reglab/housing_qa huggingface dataset:
NC Gen Stat § 58-66-30 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 66 - Hospital, Medical and Dental Service Corporation Readable Insurance Certificates Act.|§ 58-66-30 - Filing requirements; duties of the Commissioner.

 58-66-30. Filing requirements; duties of the Commissioner.(a) No insurer may make, issue, amend or renew any certificate or contract after the dates specified in G.S. 58-66-35 for the applicable type of insurance unless the certificate is in compliance with the provisions of G.S. 58-66-20 and 58-66-25, and unless the certificate is filed with the Commissioner for this approval. The policy will be deemed approved 90 days after filing unless disapproved within the 90-day period. The Commissioner may not unreasonably withhold this approval. Any disapproval must be delivered to the insurer in writing and must state the grounds for disapproval. Any certificate filed with the Commissioner must be accompanied by a certified Flesch scale readability analysis and test score and by the insurer's certification that the policy is, in the insurer's judgment, readable based on the factors specified in G.S. 58-66-20 and 58-66-25.(b) The Commissioner must disapprove any certificate covered by subsection (a) of this section if he finds that:(1) It is not accompanied by a certified Flesch scale analysis readability score of 50 or more;(2) It is not accompanied by the insurer's certification that the certificate is, in the judgment of the insurer, readable under the standards of this Article; or(3) It does not comply with the format requirements of G.S. 58-66-20. (1979, 2nd Sess., c. 1161, s. 1; 1995, c. 193, s. 57.)
NC Gen Stat § 58-66-35 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 66 - Hospital, Medical and Dental Service Corporation Readable Insurance Certificates Act.|§ 58-66-35 - Application to policies; dates.

 58-66-35. Application to policies; dates.(a) The filing requirements of G.S. 58-66-30 apply to all subscribers' contracts of hospital, medical, and dental service corporations as described in G.S. 58-65-60(a) and (b) that are made, issued, amended or renewed after July 1, 1983.(b) Repealed by Session Laws 1995, c. 193, s. 58, effective June 7, 1995. (1979, 2nd Sess., c. 1161, s. 1; 1995, c. 193, s. 58; 1995 (Reg. Sess., 1996), c. 742, s. 28.)
NC Gen Stat § 58-66-40 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 66 - Hospital, Medical and Dental Service Corporation Readable Insurance Certificates Act.|§ 58-66-40 - Construction.

 58-66-40. Construction.(a) The provisions of this Article will not operate to relieve any insurer from any provision of law regulating the contents or provisions of insurance certificates or contracts nor operate to reduce an insured's, beneficiary's or subscriber's rights or protection granted under any statute or provision of the law.(b) The provisions of this Article shall not be construed to mandate, require, or allow alteration of the legal effect of any provision of any insurance certificate or contract.(c) In any action brought by a subscriber or claimant arising out of a certificate approved pursuant to this Article, the subscriber or claimant may base such an action on either or both (i) the substantive language prescribed by such other statute or provision of law, or (ii) the wording of the approved certificate. (1979, 2nd Sess., c. 1161, s. 1.)
NC Gen Stat § 58-67-1 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-1 - Short title.

 58-67-1. Short title.This Article may be cited as the Health Maintenance Organization Act of 1979. (1977, c. 580, s. 1; 1979, c. 876, s. 1.)
NC Gen Stat § 58-67-11 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-11 - Additional HMO application information.

 58-67-11. Additional HMO application information.(a) In addition to the information filed under G.S. 58-67-10(c), each application shall include a description of the following:(1) The program to be used to evaluate whether the applicant's provider network is sufficient, in numbers and types of providers, to assure that all health care services will be accessible without unreasonable delay.(2) The program to be used for verifying provider credentials.(3) The quality management program to assure quality of care and health care services managed and provided through the health care plan.(4) The utilization review program for the review and control of health care services provided or paid for.(5) The applicant's provider network and evidence of the ability of that network to provide all health care services to the applicant's prospective enrollees.(b) G.S. 58-67-10(d) applies to the information specified in this section. (1997-519, s. 1.2.)
NC Gen Stat § 58-67-12 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-12 - Commissioner use of consultants and other professionals.

 58-67-12. Commissioner use of consultants and other professionals.(a) The Commissioner may contract with consultants and other professionals to expedite and complete the application process, examinations, and other regulatory activities required under this Article. Costs of contracts entered into under this section shall be reimbursed by the applicant or licensee.(b) Contracts under this section for financial, legal, examination, and other services shall not be subject to any of the following:(1) G.S. 114-2.3.(2) G.S. 147-17.(3) Articles 3, 3C, and 8 of Chapter 143 of the General Statutes and any rules and procedures adopted under those Articles concerning procurement, contracting, and contract review.  (2018-49, s. 2(c).)
NC Gen Stat § 58-67-15 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-15 - Health maintenance organization of bordering states may be admitted to do business; reciprocity.

 58-67-15. Health maintenance organization of bordering states may be admitted to do business; reciprocity.A federally qualified health maintenance organization approved and regulated under the laws of a state bordering this State may be admitted to do business in this State by satisfying the Commissioner that it is fully and legally organized under the laws of that state, and that it complies with all requirements for health maintenance organizations organized within this State; provided that the bordering state has a law or regulation substantially similar to this section. (1985, c. 666, s. 69.)
NC Gen Stat § 58-67-20 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-20 - Issuance and continuation of license.

 58-67-20. Issuance and continuation of license.(a) Before issuing or continuing any such license, the Commissioner of Insurance may make such an examination or investigation as he deems expedient. The Commissioner of Insurance shall issue a license upon the payment of the application fee prescribed in G.S. 58-67-160 and upon being satisfied on the following points:(1) The applicant is established as a bona fide health maintenance organization as defined by this Article;(2) The rates charged and benefits to be provided are fair and reasonable;(3) The amounts provided as working capital are repayable only out of earned income in excess of amounts paid and payable for operating expenses and expenses of providing services and such reserve as the Department of Insurance deems adequate, as provided hereinafter;(4) That the amount of money actually available for working capital be sufficient to carry all acquisition costs and operating expenses for a reasonable period of time from the date of the issuance of the license and that the health maintenance organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees. Such working capital shall initially be a minimum of one million five hundred thousand dollars ($1,500,000) for any full service medical health maintenance organization. Initial working capital for a single service health maintenance organization shall be a minimum of one hundred thousand dollars ($100,000) or such higher amount as the Commissioner shall determine to be adequate.(b) In making the determinations required under this section, the Commissioner shall consider:(1) The financial soundness of the health care plan's arrangements for health care services and the schedule of premiums used in connection therewith;(2) The adequacy of working capital;(3) Any agreement with an insurer, a hospital or medical service corporation, a government, or any other organization for insuring the payment of the cost of health care services or the provision for automatic applicability of alternative coverage in the event of discontinuance of the plan;(4) Any agreement with providers for the provision of health care services; and(5) Any firm commitment of federal funds to the health maintenance organization in the form of a grant, even though such funds have not been paid to the health maintenance organization, provided that the health maintenance organization certifies to the Commissioner that such funds have been committed, that such funds are to be paid to the health maintenance organization with a current fiscal year and that such funds may be used directly for operating purposes and for the benefit of enrollees of the health maintenance organization.(c) A license shall be denied only after compliance with the requirements of G.S. 58-67-155. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1983, c. 386, s. 2; 1987, c. 631, ss. 2, 4, 8; 1987 (Reg. Sess., 1988), c. 975, s. 1; 2003-212, s. 26(n).)
NC Gen Stat § 58-67-25 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-25 - Deposits.

 58-67-25. Deposits.(a) The Commissioner shall require a minimum deposit of five hundred thousand dollars ($500,000) for all full service medical health maintenance organizations or such higher amount as he deems necessary for the protection of enrollees.(b) The Commissioner shall require a minimum deposit of twenty-five thousand dollars ($25,000) for all single service health maintenance organizations or such higher amount as he deems necessary for the protection of enrollees.(c) All deposits required by this section shall be administered in accordance with the provisions of Article 5 of this Chapter. (1987, c. 631, s. 3; 2005-215, s. 18.)
NC Gen Stat § 58-67-30 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-30 - Management and exclusive agreements; custodial agreements.

 58-67-30. Management and exclusive agreements; custodial agreements.(a) No health maintenance organization shall enter into an exclusive agency, management, or custodial agreement unless the agreement is first filed with the Commissioner and approved under this section within 45 days after filing or such reasonable extended period as the Commissioner shall specify by notice that is given within the 45 day period.(b) The Commissioner shall disapprove an agreement submitted under subsection (a) of this section if the Commissioner determines that the agreement:(1) Subjects the health maintenance organization to excessive charges;(2) Extends for an unreasonable period of time;(3) Does not contain fair and adequate standards of performance;(4) Enables persons under the contract to manage the health maintenance organization who are not sufficiently trustworthy, competent, experienced, and free from conflict of interest to manage the health maintenance organization with due regard for the interests of its enrollees, creditors, or the public; or(5) Contains provisions that impair the interests of the organization's enrollees, creditors, or the public. (1987, c. 631, s. 10; 2001-223, s. 20.5.)
NC Gen Stat § 58-67-45 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-45 - Fiduciary responsibilities.

 58-67-45. Fiduciary responsibilities.Any director, officer or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of such organization shall be responsible for such funds in a fiduciary relationship to the enrollees. (1977, c. 580, s. 1; 1979, c. 876, s. 1.)
NC Gen Stat § 58-67-55 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-55 - Statements filed with Commissioner.

 58-67-55. Statements filed with Commissioner.Every HMO subject to this Article is subject to G.S. 58-2-165. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1999-244, s. 12.)
NC Gen Stat § 58-67-60 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-60 - Investments.

 58-67-60. Investments.With the exception of investments made in accordance with G.S. 58-67-35(a)(1) and (2) and G.S. 58-67-35(b), the funds of a health maintenance organization shall be invested or maintained only in securities, other investments, or other assets permitted by the laws of this State for the investment of assets constituting the legal reserves of life insurance companies or such other securities or investments as the Commissioner may permit. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 2001-223, s. 8.18.)
NC Gen Stat § 58-67-65 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-65 - Prohibited practices.

 58-67-65. Prohibited practices.(a) No health maintenance organization, or representative thereof, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. For purposes of this Article:(1) A statement or item of information shall be deemed to be untrue if it does not conform to fact in any respect which is or may be significant to an enrollee of, or person considering enrollment in, a health care plan.(2) A statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue, if, in the total context in which such statement is made or such item of information is communicated, such statement or item of information may be reasonably understood by a reasonable person, not possessing special knowledge regarding health care coverage, as indicating any benefit or advantage or the absence of any exclusion, limitation, or disadvantage of possible significance to an enrollee of, or person considering enrollment in a health care plan, if such benefit or advantage or absence of limitation, exclusion or disadvantage does not in fact exist.(3) An evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography and format, as well as language, shall be such as to cause a reasonable person, not possessing special knowledge regarding health care plans and evidences of coverage therefor, to expect benefits, services, premiums, or other advantages which the evidence of coverage does not provide or which the health care plan issuing such evidence of coverage does not regularly make available for enrollees covered under such evidence of coverage.(b) Article 63 of this Chapter applies to health maintenance organizations and their agents and representatives.(c) An enrollee may not be cancelled or not renewed because of any deterioration in the health of the enrollee.(d) No health maintenance organization, unless licensed as an insurer, may use in its name, contracts, or literature any of the words "insurance", "casualty", "surety", "mutual", or any other words descriptive of the insurance, casualty, or surety business or deceptively similar to the name or description of any insurance or surety corporation doing business in this State.(e) The HMO shall not refuse to enroll employees except when they can demonstrate they are unable to arrange adequate services.(f) No health maintenance organization shall refuse to enroll an individual or refuse to continue enrollment of an individual in a health care plan; limit the amount, extent, or kinds of health care plans available to an individual; or charge an individual a different rate for the same health plan, because of the race, color, or national or ethnic origin of that individual. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1989, c. 485, s. 24; 1999-244, s. 14.)
NC Gen Stat § 58-67-66 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-66 - Collaboration with local health departments.

 58-67-66. Collaboration with local health departments.A health maintenance organization and a local health department shall collaborate and cooperate within available resources regarding health promotion and disease prevention efforts that are necessary to protect the public health. (1997-474, s. 4.)
NC Gen Stat § 58-67-74 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-74 - Coverage for certain treatment of diabetes.

 58-67-74. Coverage for certain treatment of diabetes.(a) Every health care plan written by a health maintenance organization and in force, issued, renewed, or amended on or after October 1, 1997, that is subject to this Article, shall provide coverage for medically appropriate and necessary services, including diabetes outpatient self-management training and educational services, and equipment, supplies, medications, and laboratory procedures used to treat diabetes. Diabetes outpatient self-management training and educational services shall be provided by a physician or a health care professional designated by the physician. The health maintenance organization shall determine who shall provide and be reimbursed for the diabetes outpatient self-management training and educational services. The same deductibles, coinsurance, and other limitations as apply to similar services covered under the policy, contract, or plan shall apply to the diabetes coverage required under this section.(b) For the purposes of this section, "physician" is a person licensed to practice in this State under Article 1 or Article 7 of Chapter 90 of the General Statutes. (1997-225, s. 3.)
NC Gen Stat § 58-67-75 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-75 - No discrimination against mentally ill or chemically dependent individuals.

 58-67-75. No discrimination against mentally ill or chemically dependent individuals.(a) Definitions. - As used in this section, the term:(1) "Mental illness" has the same meaning as defined in G.S. 122C-3(21), with a mental disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, or subsequent editions published by the American Psychiatric Association, except those mental disorders coded in the DSM-5 or subsequent editions as autism spectrum disorder (299.00), substance-related disorders (291.0 through 292.9 and 303.0 through 305.9), those coded as sexual dysfunctions not due to organic disease (302.70 through 302.79), and those coded as "V" codes.(2) "Chemical dependency" has the same meaning as defined in G.S. 58-67-70, with a mental disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5 or subsequent editions published by the American Psychiatric Association.(b) Coverage of Physical Illness. - No health maintenance organization governed by this Chapter shall, solely because an individual has or had a mental illness or chemical dependency:(1) Refuse to enroll that individual in any health care plan covering physical illness or injury;(2) Have a higher premium rate or charge for physical illness or injury coverages or benefits for that individual; or(3) Reduce physical illness or injury coverages or benefits for that individual.(b1) [Expired October 1, 2001.](c) Chemical Dependency Coverage Not Required. - Nothing in this section requires an HMO to offer coverage for chemical dependency, except as provided in G.S. 58-67-70.(d) Applicability. - This section applies only to group contracts, other than excepted benefits as defined in G.S. 58-68-25. For purposes of this section, "group health insurance contracts" include MEWAs, as defined in G.S. 58-50A-1.(e) Nothing in this section requires an insurer to cover treatment or studies leading to or in connection with sex changes or modifications and related care.  (1989, c. 369, s. 2; 1991, c. 720, s. 83; 1997-259, s. 23; 1999-132, s. 4.4; 2007-268, s. 4; 2015-271, s. 4; 2019-202, s. 8; 2020-69, s. 3(h).)
NC Gen Stat § 58-67-77 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-77 - Coverage for prostate-specific antigen (PSA) tests.

 58-67-77. Coverage for prostate-specific antigen (PSA) tests.(a) Every health care plan written by a health maintenance organization and in force, issued, renewed, or amended on or after January 1, 1994, that is subject to this Article, shall provide coverage for prostate-specific antigen (PSA) tests or equivalent tests for the presence of prostate cancer. The same deductibles, coinsurance, and other limitations as apply to similar services covered under the plan shall apply to coverage for prostate-specific antigen (PSA) tests or equivalent tests for the presence of prostate cancer.(b) As used in this section, "prostate-specific antigen (PSA) tests or equivalent tests for the presence of prostate cancer" means serological tests for determining the presence of prostate cytoplasmic protein (PSA) and the generation of antibodies to it, as a novel marker for prostatic disease.(c) Coverage for prostate-specific antigen (PSA) tests or equivalent tests for the presence of prostate cancer shall be provided when recommended by a physician. (1993, c. 269, s. 3.)
NC Gen Stat § 58-67-78 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 67 - Health Maintenance Organization Act.|§ 58-67-78 - Coverage of certain prescribed drugs for cancer treatment.

 58-67-78. Coverage of certain prescribed drugs for cancer treatment.(a) No health care plan written by a health maintenance organization and in force, issued, renewed, or amended on or after January 1, 1994, and that provides coverage for prescribed drugs approved by the federal Food and Drug Administration for the treatment of certain types of cancer shall exclude coverage of any drug on the basis that the drug has been prescribed for the treatment of a type of cancer for which the drug has not been approved by the federal Food and Drug Administration. The drug, however, must be approved by the federal Food and Drug Administration and must have been proven effective and accepted for the treatment of the specific type of cancer for which the drug has been prescribed in any one of the following established reference compendia:(1) The National Comprehensive Cancer Network Drugs & Biologics Compendium;(2) The ThomsonMicromedex DrugDex;(3) The Elsevier Gold Standard's Clinical Pharmacology; or(4) Any other authoritative compendia as recognized periodically by the United States Secretary of Health and Human Services.(b) Notwithstanding subsection (a) of this section, coverage shall not be required for any experimental or investigational drugs or any drug that the federal Food and Drug Administration has determined to be contraindicated for treatment of the specific type of cancer for which the drug has been prescribed.(c) This section shall apply only to cancer drugs and nothing in this section shall be construed, expressly or by implication, to create, impair, alter, limit, notify, enlarge, abrogate, or prohibit reimbursement for drugs used in the treatment of any other disease or condition.  (1993, c. 506, s. 4.3; 2009-170, s. 3.)