reglab/housing_qa huggingface dataset:
NC Gen Stat § 58-53-55 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-55 - Time limit.

 58-53-55. Time limit.In order to be eligible for conversion, written application and the first premium payment for the converted policy must be made to the insurer not later than 31 days after the date of termination of insurance provided under Part 1 of this Article. The effective date of the converted policy shall be the day following the later of:(1) The termination of insurance under the group policy when it is not replaced by one providing similar coverage within 31 days of the termination date of the immediately prior group plan; or(2) The termination of the period of continued coverage under the group policy or policies. (1981, c. 706, s. 1; 1993 (Reg. Sess., 1994), c. 569, s. 10; 1997-259, s. 14.)
NC Gen Stat § 58-53-60 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-60 - Premium.

 58-53-60. Premium.(a) The premium for the converted policy or group conversion trust certificate shall be determined in accordance with the insurer's table of premium rates applicable to the age and class of risk to be covered under that policy and to the type and amount of insurance provided.(b) All insurers licensed to do business in this State, who issue conversion policies or group conversion trust certificates under this Part, have the right to increase that element of the premium that applies to hospital room and board benefit increases provided for in G.S. 58-53-95(5) by an amount proportionate to the increase promulgated by the Commissioner. Such premium increases shall be filed with the Commissioner.(c) All premium rates and adjustments to premium rates for converted policies or group conversion trust certificates shall be reasonable and must be filed with and approved by the Commissioner prior to use. A premium rate shall be deemed to be reasonable if the insurer demonstrates that the premium charged is expected to produce an incurred loss ratio to earned premiums of not less than sixty percent (60%) for all policies or group conversion trust certificates providing similar benefits offered and issued by the insurer. If an insurer experiences an incurred loss ratio of greater than eighty percent (80%) for all such policies, it shall be deemed reasonable for that insurer to increase premium rates to a level that will produce a prospective incurred loss ratio of no greater than eighty percent (80%), and the insurer shall file such new rates with the Commissioner not more often than once a year. (1981, c. 706, s. 1; 1983, c. 669; 1995, c. 517, s. 30.)
NC Gen Stat § 58-53-65 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-65 - Coverage.

 58-53-65. Coverage.The converted policy shall cover the employee or member and his eligible dependents who were covered by the group policy on the date of termination of insurance. At the option of the insurer, a separate converted policy may be issued to cover any such eligible dependent. (1981, c. 706, s. 1.)
NC Gen Stat § 58-53-70 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-70 - Exclusions.

 58-53-70. Exclusions.An insurer shall not be required to issue a converted policy covering any person if such person is or can be covered by Medicare. Furthermore, an insurer shall not be required to issue a converted policy covering any person if:(1) a. Such person is covered for similar benefits by another hospital, surgical, medical or major medical expense insurance policy, or hospital or medical service subscriber contract or medical practice or other prepayment plan, or by any other plan or program;b. Such person is or could be covered for similar benefits, whether or not covered for such benefits, under any arrangement of coverage for individuals in a group, whether insured or uninsured; orc. Similar benefits are provided for or available to such person, whether or not covered for such benefits, by reason of any State or federal law; and(2) The benefits under sources of the kind referred to in subdivision (1)a of this section for such person, or benefits provided or available under sources of the kind referred to in subdivisions (1)b and (1)c of this section for such person, together with the converted policy's benefits would result in overinsurance according to the insurer's standards for overinsurance; or(3) An enrollee's enrollment in a health maintenance organization has been terminated for cause in accord with the terms of the enrollee's evidence of coverage or the health maintenance organization's contract with the group. (1981, c. 706, s. 1; 1991, c. 195, s. 2.)
NC Gen Stat § 58-53-75 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-75 - Information.

 58-53-75. Information.A converted policy may provide that an insurer may at any time request information of an insured policyholder with respect to any person covered thereunder as to whether he is covered for the similar benefits described in G.S. 58-53-70(1)a or is or could be covered for the similar benefits described in G.S. 58-53-70(1)b and 58-53-70(1)c. The converted policy may provide that as of any premium due date an insurer may refuse to renew the policy or the coverage of any insured person for the following reasons only:(1) Either those similar benefits for which such person is or could be covered, together with the converted policy's benefits, would result in overinsurance according to the insurer's standards for overinsurance, or the policyholder of the converted policy fails to provide the requested information;(2) Fraud or material misrepresentation in applying for any benefits under the converted policy;(3) Eligibility of any insured person for coverage under Medicare, or under any other State or federal law providing benefits substantially similar to those provided by the converted policy; or(4) Termination of an enrollee's enrollment in a health maintenance organization for cause in accord with the terms of the enrollee's evidence of coverage or the health maintenance organization's contract with the group. (1981, c. 706, s. 1; 1991, c. 195, s. 3.)
NC Gen Stat § 58-53-80 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-80 - Excess benefits.

 58-53-80. Excess benefits.An insurer shall not be required to issue a converted policy providing benefits in excess of the equivalent value of hospital, surgical, or major medical insurance under the group policy from which conversion is made. (1981, c. 706, s. 1.)
NC Gen Stat § 58-53-85 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-85 - Preexisting conditions.

 58-53-85. Preexisting conditions.The converted policy shall not exclude, as a preexisting condition, any condition covered by the group policy. However, the converted policy may provide for a reduction of its hospital, surgical or medical benefits by the amount of any such benefits payable under the group policy after the individual's insurance terminates thereunder. The converted policy may also provide that during the first policy year the benefits payable under the converted policy, together with the benefits payable under the group policy, shall not exceed those that would have been payable had the individual's insurance under the group policy remained in force and effect. (1981, c. 706, s. 1.)
NC Gen Stat § 58-53-90 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-90 - Basic coverage plans.

 58-53-90. Basic coverage plans.(a) Subject to the provisions of this Article, if the group insurance policy from which conversion is made insures the employee or member for basic hospital and surgical expense insurance, the employee or member shall be entitled to obtain a converted policy providing, at his option, coverage on an expense incurred basis under any of the following plans:(1) Plan A:a. Hospital room and board daily expense benefits in a maximum dollar amount approximating the average semiprivate rate charged in the major metropolitan area of this State, for a maximum duration of 70 days;b. Miscellaneous hospital expense benefits up to a maximum amount of 10 times the hospital room and board daily expense benefits; andc. Surgical expense benefits according to a surgical procedures schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of eight hundred dollars ($800.00).(2) Plan B: Identical to Plan A, except that (i) the maximum hospital room and board daily expense benefit is seventy-five percent (75%) of the corresponding Plan A maximum and (ii) the surgical schedule maximum is six hundred dollars ($600.00).(3) Plan C: Identical to Plan A, except that (i) the maximum hospital room and board daily expense benefit is fifty percent (50%) of the corresponding Plan A maximum and (ii) the surgical schedule maximum is four hundred dollars ($400.00).(b) The maximum dollar amount for the maximum hospital room and board daily expense benefit of Plan A shall be determined by the Commissioner and may be redetermined by him from time to time as to converted policies issued subsequent to such redetermination. Such redetermination shall not be made more often than once in three years. The Plan A maximum, and the corresponding maximums in Plans B and C, shall be rounded to the nearest multiple ten dollars ($10.00), provided that rounding may be to the next higher or lower multiple of ten dollars ($10.00) if otherwise exactly midway between. (1981, c. 706, s. 1.)
NC Gen Stat § 58-53-100 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-100 - Alternative plans.

 58-53-100. Alternative plans.At the option of the insurer, such plans of benefits set forth in G.S. 58-53-90 and 58-53-95 may be provided under one policy. Instead of providing the plans of benefits set forth in G.S. 58-53-90 and 58-53-95, the insurer may elect to provide a policy of comprehensive medical expense benefits without first dollar coverage. Said policy shall conform to the requirements of G.S. 58-53-95; provided, however, that an insurer electing to provide such a policy shall make available the following deductible options: one hundred dollars ($100.00), five hundred dollars ($500.00), and one thousand dollars ($1,000). Alternatively, such a policy may provide for deductible options equal to the greater of the benefits deductible and the amount specified in the preceding sentence. (1981, c. 706, s. 1.)
NC Gen Stat § 58-53-105 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-105 - Insurer option.

 58-53-105. Insurer option.The insurer may, at its option, offer alternative plans for group health conversion in addition to those required by this Part. Furthermore, if any insurer customarily offers individual policies on a service basis, that insurer may, in lieu of converted policies on an expense incurred basis, make available converted policies on a service basis which, in the opinion of the Commissioner satisfy the intent of this Part. (1981, c. 706, s. 1.)
NC Gen Stat § 58-53-110 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-110 - Other conversion provisions.

 58-53-110. Other conversion provisions.(a) If coverage would in any event have been continued under the group policy on an employee following his retirement prior to the time he is or could be covered by Medicare and provided he would have been eligible for continuation under the group policy as specified in G.S. 58-53-10, the employee or member may elect, in lieu of such continuation of group insurance, to have the same conversion rights as would apply had that insurance terminated at retirement.(b) The converted policy may provide for reduction or termination of coverage of any person upon his eligibility for coverage under Medicare or under any other State or federal law providing for benefits similar to those provided by the converted policy.(c) Subject to the conditions set forth in this subsection, the conversion privilege shall also be available (i) to the surviving spouse, if any, at the death of the employee or member, with respect to the spouse and any eligible children whose coverage under the group policy terminates by reason of such death, or if the group policy provides for continuation of dependents' coverage following the employee's or member's death, at the end of such continuation, or (ii) to the spouse of the employee or member upon termination of coverage of the spouse because the spouse becomes ineligible because of divorce, separation, or otherwise, while the employee or member remains insured under the group policy, with respect to the spouse and such children whose coverage under the group policy terminates at the same time, or (iii) to a child solely with respect to himself upon termination of his coverage by reason of ceasing to be an eligible family member under the group policy, if a conversion privilege is not otherwise provided above with respect to such termination.(d) The insurer may elect to provide group insurance coverage in lieu of the issuance of a converted individual policy, notwithstanding the maximum period of group continuation specified in G.S. 58-53-35(1).(e) A notification of the conversion privilege shall be included in each certificate of coverage.(f) A converted policy which is delivered outside this State may be on a form which could be delivered in such other jurisdiction as a converted policy had the group policy been issued in that jurisdiction. (1981, c. 706, s. 1; 1983, c. 668, s. 1.)
NC Gen Stat § 58-53-115 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 53 - Group Health Insurance Continuation and Conversion Privileges.|§ 58-53-115 - Article inapplicable to certain plans.

 58-53-115. Article inapplicable to certain plans.The provisions of this article shall not apply to hospital, surgical or major medical plans offered by employers on a self-insured basis. (1981, c. 706, s. 2.)
NC Gen Stat § 58-54-1 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 54 - Medicare Supplement Insurance Minimum Standards.|§ 58-54-1 - Definitions.

 58-54-1. Definitions.Unless the context clearly indicates otherwise, the following words, as used in this Article, have the following meanings:(1) "Applicant" means (i) in the case of an individual Medicare supplement policy or subscriber contract, the person who seeks to contract for insurance benefits; and (ii) in the case of a group Medicare supplement policy or subscriber contract, the proposed certificate holder.(2) "Certificate" means any certificate issued under a group Medicare supplement policy, which certificate has been delivered or issued for delivery in this State.(3) "Insurer" includes entities subject to Articles 65 through 67 of this Chapter.(4) "Medicare" means the "Health Insurance for the Aged Act", Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.(5) "Policy" means a Medicare supplement policy, which is a group or individual policy of accident and health insurance under Articles 1 through 64 of this Chapter, a subscriber contract under Articles 65 and 66 of this Chapter, or an evidence of coverage under Article 67 of this Chapter, other than a policy issued pursuant to a contract under section 1876 or section 1833 of the federal Social Security Act (42 U.S.C. 1395 et seq.), or an issued policy under a demonstration project authorized pursuant to amendments to the federal Social Security Act, that is advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical, or surgical expenses of persons eligible for Medicare. (1989, c. 729, s. 1; 1991 (Reg. Sess., 1992), c. 815, s. 1; 1993, c. 553, s. 19.)
NC Gen Stat § 58-54-5 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 54 - Medicare Supplement Insurance Minimum Standards.|§ 58-54-5 - Applicability and scope.

 58-54-5. Applicability and scope.(a) Except as otherwise specifically provided, this Article applies to:(1) All policies delivered or issued for delivery in this State on or after August 7, 1989; and(2) All certificates issued under group policies that have been delivered or issued for delivery in this State on or after August 7, 1989.(b) This Article does not apply to an insurance contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees or former employees or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations.(c) This Article does not prohibit or apply to insurance contracts or health care benefit plans, including group conversion policies, that are provided to Medicare eligible persons and that are not marketed or held out to be Medicare supplement policies or benefit plans. (1989, c. 729, s. 1.)
NC Gen Stat § 58-54-10 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 54 - Medicare Supplement Insurance Minimum Standards.|§ 58-54-10 - Standards for policy provisions.

 58-54-10. Standards for policy provisions.  (a) No policy in force in this State shall contain benefits that duplicate benefits provided by Medicare.  (b) The Commissioner shall adopt rules to establish specific standards for provisions of policies. Such standards shall be in addition to and in accordance with applicable State law. No requirement of State law relating to minimum required policy benefits, other than the minimum standards contained in this Article, applies to policies. The standards may include without limitation to: terms of renewability; initial and subsequent conditions of eligibility; nonduplication of coverage; probationary periods; benefit limitations, exceptions, and reductions; elimination periods; requirements for replacement; recurrent conditions; and definitions of terms.(c) The Commissioner may adopt rules that specify prohibited policy provisions not otherwise specifically authorized by State law that, in the opinion of the Commissioner, are unjust, unfair, or unfairly discriminatory to any person insured or proposed for coverage under a policy.(d) Notwithstanding any other provision of State law, a policy may not deny a claim for losses incurred more than six months from the effective date of coverage for a preexisting condition. A policy may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.(e) Repealed by Session Laws 1991 (Regular Session, 1992), c. 815, s. 3. (1989, c. 729, s. 1; 1991, c. 490, s. 6; 1991 (Reg. Sess., 1992), c. 815, s. 3.)
NC Gen Stat § 58-54-15 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 54 - Medicare Supplement Insurance Minimum Standards.|§ 58-54-15 - Minimum standards for benefits, marketing practices, compensation arrangements, reporting practices, and claims payments.

 58-54-15. Minimum standards for benefits, marketing practices, compensation arrangements, reporting practices, and claims payments.The Commissioner shall adopt rules to establish minimum standards for benefits, marketing practices, compensation arrangements, reporting practices, and claims payments under policies. (1989, c. 729, s. 1; 1989 (Reg. Sess., 1990), c. 941, s. 8; 1993, c. 504, s. 38.)
NC Gen Stat § 58-54-20 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 54 - Medicare Supplement Insurance Minimum Standards.|§ 58-54-20 - Loss ratio standards and filing requirements.

 58-54-20. Loss ratio standards and filing requirements.(a) Every insurer providing group Medicare supplement insurance benefits to a resident of this State pursuant to G.S. 58-54-5 shall file a copy of the master policy and any certificate used in this State in accordance with the filing requirements and procedures applicable to group policies issued in this State.(b) Policies shall return to policyholders benefits that are reasonable in relation to the premium charged. The Commissioner shall adopt rules to establish minimum standards for loss ratios of policies on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices. Every insurer providing policies or certificates in this State shall annually file its rates, rating schedules, and supporting documentation to demonstrate that it is in compliance with the applicable loss ratio standards of this State. All filings of rates and rating schedules shall demonstrate that the actual and expected losses in relation to premiums comply with the requirements of this Article.(c) No insurer shall provide compensation to its agents or other producers that is greater than the renewal compensation that would have been paid on an existing policy if the existing policy is replaced by another policy with the same insurer where the new policy benefits are substantially similar to the benefits under the old policy and the old policy was issued by the same insurer or insurer group. (1989, c. 729, s. 1; 1991 (Reg. Sess., 1992), c. 815, s. 4.)
NC Gen Stat § 58-54-30 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 54 - Medicare Supplement Insurance Minimum Standards.|§ 58-54-30 - Notice of free examination.

 58-54-30. Notice of free examination.Policies or certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereon stating in substance that the applicant has the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Any refund made pursuant to this section shall be paid directly to the applicant by the insurer in a timely manner. (1989, c. 729, s. 1.)
NC Gen Stat § 58-54-35 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 54 - Medicare Supplement Insurance Minimum Standards.|§ 58-54-35 - Filing requirements for advertising.

 58-54-35. Filing requirements for advertising.Every insurer providing Medicare supplement insurance or benefits in this State shall provide a copy of any Medicare supplement advertisement intended for use in this State whether through written, radio, or television medium to the Commissioner for review or approval by the Commissioner. (1989, c. 729, s. 1.)
NC Gen Stat § 58-54-40 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 54 - Medicare Supplement Insurance Minimum Standards.|§ 58-54-40 - Penalties.

 58-54-40. Penalties.In addition to any other applicable penalties for violations of Articles 1 through 64 or 65 and 66 or 67 of this Chapter, the Commissioner may require any person that has violated or is violating any provision of this Article or any rule adopted under this Article to either (i) cease marketing any policy or certificate in this State that is related directly or indirectly to a violation or (ii) take such actions as are necessary to comply with this Article or such rules. (1989, c. 729, s. 1.)