North Carolina § 135-48 - 30. Powers and duties of the State Treasurer.

§ 135-48. 30. Powers and duties of the State Treasurer.

The State Treasurer shall have the following powers and duties: 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. Set benefits, premium rates, co-pays, deductibles, and coinsurance percentages and maximums, subject to approval by the Board of Trustees. In setting premium rates, the State Treasurer may set a partially contributory rate of zero dollars, subject to approval by the Board of Trustees. Set the allowable charges for medical and prescription drug benefits, as necessary. Design and implement coordination of benefits policies. May offer wellness incentives. Set administrative and medical policies that are not in direct conflict with this Article. Adopt and implement, in consultation with the Board of Trustees, utilization review and internal grievance procedures that are substantially equivalent to those required under G.S. 58-50-61 and G.S. 58-50-62. External review of determinations shall be conducted in accordance with Part 4 of Article 50 of Chapter 58 of the General Statutes. Implement and administer pharmacy and medical utilization management programs and programs to detect and address utilization abuse of benefits. Establish and operate fraud detection and audit programs. Expend funds for any independent audit. Establish procedures to require prior medical approval and implement the procedures after consultation with the Board of Trustees. Prepare and submit to the Governor and the General Assembly cost estimates for the Plan, including those required by Article 15 of Chapter 120 of the General Statutes. Disclose to the Governor and the General Assembly changes or additions to the health benefits programs and health care cost containment programs offered under the Plan, together with statements of financial and actuarial effects as required by Article 15 of Chapter 120 of the General Statutes. Secure and maintain tax qualification of the Plan under any applicable provisions of the Internal Revenue Code. , (16) Repealed by Session Laws 2012-173, s. 3(c), effective January 1, 2013. The State Treasurer may delegate his or her powers and duties under this section to the Executive Administrator, the Board of Trustees, and employees of the Plan. In delegating powers or duties, however, the State Treasurer maintains the responsibility for the performance of those powers or duties. (17) Optionally offer Medicare-related options under G.S. 135-48.38 . (18) In accordance with G.S. 135-48.39 and subject to approval by the Board of Trustees, issue an order declaring an option of deferring premium or debt payments when there is a state of disaster or emergency. History (2011-85, s. 2.10; 2012-173, s. 3(c), 4(b); 2020-3, s. 4.21(a).) Deductible, Coinsurance, and Co-payment Adjustments. - Session Laws 2011-85, s. 1.3(a), provides: "Effective July 1, 2011, the Executive Administrator shall make the following changes to deductibles, coinsurance maximums, and co-payments under the Basic and Standard PPO Plans: "(1) Basic Plan (70/30): "a. Increase the in-network annual deductible to nine hundred thirty-three dollars ($933.00) for member-only coverage and to one thousand eight hundred sixty-six dollars ($1,866) for the out-of-network annual deductible for member-only coverage. The aggregate maximum annual deductible for employee-child and employee-family coverage shall be three times the member-only annual deductibles. "b. Increase the in-network coinsurance maximum to three thousand seven hundred ninety-three dollars ($3,793) for member-only coverage and to seven thousand five hundred eighty-six dollars ($7,586) for member-only out-of-network maximum coinsurance. The aggregate maximum coinsurance for employee-child and employee-family coverage shall be three times the member-only coinsurance maximums. "c. Increase the in-network urgent care co-payment to eighty-seven dollars ($87.00) per covered individual. "d. Increase the in-network primary care co-payment to thirty-five dollars ($35.00) per covered individual. "e. Increase the in-network specialist co-payment to eighty-one dollars ($81.00) per covered individual, except that for mental health and substance abuse services, chiropractic services, and physical therapy, occupational therapy, and speech therapy services, the in-network specialist co-payment shall be sixty-four dollars ($64.00) per covered individual. "f. Increase the in-network and out-of-network inpatient co-payment to two hundred ninety-one dollars ($291.00) per covered individual. "g. Increase the in-network and out-of-network emergency room co-payment to two hundred ninety-one dollars ($291.00) per covered individual. "h. Increase prescription drug co-payments as required under G.S. 135-45.6(b)(1) as amended by this section. "i. Except as otherwise provided in this act, co-payments and coinsurance for coverage not otherwise listed in this subdivision shall remain as applicable in the 2010-2011 benefit year. "(2) Standard Plan (80/20): "a. Increase the in-network annual deductible to seven hundred dollars ($700.00) for member-only coverage and to one thousand four hundred dollars ($1,400) for the member-only out-of-network annual deductible. The aggregate maximum annual deductible for employee-child and employee-family coverage shall be three times the member-only annual deductibles. "b. Increase the in-network coinsurance maximum to three thousand two hundred ten dollars ($3,210) for member-only coverage and to six thousand four hundred twenty dollars ($6,420) for member-only out-of-network maximum coinsurance. The aggregate maximum coinsurance for employee-child and employee-family coverage shall be three times the member-only coinsurance maximums. "c. Increase the in-network urgent care co-payment to eighty-seven dollars ($87.00) per covered individual. "d. Increase the in-network primary care co-payment to thirty dollars ($30.00) per covered individual. "e. Increase the in-network specialist co-payment to seventy dollars ($70.00) per covered individual, except that for mental health and substance abuse services, chiropractic services, and physical therapy, occupational therapy, and speech therapy services, the in-network specialist co-payment shall be fifty-two dollars ($52.00) per covered individual. "f. Increase the in-network and out-of-network inpatient co-payment to two hundred thirty-three dollars ($233.00) per covered individual. "g. Increase the in-network and out-of-network emergency room co-payment to two hundred thirty-three dollars ($233.00) per covered individual. "h. Increase prescription drug co-pays as required under G.S. 135-45.6(b)(1) as amended by this act. "i. Except as otherwise provided in this act, co-payments and coinsurance for coverage not otherwise listed in this subdivision shall remain as applicable in the 2010-2011 benefit year." 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. 2(e), provides: "Credits toward deductibles and coinsurance maximums that Plan members earn for services incurred during the months of July and August of 2011 shall be carried forward and applied toward meeting the new deductibles and coinsurance maximums for the period beginning September 1, 2011. If a Plan member fully meets his or her deductible or coinsurance maximum during the months of July and August of 2011, then that Plan member shall receive credit for the amount of the deductible or coinsurance maximum that the Plan member met during that time, but shall then be subject to meeting any additional amounts required by the new deductible and coinsurance maximums effective September 1, 2011." Premium Adjustments. - For premium rates for partially contributory coverage and premium adjustments for contributory coverage, see Session Laws 2011-85, s. 1.2(a) and (b), and related provisions, noted under G.S. 135-48.40 . Editor's Note. - The subsection (a) designation was added at the direction of the Revisor of Statutes. Session Laws 2009-16, s. 2(g), provides: "Premium Increases. - Premium rates for contributory coverage established in accordance with G.S. 135-44.6 shall be increased to eight and nine-tenths percent (8.9%) for contributory coverage for the 2009-2010 fiscal year and shall be increased by an additional eight and ninetenths percent (8.9%) over the premium rate for contributory coverage for the 2010-2011 fiscal year." Session Laws 2011-85, s. 2.12, provides: "In repealing a specific, detailed provision of Article 3A of Chapter 135 of the General Statutes and not placing that detailed provision into Article 3B of Chapter 135 of the General Statutes, it is not necessarily the intent of the General Assembly to prohibit the State Treasurer or the State Health Plan from having that authority." Session Laws 2011-85, s. 3.1(a), provides: "The State Treasurer and the Board of Trustees of the State Health Plan for Teachers and State Employees shall do the following: "(1) Examine the issue of moving to a calendar year, including the costs and mechanics of doing so. "(2) Find savings through wellness programs, Medicare Advantage plans, alternative plan designs, or other resources and use those savings to offer a premium-free plan option no later than July 1, 2013. "(3) Strive to keep all premiums low by finding savings through wellness programs, Medicare Advantage plans, alternative plan designs, or other resources." Session Laws 2011-85, s. 3.1(b), provides: "The State Health Plan for Teachers and State Employees shall issue a Request for Proposals for a Medicare Advantage Plan no later than June 30, 2012." Session Laws 2020-3, s. 5, is a severability clause. Effect of Amendments. - Session Laws 2012-173, s. 3(c), effective January 1, 2013, repealed subdivision (a)(15) which read: "Implement and administer a program of long-term care benefits pursuant to Part 6 of this Article" and subdivision (a)(16) which read: "Establish separate premium rates for the long-term care benefits provided by Part 6 of this Article if the benefits are administered on a self-insured basis." Session Laws 2012-173, s. 4(b), effective July 1, 2012, inserted "percentages and" following "and coinsurance" in subdivision (a)(2). Session Laws 2020-3. 4.21(a), effective retroactively to January 1, 2020, added subdivision (a)(18). § 135-48.31: Reserved for future codification purposes.