House committee substitute makes the following changes to 3rd edition.
Clarifies that the State Health Plan for Teachers and State Employees (Plan) may charge up to the specified monthly premium rates for partially contributory coverage; adds rates for Medicare Primary status, distinguished from Non-Medicare Eligible/Medicare Secondary. Changes the monthly premium for Medicare eligible retirees under the Standard plan from $17.59 to $17.40. Clarifies that premium rates for contributory coverage may be increased by up to 5.2% for 2011-12 and up to an additional 5.2% for 2012-13.
Amends GS 135-45.2(d), adding that a dependent child is not eligible for Plan coverage if the dependent child is eligible for employer-based health care outside of the Plan.
Adds a section to amend GS 135-45.3 (enrollment), adding that eligible dependents younger than age 19 may enroll in the Plan at any time and will not be subject to any waiting period for a preexisting condition. Makes conforming changes, and makes conforming changes to GS 135-45.4 (concerning effective dates of coverage).
Adds a new section, effective July 1, 2010, to amend GS 135-44.4(18), permitting the Executive Administrator and Board of Trustees to authorize coverage or payment of claims denied as a result of administrative errors or system issues. Makes clarifying changes to GS 135-45.1(15) (definition for health benefits representative).
Amends the title of newly created Article 3B in GS Chapter 135 to read State Health Plan for Teachers and State Employees. Amends GS 135-48.1 (general definitions), defining subscriber as a Plan member who is not a dependent (was, a person who qualifies for coverage under the Plan as the primary insured). Deletes the term and definition for surviving spouse. Makes a clarifying change to GS 135-48.10(a) (confidentiality of information and medical records; provider contracts). Amends GS 135-48.27 (reports to the General Assembly; General Assembly access to information) to allow attendance by Legislative Services Commission employees at all Board of Trustees meetings. Also makes GS 120-32.01(a) (requiring information be supplied to specified General Assembly divisions) applicable to the Claims Processor, the Treasurer, the Board of Trustees, the Executive Administrator, and the Plan. Amends GS 135-48.30, removing the State Treasurer’s two powers related to long-term care benefits. Makes a clarifying change to GS 135-48.38 (concerning Medicare eligible members).
Adds new section to make a conforming change to GS 150B-1(d)(7) (exempting Article 3B from rule-making provisions of the Administrative Procedure Act). Effective January 1, 2012 (the date the Plan transfers to the State Treasurer), repeals Sections 1.2 (setting premium rate increases) and 1.3(a) (setting deductible, coinsurance, and co-payment increases) of the act.
Makes other clarifying and conforming changes.