Section 1 titles the act as "The Firefighters Fighting Cancer Act of 2021."

Section 2

Enacts new Article 87A, Firefighter Cancer Health Care Benefit Plan, to GS Chapter 58. Sets forth defined terms. Establishes the NC Firefighter Cancer Health Care Benefit Plan (Plan) to be administered by the Department of Insurance (Department) as a supplemental insurance policy for eligible firefighters with a new diagnosis of cancer, as defined, on or after January 1, 2022. Deems all firefighters that have served in a NC fire department for a minimum of five continuous years eligible for benefits under the Plan. Disqualifies firefighters receiving benefits related to cancer under the Workers' Compensation Act. 

Provides for reimbursement of up to $12,000 annually for any out-of-pocket expenses incurred. Provides for a lump sum payment of up to $25,000 for each diagnosis of cancer upon sufficient proof to the insurance carrier, the Department, or other applicable payor of the diagnosis by a board-certified, licensed physician in the medical specialty appropriate for the type of cancer diagnosed. Caps lifetime benefit at $50,000. Provides for the following monthly benefit amounts upon sufficient proof to the insurance carrier, the Department, or other applicable payor of total disability resulting from the diagnosis of cancer or that the cancer precludes the firefighter from serving as a firefighter, with payments beginning six months after total disability or inability to perform duties: the lesser of 75% of the firefighter's monthly salary or $5,000 for nonvolunteer firefighters; or $1,500 for volunteer firefighters. Establishes five restrictions applicable to disability benefits, including limiting duration to 36 consecutive months and requiring reevaluation as necessary. Ceases disability payments on the date specified upon the treating physician's determination that the firefighter is again able to perform the duties of a firefighter. Provides that if the firefighter returns to work as a firefighter before exhaustion of the 36-months and subsequently is unable to perform the duties of a firefighter due to disability caused by cancer, the firefighter is entitled to the remaining monthly disability benefits not to exceed 36 months in total. Makes the monthly disability benefit subordinate to other benefits for disability related to the cancer diagnosis, excluding private insurance purchased solely by the firefighter. Limits disability benefits under the new Article to the difference between the benefit amount paid by the other source and the monthly benefit amounts specified under the new Article. 

Directs the Department to annually report to the NCGA and the Governor, beginning January 1, 2023. Specifies required content of the reports. 

Effective January 1, 2022.

Section 3

Directs the Department to show proof of insurance coverage that meets the requirements of the act for all firefighters included on the Certified Roster to the NC State Firefighters' Association by January 1, 2022. 

Section 4

Amends GS 105-228.5(d)(3) as follows. Sets the additional tax on gross premiums of insurance contracts for property coverage, as defined by existing law, at 1.125% (was 0.74%), imposed on 10% of the gross premiums from insurance contracts for automobile physical damage coverage and on 100% of the gross premiums from all other contracts for property coverage. Requires 10% (was, 20%) of the net proceeds of the additional tax to be credited to the Volunteer Fire Department Fund; 14% (was, 20%) to the Department of Insurance for disbursement pursuant to GS 58-84-25; up to 14% to be credited to the Firefighters' and Rescue Squad Workers' Pension Fund; 5.5% to be credited to individual fire departments' relief funds to be used in accordance with GS 58-84-35(a)(8) for early cancer detection programs; and 11.75% to be credited to the Department of Insurance to fund the Firefighter Cancer Benefit Plan. No longer provides for up to 20% to be credited to the Workers' Compensation Fund. Maintains that the remaining net proceeds must be credited to the General Fund. 

Adds a new deduction to GS 105-153.5(b), allowing a taxpayer to deduct the amount received by or paid to an eligible firefighter during the taxable year for benefits under the Cancer Benefit Plan established under Article 87A of GS Chapter 58.

Effective July 1, 2021.