North Carolina § 135-48 - 40. Categories of eligibility.

§ 135-48. 40. Categories of eligibility.

Noncontributory Coverage. - The following persons are eligible for coverage under the Plan, on a noncontributory basis, subject to the provisions of G.S. 135-48.43: Retired employees, as defined in G.S. 135-48.1(18), and retired State law enforcement officers who retired under the Law Enforcement Officers' Retirement System prior to January 1, 1985. Except as otherwise provided in this subdivision, on and after January 1, 1988, a retiring employee or retiree must have completed at least five years of contributory retirement service with an employing unit prior to retirement from any State-supported retirement system in order to be eligible for group benefits under this Part as a retired employee or retiree. For employees first hired on and after October 1, 2006, and members of the General Assembly first taking office on and after February 1, 2007, future coverage as retired employees and retired members of the General Assembly is subject to a requirement that the future retiree have 20 or more years of retirement service credit in order to be covered by the provisions of this subdivision. Surviving spouses of: Deceased retired employees, provided the death of the former plan member occurred prior to October 1, 1986; and Deceased teachers, State employees, and members of the General Assembly who are receiving a survivor's alternate benefit under any of the State-supported retirement programs, provided the death of the former plan member occurred prior to October 1, 1986. Partially Contributory Coverage. - The following persons are eligible for coverage under the Plan, on a partially contributory basis, subject to the provisions of G.S. 135-48.43: All permanent full-time employees of an employing unit who meet either of the following conditions: Paid from general or special State funds. Paid from non-State funds and in a group for which his or her employing unit has agreed to provide coverage. All retirees who (i) are employed by an employing unit that elects to be covered by this subdivision, (ii) do not qualify for coverage under subdivision (1) of this subsection, and (iii) are determined to be "full-time" by their employing unit in accordance with section 4980H of the Internal Revenue Code and the applicable regulations, as amended. The employing unit shall pay the employer premiums for retirees who enroll under this subdivision. Repealed by Session Laws 2013-324, s. 2, effective July 23, 2013. Retired employees, as defined in G.S. 135-48.1(18), and retired State law enforcement officers who retired under the Law Enforcement Officers' Retirement System prior to January 1, 1985. Except as otherwise provided in this subdivision, on and after January 1, 1988, a retiring employee or retiree must have completed at least five years of contributory retirement service with an employing unit prior to retirement from any State-supported retirement system in order to be eligible for group benefits under this Part as a retired employee or retiree. For employees first hired on and after October 1, 2006, and members of the General Assembly first taking office on and after February 1, 2007, future coverage as retired employees and retired members of the General Assembly is subject to a requirement that the future retiree have 20 or more years of retirement service credit in order to be covered by the provisions of this subdivision. Surviving spouses of: Deceased retired employees, provided the death of the former plan member occurred prior to October 1, 1986; and Deceased teachers, State employees, and members of the General Assembly who are receiving a survivor's alternate benefit under any of the State-supported retirement programs, provided the death of the former plan member occurred prior to October 1, 1986. Employees of the General Assembly, not otherwise covered by this section, as determined by the Legislative Services Commission, except for legislative interns and pages. Members of the General Assembly. Notwithstanding the provisions of subsection (e) of this section, employees on official leave of absence while completing a full-time program in school administration in an approved program as a Principal Fellow in accordance with Article 5C of Chapter 116 of the General Statutes. Notwithstanding the provisions of G.S. 135-48.44, employees formerly covered by the provisions of this section, other than retired employees eligible for coverage on a noncontributory basis, who have been employed for 12 or more months by an employing unit, or who have completed a contract term of employment of 10 or 11 months and whose employing unit is a local school administrative unit, and whose jobs are eliminated because of a reduction, in total or in part, in the funds used to support the job or its responsibilities, provided the employees were covered by the Plan at the time of separation from service resulting from a job elimination. Employees covered by this subsection shall be covered for a period of up to 12 months following a separation from service because of a job elimination. An employee formerly covered by the provisions of this section shall not be eligible for coverage under this subdivision if the employee is provided health benefit coverage on a non-contributory basis by a subsequent employer. Any member enrolled pursuant to subdivision (1) or (2) of this subsection who is on approved leave of absence with pay or receiving workers' compensation. Employees on approved Family and Medical Leave. One-Half Contributory Coverage. - The following persons are eligible for coverage under the Plan, on a one-half contributory basis, subject to the provisions of G.S. 135-48.43: A school employee in a job-sharing position as described in G.S. 115C-326.5. If these employees elect to participate in the Plan, the employing unit shall pay fifty percent (50%) of the Plan's total employer premiums. Individual employees shall pay the balance of the total premiums not paid by the employing unit. Retired employees, as defined in G.S. 135-48.1(18), with 10 but less than 20 years of retirement service credit provided the employees were first hired on or after October 1, 2006, and the members first took office on or after February 1, 2007. For such future retirees, the State shall pay fifty percent (50%) of the Plan's total employer premiums. Individual retirees shall pay the balance of the total premiums not paid by the State. Fully Contributory Coverage. - The following persons shall be eligible for coverage under the Plan, on a fully contributory basis, subject to the provisions of G.S. 135-48.43: Former members of the General Assembly who enroll before October 1, 1986. For enrollments after September 30, 1986, former members of the General Assembly if covered under the Plan at termination of membership in the General Assembly. To be eligible for coverage as a former member of the General Assembly, application must be made within 30 days of the end of the term of office. Only members of the General Assembly covered by the Plan at the end of the term of office are eligible. If application is not made within the specified time period, the member forfeits eligibility. Surviving spouses of deceased former members of the General Assembly who enroll before October 1, 1986. Employees of the General Assembly, not otherwise covered by this section, as determined by the Legislative Services Commission, except for legislative interns and pages. For enrollments after September 30, 1986, surviving spouses of deceased former members of the General Assembly, if covered under the Plan at the time of death of the former member of the General Assembly. All permanent part-time employees (designated as half-time or more) of an employing unit who meet the conditions outlined in sub-subdivision (b)(1)a. of this section and who are not covered by the provisions of subdivision (b)(1) of this section. The spouses and eligible dependent children of enrolled teachers, State employees, retirees, former members of the General Assembly, former employees covered by the provisions of subdivision (b)(8) of this section, Disability Income Plan beneficiaries, enrolled continuation members, and members of the General Assembly. Spouses of surviving dependents are not eligible, nor are dependent children if they were not covered at the time of the member's death. Surviving spouses may cover their dependent children provided the children were enrolled at the time of the member's death or enroll within 90 days of the member's death. Blind persons licensed by the State to operate vending facilities under contract with the Department of Health and Human Services, Division of Services for the Blind and its successors, who are: Operating such a vending facility; Former operators of such a vending facility whose service as an operator would have made these operators eligible for an early or service retirement allowance under Article 1 of this Chapter had they been members of the Retirement System; and Former operators of such a vending facility who attain five or more years of service as operators and who become eligible for and receive a disability benefit under the Social Security Act upon cessation of service as an operator. Surviving spouses of deceased retirees and surviving spouses of deceased teachers, State employees, Disability Income Plan beneficiaries, and members of the General Assembly provided the death of the former Plan member occurred after September 30, 1986, and the surviving spouse was covered under the Plan at the time of death. Any eligible dependent child of the deceased retiree, teacher, State employee, member of the General Assembly, former member of the General Assembly, or Disability Income Plan beneficiary, provided the child was covered at the time of death of the retiree, teacher, State employee, member of the General Assembly, former member of the General Assembly, or Disability Income Plan beneficiary, (or was in posse at the time and is covered at birth under this Part), or was covered under the Plan on September 30, 1986. An eligible surviving dependent child can remain covered until age 26 or indefinitely if certified as incapacitated under G.S. 135-44.41(b) [135-48.41(b)]. Retired employees, as defined in G.S. 135-48.1(18), with less than 10 years of retirement service credit, provided the teachers and State employees were first hired on or after October 1, 2006, and the members first took office on or after February 1, 2007. Notwithstanding the provisions of G.S. 135-48.44, former employees covered by the provisions of this section and their spouses and eligible dependent children who were covered by the Plan at the time of the former employees' separation from service pursuant to this section, following expiration of the former employees' coverage provided by this section. Election of coverage under this subdivision shall be made within 90 days after the termination of coverage provided under this section. The following persons, their eligible spouses, and eligible dependent children, provided that the person seeking coverage as a subscriber (i) is not eligible for another comprehensive health benefit plan and (ii) has been without coverage under a comprehensive health benefit plan for at least six consecutive months: Firefighters. Rescue squad workers. Persons receiving a pension from the North Carolina Firefighters' and Rescue Squad Workers' Pension Fund. Members of the North Carolina National Guard. Retirees of the North Carolina National Guard with 20 years of service. Other Contributory Coverage. - Any employee of an employing unit is eligible for coverage under this section on a contributory basis, subject to the provisions of G.S. 135-48.43 and of this section, if (i) the employee's employing unit determines that the employee is a full-time employee and (ii) the employee does not qualify for coverage under subdivision (1), (1a), (5), (6), (7), (8), (9), or (10) of G.S. 135-48.40(b). For the purposes of this subsection, the full-time status of an employee shall be determined by the employing unit, in its sole discretion, in accordance with Section 4980H of the Internal Revenue Code and the applicable regulations, as amended. The coverage offered and the contribution required for coverage under this section shall be determined by the Treasurer and approved by the Board of Trustees. Such coverage shall do all of the following: Be designed to meet the requirements of minimum essential coverage under the Patient Protection and Affordable Care Act, P.L. 111-148, and the applicable regulations, as amended (Affordable Care Act). Provide no greater coverage than a bronze-level plan, as defined under the Affordable Care Act. Minimize the required employer contribution in an administratively feasible manner. Employees of State agencies, departments, institutions, boards, and commissions not otherwise covered by the Plan who are employed in permanent job positions on a recurring basis and who work 30 or more hours per week for nine or more months per calendar year are covered by the provisions of this subdivision. Spouses, dependent children, surviving spouses, and surviving dependent children of such members are not eligible for coverage. For the purposes of this subdivision, Medicare benefits, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) benefits, and other Uniformed Services benefits shall be considered comprehensive health benefit plans. The Plan may require certification of persons seeking coverage under this subdivision. Nothing in this section shall be construed to either (i) permit a person to enroll or (ii) require the Plan to enroll a person in the Plan when that enrollment may jeopardize the Plan's preferential tax exempt status as a governmental plan under the Internal Revenue Code. History (1981 (Reg. Sess., 1982), c. 1398, s. 6; 1983, c. 499; c. 761, ss. 252-255; c. 867, s. 4; c. 922, s. 5; 1985, c. 400, ss. 5, 6; 1985 (Reg. Sess., 1986), c. 1020, s. 29(a)-( l ); 1987, c. 738, ss. 29(n), 36(a), 36(b); c. 809, ss. 3, 4; c. 857, ss. 11(a), 11.1, 11.2, 12; 1989, c. 752, s. 22(e), (f); 1989 (Reg. Sess., 1990), c. 1074, s. 22(a); 1993, c. 321, s. 85(b); 1995, c. 278, s. 1; c. 507, ss. 7.21(a)-(c), 7.28(a)-(c); 1997-443, s. 11A.118(a); 1997-512, ss. 17, 19-27; 1999-237, s. 28.29(f); 2000-141, ss. 6(a), (b); 2000-184, ss. 1(a),(b), 3; 2001-487, s. 86(a); 2002-174, s. 4; 2003-358, s. 4; 2004-124, s. 31.21(b); 2004-199, s. 34(b); 2005-276, s. 29.31(e); 2006-174, ss. 1, 2, 3; 2007-323, s. 28.22A(g1), (o); 2007-345, s. 12; 2008-168, ss. 1(a), 3(a), (f); 2008-194, s. 6(b); 2009-16, s. 3(b); 2009-281, s. 1; 2009-570, s. 43.2; 2009-571, s. 3(a), (d); 2010-72, s. 3(a); 2010-136, ss. 1, 2; 2011-85, ss. 1.6(b), 2.6(c), 2.10; 2011-96, s. 2(a); 2013-324, ss. 1, 2; 2014-100, s. 35.16(a), (c); 2015-100, ss. 3, 4(a); 2015-241, s. 30.25(a); 2016-56, s. 8; 2017-57, s. 35.21(d); 2017-135, s. 2; 2019-110, s. 4; 2020-48, s. 1.5(b).) Local Modification. - Bladen: 2004-124, s. 31.26, as amended by 2005-276, s. 29.32; Cherokee: 2004-124, s. 31.26, as amended by 2005-276, s. 29.32; Mitchell: 2004-124, s. 31.26, as amended by 2007-405, s. 1; Rutherford: 2004-124, s. 31.26, as amended by 2005-276, s. 29.32; Washington: 2004-124, s. 31.26, as amended by 2005-276, s. 29.32; Wilkes: 2004-124, s. 31.26, as amended by 2005-276, s. 29.32; and towns of Biltmore Forest: 2004-124, s. 31.26, as amended by 2007-405, s. 1; Black Creek: 2004-124, s. 31.26, as amended by 2007-405, s. 1; Black Mountain: 2004-124, s. 31.26, as amended by 2007-405, s. 1; Blowing Rock: 2004-124, s. 31.26, as amended by 2007-405, s. 1; Forest City: 2004-124, s. 31.26, as amended by 2005-276, s. 29.32; Ocean Isle Beach: 2004-124, s. 31.26, as amended by 2007-405, s. 1; Sunset Beach: 2004-124, s. 31.26, as amended by 2007-405, s. 1; Tabor City: 2004-124, s. 31.26, as amended by 2007-405, s. 1. Premium Adjustments. - Session Laws 2011-85, s. 1.2(a), provides: "Partially Contributory Coverage. - The State Health Plan for Teachers and State Employees may charge up to the following monthly premium rates for partially contributory coverage under G.S. 135-45.2(a1)[135-48.40(b)], as enacted by Section 1.6 of this act, for the 2011-2012 and 2012-2013 fiscal years: FY 2011-2012 FY 2012-2013 Basic Standard Basic Standard Employee Contribution Non-Medicare Eligible or $10.81 $21.63 $11.38 $22.77 Medicare Secondary Medicare Primary $5.00 $10.00 $5.27 $10.53 Retiree Contribution Non-Medicare Eligible $0.00 $21.63 $0.00 $22.77 Medicare Eligible $0.00 $10.00 $0.00 $10.53 Session Laws 2011-85, s. 1.2(b), provides: "Contributory Coverage. - Premium rates for contributory coverage established in accordance with G.S. 135-44.6 may be increased by up to five and three-tenths percent (5.3%) for contributory coverage for the 2011-2012 fiscal year and may be increased by up to an additional five and three-tenths percent (5.3%) over the premium rate for contributory coverage for the 2012-2013 fiscal year." Session Laws 2011-85, s. 1.11, as amended by Session Laws 2011-96, s. 2(a), made amendments to this section by Session Laws 2011-85, s. 1.6(b), effective September 1, 2011. Session Laws 2011-85, s. 2.11(b), effective January 1, 2012, provides: "Sections 1.2 and 1.3(a) of this act are repealed." Session Laws 2011-96, s. 1(a), provides: "Notwithstanding Section 1.2(a) of Senate Bill 323 of the 2011 Regular Session, if the State Health Plan for Teachers and State Employees has sufficient available cash balance reserves to do so, the State Health Plan may offer the Basic Plan premium-free to employees during fiscal year 2011-2012." Session Laws 2011-96, s. 1(b), provides: "Notwithstanding Section 1.2(a) of Senate Bill 323 of the 2011 Regular Session, the State Health Plan for Teachers and State Employees is directed to find savings through wellness programs, Medicare Advantage plans, alternative plan designs, or other resources and, if those found savings and any available cash balance reserves allow the State Health Plan to do so, the State Health Plan may offer a premium-free plan option to employees during fiscal year 2012-2013." Editor's Note. - Session Laws 2011-85, s. 2.6(c), effective January 1, 2012, recodified former subsections (a), (a1), (b), and (c) of G.S. 135-45.2 as subsections (a)-(d) of G.S. 135-48.40 , respectively. The remainder of G.S. 135-45.2 was recodified as G.S. 135-48.41 . Former G.S. 135-45.2 itself was formerly codified as G.S. 135-40.2. It was recodified as G.S. 135-39.14 under Part 3A of Article 3A of Chapter 135 by Session Laws 2008-168, s. 3(f), effective July 1, 2008, but was renumbered as G.S. 135-45.2 at the direction of the Revisor of Statutes. In subdivision (d)(10), as amended by Session Laws 2011-85, s. 2.10, the bracketed reference was added at the direction of the Revisor of Statutes. Session Laws 2013-324, s. 7, made the amendment to subdivision (b)(1) by Session Laws 2013-324, s. 1, applicable to plan years beginning on or after January 1, 2015. Session Laws 2014-100, s. 35.16(a), repealed Session Laws 2013-324, s. 1, which amended subdivision (b)(1) of this section, effective January 1, 2015. Since the amendment by Session Laws 2013-324 was effective January 1, 2015, that amendment never took effect. Session Laws 2014-100, s. 35.16(e), made subsection (e) of this section, as added by Session Laws 2014-100, s. 35.16(c), effective January 1, 2015, and applicable to plan years beginning on or after that date. Session Laws 2014-100, s. 1.1, provides: "This act shall be known as 'The Current Operations and Capital Improvements Appropriations Act of 2014.'" Session Laws 2014-100, s. 38.7, is a severability clause. Session Laws 2017-57, s. 1.1, provides: "This act shall be known as the 'Current Operations Appropriations Act of 2017.'" Session Laws 2017-57, s. 39.6, is a severability clause. Session Laws 2019-110, s. 5, as amended by Session Laws 2019-212, s. 7(c), provides: "(a) The State Treasurer shall seek a private letter ruling from the Internal Revenue Service to determine if the provisions of this act relating to the computation of postretirement earnings of retired teachers jeopardize the status of the Teachers' and State Employees' Retirement System. "(b) If the Internal Revenue Service determines that the provisions of G.S. 135-3(8) g., as enacted by this act, relating to the computation of postretirement earnings of retired teachers jeopardize the status of the Teachers' and State Employees' Retirement System of North Carolina under the Internal Revenue Code, then this act is repealed on the last day of the month following the month of receipt of that determination by the State Treasurer. Upon receipt of that determination, the State Treasurer shall notify the Revisor of Statutes of the determination and the date of receipt. Within three business days of receipt of the determination, the State Treasurer shall notify all local school administrative units of the repeal of this act and shall publicly notice the receipt of this information on the Department of State Treasurer's Web site. Within three business days of receipt of the notice from the State Treasurer, a local school administrative unit shall notify all high-need retired teachers employed by its local board of education of the repeal of this act. "(c) Notwithstanding any other provision of law to the contrary, in order to pay costs associated with the administration of the provisions of this act, the Retirement Systems Division of the Department of State Treasurer may increase receipts from the retirement assets of the Teachers' and State Employees' Retirement System or pay costs associated with the administration directly from the retirement assets. Costs associated with the administration of the provisions of this act shall not exceed fifty thousand dollars ($50,000) to obtain the private letter ruling from the Internal Revenue Service required under subsection (a) of this section. "(d) Any beneficiary that is employed to teach by a local board of education as a high-need retired teacher, as defined in G.S. 115C-302.4(a)(1) , shall not be eligible to elect into a position that would lead him or her to be eligible to accrue any additional benefits under G.S. 135-3(8) . Any failure of a local board of education or a beneficiary to comply with the foregoing shall be corrected by the Retirement System as it determines may be appropriate under State and federal law. Any costs of the correction, as determined by the Retirement System, shall be the sole responsibility of the local board of education and shall be transferred to the Pension Accumulation Fund under G.S. 135-8 , under rules adopted by the Board of Trustees." Session Laws 2019-212, s. 7(d), provides: "If S.L. 2019-110 is repealed pursuant to the requirements of Section 5 of that act, this section is repealed on the same date as the repeal of S.L. 2019-110." Session Laws 2020-48, s. 6.1, is a severability clause. Effect of Amendments. - Session Laws 2011-85, s. 1.6(b), effective September 1, 2011, deleted subdivisions (a)(1), (a)(2), and (a)(5) through (a)(10); added subsection (a1) and (a)(2); in subsection (b), in the introductory language, substituted "One-Half Contributory Coverage" for "Partially Contributory," and substituted "one-half contributory basis" for "partially contributory basis"; in subdivisions (b)(1) and (b)(2), substituted "employer premiums" for "noncontributory premiums" and deleted "noncontributory" following "balance of the total"; in subdivision (b)(1), substituted "described in G.S. 115C-326.5 " for "defined in G.S. 135-45.4"; in subdivision (b)(2), deleted "Subject to the provisions of G.S. 135-45.4" from the beginning; in subsection (c), in the introductory language, added "Coverage" to the subsection catchline and substituted "persons" for "person"; in subdivision (c)(6), substituted "meet the condition" for "meets the condition," "sub-subdivision (a1)(1)a. of this section" for "subdivision (a)(1)a. above," and "subdivision (a1)(1) of this section" for "G.S. 135-45.2(a)(1)"; in subdivision (c)(7), substituted "former subdivision (a)(8) or subdivision (a1)(8) of this section" for "G.S. 135-45.2(a)(8)"; in subdivision (c)(10), deleted "age 19, or" and "if a full-time student" before and after "age 26," and substituted "G.S. 135-45.2(d)" for "G.S. 135-45.1(5)b."; and in subdivsion (c)(12), substituted "this section" for "G.S. 135-45.2" four times. Session Laws 2011-85, s. 2.10, effective January 1, 2012, throughout the section, substituted "G.S. 135-48.43" for "G.S. 135-45.4"; redesignated former subdivisions (a)(3) and (a)(4) as present subdivisions (a)(1) and (a)(2), respectively; in subdivisions (b)(8) and (d)(12), substituted "G.S. 135-48.44" for "G.S. 135-45.12"; corrected the internal references in subdivisions (d)(6) and (d)(7); and rewrote subdivision (d)(13), which formerly read: "Firefighters, rescue squad workers, and members of the National Guard, their eligible spouses, and eligible dependent children." Session Laws 2013-324, s. 1, effective January 1, 2015, rewrote subdivision (b)(1). For applicability, see Editor's note. Session Laws 2013-324, s. 2, effective July 23, 2013, deleted subdivision (b)(2), which read: "Permanent hourly employees who work at least one-half of the workdays of each pay period." Session Laws 2014-100, s. 35.16(c), effective January 1, 2015, added subsection (e). See Editor's note for applicability. Session Laws 2015-100, ss. 3, 4, effective July 1, 2015, substituted "other than retired employees eligible for coverage on a noncontributory basis" for "other than retired employees" in the first sentence of subdivision (b)(8); and inserted "Disability Income Plan beneficiaries" in subdivision (d)(9). Session Laws 2015-241, s. 30.25(a), effective January 1, 2016, added subdivision (b)(1a); and substituted "subdivision (1), (1a), (5), (6), (7), (8), (9), or (10)" for "subdivision (1), (5), (6), (7), (8), (9), or (10)" in the first sentence of subsection (e). Session Laws 2016-56, s. 8, effective June 30, 2016, in subdivision (d)(13)c., substituted "Firefighters"' for "Firemen." Session Laws 2017-57, s. 35.21(d), effective January 1, 2021, substituted "Retired employees, as defined in G.S. 135-48.1(18) " for "Retired teachers, State employees, members of the General Assembly" or variants in subdivisions (a)(1), (b)(3), (c)(2), and (d)(11). Session Laws 2017-135, s. 2, effective July 20, 2017, in subdivision (c)(2), added "unless prohibited by law." at the end of the third sentence, made a stylistic change, and added the last sentence. Session Laws 2019-110, s. 3, effective July 1, 2019, and expiring June 30, 2021, added "or are high-need retired teachers, as defined under G.S. 115C-302.4(a)(1) " at the end of the first sentence in subdivision (b)(1a). Session Laws 2020-48, s. 1.5(b), effective June 26, 2020, in subdivision (d)(13), deleted "group" preceding "health" throughout, and added the last sentence in the concluding paragraph.