reglab/statecodes huggingface dataset:
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-78 - Coverage of certain prescribed drugs for cancer treatment.

§ 58-67-78. Coverage of certain prescribed drugs for cancer treatment.
(a) No health care plan written by a health maintenance organization and in force, issued, renewed, or amended on or after January 1, 1994, and that provides coverage for prescribed drugs approved by the federal Food and Drug Administration for the treatment of certain types of cancer shall exclude coverage of any drug on the basis that the drug has been prescribed for the treatment of a type of cancer for which the drug has not been approved by the federal Food and Drug Administration. The drug, however, must be approved by the federal Food and Drug Administration and must have been proven effective and accepted for the treatment of the specific type of cancer for which the drug has been prescribed in any one of the following established reference compendia:
(1) The National Comprehensive Cancer Network Drugs & Biologics Compendium;
(2) The ThomsonMicromedex DrugDex;
(3) The Elsevier Gold Standard's Clinical Pharmacology; or
(4) Any other authoritative compendia as recognized periodically by the United States Secretary of Health and Human Services.
(b) Notwithstanding subsection (a) of this section, coverage shall not be required for any experimental or investigational drugs or any drug that the federal Food and Drug Administration has determined to be contraindicated for treatment of the specific type of cancer for which the drug has been prescribed.
(c) This section shall apply only to cancer drugs and nothing in this section shall be construed, expressly or by implication, to create, impair, alter, limit, notify, enlarge, abrogate, or prohibit reimbursement for drugs used in the treatment of any other disease or condition. (1993, c. 506, s. 4.3; 2009-170, s. 3.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-79 - Coverage for reconstructive breast surgery following mastectomy.

§ 58-67-79. Coverage for reconstructive breast surgery following mastectomy.
(a) Every health care plan written by a health maintenance organization that is subject to this Article and that provides coverage for mastectomy shall provide coverage for reconstructive breast surgery following a mastectomy. The coverage shall include coverage for all stages and revisions of reconstructive breast surgery performed on a nondiseased breast to establish symmetry if reconstructive surgery on a diseased breast is performed, as well as coverage for prostheses and physical complications in all stages of mastectomy, including lymphademas. The same deductibles, coinsurance, and other limitations as apply to similar services covered under the policy, contract, or plan shall apply to coverage for reconstructive breast surgery. Reconstruction of the nipple/areolar complex following a mastectomy is covered without regard to the lapse of time between the mastectomy and the reconstruction, subject to the approval of the treating physician.
(b) As used in this section, the following terms have the meanings indicated:
(1) "Mastectomy" means the surgical removal of all or part of a breast as a result of breast cancer or breast disease.
(2) "Reconstructive breast surgery" means surgery performed as a result of a mastectomy to reestablish symmetry between the two breasts, and includes reconstruction of the mastectomy site, creation of a new breast mound, and creation of a new nipple/areolar complex. "Reconstructive breast surgery" also includes augmentation mammoplasty, reduction mammoplasty, and mastopexy of the nondiseased breast.
(c) A policy, contract, or plan subject to this section shall not:
(1) Deny coverage described in subsection (a) of this section on the basis that the coverage is for cosmetic surgery;
(2) Deny to a woman eligibility or continued eligibility to enroll or to renew coverage under the terms of the contract, policy, or plan, solely for the purpose of avoiding the requirements of this section;
(3) Provide monetary payments or rebates to a woman to encourage her to accept less than the minimum protections available under this section;
(4) Penalize or otherwise reduce or limit the reimbursement of an attending provider because the provider provided care to an individual participant or beneficiary in accordance with this section; or
(5) Provide incentives, monetary or otherwise, to an attending provider to induce the provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section.
(d) Written notice of the availability of the coverage provided by this section shall be delivered to every subscriber under the plan upon enrollment and annually thereafter. The notice required by this subsection may be included as a part of any yearly informational packet sent to the subscriber. (1997-312, s. 3; 1999-351, s. 3.3; 2001-334, s. 13.3.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-80 - Meaning of terms "accident", "accidental injury", and "accidental means".

§ 58-67-80. Meaning of terms "accident", "accidental injury", and "accidental means".
(a) Effective October 1, 1989, this section applies to all health maintenance organization plans under this Article.
(b) "Accident", "accidental injury", and "accidental means" shall be defined to imply "result" language and shall not include words that establish an accidental means test. (1989, c. 485, s. 12.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-90 - Licensing and regulation of agents.

§ 58-67-90. Licensing and regulation of agents.
Every agent of any HMO authorized to do business in this State under this Article is subject to the licensing provisions of Article 33 of this Chapter and all other provisions in this Chapter applicable to life and accident and health or sickness insurance producers. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1985 (Reg. Sess., 1986), c. 928, s. 5; 1987, c. 629, s. 3; 1999-244, s. 8; 2022-46, s. 14(ffff).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-95 - Powers of insurers, hospitals, prepaid health plans, and medical service corporations.

§ 58-67-95. Powers of insurers, hospitals, prepaid health plans, and medical service corporations.
(a) Upon demonstration to the Commissioner of compliance with this Article, an insurance company licensed in this State, a prepaid health plan licensed to do business in this State, or a hospital or medical service corporation authorized to do business in this State, may either directly or through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of this Article. Notwithstanding any other law which may be inconsistent herewith, any two or more such insurance companies, hospital or medical service corporations, prepaid health plans, or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance organization. The business of insurance is deemed to include the arranging of health care by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.
(b) Notwithstanding any provision of the insurance and hospital or medical service corporation laws contained in Articles 1 through 66 of this Chapter, an insurer or a hospital or medical service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. The enrollees of a health maintenance organization constitute a permissible group under such laws. Among other things, under such contracts, the insurer or hospital or medical service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers pursuant to the health care plan. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 2018-49, s. 2(d).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-100 - Examinations.

§ 58-67-100. Examinations.
(a) The Commissioner may make an examination of the affairs of any health maintenance organization and the contracts, agreements or other arrangements pursuant to its health care plan as often as the Commissioner deems it necessary for the protection of the interests of the people of this State but not less frequently than once every five years. Examinations shall otherwise be conducted under G.S. 58-2-131 through G.S. 58-2-134.
(b) Repealed by Session Laws 1997-519, s. 1, effective January 1, 1998.
(c) Repealed by Session Laws 1995, c. 360, s. 2(m).
(d) Instead of conducting an examination, the Commissioner may accept the report of an examination made by the HMO regulator of another state. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1995, c. 360, s. 2(m); 1997-519, s. 1.4; 1999-132, s. 11.10; 2007-127, s. 16.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-105 - Hazardous financial condition.

§ 58-67-105. Hazardous financial condition.
(a) Whenever the financial condition of any health maintenance organization indicates a condition such that the continued operation of the health maintenance organization might be hazardous to its enrollees, creditors, or the general public, then the Commissioner may order the health maintenance organization to take such action as may be reasonably necessary to rectify the existing condition, including but not limited to one or more of the following steps:
(1) To reduce the total amount of present and potential liability for benefits by reinsurance;
(2) To reduce the volume of new business being accepted;
(3) To reduce the expenses by specified methods;
(4) To suspend or limit the writing of new business for a period of time; or
(5) To require an increase to the health maintenance organization's net worth by contribution.
(b) The Commissioner may adopt rules to set uniform standards and criteria for the early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees, creditors, or the general public, and to set standards for evaluating the financial condition of any health maintenance organization, which standards shall be consistent with the purposes expressed in subsection (a) of this section. (1987, c. 631, s. 5.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-110 - Protection against insolvency.

§ 58-67-110. Protection against insolvency.
(a) The Commissioner shall require deposits in accordance with the provisions of G.S. 58-67-25.
(b) Each full service health maintenance organization shall maintain a minimum net worth equal to the greater of one million dollars ($1,000,000) or the amount required pursuant to the risk-based capital provisions of Article 12 of this Chapter. Each single service health maintenance organization shall maintain a minimum net worth equal to the greater of fifty thousand dollars ($50,000) or that amount required pursuant to the risk-based capital provisions of Article 12 of this Chapter.
(c), (d) Repealed by Session Laws 2003-212, s. 21, effective October 1, 2003.
(e) Every full service medical health maintenance organization shall have and maintain at all times an adequate plan for protection against insolvency acceptable to the Commissioner. In determining the adequacy of such a plan, the Commissioner may consider:
(1) A reinsurance agreement preapproved by the Commissioner covering excess loss, stop loss, or catastrophes. The agreement must provide that the Commissioner will be notified no less than 60 days prior to cancellation or reduction of coverage.
(2) A conversion policy or policies that will be offered by an insurer to the enrollees in the event of the health maintenance organization's insolvency.
(3) Any other arrangements offering protection against insolvency that the Commissioner may require. (1987, c. 631, s. 5; 1989, c. 776, ss. 11, 12; 2003-212, s. 21.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-120 - Continuation of benefits.

§ 58-67-120. Continuation of benefits.
(a) The Commissioner shall require that each HMO have a plan for handling insolvency, which plan allows for continuation of benefits for the duration of the contract period for which premiums have been paid and continuation of benefits to enrollees who are confined in an inpatient facility until their discharge or expiration of benefits. In considering such a plan, the Commissioner may require:
(1) Insurance to cover the expenses to be paid for benefits after an insolvency;
(2) Provisions in provider contracts that obligate the provider to provide services for the duration of the period after the HMO's insolvency for which premium payment has been made and until the enrollees' discharge from inpatient facilities;
(3) Insolvency reserves such as the Commissioner may require;
(4) Letters of credit acceptable to the Commissioner;
(5) Any other arrangements to assure that benefits are continued as specified above. (1989, c. 776, s. 13.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-125 - Enrollment period.

§ 58-67-125. Enrollment period.
(a) In the event of an insolvency of an HMO upon order of the Commissioner, all other carriers that participated in the enrollment process with the insolvent HMO at a group's last regular enrollment period shall offer such group's enrollees of the insolvent HMO a 30-day enrollment period commencing upon the date of insolvency. Each carrier shall offer such enrollees of the insolvent HMO the same coverages and rates that it had offered to the enrollees of the group at its last regular enrollment period.
(b) If no other carrier had been offered to some groups enrolled in the insolvent HMO, or if the Commissioner determines that the other health benefit plan or plans lack sufficient health care delivery resources to assure that health care services will be available and accessible to all of the group enrollees of the insolvent HMO, then the Commissioner shall allocate the insolvent HMO's group contracts for such groups among all other HMOs that operate within a portion of the insolvent HMO's service area, taking into consideration the health care delivery resources of each HMO. Each HMO to which a group or groups are so allocated shall offer such group or groups that HMO's existing coverage that is most similar to each group's coverage with the insolvent HMO at rates determined in accordance with the successor HMO's existing rating methodology.
(c) The Commissioner shall also allocate the insolvent HMO's nongroup enrollees who are unable to obtain other coverage among all HMOs that operate within a portion of the insolvent HMO's service area, taking into consideration the health care delivery resources of each such HMO. Each HMO to which nongroup enrollees are allocated shall offer such nongroup enrollees that HMO's existing coverage for individual or conversion coverage as determined by his type of coverage in the insolvent HMO at rates determined in accordance with the successor HMO's existing rating methodology. Successor HMOs that do not offer direct nongroup enrollment may aggregate all of the allocated nongroup enrollees into one group for rating and coverage purposes. (1989, c. 776, s. 13.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-130 - Replacement coverage.

§ 58-67-130. Replacement coverage.
(a) Any carrier providing replacement coverage with respect to group hospital, medical, or surgical expense or service benefits, within a period of 60 days from the date of discontinuance of a prior HMO contract or policy providing such hospital, medical or surgical expense or service benefits, shall immediately cover all enrollees who were validly covered under the previous HMO contract or policy at the date of discontinuance and who would otherwise be eligible for coverage under the succeeding carrier's contract, regardless of any provisions of the contract relating to active employment or hospital confinement or pregnancy.
(b) Except to the extent benefits for the condition would have been reduced or excluded under the prior carrier's contract or policy, no provision in a succeeding carrier's contract of replacement coverage that would operate to reduce or exclude benefits on the basis that the condition giving rise to benefits preceded the effective date of the succeeding carrier's contract shall be applied with respect to those enrollees validly covered under the prior carrier's contract or policy on the date of discontinuance. (1989, c. 776. s. 13.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-135 - Incurred but not reported claims.

§ 58-67-135. Incurred but not reported claims.
(a) Every HMO shall, when determining liability, include an amount estimated in the aggregate to provide for any unearned premium and for the payment of all claims for health care expenditures that have been incurred, whether reported or unreported, that are unpaid and for which such HMO is or may be liable; and to provide for the expense of adjustment or settlement of such claims.
(b) Such liabilities shall be computed in accordance with rules adopted by the Commissioner upon reasonable consideration of the ascertained experience and character of the HMO. (1989, c. 776, s. 13.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-140 - Suspension or revocation of license.

§ 58-67-140. Suspension or revocation of license.
(a) The Commissioner may suspend or revoke an HMO license if the Commissioner finds that the HMO:
(1) Is operating significantly in contravention of its basic organizational document, or in a manner contrary to that described in and reasonably inferred from any other information submitted under G.S. 58-67-10, unless amendments to such submissions have been filed with and approved by the Commissioner.
(2) Issues evidences of coverage or uses a schedule of premiums for health care services that do not comply with G.S. 58-67-50.
(3) Is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees.
(4) Has itself or through any person on its behalf advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive or unfair manner.
(5) Is operating in a manner that would be hazardous to its enrollees.
(6) Knowingly or repeatedly fails or refuses to comply with any law or rule applicable to the HMO or with any order issued by the Commissioner after notice and opportunity for a hearing.
(7) Repealed by Session Laws 2015-92, s. 7, effective June 19, 2015.
(b) A license shall be suspended or revoked only after compliance with G.S. 58-67-155.
(c) When an HMO license is suspended, the HMO shall not, during the suspension, enroll any additional enrollees except newborn children or other newly acquired dependents of existing enrollees, and shall not engage in any advertising or solicitation.
(d) When an HMO license is revoked, the HMO shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs, and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of the HMO. The HMO shall engage in no advertising or solicitation. The Commissioner may, by written order, permit such further operation of the HMO as the Commissioner may find to be in the best interest of enrollees, to the end that enrollees will be afforded the greatest practical opportunity to obtain continuing health care coverage. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1997-519, s. 1.5; 2003-212, ss. 22, 23, 26(l); 2015-92, s. 7.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-145 - Rehabilitation, liquidation, or conservation of health maintenance organization.

§ 58-67-145. Rehabilitation, liquidation, or conservation of health maintenance organization.
Any rehabilitation, liquidation or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the Commissioner pursuant to the law governing the rehabilitation, liquidation, or conservation of insurance companies, except that the provisions of Article 48 of this Chapter shall not apply to health maintenance organizations. The Commissioner may apply for an order directing him to rehabilitate, liquidate, or conserve a health maintenance organization upon one or more grounds set out in Article 30 of this Chapter or when in his opinion the continued operation of the health maintenance organization would be hazardous either to the enrollees or to the people of this State. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1989, c. 452, s. 2; c. 776, s. 14; 1998-211, s. 5; 2018-120, s. 1.2(a).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-150 - Regulations.

§ 58-67-150. Regulations.
The Commissioner may, after notice and hearing, promulgate reasonable rules and regulations as are necessary or proper to carry out the provisions of this Article. Such rules and regulations shall be subject to review in accordance with G.S. 58-67-155. (1977, c. 580, s. 1; 1979, c. 876, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-155 - Administrative procedures.

§ 58-67-155. Administrative procedures.
(a) When the Commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, he shall notify the health maintenance organization in writing specifically stating the grounds for denial, suspension, or revocation and fixing a time of at least 30 days thereafter for a hearing on the matter.
(b) After such hearing, or upon the failure of the health maintenance organization to appear at such hearing, the Commissioner shall take action as is deemed advisable or written findings which shall be mailed to the health maintenance organization. The action of the Commissioner shall be subject to review by the Superior Court of Wake County. The court may, in disposing of the issue before it, modify, affirm, or reverse the order of the Commissioner in whole or in part.
(c) The provisions of Chapter 150B of the General Statutes of this State shall apply to proceedings under this section to the extent that they are not in conflict with subsections (a) and (b). (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1987, c. 827, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-160 - Fees.

§ 58-67-160. Fees.
Every health maintenance organization subject to this Article shall pay to the Commissioner a fee of five hundred dollars ($500.00) for filing an application for a license and an annual license continuation fee of two thousand dollars ($2,000) for each license. The license shall continue in full force and effect, subject to timely payment of the annual license continuation fee in accordance with G.S. 58-6-7 and subject to any other applicable provisions of the insurance laws of this State. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1989 (Reg. Sess., 1990), c. 1069, s. 6; 1995, c. 507, s. 11A(c); 1999-435, s. 6; 2003-212, s. 26(m); 2005-424, s. 1.6; 2009-451, s. 21.10(a).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-165 - Penalties and enforcement.

§ 58-67-165. Penalties and enforcement.
(a) The Commissioner may, in addition to or in lieu of suspending or revoking a license under G.S. 58-67-140, proceed under G.S. 58-2-70, provided that the health maintenance organization has a reasonable time within which to remedy the defect in its operations that gave rise to the procedure under G.S. 58-2-70.
(b) Any person who violates this Article or any other provision of this Chapter that expressly applies to health maintenance organizations shall be guilty of a Class 1 misdemeanor.
(c) (1) If the Commissioner shall for any reason have cause to believe that any violation of this Article or any other provision of this Chapter that expressly applies to health maintenance organizations has occurred or is threatened, the Commissioner may give notice to the health maintenance organization and to the representatives or other persons who appear to be involved in such suspected violation to arrange a conference with the alleged violators or their authorized representatives for the purpose of attempting to ascertain the facts relating to such suspected violation, and, in the event it appears that any violation has occurred or is threatened, to arrive at an adequate and effective means of correcting or preventing such violation.
(2) Proceedings under this subsection shall not be governed by any formal procedural requirements, and may be conducted in such manner as the Commissioner may deem appropriate under the circumstances.
(d) (1) The Commissioner may issue an order directing a health maintenance organization or a representative of a health maintenance organization to cease and desist from engaging in any act or practice in violation of the provisions of this Article or any other provision of this Chapter that expressly applies to health maintenance organizations.
(2) Within 30 days after service of the cease and desist order, the respondent may request a hearing on the question of whether acts or practices have occurred that are in violation of this Article or any other provision of this Chapter that expressly applies to health maintenance organizations. The hearing shall be conducted under Article 3A of Chapter 150B of the General Statutes, and judicial review shall be available as provided by Article 4 of Chapter 150B of the General Statutes.
(e) In the case of any violation of the provisions of this Article or any other provision of this Chapter that expressly applies to health maintenance organizations, if the Commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued under subsection (d) of this section, the Commissioner may institute a proceeding to obtain injunctive relief, or seeking other appropriate relief, in the Superior Court of Wake County. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1985, c. 666, s. 52; 1987, c. 827, s. 1; 1993, c. 539, s. 470; 1994, Ex. Sess., c. 24, s. 14(c); 2001-5, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-170 - Statutory construction and relationship to other laws.

§ 58-67-170. Statutory construction and relationship to other laws.
(a) Except as otherwise provided in this Chapter, provisions of the insurance laws and service corporation laws do not apply to any health maintenance organization licensed under this Article. This subsection does not apply to an insurer or service corporation licensed and regulated under the insurance laws or the service corporation laws of this State except with respect to its health maintenance organization activities authorized and regulated under this Article or any other provision of this Chapter that expressly applies to health maintenance organizations.
(b) Solicitation of enrollees by a health maintenance organization granted a license, or its representatives, shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.
(c) Any health maintenance organization authorized under this Article shall not be deemed to be practicing medicine or dentistry and shall be exempt from the provisions of Chapter 90 of the General Statutes relating to the practice of medicine and dentistry; provided, however, that this exemption does not apply to individual providers under contract with or employed by the health maintenance organization. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1985, c. 30; 2001-5, s. 2.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-171 - Other laws applicable to HMOs.

§ 58-67-171. Other laws applicable to HMOs.
The following provisions of this Chapter are applicable to HMOs that are subject to this Article are as follows:
G.S. 58-2-125 Authority over all insurance companies; no exemptions from
license.
G.S. 58-2-150 Oath required for compliance with law.
G.S. 58-2-155 Investigation of charges.
G.S. 58-2-160 Reporting and investigation of insurance and reinsurance fraud and
the financial condition of licensees; immunity from liability.
G.S. 58-2-162 Embezzlement by insurance producers or administrators.
G.S. 58-2-185 Record of business kept by companies and insurance producers;
Commissioner may inspect.
G.S. 58-2-190 Commissioner may require special reports.
G.S. 58-2-195 Commissioner may require records, reports, etc., for agencies,
insurance producers, and others.
G.S. 58-2-200 Books and papers required to be exhibited.
G.S. 58-3-50 Companies must do business in own name; emblems, insignias, etc.
G.S. 58-3-100(c),(e) Insurance company licensing provisions.
G.S. 58-3-115 Twisting with respect to insurance policies; penalties.
G.S. 58-7-21 Credit allowed a domestic ceding insurer.
G.S. 58-7-26 Asset or reduction from liability for reinsurance ceded by a
domestic insurer to an assuming insurer not meeting the
requirements of G.S. 58-7-21.
G.S. 58-7-30 Insolvent ceding insurer.
G.S. 58-7-31 Life and health reinsurance agreements.
G.S. 58-7-46 Notification to Commissioner for president or chief executive
officer changes.
G.S. 58-7-73 Dissolution of insurers.
Part 7 of Article 10 Annual Financial Reporting.
G.S. 58-50-35 Notice of nonpayment of premium required before forfeiture.
G.S. 58-51-15(a)(2)b Accident and health policy provisions.
G.S. 58-51-17 Portability for accident and health insurance.
G.S. 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.
G.S. 58-51-35 Insurers and others to afford coverage to children with an
intellectual or physical disability.
G.S. 58-51-45 Policies to be issued to any person possessing the sickle-cell trait or
hemoglobin C trait.
G.S. 58-62 Life and Health Insurance Guaranty Association.
(1999-244, s. 2; 2005-215, s. 20; 2009-382, s. 7; 2009-384, s. 4; 2018-47, s. 7(f); 2018-120, s. 1.2(b); 2022-46, ss. 4, 14(gggg).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-175 - Filings and reports as public documents.

§ 58-67-175. Filings and reports as public documents.
All applications, filings and reports required under this Article shall be treated as public documents. (1977, c. 580, s. 1; 1979, c. 876, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-180 - Confidentiality of medical information.

§ 58-67-180. Confidentiality of medical information.
Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of this Article; or upon the express consent of the enrollee or applicant; or pursuant to statute; or pursuant to court order for the production of evidence or the discovery thereof; or in the event of claim or litigation between such person and the health maintenance organization wherein such data or information is pertinent. A health maintenance organization shall be entitled to claim any statutory privileges against such disclosure which the provider who furnished such information to the health maintenance organization is entitled to claim. (1977, c. 580, s. 1; 1979, c. 876, s. 1; 1999-272, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 67 - Health Maintenance Organization Act. › § 58-67-185 - Severability.

§ 58-67-185. Severability.
If any section, term, or provision of this Article shall be adjudged invalid for any reason, such judgments shall not affect, impair, or invalidate any other section, term, or provision of this Article, but the remaining sections, terms, and provisions shall be and remain in full force and effect. (1977, c. 580, s. 1; 1979, c. 876, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 68 - Health Insurance Portability and Accountability. › § 58-68-35 - Prohibiting discrimination against individual participants and beneficiaries based on health status.

§ 58-68-35. Prohibiting discrimination against individual participants and beneficiaries based on health status.
(a) In Eligibility To Enroll. –
(1) In general. – Subject to subdivision (2) of this subsection, a group health insurer shall not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of the health insurer's plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
a. Health status.
b. Medical condition (including both physical and mental illnesses).
c. Claims experience.
d. Receipt of health care.
e. Medical history.
f. Genetic information.
g. Evidence of insurability (including conditions arising out of acts of domestic violence).
h. Disability.
(2) No application to benefits or exclusions. – To the extent consistent with G.S. 58-68-30, subdivision (1) of this subsection shall not be construed:
a. To require a group health insurance plan to provide particular benefits other than those provided under the terms of the plan, or
b. 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.
(3) Construction. – For the purposes of subdivision (1) of this subsection, rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for the enrollment.
(b) In Premium Contributions. –
(1) In general. – A group health insurance plan shall not require any individual (as a condition of enrollment or continued enrollment under 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 under the plan as a dependent of individual.
(2) Construction. – Nothing in subdivision (1) of this subsection shall be construed:
a. To restrict the amount that an employer may be charged for coverage under a group health insurance plan; or
b. To prevent a group health insurer from establishing premium discounts or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention. (1997-259, s. 1(c).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 68 - Health Insurance Portability and Accountability. › § 58-68-50 - Disclosure of information.

§ 58-68-50. Disclosure of information.
(a) Disclosure of Information by Health Insurers. – In connection with the offering of any health insurance coverage to a small employer, a health insurer:
(1) Shall make a reasonable disclosure to the employer, as part of its solicitation and sales materials, of the availability of information described in subsection (b) of this section, and
(2) Shall upon request of the small employer, provide the information.
(b) Information Described. –
(1) In general. – Subject to subdivision (3) of this subsection, with respect to a health insurer offering health insurance coverage to a small employer, information described in this subsection is information concerning:
a. The provisions of the coverage concerning the health insurer's right to change premium rates and the factors that may affect changes in premium rates;
b. The provisions of the coverage relating to renewability of coverage;
c. The provisions of the coverage relating to any preexisting condition exclusion; and
d. The benefits and premiums available under all health insurance coverage for which the employer is qualified.
(2) Form of information. – Information under this subsection shall be provided to small employers in a manner determined to be understandable by the average small employer, and shall be sufficient to reasonably inform small employers of their rights and obligations under the health insurance coverage.
(3) Exception. – A health insurer is not required under this section to disclose any information that is proprietary and trade secret information under applicable law. (1997-259, s. 1(c).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 68 - Health Insurance Portability and Accountability. › § 58-68-55 - Exclusion of certain plans.

§ 58-68-55. Exclusion of certain plans.
(a) Exception for Certain Benefits. – The requirements of Subparts 1 and 2 of this Part do not apply to any group health insurance coverage in relation to its provision of excepted benefits described in G.S. 58-68-25(b)(1).
(b) Exception for Certain Benefits if Certain Conditions Met. –
(1) Limited, excepted benefits. – The requirements of Subparts 1 and 2 of this Part do not apply to any group health insurance plan in relation to its provision of excepted benefits described in G.S. 58-68-25(b)(2) if the benefits:
a. Are provided under a separate policy, certificate, or contract of insurance; or
b. Are otherwise not an integral part of the plan.
(2) Noncoordinated, excepted benefits. – The requirements of Subparts 1 and 2 of this Part do not apply to any group health insurance plan in relation to its provision of excepted benefits described in G.S. 58-68-25(b)(3) if all of the following conditions are met:
a. The benefits are provided under a separate policy, certificate, or contract of insurance.
b. There is no coordination between the provision of the benefits and any exclusion of benefits under any group health insurance plan maintained by the same policyholder.
c. The benefits are paid with respect to an event without regard to whether benefits are provided with respect to that event under any group health insurance plan maintained by the same policyholder.
(3) Supplemental, excepted benefits. – The requirements of this Part do not apply to any group health insurance plan in relation to its provision of excepted benefits described in G.S. 58-68-25(b)(4) if the benefits are provided under a separate policy, certificate, or contract of insurance. (1997-259, s. 1(c).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 68 - Health Insurance Portability and Accountability. › § 58-68-70 - Certification of coverage.

§ 58-68-70. Certification of coverage.
G.S. 58-68-30(e) applies to health insurance coverage offered by a health insurer in the individual market in the same manner that it applies to health insurance coverage offered by a health insurer in the small or large group market. (1997-259, s. 1(c).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 68 - Health Insurance Portability and Accountability. › § 58-68-75 - General exceptions.

§ 58-68-75. General exceptions.
(a) Exception for Certain Benefits. - This Part does not apply to any health insurance coverage in relation to its provision of excepted benefits described in G.S. 58-68-25(b)(1).
(b) Exception for Certain Benefits if Certain Conditions Met. - This Part does not apply to any health insurance coverage in relation to its provision of excepted benefits described in G.S. 58-68-25(b)(2), (3), or (4) if the benefits are provided under a separate policy, certificate, or contract of insurance. (1997-259, s. 1(c).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 69 - Motor Clubs and Associations. › § 58-69-2 - Definitions.

§ 58-69-2. Definitions.
As used in this Article:
(1) "Branch or district office" means any physical location, other than a motor club's home office, that is used by the motor club or its representatives as a principal place of business for conducting any type of business authorized under this Article and as a place of business that is used by clients or prospective clients in meeting or dealing with the motor club or its representatives in the normal course of business authorized under this Article.
(2) "Licensee" means a motor club to which a license has been issued under this Article.
(3) "Motor club" means any person, whether or not residing, domiciled, or chartered in this State, that, in consideration of dues, assessments, or periodic payments of money, promises its members to assist them in matters relating to the ownership, operation, use, or maintenance of motor vehicles by rendering three or more of the following services:
a. Automobile theft reward service. – A reward payable to any person, law enforcement agency, or officer for information leading to the recovery of a member's stolen vehicle and to the apprehension and conviction of the person or persons unlawfully taking the vehicle.
b. Bail or cash appearance bond service. – The furnishing of cash or a surety bond for a member accused of a violation of the motor vehicle law, or of any law of this State by reason of an automobile accident to secure the member's release and subsequent appearance in court.
c. Emergency road service. – Roadside adjustment of a motor vehicle so that the vehicle may be operated under its own power.
d. Legal service. – Providing for reimbursement to a member for attorneys' fees if criminal proceedings are instituted against the member as a result of the operation of a motor vehicle.
e. Map service. – The furnishing of road maps to members without cost.
f. Personal travel and accident insurance service. – Making available to members a personal travel and accident insurance policy issued by a duly licensed insurance company in this State.
g. Touring service. – The furnishing of touring information to members without cost.
h. Towing service. – Furnishing means to move a motor vehicle from one place to another under power other than its own. (1963, c. 698; 1983, c. 542; 1985, c. 666, s. 81; 1991, c. 401, s. 1; 1999-132, s. 12.2; 2000-122, s. 7.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 69 - Motor Clubs and Associations. › § 58-69-5 - License required.

§ 58-69-5. License required.
No motor club, district or branch office of a motor club, or franchise motor club shall engage in business in this State unless it holds a valid license issued to it by the Commissioner as provided in this Article. The license shall at all times be prominently displayed in each office of the entity to which the license is issued. (1963, c. 698; 1991, c. 644, s. 15.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 69 - Motor Clubs and Associations. › § 58-69-10 - Applications for licenses; fees; bonds or deposits.

§ 58-69-10. Applications for licenses; fees; bonds or deposits.
Licenses hereunder shall be obtained by filing a written application with the Commissioner in such form and manner as the Commissioner shall require. As a prerequisite to issuance of a license:
(1) The applicant shall furnish to the Commissioner such data and information as the Commissioner may deem reasonably necessary to enable him to determine, in accordance with the provisions of G.S. 58-69-15, whether or not a license should be issued to the applicant.
(1a) If the applicant has never been issued a motor club license it shall be required to submit an audited financial statement. If the applicant has previously been licensed the Commissioner may require that the financial statement be audited if it is reasonably necessary to determine whether or not a license should be issued to the applicant.
(2) If the applicant is a motor club it shall be required to pay to the Commissioner a nonrefundable annual license fee of six hundred dollars ($600.00) and to deposit or file with the Commissioner a bond, in favor of the State of North Carolina and executed by a surety company duly authorized to transact business in this State, in the amount of fifty thousand dollars ($50,000), or securities of the type hereinafter specified in the amount of fifty thousand dollars ($50,000), pledged to or made payable to the State of North Carolina and conditioned upon the full compliance by the applicant with the provisions of this Article and the regulations and orders issued by the Commissioner pursuant thereto, and upon the good faith performance by the applicant of its contracts for motor club services.
(3) If the applicant is a branch or district office of a motor club licensed under this Article it shall pay to the Commissioner a nonrefundable license fee of one hundred dollars ($100.00).
(4) If the applicant is a franchise motor club it shall pay to the Commissioner a nonrefundable annual license fee of two hundred dollars ($200.00) and shall deposit or file with the Commissioner a bond, in favor of the State of North Carolina and executed by a surety company duly authorized to transact business in this State, in the amount of fifty thousand dollars ($50,000), or securities of the type hereinafter specified in the amount of fifty thousand dollars ($50,000), pledged to or made payable to the State of North Carolina and conditioned upon the full compliance by the applicant with the provisions of this Article and the regulations and orders issued by the Commissioner pursuant thereto and upon the good faith performance by the applicant of its contracts for motor club services.
(5) Any applicant depositing securities under this section shall do so in the form and manner as prescribed in Article 5 of this Chapter, and the provisions of Article 5 of this Chapter, shall be applicable to securities pledged under this Article. (1963, c. 698; 1983, c. 790, ss. 7-9; 1991, c. 425, s. 1; c. 721, s. 2; 2009-451, s. 21.6(a).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 69 - Motor Clubs and Associations. › § 58-69-15 - Issuance or refusal of license; notice of hearing on refusal; renewal.

§ 58-69-15. Issuance or refusal of license; notice of hearing on refusal; renewal.
Within 60 days after an application for license is filed, the Commissioner shall issue a license to the applicant unless he shall find:
(1) That the applicant has not met all of the requirements of this Article, or
(2) That the applicant does not have sufficient financial responsibility to engage in business as a motor club in this State, or
(3) That the applicant has failed to make a reasonable showing that its managers, officers, directors and agents are persons of reliability and integrity. If any such finding is made, the Commissioner shall notify the applicant as soon as practicable of the reason for his refusal to issue the license, and inform the applicant of its right to a hearing on the matters as provided in G.S. 58-69-25. All licenses issued hereunder, and all renewals thereof, shall expire on June 30 following such issuance or renewal. Renewal of all licenses not previously revoked or suspended shall be automatic upon timely payment by the licensee of the annual fee. (1963, c. 698.)