AN ACT TO ALLOW VISION SERVICE PLANS AND TO MAKE TECHNICAL AND CONFORMING CHANGES TO CHAPTER 58 OF THE GENERAL STATUTES.
Makes the following changes to Part 1, Hospital, Medical and Dental Service Corporations, of Article 65 of GS Chapter 58, which governs hospital, medical and dental service corporations.
Amends GS 58-65-1 to expand the scope of Articles 65 and 66 to include corporations organized for the purpose of maintaining and operating a nonprofit vision service plan whereby vision services can be provided by the corporation or optometrists participating in the plan(s) (Article 66 regulates the readability of hospital, medical and dental service corporations' insurance certificates). Explicitly exempts such corporations from all other state insurance laws, except as otherwise provided. Authorizes all corporations subject to Articles 65 and 66 with certificates of incorporation which authorize the operation of either a dental, hospital, medical, or vision service plan, or any combination of the plans, to, with the approval of the Commissioner of Insurance (Commissioner): (1) issue subscribers' contracts or certificates for the provision of or payment of fees for services or care; and (2) enter into contracts with health care providers for the provision of or the payment of fees for services or care (previously, authorities reserved for hospital service corporations only).
Enacts 58-65-1.1 to set forth the Article's defined terms. Moves the seven defined terms previously set forth in GS 58-65-1 to this statute, with technical changes and modifications discussed below. Adds the terms dental service corporation and vision service corporation. Adds the term vision service plan and defines the term to mean any contract for the provision of or the payment of fees for vision care or vision services, including any other professional services permitted to be provided by a duly licensed optometrist or ophthalmologist. Replaces the definition of hospital service corporation, now defining the term to mean any nonprofit corporation that operates a hospital service plan (previously, included operation of hospital, medical or dental service plans). Modifies the term single-service corporation to mean any corporation organized under the provisions of the Article that offers only a dental service plan, a vision service plan, or both a dental service plan and a vision service plan but no other plans (previously, a corporation that offered only a dental service plan).
Amends GS 58-65-2, which identifies specific insurance laws applicable to service corporations subject to the Article. More specifically makes the identified statutes applicable to all full-service (defined as corporations offering a medical service plan or a hospital plan) and single-service corporations subject to the Article (previously, all service corporations subject to the Article). Adds GS 58-50-300, Health benefit plans or insurers contracting for the provision of vision services or materials; no limitation on fees for noncovered services or materials, to the statutes identified.
Amends GS 58-65-5, authorizing both full-service and single-service corporations (was, any corporation) to contract with other firms and corporations for joint assumption or underwriting of any or all risks undertaken, subject to Commissioner approval of the terms and conditions. Makes similar changes throughout to reference both full-service and single-service corporations where appropriate.
Makes technical and clarifying changes to GS 58-65-10 regarding payment of premiums.
Makes conforming changes to GS 58-65-25 (concerning various types of contracts), making existing language applicable to vision services as appropriate. Makes technical changes and makes language gender neutral.
Amends GS 58-65-50 to explicitly require a certificate or license issued by the Commissioner for a corporation to issue contracts for the rendering of vision services to subscribers, and making existing application requirements applicable to such corporations. Makes conforming and technical changes. Makes language gender neutral.
Make conforming and technical changes to GS 58-65-55 concerning the issuance and continuances of licenses upon fee payment.
Amends GS 58-65-60 concerning subscriber contracts to require all subscriber contracts of corporations subject to the Article and Article 66 to be in writing with a certificate stating the terms and conditions furnished to the subscriber to keep. Makes conforming, technical and clarifying changes. Makes language gender neutral.
Makes technical and conforming changes to GS 58-65-65, regarding required coverage for active medical treatment in tax-supported institutions.
Makes technical and conforming changes to GS 58-65-70, concerning required coverage of persons possessing the sickle cell trait or hemoglobin C trait.
Makes conforming and clarifying changes to GS 58-65-95 and GS 58-65-110 concerning corporations' investments and reserves, and expenses.
Makes technical and conforming changes to GS 58-65-120 regarding transacting through licensed agents, and GS 58-65-131 and GS 58-65-132 regarding required procedures for full-service and single-service corporations to convert to a stock accident and health insurance company or stock life insurance company subject to separate GS Chapter 58 Articles.
Makes conforming, technical and clarifying changes to GS 58-65-135 concerning group service plans administered on a cost plus administrative expense basis.
Amends GS 58-65-150 regarding the scope and construction of Articles 65 and 66. Authorizes the Commissioner to require full-service and single-service plans or medical service associations to provide information necessary to determine whether the service plan or medical service association is exempt from the provisions of Articles 65 and 66. Makes conforming changes. Makes organizational and technical changes. Makes language gender neutral.
Makes conforming changes to GS 58-65-155 concerning mergers and consolidations. Makes organizational and clarifying changes. Adds an explicit requirement that the terms of merger or consolidation agreements be written, with content and signatures of directors or trustees as presently required. No longer allows for voting by proxy at the required meeting for adoption of an agreement for merger or consolidation. Makes technical changes and makes language gender neutral.
Makes technical and conforming changes to GS 58-65-165 concerning the determination of exempt corporations. Makes language gender neutral.
Amends GS 58-65-166, which sets forth the defined terms as used in Part 2 of Article 65 concerning indemnification. Includes nonprofit domestic vision service corporations and their successors in the definition of corporation.
Modifies Article 66, Hospital, Medical and Dental Service Corporation Readable Insurance Certificates Act, of GS Chapter 58. Expands the Article's scope to include vision service corporations. Makes conforming changes to GS 58-66-35 concerning filing requirements.
Makes conforming changes to GS 58-38-35 regarding readable insurance policies, GS 58-49-25 regarding required disclosure, GS 58-50-5 regarding general health insurance guidelines, and GS 58-50-45 regarding required notice to insurance fiduciaries. Additionally, makes clarifying changes to GS 58-50-5, and makes language gender neutral.
Makes the act applicable to contracts issued, amended, or renewed on or after October 1, 2021.
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