§ 58-93-1 – Short title.
58-93-1. Short title. This Article may be cited as the Prepaid Health Plan Licensing Act. (2018-49, s. 1(a).)
§ 58-93-10 – Maximize federal reimbursement.
58-93-10. Maximize federal reimbursement. The Commissioner shall work with DHHS to maximize federal reimbursement of the Department’s expenses in administering this Article to the extent that federal reimbursement is allowed under federal law. (2018-49, s. 1(a).)
§ 58-93-100 – Penalties and enforcement.
58-93-100. Penalties and enforcement. (a) The Commissioner may, in addition to or in lieu of suspending or revoking a license under G.S. 58-93-85, proceed under G.S. 58-2-70, provided that the PHP has reasonable time to remedy the defect in its operations that gave rise to the procedure under G.S. 58-2-70. (b) Violation of this Article […]
§ 58-93-105 – Confidentiality of information.
58-93-105. Confidentiality of information. (a) All applications, filings, and reports required under this Article shall be treated as public documents unless otherwise determined by the Commissioner to be proprietary information. (b) Information shared between the Department and DHHS under this Article is confidential and not open to public inspection under G.S. 132-6, unless the information […]
§ 58-93-110 – (Effective until contingency met see note) Statutory construction and relationship to other laws.
58-93-110. Statutory construction and relationship to other laws. (a) Except as otherwise provided in this Article, provisions of this Chapter do not apply to either of the following: (1) A PHP that is not a licensed health organization. (2) A PHP that is a licensed health organization in regards to activities that relate solely to […]
§ 58-93-115 – Rules.
58-93-115. Rules. The Commissioner may adopt rules to carry out the provisions of this Article. (2018-49, s. 1(a).)
§ 58-93-120 – Other laws applicable to PHPs.
58-93-120. Other laws applicable to PHPs. The following provisions of this Chapter are applicable to PHPs in the manner in which they are applicable to insurers: (1) G.S. 58-2-131, Examinations to be made; authority, scope, scheduling, and conduct of examinations. (2) G.S. 58-2-132, Examination reports. (3) G.S. 58-2-133, Conflict of interest; cost of examinations; immunity […]
§ 58-93-15 – Commissioner use of consultants and other professionals.
58-93-15. Commissioner use of consultants and other professionals. (a) The Commissioner may contract with consultants and other professionals to expedite and complete the application process, examinations, and other regulatory activities required under this Article. Costs of contracts entered into under this section shall be reimbursed by the applicant or licensee. (b) Contracts under this section […]
§ 58-93-20 – Licensing.
58-93-20. Licensing. (a) Any commercial plan or provider-led entity may apply to the Commissioner for a license to operate as a PHP in compliance with this Article. (b) Each license application shall be verified by an officer or authorized representative of the applicant, shall be in a form prescribed by the Commissioner, and shall be […]
§ 58-93-25 – Issuance and continuation of license.
58-93-25. Issuance and continuation of license. (a) Before issuing or continuing any PHP license, the Commissioner of Insurance may make any examination as the Commissioner deems expedient. Except as otherwise provided in subsection (c) of G.S. 58-93-20, the Commissioner shall issue a license upon the payment of the application fee prescribed in G.S. 58-93-30 and […]
§ 58-93-30 – Fees.
58-93-30. Fees. The Commissioner shall charge an application fee of two thousand dollars ($2,000) for entities filing an application to be licensed as a PHP under this Article. The Commissioner shall charge an annual PHP license continuation fee of five thousand dollars ($5,000). The PHP license shall continue in full force and effect subject to […]
§ 58-93-35 – Deposits.
58-93-35. Deposits. (a) All deposits required by this section shall be administered in accordance with the provisions of Article 5 of this Chapter. (b) The Commissioner shall require a minimum deposit of five hundred thousand dollars ($500,000) or such higher amount as the Commissioner determines to be necessary for the protection of enrollees. (c) For […]
§ 58-93-40 – Management and exclusive agreements; custodial agreements.
58-93-40. Management and exclusive agreements; custodial agreements. (a) No PHP shall enter into an exclusive management or custodial agreement unless the agreement is first filed with the Commissioner and approved under this section within (i) 45 days after filing or (ii) a reasonable extended period as specified by notice from the Commissioner given within a […]
§ 58-93-45 – Fiduciary responsibilities.
58-93-45. Fiduciary responsibilities. Any director, officer, trustee, manager, or partner of a PHP who receives, collects, disburses, or invests funds in connection with the activities of the PHP shall be responsible for those funds in a fiduciary relationship to the enrollees and to the State. (2018-49, s. 1(a).)
§ 58-93-5 – (Effective until contingency met see note) Definitions.
58-93-5. Definitions. The following definitions apply in this Article: (1) Commercial Plan. – Any person, entity, or organization, profit or nonprofit, that (i) undertakes to provide or arrange for the delivery of health care services to enrollees on a prepaid basis except for enrollee responsibility for copayments and deductibles and (ii) is not a provider-led […]
§ 58-93-50 – Statements filed with Commissioner.
58-93-50. Statements filed with Commissioner. Every PHP subject to this Article is subject to G.S. 58-2-165. (2018-49, s. 1(a).)
§ 58-93-55 – Investments.
58-93-55. Investments. (a) With the exception of investments made in accordance with subsection (b) of this section, the funds of a PHP shall be invested or maintained only in securities, other investments, or other assets permitted by the laws of this State for the investment of assets constituting the legal reserves of life insurance companies […]
§ 58-93-60 – Examinations.
58-93-60. Examinations. The Commissioner may make an examination of the affairs of any PHP as often as the Commissioner determines it to be necessary for the protection of the interests of the enrollees or the State but not less frequently than once every five years. The Commissioner shall notify DHHS prior to any examination of […]
§ 58-93-65 – Hazardous financial condition.
58-93-65. Hazardous financial condition. (a) Whenever the financial condition of any PHP indicates a condition such that the continued operation of the PHP might be hazardous to its enrollees, creditors, the general public, or the State, the Commissioner may order the PHP to take action as may be reasonably necessary to rectify the existing condition, […]
§ 58-93-70 – Protection against insolvency.
58-93-70. Protection against insolvency. (a) The Commissioner shall require deposits in accordance with the provisions of G.S. 58-93-35. (b) Each PHP shall maintain a minimum capital and surplus equal to the greater of one million dollars ($1,000,000) or the amount required under the risk-based capital provisions of Article 12 of this Chapter. (c) Every PHP […]