Bill Summaries: H928 STATE HEALTH PLAN SOLVENCY REFORM ACT.

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  • Summary date: Jun 8 2011 - View Summary

    House committee substitute makes the following changes to 1st edition.
    Makes clarifying changes to proposed subsection (c1) of GS 135-45.2. Effective January 1, 2012, recodifies proposed GS 135-45.2(c1) (Non-Medicare Eligible Retiree Coverage), as enacted in this act, as GS 135-48.40(e). Makes technical changes to GS 135-48.40(e).
    Amends GS 135-48.40 adding a new subsection (f), effective July 1, 2012, to provide retiree supplemental plan coverage for retirees who (1) would otherwise qualify for health care coverage under subsections (a) through (e) of GS 135-48.40, (2) do not qualify for Medicare, and (3) are eligible for health care coverage from an employer for which the employer pays over 50% of the premium costs.
    Effective January 1, 2012, recodifies proposed GS 135-45.11(c), (Member Audits of Bills) as enacted in this act, as GS 135-48.53(a). Amends GS 135-48.53(a) to direct the State Treasurer (was, Executive Administrator in GS 135-45.11(c), as enacted) and the Board of Trustees to adopt an incentive program to encourage Plan members to find certain errors in medical billing.
    Effective January 1, 2012, recodifies proposed GS 135-45.11(d), (Identification of Third-Party Tortfeasors), as enacted in this act, as GS 135-48.53(b).
    Effective January 1, 2012, recodifies GS 135-45.11(e), (Fraud Detection) as enacted in this act, as GS 135-48.53(c).
    Deletes changes regarding converting from a state fiscal year plan to a calendar year plan from GS 135-45.1(21), and reorganizes those provisions into uncodified Section 5 in this act, which also incorporates provisions for a half-year plan “year” necessary to make the change from a fiscal year to a calendar year.
    Amends GS 115C-341.1, (relating to the salaries of employees of local boards of education), GS 115D-25.2, (relating to the salaries of employees of community college boards of trustees), GS 116-17.2 (relating to the salaries of employees of the University of North Carolina), and GS 126-95(b), (relating to the salaries of officers and employees of departments, institutions, and agencies of state government) to provide that the employing entities may provide a flexible compensation plan that may offer a TRICARE supplement insurance plan. Directs any state entity electing to offer a TRICARE supplement option to use a competitive bid process to award contracts to any third-party provider. Requires the NC Flex plan administered by the Office of State Personnel to offer a TRICARE supplement no later than January 1, 2013.
    Deletes provision transferring $75 million from the Golden LEAF Foundation to the Golden LEAF to State Health Plan Transfer Reserve in $15 million increments over a period of five years from 2011 to 2015. Also deletes amendments to subsection (g), Right of Recovery, in GS 135-45.14. Deletes definitions section as applied in this act.
    Except as otherwise specified, effective July 1, 2011.


  • Summary date: May 5 2011 - View Summary

    Adds a new coverage category to GS 135-45.2 for retirees who are at least age 65, but who do not yet qualify for Medicare. Sets premium contribution rates for these retirees. Amends GS 135-45.11 to direct the State Health Plan (the Plan) to adopt an incentive program to find medical billing errors. Authorizes subrogation by the Plan, in addition to the Plan’s claims processor. Amends GS 135-45.11 to direct the Plan or claims processor to send a questionnaire to Plan members who are in accidents to try to identify third-party tortfeasors. Changes the Plan year to the calendar year, effective January 1, 2013, and provides for a transition period from July 1, 2012, through December 31, 2012. Directs the Plan and claims processors to analyze claims before making payments to try to detect fraud and abuse. Transfers $75 million from the Golden LEAF Foundation to a new State Health Plan Transfer Reserve fund in the office of State Budget and Management, and directs future transfers in 2011 through 2015 of $15 million each year from the Golden LEAF Foundation to the new fund. Encourages the Plan to use the transferred funds to develop a high-deductible maternity benefit option with a Health Savings Account. Effective July 1, 2011, unless otherwise indicated.