TO REQUIRE THE STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES TO REFUND PREMIUMS PAID WHEN THE PLAN DID NOT ACTUALLY PROVIDE COVERAGE.
Enacts new GS 135-45.12A providing that the cited health plan must (except in cases of fraud) refund premiums paid for months during which a subscriber or dependent was in fact not covered because the individual was ineligible. The plan may deduct any claims paid on behalf of the ineligible person and reasonable administrative costs related to the subscriber’s failure to notify the plan of a coverage category change in a timely manner. Provides that subscriber may, regardless of the refund, still owe the plan reimbursement for claims paid during the period of ineligibility. Effective July 1, 2008.
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