reglab/housing_qa huggingface dataset:
NC Gen Stat § 58-50-149 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50 - General Accident and Health Insurance Regulations.|§ 58-50-149 - Limit on cessions to the Reinsurance Pool.

 58-50-149. Limit on cessions to the Reinsurance Pool.In addition to any individual or group previously reinsured in accordance with G.S. 58-50-150(g)(1), the Pool shall only reinsure a health benefit plan issued or delivered for original issue by a reinsuring carrier on or after October 1, 1995, if the health benefit plan provides coverage to a small employer with no more than 25 eligible employees, including self-employed individuals. Notwithstanding any other provision of law, the Pool shall cease to reinsure any individual or group on January 1, 2007. Reinsuring carriers as of that date shall continue to be governed by G.S. 58-50-135(b) and G.S. 58-50-150 until and through the termination of the Pool. (1995, c. 517, s. 29; 2006-154, s. 8.)
NC Gen Stat § 58-50-151 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50 - General Accident and Health Insurance Regulations.|§ 58-50-151 - (Recodified as § 58-51-116 effective July 1, 2002) ERISA plans may not require Medicaid to pay first.

 58-50-151. (Recodified as 58-51-116 effective July 1, 2002) ERISA plans may not require Medicaid to pay first.An employee benefit plan as defined in ERISA shall not include any provision which, because an individual is provided or is eligible for benefits or service pursuant to a State plan under Title XIX of the Social Security Act (Medicaid), has the effect of limiting or excluding coverage or payment for any health care for that individual under the terms of the employee benefit plan, provided that the individual is one who would otherwise be covered or entitled to benefits or services under the employee benefit plan. (1993, c. 321, s. 238.1.)
NC Gen Stat § 58-50-270 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50 - General Accident and Health Insurance Regulations.|§ 58-50-270 - Definitions.

 58-50-270. Definitions.Unless the context clearly requires otherwise, the following definitions apply in this Part.(1) "Amendment" - Any change to the terms of a contract, including terms incorporated by reference, that modifies fee schedules. A change required by federal or State law, rule, regulation, administrative hearing, or court order is not an amendment.(2) "Contract" - An agreement between an insurer and a health care provider for the provision of health care services by the provider on a preferred or in-network basis.(3) "Health benefit plan" - A policy, certificate, contract, or plan as defined in G.S. 58-3-167.(3a) "Health care provider" - An individual who is licensed, certified, or otherwise authorized under Chapter 90 or Chapter 90B of the General Statutes or under the laws of another state to provide health care services in the ordinary course of business or practice of a profession or in an approved education or training program and a facility that is licensed under Chapter 131E or Chapter 122C of the General Statutes or is owned or operated by the State of North Carolina in which health care services are provided to patients.(4) "Insurer" - An entity as defined in G.S. 58-3-227(a)(4).  (2009-352, s. 1; 2009-487, s. 2(a).)
NC Gen Stat § 58-50-275 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50 - General Accident and Health Insurance Regulations.|§ 58-50-275 - Notice contact provisions.

 58-50-275. Notice contact provisions.(a) All contracts shall contain a "notice contact" provision listing the name or title and address of the person to whom all correspondence, including proposed amendments and other notices, pertaining to the contractual relationship between parties shall be provided. Each party to a contract shall designate its notice contact under such contract.(b) Means for sending all notices provided under a contract shall be one or more of the following, calculated as (i) five business days following the date the notice is placed, first-class postage prepaid, in the United States mail; (ii) on the day the notice is hand delivered; (iii) for certified or registered mail, the date on the return receipt; or (iv) for commercial courier service, the date of delivery. Nothing in this section prohibits the use of an electronic medium for a communication other than an amendment if agreed to by the insurer and the provider.  (2009-352, s. 1; 2009-487, s. 2(b).)
NC Gen Stat § 58-50-280 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50 - General Accident and Health Insurance Regulations.|§ 58-50-280 - Contract amendments.

 58-50-280. Contract amendments.(a) A health benefit plan or insurer shall send any proposed contract amendment to the notice contact of a health care provider pursuant to G.S. 58-50-275. The proposed amendment shall be dated, labeled "Amendment," signed by the health benefit plan or insurer, and include an effective date for the proposed amendment.(b) A health care provider receiving a proposed amendment shall be given at least 60 days from the date of receipt to object to the proposed amendment. The proposed amendment shall be effective upon the health care provider failing to object in writing within 60 days.(c) If a health care provider objects to a proposed amendment, then the proposed amendment is not effective and the initiating health benefit plan or insurer shall be entitled to terminate the contract upon 60 days written notice to the health care provider.(d) Nothing in this Part prohibits a health care provider and insurer from negotiating contract terms that provide for mutual consent to an amendment, a process for reaching mutual consent, or alternative notice contacts.  (2009-352, s. 1; 2009-487, s. 2(c).)
NC Gen Stat § 58-50-285 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50 - General Accident and Health Insurance Regulations.|§ 58-50-285 - Policies and procedures.

 58-50-285. Policies and procedures.(a) A health benefit plan or insurer shall provide a copy of its policies and procedures to a health care provider prior to execution of a new or amended contract and annually to all contracted health care providers. Such policies and procedures may be provided to the health care provider in hard copy, CD, or other electronic format, and may also be provided by posting the policies and procedures on the Web site of the health plan or insurer.(b) The policies and procedures of a health benefit plan or insurer shall not conflict with or override any term of a contract, including contract fee schedules. In the event of a conflict between a policy or procedure and the language in a contract, the contract language shall prevail.  (2009-352, s. 1.)
NC Gen Stat § 58-50-290 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50 - General Accident and Health Insurance Regulations.|§ 58-50-290 - Health benefit plans or insurers contracting for provision of dental services; no limitation on fees for noncovered services or on methods of claims payment.

 58-50-290. Health benefit plans or insurers contracting for provision of dental services; no limitation on fees for noncovered services or on methods of claims payment.(a) No agreement between an insurer or an entity that writes stand-alone dental insurance and a dentist for the provision of dental services on a preferred or in-network basis to plan members or insurance subscribers in connection with coverage under a stand-alone dental plan, but not in connection with or incidental to coverage under a medical plan or health insurance policy, may require that a dentist provide services at a fee limited or set by the plan or insurer, unless the services are reimbursed as covered services under the contract.(b) For purposes of this section, "covered services" means a service for which reimbursement is available under an insurer's policy, without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, or other limitation.(c) No agreement between an insurer or another entity contracting for the provision of dental services and a provider of dental services shall contain restrictions on methods of claim payment in which the only acceptable payment method from the insurer or entity to the provider of the dental services is a credit card payment.  (2010-138, s. 1; 2019-26, s. 1.)
NC Gen Stat § 58-50-292 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50 - General Accident and Health Insurance Regulations.|§ 58-50-292 - Dental provider networks; confidential business information.

 58-50-292. Dental provider networks; confidential business information.(a) The following definitions apply in this section:(1) Insurer. - As defined in G.S. 58-3-225(a).(2) Provider network contract. - A contract between an insurer and a dental services provider specifying the rights and responsibilities of the insurer and the provider for the delivery of and payment for dental services.(3) Third party. - A person or entity that enters into a contract with an insurer or with another entity to gain access to a dental provider network contract. Third party does not include an employer group or other group for which the insurer provides administrative services, including payment of claims.(b) An insurer may grant access to its provider network contract to a third party if:(1) At the time the provider network contract is entered into and at the time the provider network contract is renewed, the insurer allows any provider who is part of the carrier's provider network to choose not to participate in third party access to the provider network contract. The third party access provision of any provider network contract shall be clearly identified in the provider network contract. An insurer shall not grant third party access to the provider network contract of any provider who does not participate in third party access.(2) The insurer includes on its Web site a listing identifying all third parties who have been granted such access.(3) The third party accessing the provider network contract agrees to comply with all of the provider network contract's terms.(c) This section shall not apply to the assignment of or access to a provider network contract to an entity operating under the same brand licensee program as the contracting entity or any affiliates of the contracting entity.  (2019-26, s. 2.)
NC Gen Stat § 58-50-295 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50 - General Accident and Health Insurance Regulations.|§ 58-50-295 - Prohibited contract provisions related to reimbursement rates.

 58-50-295. Prohibited contract provisions related to reimbursement rates.No contract with a health care provider shall do any of the following:(1) Prohibit, or grant a health insurance carrier an option to prohibit, the provider from contracting with another health insurance carrier to provide health care services at a rate that is equal to or lower than the payment specified in the contract.(2) Require the provider to accept a lower payment rate in the event that the provider agrees to provide health care services to any other health insurance carrier at a rate that is equal to or lower than the payment specified in the contract.(3) Require, or grant a health insurance carrier an option to require, termination or renegotiation of an existing health care contract in the event that the provider agrees to provide health care services to any other health insurance carrier at a rate that is equal to or lower than the payment specified in the contract.(4) Require, or grant a health insurance carrier an option to require, the provider to disclose, directly or indirectly, the provider's contractual rates with another health insurance carrier.(5) Require, or grant a health insurance carrier an option to require, the nonnegotiated adjustment by the issuer of the provider's contractual rate to equal the lowest rate the provider has agreed to charge any other health insurance carrier.(6) Require, or grant a health insurance carrier an option to require, the provider to charge another health insurance carrier a rate that is equal to or more than the reimbursement rate specified in the contract.  (2013-46, s. 1.)
NC Gen Stat § 58-50-300 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50 - General Accident and Health Insurance Regulations.|§ 58-50-300 - Health benefit plans or insurers contracting for provision of vision services or materials; no limitation on fees for noncovered services or materials.

 58-50-300. Health benefit plans or insurers contracting for provision of vision services or materials; no limitation on fees for noncovered services or materials.(a) No agreement between an insurer or an entity that writes vision insurance and an optometrist for the provision of vision services on a preferred or in-network basis to plan members or insurance subscribers in connection with coverage under a stand-alone vision plan, a medical plan, or health insurance policy may require that an optometrist provide services or materials at a fee limited or set by the plan or insurer unless the services or materials are reimbursed as covered services under the contract.(b) For purposes of this section, "covered services" means a service for which reimbursement is available under an insurer's policy without regard to contractual limitations by a deductible, co-payment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, or other limitation. For purposes of this section, "materials" includes lenses, devices containing lenses, prisms, lens treatments and coatings, contact lenses, orthoptics, vision training, and prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye or its adnexa.  (2014-43, s. 1.)
NC Gen Stat § 58-50A-1 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements.|§ 58-50A-1 - Definitions.

 58-50A-1. Definitions.The following definitions apply in this Article:(1) Employer member. - A person or entity acting directly as the employer of at least one employee, or a working owner, either of whom is a participant covered under a Path 2 MEWA.(2) Employee welfare benefit plan. - The term as defined in Section 3 of the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1002(1), as amended.(3) Multiple employer welfare arrangement or MEWA. - The term as defined in Section 3 of the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1002(40(A)), as amended, that meets at least one of the following criteria:a. Has at least one employer member of the MEWA that is either domiciled in this State or has its principal headquarters or principal administrative office in this State.b. Solicits an employer that is domiciled in this State or that has its principal headquarters or principal administrative office in this State.(4) Path 2 MEWA. - A MEWA that is established or maintained by an association of employers classified by the United States Department of Labor as a bona fide group or association under the requirements of 29 C.F.R. 2510.3-5 and is formed by a sponsoring association that meets the following requirements:a. Has a constitution or bylaws that provides for all of the following:1. Regular meetings.2. Collection of dues from members.3. Operation by a board of trustees that includes an owner, partner, officer, director, or employee of at least one of the employer members of the association.b. Has at least one substantial business purpose unrelated to the offering and providing of health insurance or other employee benefits to its employer members and their employees.c. Has a commonality of interest shared among the employers comprising the Path 2 MEWA based on either of the following:1. Establishment by employers in the same trade, industry, line of business, or profession.2. Being a statewide organization where each employer that is a member of the organization has a principal place of business that does not exceed the boundaries of the State or a metropolitan area that is at least partially within the State, even if that metropolitan area includes portions of other states.(5) Sponsoring association. - An association of two or more employer members that offers an employee welfare benefit plan as a Path 2 MEWA. For purposes of this Chapter, a sponsoring association that meets the requirements of this Article shall be deemed to be a large employer.  (2019-202, s. 1.)
NC Gen Stat § 58-50A-5 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements.|§ 58-50A-5 - Compliance with requirements.

 58-50A-5. Compliance with requirements.Regardless of the domicile of the sponsoring association receiving the policy, no group health plan shall be offered by a sponsoring association in this State unless it complies with the requirements of this Chapter. Nothing in this Article shall be interpreted to regulate or prohibit any group health insurance policy that is not offered by a sponsoring association in accordance with this Article.  (2019-202, s. 1.)
NC Gen Stat § 58-50A-10 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements.|§ 58-50A-10 - Sponsoring association requirements.

 58-50A-10. Sponsoring association requirements.No insurer shall deliver or issue for delivery a group health plan to a sponsoring association or an employer member of a sponsoring association unless that sponsoring association meets the requirements of a Path 2 MEWA.  (2019-202, s. 1.)
NC Gen Stat § 58-50A-15 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements.|§ 58-50A-15 - Membership requirements.

 58-50A-15. Membership requirements.(a) Group health plans offered by a sponsoring association may only provide coverage to the following:(1) Eligible employees of the employer member as defined in G.S. 58-51-80(c) and working owners pursuant to 29 C.F.R. 2510.3-5.(2) The spouse or dependent children of any individual identified in subdivision (1) of subsection (a) of this section.(b) In order to obtain coverage for their employees under a group health plan offered by a sponsoring association, employer members must commit to remaining members of the sponsoring association and receiving and paying for benefits under the group health plan for at least one twelve-month policy period.  (2019-202, s. 1.)
NC Gen Stat § 58-50A-20 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements.|§ 58-50A-20 - Health plan requirements.

 58-50A-20. Health plan requirements.Any group health plan offered by a sponsoring association must meet all of the following requirements:(1) Neither be offered nor advertised to the public generally.(2) Provides a level of coverage equal to or greater than sixty percent (60%) of the actuarial value of allowed costs for covered benefits.(3) Provides coverage for hospital and physician services.(4) Complies with the provisions of G.S. 58-3-150.  (2019-202, s. 1.)
NC Gen Stat § 58-50A-25 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements.|§ 58-50A-25 - Solvency requirements.

 58-50A-25. Solvency requirements.No insurer shall deliver or issue for delivery a group health plan to a sponsoring association or an employer member of a sponsoring association unless the sponsoring association meets all of the following solvency requirements:(1) Has been established and maintained in good faith for a period of at least three years.(2) Has at the outset a minimum of 500 individuals eligible for coverage pursuant to G.S. 58-50A-15(a).(3) Requires employer members to offer group health coverage to all individuals eligible for coverage under G.S. 58-50A-15(a) for a period of at least one year.(4) Maintains a minimum net worth equal to at least one month's premium, which must be held in trust and separate from the sponsoring association's operating assets. This amount shall be adjusted at the beginning of each policy period.(5) Maintains at all times an adequate plan for protection against insolvency that is acceptable to the Commissioner.  (2019-202, s. 1.)
NC Gen Stat § 58-50A-30 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements.|§ 58-50A-30 - Nondiscrimination.

 58-50A-30. Nondiscrimination.(a) No sponsoring association may condition eligibility for coverage, including continuing eligibility for coverage, on any of the following health-status factors:(1) Health status.(2) Medical condition, including both physical and mental illness.(3) Claims experience.(4) Receipt of health care.(5) Medical history.(6) Genetic information.(7) Evidence of insurability.(8) Disability.(b) An insurer or sponsoring association may make rating distinctions among its employer members based on factors other than health-status factors, such as industry, occupation, or geography, provided that the rating distinction is not directed at individual beneficiaries or based on a factor listed in subsection (a) of this section.(c) No limitations shall be based on preexisting conditions.(d) This section shall not be construed to require a sponsoring association or insurer to provide particular benefits other than those provided under the terms of the plan, or otherwise required by law, or to prevent the plan from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan.  (2019-202, s. 1.)
NC Gen Stat § 58-50A-35 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements.|§ 58-50A-35 - Premium contributions.

 58-50A-35. Premium contributions.(a) Neither an insurer nor a sponsoring association shall require any individual, as a condition of initial enrollment or continued enrollment in the plan, to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled in the plan as a spouse or dependent of the individual.(b) Nothing in this section shall be construed to restrict the amount an insurer may charge for coverage under a group health plan offered to a sponsoring association under this section or to prevent an insurer from establishing premium discounts or modifying otherwise applicable co-payments or deductibles for a group health plan offered to a sponsoring association under this section in return for adherence to programs of health promotion and disease prevention.  (2019-202, s. 1.)
NC Gen Stat § 58-50A-40 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements.|§ 58-50A-40 - Use of licensed agents and brokers.

 58-50A-40. Use of licensed agents and brokers.Nothing in this Article shall preclude a sponsoring association from engaging a broker or agent licensed to sell insurance in this State for the purposes of reviewing and considering any group health plan offered to a sponsoring association under this section.  (2019-202, s. 1.)