Bill Summary for S 228 (2021-2022)

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Summary date: 

Mar 10 2021

Bill Information:

View NCGA Bill Details2021
Senate Bill 228 (Public) Filed Wednesday, March 10, 2021
Intro. by Edwards, Krawiec, Burgin.

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Bill summary

Enacts GS 58-50-56.1 as follows. Regarding continuity of care following a termination of a contract between an insurer and a health care provider offering an exclusive provider benefit plan due to a change in the terms of provider participation in the benefit plan when an insured is undergoing treatment from the provider for an ongoing special condition on the date of termination, requires the insurer to timely notify the insurer of the right to elect continuation of coverage of treatment by the provider during a transitional period, subject to the insured having a claim for services provided by the terminated provider or the insured otherwise being known as a patient of the terminated provider by the insurer. Defines ongoing special condition to include specified acute illnesses, chronic illnesses, and terminal illnesses, and pregnancy from the start of the second trimester. Defines exclusive provider benefit plan (benefit plan), insurer, and terminated or termination.

Requires each benefit plan offered by an insurer to provide transition coverage to individuals who are newly covered by a benefit plan because the individual's employer has changed benefit plans and are undergoing treatment from a provider for an ongoing special condition. Requires an insurer to notify the newly covered insured on the date of enrollment of the right to elect continuation of coverage of treatment by a provider that is not contracted with the benefit plan and permit the newly covered insured to elect to continue to be covered with respect to the treatment by the provider of an ongoing special condition during a transitional period.

Allows the treating hospital care provider to determine the length of the transitional period, not exceeding 90 days after the date of the notice to the individual regarding termination of the provider or the date of enrollment in a new benefit plan, as described.

Provides for specified extensions of the general transitional period for  individuals who had scheduled or were on a waiting list to schedule surgery, organ transplantation, or inpatient care; individuals entering the second trimester of pregnancy; and individuals who were terminally ill.

Identifies six terms and conditions upon which an insurer can condition coverage of a continued treatment by a provider, including that the provider agrees to adhere to the insurer's established policies and procedures for participating providers. 

Provides parameters for the statute's construction, including that the statute does not require an insurer to offer a transitional period when the insurer terminates a provider's contract for reasons relating to quality of care or fraud. 

Requires insurers to include a clear description of an insured's rights under the statute in its evidence of coverage and summary plan description.

Authorizes the Department of Insurance to adopt temporary implementing rules.

Makes conforming changes to GS 58-50-56(i).

Applies to insurance contracts issued, renewed, or amended on or after October 1, 2021.