North Carolina § 58-50-125 - Health care plans; formation; approval; offerings.

§ 58-50-125. Health care plans; formation; approval; offerings.

Repealed by Session Laws 2013-357, s. 2(e), effective January 1, 2015. Repealed by Session Laws 2013-357, s. 2(e), effective January 1, 2015. Repealed by Session Laws 2006-154, s. 9, effective July 23, 2006. Except as provided under Article 68 of this Chapter, the plans developed under this section are not required to provide coverage that meets the requirements of other provisions of this Chapter that mandate either coverage or the offer of coverage by the type or level of health care services or health care provider. If a small employer carrier offers coverage to a small employer, the small employer carrier shall offer coverage to all eligible employees of a small employer and their dependents. A small employer carrier shall not offer coverage to only certain individuals in a small employer group except in the case of late enrollees as provided in G.S. 58-50-130(a)(4b). A small employer carrier shall not modify any health benefit plan with respect to a small employer, any eligible employee, or dependent through riders, endorsements, or otherwise, in order to restrict or exclude coverage for certain diseases or medical conditions otherwise covered by the health benefit plan. In the case of an eligible employee or dependent of an eligible employee who, before the effective date of the plan, was excluded from coverage or denied coverage by a small employer carrier in the process of providing a health benefit plan to an eligible small employer, the small employer carrier shall provide an opportunity for the eligible employee or dependent of an eligible employee to enroll in the health benefit plan currently held by the small employer. Repealed by Session Laws 2006-154, s. 9, effective July 23, 2006. To the extent it is required under this section and G.S. 58-68-40, every small employer carrier shall fairly market all of its small group health benefit plans it offers on a guaranteed issue basis to all small employers in the geographic areas in which the carrier makes coverage available or provides benefits. Repealed by Session Laws 2006-154, s. 9, effective July 23, 2006. The provisions of subsection (d) of this section apply to every health benefit plan delivered, issued for delivery, renewed, or continued in this State or covering persons residing in this State on or after the date the plan becomes operational, as determined by the Commissioner. For purposes of this subsection, the date a health benefit plan is continued is the anniversary date of the issuance of the health benefit plan. History (1991, c. 630, s. 1; c. 761, s. 10; 1993, c. 529, s. 3.6; 1997-259, ss. 3, 4; 2006-154, ss. 1, 2, 9, 10, 14; 2013-357, s. 2(d), (e).) Editor's Note. - Session Laws 2013-357, s. 1, provides: "Corrections to small group act. - No small employer carrier shall be required to issue the basic or standard health benefit plan as described in G.S. 58-50-125(a) . Any basic or standard health benefit plans described in G.S. 58-50-125(a) that are not 'grandfathered health plans,' as that term is used under Section 1251 of the Affordable Care Act, P.L. 11-148, as amended, shall be terminated on the next anniversary date on or after January 1, 2014, and the small employer carrier shall offer the employer replacement coverage from available small group health benefit plans pursuant to and in accordance with all applicable State and federal laws and regulations. The termination shall be preceded by a 90-day notice to the Commissioner, the employer policyholder, the participants, and the beneficiaries. If the plan is issued to a self-employed individual, as defined in G.S. 58-50-110 (21a), then the small employer carrier shall offer (i) replacement coverage from available individual health benefit plans or (ii) if the small employer carrier does not offer individual health benefit plans in this State, then individual conversion coverage pursuant to G.S. 58-53-45 ." Session Laws 2013-357, s. 6, made the amendment to subsection (d) by Session Laws 2013-357, s. 2(d), applicable to all insurance contracts and policies issued, renewed, or amended on or after January 1, 2014. Effect of Amendments. - Session Laws 2006-154, ss. 1, 2, 9, 10, and 14, effective July 23, 2006, added subsection (a1); in subsection (d), in the first paragraph, rewrote the first sentence, and substituted "G.S. 58-50-130(a)(4b)" for "G.S. 58-50-130(a)(4)" in the second paragraph; repealed subsections (b), (e), and (g); in subsection (f), inserted "To the extent it is required under this section and G.S. 58-68-40 " and substituted "all of its small group health benefit plans it offers on a guaranteed issue basis" for "the basic and standard health care plan"; and substituted "subsection (d)" for "subsections (b), (d), and (g) and subdivision (e)(2)" near the beginning of subsection (h). Session Laws 2013-357, s. 2(d), effective January 1, 2014, deleted the former first paragraph in subsection (d). For applicability, see editor's note. Session Laws 2013-357, s. 2(e), effective January 1, 2015, repealed subsections (a) and (a1).