AN ACT TO MAKE TECHNICAL AND CLARIFYING CHANGES TO THE INSURANCE LAWS, AS RECOMMENDED BY THE DEPARTMENT OF INSURANCE.
Senate committee substitute to the 2nd edition makes the following changes.
Deletes Part XII, which amended GS 58-57-90 to require each writer of credit property insurance written in the State to submit the specified information to the Department of Insurance for each of the last five calendar years by April 1 of each year, and require the Department to publish the information in an aggregate form on its website by July 1 of each year.
Reinstates the following as it appeared in the 1st edition (previously removed in the 2nd edition).
Amends GS 58-50-56 by removing the provision allowing a person enrolled in a preferred provider benefit plan to obtain covered health care services from a provider who does not participate in the plan. Makes the preferred provider benefit plan coverage limitations subject to GS 58-3-190 (coverage required for emergency care).
Enacts new GS 58-50-56.1 providing that if (1) a contract between an insurer and a health care provider offering an exclusive provider benefit plan is terminated by the provider or by the insurer, or benefits or coverage provided by the insurer are terminated because of a change in the terms of provider participation in an insurer's exclusive provider benefit plan and (2) an insured is undergoing treatment from the provider for an ongoing special condition on the date of termination, then: (1) upon termination of the contract by the insurer or receipt by the insurer of written notification of termination by the provider, the insurer must notify the insured of the termination and of the right to continuation of coverage of treatment by the provider and (2) the insurer must allow an insured to elect to continue to be covered with respect to the treatment by the terminated provider for the ongoing special condition during a transitional period. Sets out transitional periods in general, for scheduled surgery, organ transplantation, or inpatient care; for pregnancy; and for terminal illness.
Requires each exclusive provider benefit plan offered by an insurer to provide transition coverage to individuals who (1) are newly covered under an exclusive provider benefit plan because the individual's employer has changed benefit plans and (2) are undergoing treatment from a provider for an ongoing special condition.
Allows an insurer to condition coverage of continued treatment on six specified terms and conditions. Requires insurers to include a description of an insured’s rights in its evidence of coverage and summary plan description.
Allows the Department of Insurance to adopt temporary rules to implement the statute.
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