 58-51-15 shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to Articles 50 through 55 of this Chapter. (b) Policy […]
58-50-150. North Carolina Small Employer Health Reinsurance Pool. (a) There is created a nonprofit entity to be known as the North Carolina Small Employer Health Reinsurance Pool. All carriers issuing or providing health benefit plans in this State from January 1, 1992, until the termination of the Pool, except any small employer carrier electing to […]
58-50-151. (Recodified as 58-51-116 effective July 1, 2002) ERISA plans may not require Medicaid to pay first. An employee benefit plan as defined in ERISA shall not include any provision which, because an individual is provided or is eligible for benefits or service pursuant to a State plan under Title XIX of the Social Security […]
58-50-20. Age limit. If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after […]
58-50-25. Nurses’ services. (a) No agency, institution or physician providing a service for which payment or reimbursement is required to be made under a policy governed by Articles 1 through 64 of this Chapter shall be denied such payment or reimbursement on account of the fact that such services were rendered through a registered nurse […]
58-50-26. Physician services provided by physician assistants. No agency, institution, or physician providing a service for which payment or reimbursement is required to be made under a policy governed by Articles 1 through 64 of this Chapter shall be denied the payment or reimbursement on account of the fact that the services were rendered through […]
58-50-270. Definitions. Unless the context clearly requires otherwise, the following definitions apply in this Part. (1) "Amendment" – Any change to the terms of a contract, including terms incorporated by reference, that modifies fee schedules. A change required by federal or State law, rule, regulation, administrative hearing, or court order is not an amendment. (2) […]
58-50-275. Notice contact provisions. (a) All contracts shall contain a "notice contact" provision listing the name or title and address of the person to whom all correspondence, including proposed amendments and other notices, pertaining to the contractual relationship between parties shall be provided. Each party to a contract shall designate its notice contact under such […]
58-50-280. Contract amendments. (a) A health benefit plan or insurer shall send any proposed contract amendment to the notice contact of a health care provider pursuant to G.S. 58-50-275. The proposed amendment shall be dated, labeled "Amendment," signed by the health benefit plan or insurer, and include an effective date for the proposed amendment. (b) […]
58-50-285. Policies and procedures. (a) A health benefit plan or insurer shall provide a copy of its policies and procedures to a health care provider prior to execution of a new or amended contract and annually to all contracted health care providers. Such policies and procedures may be provided to the health care provider in […]