AN ACT TO MAKE APPROPRIATIONS AND ADJUSTMENTS FOR THE 2011-2013 FISCAL BIENNIUM TO THE STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES; AND TO TRANSFER THE STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES TO THE OFFICE OF STATE TREASURER. Summarized in Daily Bulletin 4/19/11, 4/20/11, and 4/28/11. Enacted May 23, 2011. Part I is effective July 1, 2011, except as otherwise provided. Part II is effective January 1, 2012, except as otherwise provided. The remainder is effective May 23, 2011, except as otherwise provided.
Bill Summaries: S323 (2011-2012 Session)
Summary date: May 24 2011 - View summary
Summary date: Apr 28 2011 - View summary
Conference report recommends the following changes to 4th edition to reconcile matters in controversy.
Increases the appropriations from the General Fund and the Highway Fund to the State Health Plan Reserve as follows: $7,119,541 for 2011-12 and $102,151,104 for 2012-13 from the General Fund, and $332,245 for 2011-12 and $4,767,052 for 2012-13 from the Highway Fund. The State Health Plan for Teachers and State Employees may charge up to the listed monthly premiums for partially contributory coverage in 2011-12 and 2012-13 (deletes provisions allowing active members to participate in the Basic Plan at no cost). Specifies that premium rates for contributory coverage may increase by up to 5.3% (rather than 5.43%) in 2011-12 and by up to an additional 5.3% (rather than 5.43%) for 2012-13. Increases the copayment for generic prescriptions from $10 to $12. Changes employer contribution rates and amounts for 2011-13 with effective dates of July 1, 2011, and July 1, 2012. Makes conforming changes to provisions concerning noncontributory coverage.
Grants the State Treasurer authority to appoint an executive administrator, effective July 1, 2011 (was, effective when the act becomes law). Allows the State Treasurer to set a partially contributory rate of zero dollars, subject to approval by the Board of Trustees. Directs the State Treasurer and the Board of Trustees to: (1) examine the issue of moving to a calendar year, (2) find savings through wellness programs, Medicare Advantage plans, or other resources and use those savings to offer a premium-free option before July 1, 2013, and (3) strive to keep all premiums low by finding savings. Directs the State Health Plan to issue a Request for Proposals for a Medicare Advantage Plan before June 30, 2012.
Summary date: Apr 20 2011 - View summary
House amendment makes the following changes to 3rd edition.
The previous edition charged a monthly premium for all active members of the State Health Plan for Teachers and State Employees. The amendment charges no premium for active members in the Basic Plan, and allows a charge for the Standard Plan up to the listed monthly premium rates (rates increased from previous edition) for partially contributory coverage. Increases the appropriations from the General Fund and the Highway Fund to the State Health Plan Reserve as follows: $11,725,587 for 2011-12 and $109,480,158 for 2012-13 from the General Fund, and $547,194 for 2011-12 and $5,109,074 for 2012-13 from the Highway Fund. Specifies that premium rates for contributory coverage may increase by up to 5.43% (rather than 5.2%) in 2011-12 and by up to an additional 5.43% (rather than 5.2%) for 2012-13. Increases employer contribution rates and amounts for 2011-13 with effective dates of July 1, 2011, and July 1, 2012. Makes conforming changes to restore language for noncontributory coverage for certain active employees and to allow certain surviving spouses to participate on a partially contributory basis.
Summary date: Apr 19 2011 - View summary
House committee substitute makes the following changes to 2d edition. Replaces previous bill with provisions identical to S 265, introduced March 9, 2011, and ratified on April 5, 2011 with following changes: Directs State Treasurer to strive to maintain low premiums by finding operational savings in the plan and directs Treasurer to implement a program for long-term care benefits and establish separate premium rates for the benefits.
Summary date: Mar 24 2011 - View summary
Senate committee substitute makes the following changes to 1st edition.
Adds new section enacting GS 58-2-31 to establish the Seniors' Health Insurance Information Program within the Department of Insurance to provide the state's Medicare beneficiaries with counseling in Medicare, Medicare supplement insurance, long-term care insurance, and related health care coverage plans, effective when the act becomes law. Amends proposed GS 58-50-131, which requires Commissioner of Insurance (Commissioner) review of premium rate schedules, to delete the provision granting hearings upon Commissioner disapproval. Makes clarifying changes.
Amends proposed GS 58-33-27(b), clarifying that no adjuster license is required for an individual who, in connection solely with coverage on the repair and replacement of portable consumer electronic devices (was, in connection with insurance on the devices), collects claim information from or furnishes claim information to insured parties (was, insured parties or claimants), conducts data entry as detailed, and does not exercise discretion in the claim disposition, provided the individual is supervised by a licensed adjuster (was, provided the individual was an employee of a licensee) and there are no more than 25 individuals adjusting claims under that adjuster's supervision. Deletes language stating that a producer acting as a supervisor is not required to be licensed as an adjuster. Enacts new GS 58-33-27(c), specifying that if other property losses occur with the loss associated with the portable consumer electronic device, then the individual performing duties listed in GS 58-33-10(2) (defining adjuster) on the total loss must hold an adjuster license. Makes conforming changes.
Adds new section, amending GS 97-130 and 97-131, to remove language requiring approval by the Commissioner in those provisions of the NC Self-Insurance Security Association, effective July 1, 2011.
Makes other clarifying and organizational changes. Makes a conforming change to the title to reflect new bill content.
Summary date: Mar 10 2011 - View summary
Identical to H 298, filed 3/9/11.
Amends GS 58-2-69(g) to authorize the Commissioner of Insurance (Commissioner) to contract with the National Association of Insurance Commissioners (NAIC) or other parties to provide online services to applicants and licensees, for administrative services, license processing and support services, and regulatory data systems. Allows the NAIC or other contracted party to charge applicants and licensees a reasonable fee for these services, in addition to any applicable license application and renewal fees. Current law exempts contracts for these services from the provisions of Articles 3, 3C, and 8 of GS Chapter 143 (contracting requirements) and Article 3D of GS Chapter 147 (State Information Technology Services). Effective July 1, 2011.
Enacts new subsections (d), (e), (f), and (g) to GS 58-3-150 (forms to be approved by the Commissioner) to define a certificate of insurance as a document prepared or issued by an insurance company or producer used to verify or evidence the existence of property or casualty insurance coverage, but does not include a policy of insurance or insurance binder. States that a certificate of insurance does not amend, extend, or alter the coverage of the policy to which the certificate of insurance refers, and does not confer to a certificate holder new or additional rights beyond those expressly provided in the referenced policy. Makes it unlawful to knowingly prepare, issue, request, or require a certificate of insurance that (1) has not been filed with and approved by the Commissioner; (2) contains any false or misleading information; or (3) purports to alter, amend, or extend the coverage provided by the applicable insurance policy. Provides that a certificate holder will only have a legal right to notice of cancellation, nonrenewal, or any material change if the holder is named in the policy or endorsement, which requires notice. Effective October 1, 2011.
Enacts new GS 58-50-131 to prohibit any schedule of premiums for health benefit plan coverage or amendment from being used with the health benefit plan until a copy of the premium schedule or amendment has been filed with and approved by the Commissioner. Lists requirements for schedules or amendments so filed. Directs the Commissioner to approve or disapprove a schedule of premium rates within 60 days of a complete filing. Provides for notice and a hearing if the Commissioner disapproves the schedule. Requires the Commissioner to adopt rules (1) to prevent the federal preemption of health insurance regulation in North Carolina; (2) to implement the statute's provisions; and (3) to establish minimum standards for loss ratios of policies, as detailed. Effective July 1, 2011.
Enacts new GS 58-3-285 to direct an insurer who offers nondependent child coverage to offer open enrollment either continuously throughout the year or during January and July of each year. Requires this coverage to be issued without any riders based on the child's health status. Clarifies that an insurer may adjust the initial premium to the extent that the adjustment is in compliance with the applicable product's current approved rate filing. Defines terms used in the statute, and directs the Commissioner to adopt rules as necessary and proper to implement the statute. Effective October 1, 2011.
Amends GS 58-12-2 (definitions applicable to Risk-Based Capital Requirements) to add that a health organization is any insurer required by the Commissioner to use the NAIC Health Annual Statement Blank when filing the annual statement under GS 58-2-165. Clarifies that a life or health insurer, a property or casualty insurer, and a domestic insurer do not include any insurer that is required by the Commissioner to use the NAIC Health Annual Statement Blank when it files the annual statement. Makes a conforming change. Effective October 1, 2011.
Amends GS 58-12-11(a) to add that a company action level event also occurs with the filing of a risk-based capital report that indicates the insurer has total adjusted capital that is greater than or equal to its company action level risk-based capital, as specified, in the case of a property or casualty insurer or health organization. Makes conforming and clarifying changes. Effective October 1, 2011.
Enacts new GS 58-33-27 to provide that no adjuster license is required for an individual who, in connection with insurance on portable consumer electronic devices, collects claim information from or furnishes claim information to insured parties or claimants, conducts data entry as detailed, and does not exercise discretion in the claim disposition, provided the individual is an employee of a licensee under GS Chapter 58 (Insurance Law). States that a producer acting as a supervisor is not required to be licensed as an adjuster. Defines automated claims adjudication system and portable consumer electronic devices. Applies to licenses issued on or after July 1, 2012.
Amends GS 58-33-30(e) by adding new subsection (2a) requiring adjusters who adjust federal crop insurance claims to pass a proficiency examination approved by the federal Risk Management Agency, or another approved exam, as a condition of obtaining an adjuster's license. Amends GS 58-33-30(e)(1) to exempt adjusters who adjust only federal crop insurance claims from the subsection's examination requirements, provided the adjuster is certified under proposed subsection (2a).
Amends GS 97-132 to remove language requiring approval by the Commissioner for appointments to the North Carolina Self-Insurance Security Association (Association) Board of Directors (Board). Amends GS 97-133(a)(1a) (concerning the North Carolina Self-Insurance Security Fund) to delete language providing for Fund segregation in the Board's discretion. Amends GS 97-133(a)(2a) (establishing the Association Aggregate Security System (System)) to remove provisions requiring and explaining a written plan and language referencing the Commissioner, and instead requires the System to notify the Commissioner at least 90 days before termination if the Association determines it is no longer feasible or practical to continue the System. Also directs the Association to require each member to determine annually its total undiscounted claims liability and inform the Association. Amends GS 97-134 (plan of operation) to direct the Board (instead of the Association) to adopt a Plan of Operation. Removes language and provisions requiring approval by the Commissioner. Makes additional conforming and technical changes, and makes a conforming change to GS 97-136. Amends GS 97-137 to require the Board to submit a financial report for the preceding calendar year, before June 1 (rather than March 30) of each year. Amends GS 97-185(a1)(2) to exclude individual self-insurers with a debt rating below the minimum Standard & Poor's or Moody's rating if a minimum debt rating has been established by the Board from the System. Makes these amendments effective July 1, 2011.