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2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-1.1 - Definitions applicable to this Article.

§ 58-65-1.1. Definitions applicable to this Article.
The following definitions apply in this Article:
(1) Dental service plan. – A contract for the provision of, or the payment of fees for, dental care or dental services, including any other professional services authorized or permitted to be provided by a duly licensed dentist.
(2) Full-service corporation. – Any corporation organized under the provisions of this Article that offers a medical service plan or a health care service plan.
(3) Health care service plan. – Any contract for the provision of, or the payment of fees for, hospital care, laboratory facilities, X-ray facilities, drugs, health care appliances, anesthesia, nursing care, operating and obstetrical equipment, or health care accommodations, including any other services permitted to be provided by a hospital under the laws of this State and approved by the North Carolina Hospital Association or the American Medical Association.
(4) Hospital service corporation. – Any nonprofit corporation that operates one or any combination of the following:
a. Dental service plan.
b. Health care service plan.
c. Medical service plan.
d. Vision service plan.
(5) Medical service plan. – Any contract for the furnishing of, or the payment of fees for, any of the following:
a. Medical, obstetrical, surgical, or any other professional services authorized or permitted to be provided by a duly licensed physician or other provider listed in G.S. 58-50-30.
b. Professional medical services authorized or permitted to be provided by a health care provider licensed under Chapter 90 of the General Statutes.
(6) Preferred provider. – A health care provider who has agreed to accept, from a corporation organized for the purposes authorized by this Article, special reimbursement terms in exchange for providing services to beneficiaries of a plan administered pursuant to this Article.
(7) Single-service corporation. – Any corporation organized under the provisions of this Article that offers any of the following:
a. Only a dental service plan.
b. Only a vision service plan.
c. Both a dental service plan and a vision service plan, but no other plans.
(8) Vision service plan. – Any contract for the provision of, or the payment of fees for, vision care or vision services, including any other professional services permitted to be provided by a duly licensed optometrist or ophthalmologist. (2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-2 - Other laws applicable to all service corporations.

§ 58-65-2. Other laws applicable to all service corporations.
The following provisions of this Chapter are applicable to hospital service corporations that are subject to this Article:
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. 58-7-46. Notification to Commissioner for president or chief
executive officer changes.
Part 7 of Article 10. Annual Financial Reporting.
G.S. 58-50-35. Notice of nonpayment of premium required before
forfeiture.
G.S. 58-50-290. Health benefit plans or insurers contracting for the provision
of dental services; no limitation on fees for noncovered
services.
G.S. 58-50-300. Health benefit plans or insurers contracting for the provision
of vision services or materials; no limitation on fees for
noncovered services or materials.
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. 58-51-95(h), (i), (j). Approval by Commissioner of forms, classification and
rates; hearings; exceptions. (1999-244, s. 1; 2005-215, s. 17; 2005-412, s. 3; 2009-382, s. 6; 2009-384, s. 3; 2010-138, s. 2; 2018-47, s. 7(d); 2021-169, s. 1; 2022-46, s. 14(cccc).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-5 - Contract for joint assumption or underwriting of risks.

§ 58-65-5. Contract for joint assumption or underwriting of risks.
Any hospital service corporation organized or regulated by the provisions of this Article and Article 66 of this Chapter is authorized to enter into contracts with any other firm or corporation for joint assumption or underwriting of any part, or all, of any risks undertaken upon terms and conditions that are approved by the Commissioner of Insurance. (1955, c. 894, s. 1; 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-10 - Premium or dues paid.

§ 58-65-10. Premium or dues paid.
(a) Any premium or dues charged by a corporation regulated under the provisions of this Article and Article 66 of this Chapter may be paid by the employer, employee, principal, or agent. The term "employer" as used in this section includes counties, municipal corporations, and all departments or subdivisions of the State, county, municipal corporation, and official boards including city and county boards of alcoholic control, together with all others occupying the status of employer and employee, principal and agent.
(b) Any premium or dues charged by a corporation regulated under the provisions of this Article and Article 66 of this Chapter may be paid jointly and severally. (1955, c. 894, s. 2; 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-15 - Incorporation.

§ 58-65-15. Incorporation.
Any number of persons not less than seven, desiring to form a nonprofit hospital service corporation, shall incorporate under the provisions of the general laws of the State of North Carolina governing corporations, but subject to the following provisions:
(1) The certificate of incorporation of each such corporation shall have endorsed thereon or attached thereto, the consent of the Commissioner of Insurance, if he shall find the same to be in accordance with the provisions of this Article and Article 66 of this Chapter.
(2) A statement of the services to be rendered by the corporation and the rates currently to be charged therefor which said statement shall be accompanied by two copies of each contract for services which the corporation proposes to make with its subscribers, and two copies of the type of contract which said corporation proposes to make with participating hospitals, shall have been furnished the Commissioner of Insurance; provided, however, that if the articles of incorporation of any such corporation within the meaning of this Article and Article 66 of this Chapter shall have been filed with the Secretary of State prior to March 15, 1941, the approval thereof by the Commissioner of Insurance shall be evidenced by a separate instrument in writing filed with the Secretary of State. (1941, c. 338, s. 2.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-20 - Members of governing boards.

§ 58-65-20. Members of governing boards.
(a) For the purpose of this section the words "board of directors" includes the board of directors, trustees, or other governing board.
(b) The board of directors of each hospital service corporation subject to the provisions of this Article shall include persons who are representative of its subscribers and the general public. Less than one half of the directors of any such corporation shall be persons who are licensed to practice medicine in this State or who are paid directors or employees of a corporation organized for hospital purposes. (1979, c. 538, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-25 - Hospital, physician, dentist, and optometrist contracts.

§ 58-65-25. Hospital, physician, dentist, and optometrist contracts.
(a) Any full-service corporation organized under this Article may enter into contracts for the rendering of hospital service to any of its subscribers by hospitals approved by the American Medical Association or the North Carolina Hospital Association.
(a1) Any hospital service corporation may enter into contracts for the provision of, or the payment in whole or in part for, medical, dental, or vision services rendered to any of its subscribers by duly licensed physicians, dentists, or optometrists in accordance with this Article.
(a2) All obligations arising under contracts issued by a hospital service corporation to its subscribers shall be satisfied by payments made (i) directly to the hospitals or physicians, dentists, or optometrists rendering the service, or (ii) directly to the subscriber or the subscriber's legal representatives upon the receipt by the corporation from the subscriber of a statement marked paid by the hospitals, physicians, dentists, or optometrists rendering the applicable service. Nothing in this section shall be construed to discriminate against hospitals conducted by other schools of medical practice.
(b) All certificates, plans or contracts issued to subscribers or other persons by hospital service corporations operating under this Article shall contain in substance a provision as follows: "After two years from the date of issue of this certificate, contract or plan no misstatements, except fraudulent misstatements made by the applicant in the application for such certificate, contract or plan, shall be used to void said certificate, contract or plan, or to deny a claim for loss incurred or disability (as therein defined) commencing after the expiration of such two-year period." (1941, c. 338, s. 3; 1943, c. 537, s. 2; 1947, c. 820, s. 1; 1955, c. 850, s. 7; 1961, c. 1149; 1979, c. 755, s. 17; 1997-259, s. 16; 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-30 - Dentists' services.

§ 58-65-30. Dentists' services.
Any corporation organized under the provisions of this Article and Article 66 of this Chapter may, in addition to its authority to contract under G.S. 58-65-25, enter into contracts to pay duly licensed dentists for treatment of fractures and dislocations of the jaw, and cutting procedures in the oral cavity other than extractions, repairs and care of the teeth and gums. (1957, c. 987.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-35 - Nurses' services.

§ 58-65-35. Nurses' services.
No agency, institution or physician providing a service for which payment or reimbursement is required to be made under a contract governed by this Article and Article 66 of this Chapter shall be denied such payment or reimbursement on account of the fact that the service was rendered through a registered nurse acting under authority of rules and regulations adopted by the North Carolina Medical Board and the Board of Nursing pursuant to G.S. 90-6 and 90-171.23. (1973, c. 436; 1991, c. 720, s. 37; 1993, c. 347, s. 4; 1995, c. 94, s. 4; 1997-197, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-36 - Physician services provided by physician assistants.

§ 58-65-36. Physician services provided by physician assistants.
No agency, institution, or physician providing a service for which payment or reimbursement is required to be made under a contract governed by this Article or Article 66 of this Chapter shall be denied the payment or reimbursement on account of the fact that the service was rendered through a physician assistant acting under authority of rules adopted by the North Carolina Medical Board pursuant to G.S. 90-18.1. (1999-210, s. 4.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-40 - Supervision of Commissioner of Insurance; form of contract with subscribers; schedule of rates.

§ 58-65-40. Supervision of Commissioner of Insurance; form of contract with subscribers; schedule of rates.
No hospital service corporation shall enter into any contract with subscribers unless and until it shall have filed with the Commissioner of Insurance a specimen copy of the contract or certificate and of all applications, riders, and endorsements for use in connection with the issuance or renewal thereof to be formally approved by him as conforming to the section of this Article entitled "Subscribers' contracts," and conforms to all rules and regulations promulgated by the Commissioner of Insurance under the provisions of this Article and Article 66 of this Chapter. The Commissioner of Insurance shall, within a reasonable time after the filing of any such form, notify the corporation filing the same either of his approval or of his disapproval of such form.
No corporation subject to the provisions of this Article and Article 66 of this Chapter shall enter into any contract with a subscriber after the enactment hereof unless and until it shall have filed with the Commissioner of Insurance a full schedule of rates to be paid by the subscribers to such contracts and shall have obtained the Commissioner's approval thereof. The Commissioner may refuse approval if he finds that such rates are excessive, inadequate, or unfairly discriminatory; or do not exhibit a reasonable relationship to the benefits provided by such contracts. At all times such rates and form of subscribers' contracts shall be subject to modification and approval of the Commissioner of Insurance under rules and regulations adopted by the Commissioner, in conformity to this Article and Article 66 of this Chapter. (1941, c. 338, s. 4; 1989, c. 485, s. 57.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-50 - Application for certificate of authority or license.

§ 58-65-50. Application for certificate of authority or license.
No corporation subject to the provisions of this Article and Article 66 of this Chapter shall issue contracts for the rendering of dental, health care, medical, or vision service to subscribers, until the Commissioner of Insurance has, by formal certificate or license, authorized it to do so. Application for a certificate of authority or license shall be made on forms to be supplied by the Commissioner of Insurance and containing any information required by the Commissioner. Each application for a certificate of authority or license shall include duplicate copies of the following documents duly certified by at least two of the executive officers of the corporation:
(1) Certificate of incorporation, including any amendments.
(2) Bylaws, including any amendments.
(3) Each contract executed or proposed to be executed by and between the corporation and any participating hospital or physician, dentist, or optometrist under the terms of which dental, health care, medical, or vision service is to be furnished to subscribers to the plan.
(4) Each form of contract, application, rider, and endorsement, issued or proposed to be issued to subscribers to the plan, or in renewal of any of contracts with subscribers to the plan, together with a table of rates charged or proposed to be charged to subscribers for each form of the contract.
(5) Financial statement of the corporation which shall include the amounts of each contribution paid or agreed to be paid to the corporation for working capital, the name or names of each contributor, and the terms of each contribution. (1941, c. 338, s. 5; 1943, c. 537, s. 3; 1961, c. 1149; 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-55 - Issuance and continuation of license.

§ 58-65-55. Issuance and continuation of license.
(a) Every corporation subject to this Article shall pay to the Commissioner a fee of two hundred fifty dollars ($250.00) for filing an application for a license. Fee payment shall be contemporaneous with the filing. Before issuing or continuing any license or certificate under this Article, the Commissioner may make an examination or investigation as the Commissioner deems expedient. The Commissioner shall issue a license upon the payment of a fee of one thousand five hundred dollars ($1,500) for a single-service corporation or two thousand five hundred dollars ($2,500) for a full-service corporation and upon being satisfied on the following points:
(1) The applicant is established as a bona fide nonprofit hospital service corporation as defined by this Article and Article 66 of this Chapter.
(2) The rates charged and benefits to be provided are fair and reasonable.
(3) The amounts provided as working capital of the corporation are repayable only out of earned income in excess of amounts paid and payable for operating expenses and dental, health care, medical, or vision expenses, and the reserve is deemed adequate by the Department.
(4) The amount of money actually available for working capital is sufficient to carry all acquisition costs and operating expenses for a reasonable period of time from the date of the issuance of the certificate.
(b) The license shall continue in full force and effect, subject to payment of an annual license continuation fee of one thousand five hundred dollars ($1,500) for a single-service corporation or two thousand five hundred dollars ($2,500) for a full-service corporation, subject to all other provisions of subsection (a) of this section and subject to any other applicable provisions of the insurance laws of this State. (1941, c. 338, s. 6; 1943, c. 537, s. 4; 1947, c. 820, s. 2; 1961, c. 1149; 1989 (Reg. Sess., 1990), c. 1069, s. 5; 1995, c. 507, s. 11A(c); 1999-435, s. 5; 2003-212, s. 26(j); 2005-424, s. 1.5; 2009-451, s. 21.13(b); 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-65 - Coverage for active medical treatment in tax-supported institutions.

§ 58-65-65. Coverage for active medical treatment in tax-supported institutions.
(a) No dental, health care, medical, or vision service plan, contract, or certificate governed by this Article and Article 66 of this Chapter shall be delivered, issued, executed, or renewed in this State, or approved for issuance or renewal in this State, unless it provides for the payment of benefits for charges made for medical care rendered by duly licensed State tax-supported institutions on a basis no less favorable than the basis that would apply had the medical care been rendered by any other public or private institution or provider. The term "State tax-supported institutions" includes community mental health centers and other health clinics that are certified as Medicaid providers.
(b) No plan, contract, or certificate shall exclude payment for charges of a duly licensed State tax-supported institution because of its being a specialty facility for one particular type of illness nor because it does not have an operating room and related equipment for the performance of surgery, but it is not required that benefits be payable for domiciliary or custodial care, rehabilitation, training, schooling, or occupational therapy.
(c) This section does not apply to any plan, contract, or certificate that is individually underwritten or provided for a specific individual and the members of the individual's family as a nongroup policy. (1975, c. 345, s. 2; 2018-47, s. 7(e); 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-70 - Contracts to cover any person possessing the sickle cell trait or hemoglobin C trait.

§ 58-65-70. Contracts to cover any person possessing the sickle cell trait or hemoglobin C trait.
No hospital service corporation governed by this Article and Article 66 of this Chapter shall do either of the following:
(1) Refuse to issue or deliver any individual or group hospital, dental, medical, vision, or health service contract in this State that provides benefits or coverage for any health care treatment or service authorized or permitted to be provided by a hospital, health care facility, or health care personnel, on account of the fact that the person who is to be insured possesses sickle cell trait or hemoglobin C trait.
(2) Issue and deliver a policy that has a higher premium rate or charge on account of the fact that the person who is to be insured possesses sickle cell trait. (1975, c. 599, s. 2; 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-80 - Meaning of terms "accident", "accidental injury", and "accidental means".

§ 58-65-80. Meaning of terms "accident", "accidental injury", and "accidental means".
(a) This section applies to the provisions of all subscriber contracts under this Article and Article 66 of this Chapter that are issued on or after October 1, 1989, and preferred provider arrangements under this Article and Article 66 of this Chapter that are entered into on or after October 1, 1989.
(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. 11.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-85 - Discriminatory practices prohibited.

§ 58-65-85. Discriminatory practices prohibited.
No person subject to this Article and Article 66 of this Chapter shall refuse to issue or refuse to reissue to an individual any certificate, plan, or contract governed by this Article and Article 66 of this Chapter; limit the amount, extent, or kind of services available to an individual; or charge an individual a different rate for the same services, because of the race, color, or national or ethnic origin of that individual. (1989, c. 485, s. 23.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-90 - No discrimination against mentally ill or chemically dependent individuals.

§ 58-65-90. No discrimination against mentally ill or chemically dependent individuals.
(a) Definitions. – As used in this section, the term:
(1) "Mental illness" has the same meaning as defined in G.S. 122C-3(21), with a mental disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, or subsequent editions published by the American Psychiatric Association, except those mental disorders coded in the DSM-5 or subsequent editions as substance-related disorders (291.0 through 292.9 and 303.0 through 305.9), those coded as autism spectrum disorder (299.00), sexual dysfunctions not due to organic disease (302.70 through 302.79), and those coded as "V" codes.
(2) "Chemical dependency" has the same meaning as defined in G.S. 58-65-75, with a mental disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, or subsequent editions published by the American Psychiatric Association.
(b) Coverage of Physical Illness. – No service corporation governed by this Chapter shall, solely because an individual to be insured has or had a mental illness or chemical dependency:
(1) Refuse to issue or deliver to that individual any individual or group subscriber contract in this State that affords benefits or coverage for medical treatment or service for physical illness or injury;
(2) Have a higher premium rate or charge for physical illness or injury coverages or benefits for that individual; or
(3) Reduce physical illness or injury coverages or benefits for that individual.
(b1) [Expired October 1, 2001.]
(c) Chemical Dependency Coverage Not Required. – Nothing in this section requires a service corporation to offer coverage for chemical dependency, except as provided in G.S. 58-65-75.
(d) Applicability. – This section applies only to group health insurance contracts, other than excepted benefits as defined in G.S. 58-68-25. For purposes of this section, "group health insurance contracts" include MEWAs, as defined in G.S. 58-50A-1.
(e) Nothing in this section requires an insurer to cover treatment or studies leading to or in connection with sex changes or modifications and related care. (1989, c. 369, s. 1; 1991, c. 720, s. 82; 1997-259, s. 22; 1999-132, s. 4.3; 2007-268, s. 3; 2015-271, s. 5; 2019-202, s. 8; 2020-69, s. 3(g).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-91 - Coverage for certain treatment of diabetes.

§ 58-65-91. Coverage for certain treatment of diabetes.
(a) Every insurance certificate or subscriber contract under any hospital service plan or medical service plan governed by this Article and Article 66 of this Chapter, and every preferred provider plan under G.S. 58-50-56 that is issued, renewed, or amended on or after October 1, 1997, shall provide coverage for medically appropriate and necessary services, including diabetes outpatient self-management training and educational services, and equipment, supplies, medications, and laboratory procedures used to treat diabetes. Diabetes outpatient self-management training and educational services shall be provided by a physician or a health care professional designated by the physician. The hospital or medical service plan shall determine who shall provide and be reimbursed for the diabetes outpatient self-management training and educational services. The same deductibles, coinsurance, and other limitations as apply to similar services covered under the policy, contract, or plan shall apply to the diabetes coverage required under this section.
(b) For the purposes of this section, "physician" is a person licensed to practice in this State under Article 1 or Article 7 of Chapter 90 of the General Statutes. (1997-225, s. 2; 1997-519, s. 3.12.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-93 - Coverage for prostate-specific antigen (PSA) tests.

§ 58-65-93. Coverage for prostate-specific antigen (PSA) tests.
(a) Every insurance certificate or subscriber contract under any hospital service plan or medical service plan governed by this Article and Article 66 of this Chapter, and every preferred provider benefit plan under G.S. 58-50-56, that is issued, renewed, or amended on or after January 1, 1994, shall provide coverage for prostate-specific antigen (PSA) tests or equivalent tests for the presence of prostate cancer. The same deductibles, coinsurance, and other limitations as apply to similar services covered under the certificate or contract shall apply to coverage for prostate-specific antigen (PSA) tests or equivalent tests for the presence of prostate cancer.
(b) As used in this section, "prostate-specific antigen (PSA) tests or equivalent tests for the presence of prostate cancer" means serological tests for determining the presence of prostate cytoplasmic protein (PSA) and the generation of antibodies to it, as a novel marker for prostatic disease.
(c) Coverage for prostate-specific antigen (PSA) tests or equivalent tests for the presence of prostate cancer shall be provided when recommended by a physician. (1993, c. 269, s. 2; 1997-519, s. 3.7.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-94 - Coverage of certain prescribed drugs for cancer treatment.

§ 58-65-94. Coverage of certain prescribed drugs for cancer treatment.
(a) No insurance certificate or subscriber contract under any hospital service plan or medical service plan governed by this Article and Article 66 of this Chapter, and no preferred provider benefit plan under G.S. 58-50-56, that is 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. 4.2; 1997-519, s. 3.8; 2009-170, s. 2.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-95 - Investments and reserves.

§ 58-65-95. Investments and reserves.
(a) Corporations subject to this Article shall invest in or hold only those assets permitted by Article 7 of this Chapter for life and health insurance companies.
(b) Every such corporation shall accumulate and maintain, in addition to proper reserves for current administrative liabilities and whatever reserves are deemed to be adequate and proper by the Commissioner for unpaid dental, health care, medical, or vision bills and unearned membership dues, a special contingent surplus or reserve at the following rates annually of its gross annual collections from membership dues, exclusive of receipts from cost plus plans, until the reserve equals an amount that is three times its average monthly expenditures for claims and administrative and selling expenses:
(1) First $200,000 4%
(2) Next $200,000 2%
(3) All above $400,000 1%
(c) Any corporation subject to this Article may accumulate and maintain a contingent reserve in excess of the reserve required in subsection (b) of this section, not to exceed an amount equal to six times the average monthly expenditures for claims and administrative and selling expenses.
(d) If the Commissioner finds that special conditions exist warranting an increase or decrease in the reserves or schedule of reserves in subsection (b) of this section, the Commissioner may modify them accordingly. Provided, however, when special conditions exist warranting an increase in the schedule of reserves, the schedule shall not be increased by the Commissioner until a reasonable length of time has elapsed after the Commissioner gives notice of the increase. (1941, c. 338, s. 8; 1943, c. 537, s. 5; 1947, c. 820, s. 5; 1961, c. 1149; 1991, c. 720, s. 79; 1999-244, s. 6; 2003-212, s. 18; 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-100 - Statements filed with Commissioner.

§ 58-65-100. Statements filed with Commissioner.
Every service corporation subject to this Article is subject to G.S. 58-2-165. (1941, c. 338, s. 9; 1999-244, s. 11.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-105 - Visitations and examinations.

§ 58-65-105. Visitations and examinations.
Service corporations subject to this Article shall be examined under G.S. 58-2-131, 58-2-132, 58-2-133, and 58-2-134. (1941, c. 338, s. 10; 1995, c. 360, s. 2(l); 1999-244, s. 5.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-110 - Expenses.

§ 58-65-110. Expenses.
All acquisition expenses in connection with the solicitation of subscribers to a dental, health care, medical, or vision service plan and administration costs including salaries paid to officers of the corporations, if any, shall at all times be subject to inspection by the Commissioner of Insurance. (1941, c. 338, s. 11; 1943, c. 537, s. 6; 1961, c. 1149; 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-115 - Licensing and regulation of agents.

§ 58-65-115. Licensing and regulation of agents.
Every agent of any service corporation 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. (1941, c. 338, s. 12; 1943, c. 537, s. 7; 1947, c. 1023, s. 1; 1961, c. 1149; 1971, c. 1080, s. 2; 1983, c. 790, s. 5; 1985 (Reg. Sess., 1986), c. 928, s. 4; 1987, c. 629, s. 2; 1999-244, s. 7; 2022-46, s. 14(dddd).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-120 - Dental, health care, medical, and vision service associations and agent to transact business through licensed producers only.

§ 58-65-120. Dental, health care, medical, and vision service associations and agent to transact business through licensed producers only.
No dental, health care, medical, or vision service association, nor any agent of the association, shall on behalf of the association or agent knowingly permit any person not licensed as an insurance producer as required by law, to solicit, negotiate for, collect or transmit a premium for a new contract of dental, health care, medical, or vision service certificate or to act in any way in the negotiation for any contract or policy. No license shall be required of any of the following:
(1) Persons designated by the association or subscriber to collect or deduct or transmit premiums or other charges for dental, health care, medical, or vision contracts, or to perform any acts as may be required for providing coverage for additional persons who are eligible under a master contract.
(2) An agency office employee acting in the confines of the insurance producer's office, under the direction and supervision of the duly licensed insurance producer and within the scope of that insurance producer's license, in the acceptance of request for insurance and payment of premiums, and the performance of clerical, stenographic, and similar office duties. (1955, c. 1268; 1961, c. 1149; 2021-169, s. 1; 2022-46, s. 14(eeee).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-125 - Revocation and suspension of license; unfair trade practices.

§ 58-65-125. Revocation and suspension of license; unfair trade practices.
(a) The Commissioner may revoke or suspend the license of any service corporation if:
(1) The service corporation fails or refuses to comply with any law, order, or rule applicable to the service corporation.
(2) The service corporation's financial condition is unsound.
(3) The service corporation has published or made to the Department or to the public any false statement or report.
(4) The service corporation refuses to submit to any examination authorized by law.
(5) The service corporation is found to make a practice of unduly engaging in litigation or of delaying the investigation of claims or the adjustment or payment of valid claims.
(b) Any suspension or revocation of a service corporation's license under this section may also be made applicable to the license or registration of any natural person regulated under this Chapter who is a party to any of the causes for licensing sanctions listed in subsection (a) of this section.
(c) Article 63 of this Chapter applies to service corporations and their agents and representatives. (1941, c. 338, s. 13; 1943, c. 537, s. 8; 1971, c. 1080, s. 3; 1999-244, s. 3; 1999-351, s. 8; 2003-212, s. 26(k).)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-135 - Cost plus plans.

§ 58-65-135. Cost plus plans.
(a) Any corporation organized under the provisions of this Article and Article 66 of this Chapter shall be authorized as agent of any other corporation, firm, group, partnership, or association, or any subsidiary or subsidiaries thereof, municipal corporation, State, federal government, or any agency thereof, to administer on behalf of such corporation, firm, group, partnership, or association, or any subsidiary or subsidiaries thereof, municipal corporation, State, federal government, or any agency thereof, any group dental, health care, medical, or vision service plan, promulgated by the corporation, firm, group, partnership, or association, or any subsidiary or subsidiaries thereof, municipal corporation, State, federal government, or any agency thereof, on a cost plus administrative expense basis, only if all of the following apply:
(1) The other corporation, firm, group, partnership, or association, or any subsidiary or subsidiaries thereof, municipal corporation, State, federal government, or any agency thereof shall have had an active existence for at least one year preceding the establishment of the plan, and was formed for purposes other than procuring the group dental, health care, medical, or vision service coverage in a cost plus administrative expense basis.
(2) Administrative costs of the cost plus plan administered by a corporation organized under the provisions of this Article and Article 66 of this Chapter, acting as an agent as provided by this section, shall not exceed the remuneration received.
(3) The corporation organized under this Article and Article 66 of this Chapter administering the cost plus plan shall have no liability to the subscribers or to the hospitals or health care providers for the success or failure, liquidation or dissolution of the group dental, health care, medical, or vision service plan.
(b) Nothing in this section shall be construed to require that a corporation, firm, group, partnership, or association, or any subsidiary or subsidiaries thereof, municipal corporation, State, federal government, or any agency thereof, conform to the provisions of this Article and Article 66 of this Chapter if a group hospitalization service plan is administered by a corporation organized under this Article and Article 66 of this Chapter, on a cost plus expense basis.
(c) The administration of any cost plus plans as provided for by this section shall not be subject to regulation or supervision by the Commissioner of Insurance. (1941, c. 338, s. 16; 1943, c. 537, s. 9; 1947, c. 820, s. 7; 1961, c. 1149; 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-145 - Preexisting hospital service corporations.

§ 58-65-145. Preexisting hospital service corporations.
No corporations organized under the laws of this State prior to the ratification of this Article and Article 66 of this Chapter, for the purposes herein provided, shall be required to reincorporate as provided for herein, and the provisions of this Article and Article 66 of this Chapter shall apply to said corporations only with regard to operations by said corporations with respect to subscribers' contracts, participating hospital contracts, reserves, investments, reports, visitations, expenses, taxation, amendments to charters, supervision of Commissioner of Insurance, application for certificate, issuance of certificates, licensing of agents after the date of the passage of this Article and Article 66 of this Chapter, provided, however, as soon as practical hereafter and in accordance with rules and regulations adopted by the Commissioner of Insurance said corporations shall conform to this Article and Article 66 of this Chapter as near as practical with respect to subscribers' contracts, endorsements, riders, and applications entered into prior to the ratification of this Article and Article 66 of this Chapter. (1941, c. 338, s. 17.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-150 - Construction of Chapter as to single employer plans; associations exempt.

§ 58-65-150. Construction of Chapter as to single employer plans; associations exempt.
(a) Nothing in this Article and Article 66 of this Chapter shall be construed to affect or apply to dental, health care, medical, or vision service plans which limit their membership to employees and the immediate members of the families of the employees of a single employer or his or its subsidiary or subsidiaries and which plans are operated by such employer of such limited group of the employees.
(b) Nothing in this Article and Article 66 of this Chapter [shall] be construed to affect or apply to any nonstock, nonprofit medical service association which was, on January 1, 1943, organized solely for the purpose of, and actually engaged in, the administration of any medical service plan in this State upon contracts and participating agreements with physicians, surgeons, or medical societies that underwrite the medical service plan by contributing their services to members of the association upon agreement with the association as to the schedule of fees to apply and the rate and method of payment by the association from the common fund paid in periodically by the members for medical, surgical and obstetrical care.
(c) All service plans described in subsection (a) of this section and all medical service associations described in subsection (b) of this section are exempt from the provisions of this Article and Article 66 of this Chapter.
(d) The Commissioner of Insurance may require from any full-service or single-service plan or medical service association any information necessary to enable the Commissioner to determine whether the service plan or medical service association is exempt from the provisions of this Article and Article 66 of this Chapter. (1941, c. 338, s. 18; 1943, c. 537, s. 10; 1947, c. 140; 1961, c. 1149; 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-165 - Commissioner of Insurance determines corporations exempt from this Article and Article 66 of this Chapter.

§ 58-65-165. Commissioner of Insurance determines corporations exempt from this Article and Article 66 of this Chapter.
The Commissioner of Insurance may require from any corporation writing dental, health care, medical, or vision service contracts or any or all of them, any information that will enable the Commissioner to determine whether the corporation is subject to the provisions of this Article and Article 66 of this Chapter. (1947, c. 820, s. 9; 1961, c. 1149; 2021-169, s. 1.)
2023 North Carolina General Statutes › Chapter 58 - Insurance › Article 65 - Hospital Service Corporations. › § 58-65-166 - Policy statement and definitions.

§ 58-65-166. Policy statement and definitions.
(a) It is the public policy of this State to enable corporations organized under this Chapter to attract and maintain responsible, qualified directors, officers, employees, and agents, and, to that end, to permit corporations organized under this Chapter to allocate the risk of personal liability of directors, officers, employees, and agents through indemnification and insurance as authorized in this Part.
(b) Definitions in this Part:
(1) "Corporation" includes any not for profit domestic hospital service corporation, or successor of a corporation in a merger or other transaction in which the predecessor's existence ceased upon consummation of the transaction.
(2) "Director" or "Trustee" means an individual who is or was a director of a corporation or an individual who, while a director of a corporation, is or was serving at the corporation's request as a director, officer, partner, trustee, employee, or agent of another foreign or domestic corporation, partnership, joint venture, trust, employee benefit plan, or other enterprise. A director is considered to be serving an employee benefit plan at the corporation's request if his duties to the corporation also impose duties on, or otherwise involve services by, him to the plan or to participants in or beneficiaries of the plan. "Director" or "Trustee" includes, unless the context requires otherwise, the estate or personal representative of a director or trustee.
(3) "Expenses" means expenses of every kind incurred in defending a proceeding, including counsel fees.
(4) "Liability" means the obligation to pay a judgment, settlement, penalty, fine (including an excise tax assessed with respect to an employee benefit plan), or reasonable expenses incurred with respect to a proceeding.
(5) "Official capacity" means: (i) when used with respect to a director or trustee, the office of director or trustee in a corporation; and (ii) when used with respect to an individual other than a director or trustee, as contemplated in G.S. 58-65-172, the office in a corporation held by the officer or the employment or agency relationship undertaken by the employee or agent on behalf of the corporation. "Official capacity" does not include service for any other foreign or domestic corporation or any partnership, joint venture, trust, employee benefit plan, or other enterprise.
(6) "Party" includes an individual who was, is, or is threatened to be made a named defendant or respondent in a proceeding.
(7) "Proceeding" means any threatened, pending, or completed action, suit, or proceeding, whether civil, criminal, administrative, or investigative and whether formal or informal.
(8) "Trustee". Whenever the term "director" or "directors" is used herein it shall include the term "trustee", or a person who is designated as a "trustee" under a corporation governed by this Article. (1989 (Reg. Sess., 1990), c. 1071, s. 1; 2021-169, s. 2.)