• Summary date: Apr 15 2013 - More information

    Enacts GS 58-3-300 defining habilitative services as those services covered by the North Carolina Health Choice Program as of January 1 of the calendar year proceeding the coverage year. Applies to non-grandfathered health benefit plans, in the individual and small group markets, that are issued or renewed on or after January 1, 2014.

    Prohibits small employer carries from issuing the basic or standard health benefit plan. Provides for the termination of plans that are not grandfathered health plans, on the next anniversary date on or after January 1, 2014, and requires the carrier to offer the employer replacement coverage. Includes additional requirements for plans issued to a self-employed individual. Repeals GS 58-50-110(21a) (defining self employed individual), GS 58-50-126 (alternative coverage permitted), GS 58-50-127 (small employer carrier plan elections), GS 58-50-135 (Elections by carriers), GS 58-50-155 (Standard and basic health care plan coverages), and GS 58-50-156 (Coverage of certain prescribed drugs for cancer treatment). Amends GS 58-50-110(22) removing the distinction that the term "small employer" included self-employed individuals. Amends GS 58-50-115 deleting "self-employed individuals" in subsection (a) and deleting subsection (d) (which required carriers to offer small employers at least one basic and one standard health care plan or alter coverages in GS 58-50-126). Effective January 1, 2015, repeals GS 58-50-125(a) and (b). Amends GS 58-50-130(b) specifying that the small employer health benefit plans that receive the enumerated premium rates are plans that were grandfathered health benefit plans as defined in GS 58-50-305. Amends GS 58-50-130 adding subsection (i) prohibiting a small employer carrier from modifying the premium rate charged to a small group non-grandfathered health benefit plan or small employer group member for 12 months from the initial issue date or renewal date. Effective January 1, 2014.

    Enacts Part 8 of Article 50 in Chapter 58 of the General Statutes establishing uniform standards for health benefit plan rating. Identifies premium ratios that are to be deemed unreasonable in relation to benefits.

    Enacts GS 58-50-53 establishing the State law for utilization review and grievances related to non-grandfathered health benefit plans as the same as provided under the Affordable Care Act.

    Enacts GS 58-50-73 identifying the State law for external review related to non-grandfathered health benefit plans as the same as those provided under the Affordable Care Act.

    Requires the Department of Insurance to monitor the health insurance market for negative impacts of the Patient Protection and Affordable Care Act, and publish quarterly reports on the impacts beginning on October 1, 2013, and continuing until July 1, 2015.

    Also requires the Department of Insurance to re-scope previously awarded Exchange-related grants so as to fund the increased regulatory costs due to the Affordable Care Act. Appropriates funds from those grants that have not otherwise been appropriated to the Department, for fiscal year 2013-14, for allowable expenses under the grants. Effective July 1, 2013.

    Unless otherwise provided, the act is effective when it becomes law.


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