Bill Summary for S 228 (2021-2022)

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Summary date: 

Apr 28 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

Senate committee substitute makes the following changes to the 1st edition.

Changes the section number for previously proposed GS 58-50-56.1 to GS 58-50-56.2 and makes the following changes to the proposed statute. Removes the defined terms exclusive provider benefit plan and insurer. Adds to the required notice on the date of enrollment by an insurer offering an exclusive provider benefit plan required to provide transition coverage for a newly covered insured covered because of the individual's employer has changed benefit plans and who is undergoing treatment from a provider for an ongoing special condition, to include the method and time line by which the insured should contact the insurer regarding the right to elect continuation of coverage of treatment by a provider that is not contracted with the exclusive provider benefit plan. Regarding permitted conditions of coverage, allows the provider to agree to accept the preferred provider organization rate or other rate agreed to by the provider or insurer plus applicable copayments for reimbursement in full from the insurer and the insured for all covered services provided by a provider not contracted with the exclusive provider benefit plan but who the insured elects to continue coverage of ongoing treatment under subsection (c). Makes technical and clarifying changes.

Enacts new GS 58-50-56.1, authorizing insurers to contract for an exclusive provider organization, as defined, with licensed health care providers of all kinds, with contracts not disapproved by the Commissioner of Insurance within 90 days of filing deemed approved. Voids any contractual provision between an insurer offering an exclusive provider benefit plan, as defined, and a health care provider that restricts the provider's right to enter into provider contracts with other persons. Mandates applicable contracts to provide all participating providers information about the insurer and the insurer's exclusive provider benefit plans, as specified. Makes the Commissioner's rules applicable to preferred provider organizations related to provider accessibility for the insured group, adequacy of providers, availability of services at reasonable times, and financial solvency also applicable to exclusive provider organizations. Provides for summary data and annual disclosures to the Commissioner by insurers offering an exclusive provider benefit plan. Includes defined terms. 

Deletes the proposed conforming changes to GS 58-50-56(i).

Changes the act's effective date, making the act now applicable to insurance contracts issued, renewed, or amended on or after July 1, 2021 (was October 1, 2021). Adds that any provisions of GS Chapter 58 that apply to preferred provider benefit plans or preferred provider benefit organizations as of July 1, 2021, also apply to exclusive provider benefit plans or exclusive provider benefit organizations.