Amends GS 58-3-190 to require health insurance to cover emergency services necessary to transport the covered person to a medically appropriate location for screening and stabilization. Requires coverage of services provided by a health care provider who is not under contract with the insurer if the covered person did not have a choice in the ground ambulance transportation service provider due to the emergency. Adds that the prohibition on imposing cost-sharing for emergency services that differs from the cost-sharing that would be imposed if the provider were contracting with the insurer includes emergency ambulance transportation services. Amends the definition of emergency services as it applies to this statute by including ambulance transportation services; also removes the definitions of health benefit plan and insurer. Amends the definition of stabilize to require compliance with guidelines and policies of the Centers for Medicare and Medicaid Services (was, the Health Care Financing Administration).
Enacts new GS 58-3-193, applying to nonemergency ground ambulance transportation service. Allows nonemergency ground ambulance transportation services to be subject to cost-sharing, including deductibles, coinsurance, and copayments. Prohibits an insurer, when nonemergency ground ambulance transportation services are provided by an entity that is not a participating provider in the insured's health benefit plan from charging cost-sharing in an amount greater than 110% of the cost-sharing amount for nonemergency ground ambulance transportation services provided by a participating network provider. Applies to insurance contracts issued, renewed, or amended on or after October 1, 2025.
Amends GS 135-48.51 to make new GS 58-3-193 applicable to the State Health Plan. Applies as of the start of the next plan year.
Appropriates $1 million in recurring funds for each year of the 2025-27 biennium from the General Fund to the Department of State Treasurer to provide the additional coverage required under the act.
NO SURPRISES FOR AMBULANCE SERVICES ACT.
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View NCGA Bill Details(link is external) | 2025-2026 Session |
AN ACT TO MAKE HEALTH INSURANCE COVERAGE OF GROUND AMBULANCE SERVICE MORE EQUITABLE AND THE COST-SHARING REQUIREMENTS MORE TRANSPARENT.Intro. by von Haefen, Buansi, Greenfield, Colvin.
Status: Ref to the Com on Appropriations, if favorable, Rules, Calendar, and Operations of the House (House action) (Mar 20 2025)
Bill History:
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Wed, 19 Mar 2025 House: Filed(link is external)
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Thu, 20 Mar 2025 House: Passed 1st Reading(link is external)
H 456
Bill Summaries:
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Bill H 456 (2025-2026)Summary date: Mar 19 2025 - View Summary
View: All Summaries for Bill