135-48.1. General definitions. As used in this Article unless the context clearly requires otherwise, the following definitions apply: (1) Authorized representatives who are assisting the State Health Plan Division staff. – Staff of the Department of the State Treasurer, staff of the Department of Justice, or persons providing internal auditing assistance required under G.S. 143-746(b). […]
135-48.10. Confidentiality of information and medical records; provider contracts. (a) Any information described in this section that is in the possession of the State Health Plan for Teachers and State Employees or its Claims Processor under the Plan or the Predecessor Plan shall be confidential and shall be exempt from the provisions of Chapter 132 […]
135-48.12. Committee on Actuarial Valuation of Retired Employees’ Health Benefits. (a) There is established the Committee on Actuarial Valuation of Retired Employees’ Health Benefits. The Committee shall be responsible for collecting data and reviewing assumptions for the sole purpose of conducting required actuarial valuations of State supported retired employees’ health benefits under other post-employment benefit […]
135-48.15. Whistle-blower protections related to the State Health Plan. (a) Statement of Public Policy. – It is the policy of this State that persons shall be encouraged to report verbally or in writing to the State Health Plan, Attorney General, or other appropriate authority evidence of activity related to the State Health Plan and involving […]
135-48.16. Fraud detection and audit programs. (a) Access to Persons and Records. – In the course of conducting an investigation or an audit under G.S. 135-48.30(a)(9), the Plan, or authorized representatives who are assisting the State Health Plan Division staff, shall have ready access to the following: (1) Persons, books, records, reports, vouchers, correspondence, files, […]
135-48.2. Undertaking. (a) The State of North Carolina undertakes to make available a State Health Plan (hereinafter called the "Plan") exclusively for the benefit of eligible employees, eligible retired employees, and certain of their eligible dependents, which will pay benefits in accordance with the terms of this Article. The Plan shall have all the powers […]
135-48.20. Board of Trustees established. (a) There is established the Board of Trustees of the State Health Plan for Teachers and State Employees. (b) The Board of Trustees of the State Health Plan for Teachers and State Employees shall consist of 10 members. (c) The State Treasurer shall be an ex officio member of the […]
135-48.21. Board officers, quorum, meetings. (a) Besides the Chair, the Board of Trustees shall elect from its own membership such officers as it sees fit. (b) A majority of the voting members of the Board of Trustees in office shall constitute a quorum. Decisions of the Board of Trustees shall be made by a majority […]
135-48.22. Board powers and duties. The Board of Trustees shall have the following powers and duties: (1) Approve benefit programs, as provided in G.S. 135-48.30(a)(2). (2) Approve premium rates, co-pays, deductibles, and coinsurance percentages and maximums for the Plan, as provided in G.S. 135-48.30(a)(2). (2a) Approve the benefit program, premium rates, co-pays, deductibles, and coinsurance […]
135-48.23. Executive Administrator. (a) The Plan shall have an Executive Administrator. The Executive Administrator position is exempt from the provisions of Chapter 126 of the General Statutes as provided in G.S. 126-5(c1). (b) The Executive Administrator shall be appointed by the State Treasurer. The term of employment and salary of the Executive Administrator shall be […]
135-48.24. Administrative review. (a) If, after exhaustion of internal appeal handling outlined in the contract with the Claims Processor, any person is aggrieved, then the Claims Processor shall bring the matter to the attention of the Executive Administrator. The Executive Administrator shall promptly decide whether the subject matter of the internal appeal is a determination […]
135-48.25. Rules. The State Treasurer, in consultation with the Board of Trustees, may adopt rules to implement this Article. The State Treasurer shall provide to all employing units, all health benefit representatives, all relevant health care providers affected by a rule, and to any other persons requesting a written description and approved by the State […]
135-48.27. Reports to the General Assembly; General Assembly access to information. The State Treasurer, the Executive Administrator, and Board of Trustees shall report to the General Assembly as requested, and in the manner designated, by the President Pro Tempore of the Senate and the Speaker of the House of Representatives. Employees of the Legislative Services […]
135-48.28. Auditing of the Plan. The State Health Plan for Teachers and State Employees and the Claims Processor shall be subject to the oversight of the State Auditor pursuant to Article 5A of Chapter 147 of the General Statutes. (1981 (Reg. Sess., 1982), c. 1398, s. 6; 1983, c. 913, s. 24; 1985, c. 732, […]
135-48.3. Right to amend. The General Assembly reserves the right to alter, amend, or repeal this Article. (1981 (Reg. Sess., 1982), c. 1398, s. 6; 1985, c. 732, s. 62; 2008-168, ss. 3(a), (u); 2011-85, s. 2.6(k); 2012-173, s. 5.)
135-48.30. Powers and duties of the State Treasurer. (a) The State Treasurer shall have the following powers and duties: (1) Administer and operate the State Health Plan for Teachers and State Employees in accordance with G.S. 135-48.2 and the provisions of this Article. (2) Set benefits, premium rates, co-pays, deductibles, and coinsurance percentages and maximums, […]
135-48.32. Contracts to provide benefits. (a) The Plan benefits shall be provided under contracts between the Plan and the claims processors selected by the Plan. The contracts necessarily will conform to applicable State law. (b) Unless otherwise directed by the Plan, each Claims Processor shall provide the Plan with a Claims Data Feed, which includes […]
135-48.33. Contracting provisions; large contract review by Board of Trustees and Attorney General, auditing, no cost plus contracts. (a) The Board of Trustees must approve all Plan contracts in excess of three million dollars ($3,000,000), including contracts with an initial cost of less than three million dollars ($3,000,000), but that may exceed three million dollars […]
135-48.34. Contracts not subject to Article 3 of Chapter 143 of the General Statutes. The design, adoption, and implementation of the preferred provider contracts, networks, and optional alternative comprehensive health benefit plans, and programs available under the optional alternative plans, as authorized under G.S. 135-48.2, are not subject to the requirements of Article 3 of […]
135-48.35. Contract disputes not contested case under the Administrative Procedure Act, Chapter 150B of the General Statutes. A dispute involving the performance, terms, or conditions of a contract between the Plan and an entity under contract with the Plan is not a contested case under Article 3 of Chapter 150B of the General Statutes. (2001-192, […]
