Identical to S 159, filed 2/25/21.
Amends GS 135-48.33, increasing the threshold of contracts for the State Health Plan for Teachers and State Employees (SHP) that require approval of the Board of Trustees from contracts in excess of $500,000 to contracts in excess of $5 million. Makes conforming changes.
Amends GS 135-48.41(b), eliminating the prohibition against dependent child eligibility for coverage under the SHP if the dependent child is eligible for employer-based health care outside of the SHP, other than a parent's claim. Modifies the authorization for continued coverage for certain disabled dependent children beyond the child's 26th birthday to require the dependent child to be disabled and covered by the SHP on his or her 26th birthday, with verification provided within 60 days after the child's 26th birthday. No longer requires that the dependent child be incapable of earning a living with a handicap that developed or began before the 19th birthday, or the 26th birthday. Makes conforming changes.
Amends GS 135-48.24, modifying the administrative review process for appealed claims to eliminate participation by the SHP Board of Trustees. Requires the Executive Administrator to make binding decisions on matters determined not to be subject to external review. No longer requires provision of written summaries to employing units, health benefit representatives, relevant health care providers, and approved parties requesting the summary. Specifies that determination includes decisions that health care services have been reviewed and do not meet the SHP's benefit offerings. Makes technical and clarifying changes.
Makes conforming repeal of GS 135-48.22(3), which includes oversight of administrative reviews and appeals as a duty of the SHP Board of Trustees.
Amends GS 150B-1 to exclude decisions by the Executive Administrator that an internal appeal is not subject to external review under GS 135-48.24, as amended, from the Chapter's contested case provisions. Makes conforming changes.
Amends GS 135-48.27 to specify that reports of the State Treasurer, Executive Administrator, and SHP Board of Trustees to the NCGA are upon request and in the manner designated by the previously specified NCGA leadership. Eliminates a statutory reference since repealed.
Corrects a statutory reference in GS 135-48.1(14).
Bill H 177 (2021-2022)Summary date: Feb 25 2021 - View summary