Amends GS 58-50-180(e)(4a) (powers and authority of the Health Insurance Risk Pool) to add that the Health Insurance Risk Pool (Pool) may provide premium subsidies from (1) federal grants made to the Pool, and (2) the Pool’s own funds, not to exceed the amount of the most recent year that the Pool received a federal grant award, as specified. Current law allows the Pool to provide premium subsidies if federal grant funds are available for individuals with incomes up to 300% of the federal poverty guidelines, and if the Pool Board of Directors (Board) deems it is fiscally prudent to do so. Proposed amendments would delete the federal grant funds requirement and would allow the Pool to provide premium subsidies for individuals with incomes up to 300% of the federal poverty guidelines where the Board deems it is fiscally prudent.
Amends GS 55-50-190(b) (Risk Pool risk rates) to provide that the Pool rates will be 125% to 175% (currently, 150% to 200%) of rates established as applicable for individual standard rates and will be adjusted annually.
Enacts new GS 58-50-195(a)(8) to add that any individual who is and continues to be a resident of North Carolina is eligible for Poolcoverage if the individual is eligible for and has not exhausted current COBRA health insurance coverage at a rate exceeding the Pool rate and provides evidence of eligibility for Pool coverage under any of the subdivisions (1) through (4) of GS 58-50-195(a).
Amends GS 58-50-210(a) to direct Pool coverage to exclude charges or expenses incurred during the first six months (currently, 12 months) following the effective date of coverage, for any condition for which medical advice, care, or treatment was recommended or received during the 12-month period immediately preceding the effective date of coverage, except as specified.
Effective October 1, 2011.