reglab/statecodes huggingface dataset:
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 50 - General Accident and Health Insurance Regulations. › § 58-50-115 - Health benefit plans subject to Act.

§ 58-50-115. Health benefit plans subject to Act.
(a) A health benefit plan is subject to this Act if it provides health benefits for small employers and if any of the following conditions are met:
(1) Any part of the premiums or benefits is paid by a small employer or any covered individual is reimbursed, whether through wage or adjustments or otherwise, by a small employer for any portion of the premium;
(2) The health benefit plan is treated by the employer as part of a plan or program for the purpose of sections 106, 125, or 162 of the United States Internal Revenue Code; or
(3) The small employer has permitted payroll deductions for the eligible enrollees for the health benefit plans.
(b) Repealed by Session Laws 1993, c. 529, s. 3.5, effective January 1, 1995.
(c) A health benefit plan is not subject to this Act if it provides health benefits for employers who are employer members of a Path 2 MEWA pursuant to Article 50A of this Chapter through a policy issued to the Path 2 MEWA. (1991, c. 630, s. 1; 1993, c. 529, s. 3.5; 2013-357, s. 2(c); 2019-202, s. 4(b); 2020-69, s. 3(d).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 50 - General Accident and Health Insurance Regulations. › § 58-50-125 - Health care plans; formation; approval; offerings.

§ 58-50-125. Health care plans; formation; approval; offerings.
(a), (a1) Repealed by Session Laws 2013-357, s. 2(e), effective January 1, 2015.
(b) Repealed by Session Laws 2006-154, s. 9, effective July 23, 2006.
(c) Except as provided under Article 68 of this Chapter, the plans developed under this section are not required to provide coverage that meets the requirements of other provisions of this Chapter that mandate either coverage or the offer of coverage by the type or level of health care services or health care provider.
(d) If a small employer carrier offers coverage to a small employer, the small employer carrier shall offer coverage to all eligible employees of a small employer and their dependents. A small employer carrier shall not offer coverage to only certain individuals in a small employer group except in the case of late enrollees as provided in G.S. 58-50-130(a)(4b). A small employer carrier shall not modify any health benefit plan with respect to a small employer, any eligible employee, or dependent through riders, endorsements, or otherwise, in order to restrict or exclude coverage for certain diseases or medical conditions otherwise covered by the health benefit plan. In the case of an eligible employee or dependent of an eligible employee who, before the effective date of the plan, was excluded from coverage or denied coverage by a small employer carrier in the process of providing a health benefit plan to an eligible small employer, the small employer carrier shall provide an opportunity for the eligible employee or dependent of an eligible employee to enroll in the health benefit plan currently held by the small employer.
(e) Repealed by Session Laws 2006-154, s. 9, effective July 23, 2006.
(f) To the extent it is required under this section and G.S. 58-68-40, every small employer carrier shall fairly market all of its small group health benefit plans it offers on a guaranteed issue basis to all small employers in the geographic areas in which the carrier makes coverage available or provides benefits.
(g) Repealed by Session Laws 2006-154, s. 9, effective July 23, 2006.
(h) The provisions of subsection (d) of this section apply to every health benefit plan delivered, issued for delivery, renewed, or continued in this State or covering persons residing in this State on or after the date the plan becomes operational, as determined by the Commissioner. For purposes of this subsection, the date a health benefit plan is continued is the anniversary date of the issuance of the health benefit plan. (1991, c. 630, s. 1; c. 761, s. 10; 1993, c. 529, s. 3.6; 1997-259, ss. 3, 4; 2006-154, ss. 1, 2, 9, 10, 14; 2013-357, ss. 2(d), (e).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 50 - General Accident and Health Insurance Regulations. › § 58-50-131 - Premium rates for health benefit plans; approval authority; hearing.

§ 58-50-131. Premium rates for health benefit plans; approval authority; hearing.
(a) No schedule of premium rates for coverage for a health benefit plan subject to this act, or any amendment to the schedule, shall be used in conjunction with any such health benefit plan until a copy of the schedule of premium rates or premium rate amendment has been filed with and approved by the Commissioner. Any schedule of premium rates or premium rate amendment filed under this section shall be established in accordance with G.S. 58-50-130(b). The schedule of premium rates shall not be excessive, unjustified, inadequate, or unfairly discriminatory and shall exhibit a reasonable relationship to the benefits provided by the contract of insurance. Each filing shall include a certification by an actuary who is a member of the American Academy of Actuaries and qualified to provide such certifications as described in the U.S. Qualifications Standards promulgated by the American Academy of Actuaries pursuant to its Code of Professional Conduct.
(b) The Commissioner shall approve or disapprove a schedule of premium rates within 60 days of receipt of a complete filing. It shall be unlawful to use a schedule of premium rates until approved. If the Commissioner disapproves the filing, the Commissioner shall notify the filer, shall specify the reasons for disapproval, and shall provide an opportunity for refiling.
(c) The Commissioner shall adopt rules as necessary or proper (i) to prevent the federal preemption of health insurance regulation in the State, (ii) to implement the provisions of this section, and (iii) to establish minimum standards for loss ratios of policies subject to this section in accordance with accepted actuarial principles and practices to assure that the benefits are reasonable in relation to the premium charged. The Commissioner shall adopt rules to require the submission of supporting data and any information that the Commissioner considers necessary or proper to determine whether the filed schedule of premium rates meets the standards set forth in this section. (2011-196, s. 4; 2013-199, s. 9.)
2023 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.)
2023 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.)
2023 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).)
2023 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).)
2023 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).)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements. › § 58-50A-40 - Use of licensed insurance producers.

§ 58-50A-40. Use of licensed insurance producers.
Nothing in this Article shall preclude a sponsoring association from engaging an insurance producer 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; 2022-46, s. 14(ttt).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements. › § 58-50A-60 - Multiple employer welfare arrangements; administrators.

§ 58-50A-60. Multiple employer welfare arrangements; administrators.
(a) Repealed by Session Laws 2019-202, s. 3(a), effective October 1, 2019, and applicable to contracts entered into, amended, or renewed on or after January 1, 2020.
(b) Each insurer licensed to do business in this State that administers a MEWA shall, at the request of the Commissioner, provide the Commissioner with such information regarding the insurer's administrative services contract or contracts with such MEWA or MEWAs that the Commissioner requires. No unlicensed insurer shall administer any MEWA. (1989 (Reg. Sess., 1990), c. 1055, s. 1; 1991, c. 611, s. 3; 2019-202, ss. 2(a), 3(a); 2020-69, s. 3(e).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements. › § 58-50A-65 - Multiple employer welfare arrangements; license required; penalty.

§ 58-50A-65. Multiple employer welfare arrangements; license required; penalty.
(a) It is unlawful to operate, maintain, or establish a MEWA unless the MEWA has a valid license issued by the Commissioner. Any MEWA operating in this State without a valid license is an unauthorized insurer.
(b) G.S. 58-50A-60 through G.S. 58-50A-95 do not apply to a MEWA that offers or provides benefits that are fully insured by an authorized insurer or to a MEWA that is exempt from state insurance regulation in accordance with the Employee Retirement Income Security Act of 1974, Public Law Number 43-406. (1991, c. 611, s. 1; 2019-202, ss. 2(b), 8.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements. › § 58-50A-75 - Certain words prohibited in name of MEWA.

§ 58-50A-75. Certain words prohibited in name of MEWA.
No licensed MEWA shall use in its name, contracts, literature, advertising in any medium, or any other printed matter the words "insurance", "casualty", "surety", "mutual", or any other words descriptive of the insurance business or deceptively similar to the name or description of any insurer doing business in this State. (1991, c. 611, s. 1; 2019-202, s. 2(d).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements. › § 58-50A-85 - Examinations; deposits; solvency regulation.

§ 58-50A-85. Examinations; deposits; solvency regulation.
(a) The provisions of Articles 2, 5, and 30 of this Chapter regarding examinations, deposits, and supervision and receivership respectively apply to MEWAs. The provisions of Article 62 of this Chapter and of Article 8B of Chapter 105 of the General Statutes do not apply to MEWAs.
(b) An audit or examination of a MEWA shall be conducted only when there are circumstances to support a reasonable belief of a MEWA's noncompliance with this Article. (1991, c. 611, s. 1; 2019-202, s. 2(f).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements. › § 58-50A-90 - Annual reports; actuarial certifications; quarterly reports.

§ 58-50A-90. Annual reports; actuarial certifications; quarterly reports.
(a) Every MEWA shall, within 150 days after the end of each of its fiscal years or within any such extension of time that the Commissioner for good cause grants, file a report with the Commissioner, on forms prescribed by the Commissioner and verified by the oath of a member of the board of trustees and by an administrative executive appointed by the board, showing its financial condition on the last day of the preceding fiscal year. The report shall contain an audited financial statement of the MEWA prepared in accordance with statutory accounting principles, including its balance sheet and a statement of the operations for the preceding fiscal year certified by an independent certified public accountant. The report shall also include an analysis of the adequacy of reserves and contributions or premiums charged, based on a review of past and projected claims and expenses.
(b) In addition to the information called for and furnished in connection with the annual report, if reasonable grounds exist, the Commissioner may request information that summarizes paid and incurred expenses and contributions or premiums received; and may request evidence satisfactory to the Commissioner that the MEWA is actuarially sound. That information and evidence shall be furnished by the MEWA not later than 30 days after the request, unless the Commissioner, for good cause, grants an extension.
(c) Annually, in conjunction with the annual report required in subsection (a) of this section, the MEWA shall submit an actuarial certification prepared by an independent qualified actuary that indicates:
(1) The MEWA is actuarially sound, with the certification considering the rates, benefits, and expenses of, and any other funds available for the payment of obligations of, the MEWA;
(2) The rates being charged and to be charged for contracts are actuarially adequate to the end of the period for which rates have been guaranteed;
(3) Incurred but not reported claims and claims reported but not fully paid have been adequately provided for; and
(4) Such other information relating to the performance of the MEWA that is required by the Commissioner.
(d) If reasonable grounds exist, the Commissioner may require a MEWA to file quarterly, within 45 days after the end of each of its fiscal quarters, an unaudited financial statement on a form prescribed by the Commissioner, verified by the oath of a member of the board of trustees and an administrative executive appointed by the board, showing its financial condition on the last day of the preceding quarter.
(e) Any MEWA that fails to file a report as required by this section is subject to G.S. 58-2-70; and after notice and opportunity for hearing, the Commissioner may suspend the MEWA's authority to enroll new insureds or to do business in this State while the failure continues. (1991, c. 611, s. 1; 2019-202, s. 2(g).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 50A - Association Health Plans and Multiple Employer Welfare Arrangements. › § 58-50A-95 - Denial, suspension, or revocation of license.

§ 58-50A-95. Denial, suspension, or revocation of license.
(a) The Commissioner shall deny, suspend, or revoke a MEWA's license if the Commissioner finds that the MEWA:
(1) Is insolvent;
(2) Is using such methods and practices in the conduct of its business as to render its further transaction of business in this State hazardous or injurious to its participating employers, covered employees and dependents, or to the public;
(3) Has failed to pay any final judgment rendered against it in a court of competent jurisdiction within 60 days after the judgment became final;
(4) Is or has been in violation of or threatens to violate any provision of this Article;
(5) Is no longer actuarially sound; or
(6) Is charging rates that are excessive, inadequate, or unfairly discriminatory.
(b) The Commissioner may deny, suspend, or revoke the license of any MEWA if the Commissioner determines that the MEWA:
(1) Has violated any lawful order or rule of the Commissioner; or any applicable provision of this Article; or
(2) Has refused to produce its accounts, records, or files for examination under G.S. 58-50A-85 or through any of its officers has refused to give information with respect to its affairs or to perform any other legal obligation as to an examination.
(c) Whenever the financial condition of the MEWA is such that, if not modified or corrected, its continued operation would result in impairment or insolvency, in addition to any provisions in Article 30 of this Chapter, the Commissioner may order the MEWA to file with the Commissioner and implement a corrective action plan designed to do one or more of the following:
(1) Reduce the total amount of present potential liability for benefits by reinsurance or other means.
(2) Reduce the volume of new business being accepted.
(3) Reduce the expenses of the MEWA by specified methods.
(4) Suspend or limit the writing of new business for a period of time.
If the MEWA fails to submit a plan within the time specified by the Commissioner or submits a plan that is insufficient to correct the MEWA's financial condition, the Commissioner may order the MEWA to implement one or more of the corrective actions listed in this subsection.
(d) The Commissioner shall, in the order suspending the authority of a MEWA to enroll new insureds, specify the period during which the suspension is to be in effect and the conditions, if any, that must be met prior to reinstatement of its authority to enroll new insureds. The order of suspension is subject to rescission or modification by further order of the Commissioner before the expiration of the suspension period. Reinstatement shall not be made unless requested by the MEWA; however, the Commissioner shall not grant reinstatement if it is found that the circumstances for which suspension occurred still exist. (1991, c. 611, s. 1; 2019-202, ss. 2(h), 8.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 51 - Nature of Policies. › § 58-51-1 - Form, classification and rates to be approved by Commissioner.

§ 58-51-1. Form, classification and rates to be approved by Commissioner.
No policy of insurance against loss or damage from the sickness or the bodily injury or death of the insured by accident shall be issued or delivered to any person in this State until a copy of the form thereof and of the classification of risks and the premium rates pertaining thereto have been filed with, and the forms approved by, the Commissioner. If the Commissioner shall notify, in writing, the company or other insurer which has filed such form that it does not comply with the requirements of law, specifying the reasons for his opinion, it shall be unlawful thereafter for any such insurer to issue any policy in such form. The action of the Commissioner in this regard shall be subject to review by any court of competent jurisdiction; but nothing in this Article shall be construed to give jurisdiction to any court not already having jurisdiction. (1911, c. 209, s. 1; 1913, c. 91, s. 1; C.S., s. 6477; 1945, c. 385; 1991, c. 720, s. 4.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 51 - Nature of Policies. › § 58-51-10 - Right to return policy and have premium refunded.

§ 58-51-10. Right to return policy and have premium refunded.
Every individual or family hospitalization policy, certificate, contract or plan issued for delivery in the State of North Carolina on and after July 1, 1961, must have printed thereon or attached thereto a notice stating substantially: "YOUR POLICY MAY NOT BE IN FORCE WHEN YOU HAVE A CLAIM! PLEASE READ! Your policy was issued based on the information entered in your application, a copy of which is attached to the policy. If, to the best of your knowledge and belief, there is any misstatement in your application or if any information concerning the medical history of any insured person has been omitted, you should advise the Company immediately regarding the incorrect or omitted information; otherwise, your policy may not be a valid contract. RIGHT TO RETURN POLICY WITHIN 10 DAYS. If for any reason you are not satisfied with your policy, you may return it to the Company within 10 days of the date you received it and the premium you paid will be promptly refunded." If a policyholder or certificate holder or purchaser of a contract or plan returns same pursuant to such notice, coverage under such policy, certificate, contract or plan shall become void immediately upon the mailing or delivery of the contract, certificate, policy or plan to the insurance company at its home or branch office or to the agent through whom it was purchased. Coverage shall exist under such policy, certificate, contract or plan within said 10-day period until said mailing or delivery of the contract. (1955, c. 850, s. 10; 1961, c. 962.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 51 - Nature of Policies. › § 58-51-16 - Intoxicants and narcotics.

§ 58-51-16. Intoxicants and narcotics.
(a) Except for the payment of benefits for the necessary care and treatment of chemical dependency as provided by law, an accident and health insurer shall not be liable for any loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered on the advice of a physician.
(b) The provision in subsection (a) of this section may not be used with respect to a medical expense policy.
(c) For purposes of this section, "medical expense policy" means an accident and health insurance policy that provides hospital, medical, and surgical expense coverage. (2001-334, s. 4.2.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 51 - Nature of Policies. › § 58-51-20 - Renewability of individual and blanket hospitalization and accident and health insurance policies.

§ 58-51-20. Renewability of individual and blanket hospitalization and accident and health insurance policies.
(a) Every individual or blanket family hospitalization policy and accident and health policy, other than noncancelable or nonrenewable policies but including group, blanket and franchise policies, as defined in Articles 1 through 64 of this Chapter, covering less than 10 persons, issued in North Carolina after January 1, 1956, shall include in substance the following provision:
Renewability: This policy is renewable at the option of the policyholder unless sufficient notice of nonrenewal is given the policyholder in writing by the insurer.
Sufficient notice shall be, during the first year of any policy, or during the first year following any lapse and reinstatement, a period of 30 days before the premium due date. After one continuous year of coverage and acceptance of premium for any portion of the second or subsequent year sufficient notice shall be a number of full months most nearly equivalent to one fourth the number of months of continuous coverage from the inception date of the policy, to the date of mailing of the notice: Provided no period of required notice shall exceed two years.
(b) No insurance company issuing individual or blanket family hospitalization or accident and health policies of insurance shall have the right to unilaterally restrict coverage, reduce benefits or increase rates upon any contract of hospitalization or accident and health insurance which is subject to the provisions of this section except as provided herein.
(c) Any hospitalization or accident and health policy reissued or renewed in the name of the insured during the grace period shall be construed to be a continuation of the policy first issued.
(d) The requirements of this section do not apply to a refusal or renewal because of a change of occupation of an insured to one classified by the insurer as uninsurable nor to an increase in rate due to a change of occupation of an insured to a more hazardous occupation. (1955, c. 886, s. 2; 1957, c. 1085, s. 2; 1979, c. 755, s. 13; 1985, c. 666, s. 71; 1989, c. 485, s. 55; 1991, c. 644, s. 27.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 51 - Nature of Policies. › § 58-51-25 - Policy coverage to continue as to children with an intellectual or physical disability; or dependent students on medically necessary leave of absence.

§ 58-51-25. Policy coverage to continue as to children with an intellectual or physical disability; or dependent students on medically necessary leave of absence.
(a) An individual or group accident and health insurance policy, hospital service plan policy, or medical service plan policy that provides that coverage of a dependent child shall terminate upon attainment of the limiting age for dependent children specified in the policy or contract, shall also provide in substance that attainment of the limiting age shall not operate or terminate the coverage of the child while the child is and continues to be (i) incapable of self-sustaining employment by reason of an intellectual or physical disability; and (ii) chiefly dependent upon the policyholder or subscriber for support and maintenance. The proof of such incapacity and dependency shall be furnished to the insurer, hospital service plan corporation, or medical service plan corporation by the policyholder or subscriber within 31 days of the child's attainment of the limiting age and subsequently as may be required by the insurer or corporation, but not more frequently than annually after the child's attainment of the limiting age.
(b) All health benefit plans, as defined in G.S. 58-3-167, that provide that coverage of a dependent child shall terminate upon a change in enrollment of the child in a postsecondary educational institution shall provide for the continued eligibility of the dependent child during a medically necessary leave of absence from the postsecondary educational institution in accordance with all applicable requirements of Public Law 110-381, known as Michelle's Law. (1969, c. 745, s. 1; 1971, c. 1126, s. 1; 2009-382, s. 17; 2018-47, s. 7(a).)