Primary Sponsors: Rep. Mitchell Setzer (R-Cawtawba), Rep. Dana Bumgardner (R-Gaston), Rep. Kevin Corbin (R-Cherokee)

Current Bill Summary

Part IX – Prepaid Health Plan Licensing Act

This bill makes technical changes to statutes relating to prepaid health plans.

This bill would require the Insurance Commissioner to notify the Department of Health and Human Services (DHHS) before conducting an examination of a prepaid health plan and provide the results of any examination.

The bill requires the Insurance Commissioner to give notice to DHHS before seeking an application to rehabilitate or liquidate a prepaid health plan.

The bill requires the Insurance Commissioner to provide DHHS a copy of the written notice given to a prepaid health plan stating the grounds of denial, suspension, or revocation of a license.

Part XI Medicare Supplement Changes

The bill requires insurers to make Medicare Supplement A coverage available to disabled individuals over the age of 65. Insurers would also make Medicare Standardized Plan D and G available to individuals age 65 or over.

Part XII Exclusive Provider Benefit Plans

The bill defines continuity of care decisions.

The bill provides a process for continued care of the insured under Exclusive Provider Benefit Plans if the insured is undergoing treatment for an ongoing special condition from a provider, and the contract between the provider and the insurer expires or is terminated. The insured would be allowed to elect continuation of treatment from the current provider.

The bill provides a transitional period for individuals newly covered under an Exclusive Provider Benefit Plan.

The bill requires insurers to provide a clear description to to the insured’s rights under this section as evidence of coverage and summary plan description.

Bill Summary – Version 1

Section VIII – Provider Benefit Plans

The bill states that a person covered by a preferred provider plan could not receive covered services by a provider who is not in the plan.

The bill redefines the an Exclusive Provider Benefit Plan as a plan where the enrollees receive covered services from in network providers. Emergency services and medically necessary services are excluded from this provision.

The bill outlines a process in which the insurer would be required to inform the enrollee about a change in their provider being in network.

The bill also outlines several transition periods that would be determined by the provider that would be given a 90 consideration period.

Section IX PHP Technical Changes

This bill would allow the Comissioner to charge an application PHP fee of $2,000 and a license continuation fee of $5,000.

The bill states that the Commissioner is required to notify DHHS of any examination to a PHP prior to the examination. It also requires the Commissioner to share the results with DHHS.

Bill Movement

This bill was filed on February 27, 2019.

This bill was referred to the following House Commitees:

  • Insurance – Proposed Committee Substitute passed on April 26, 2019
  • Finance – Withdrawn from April 30, 2019
  • Rules – Passed May 1, 2019

This bill passed the House on May 2, 2019.

This bill was referred to the following Senate Committees:

  • Commerce and Insurance
    • A proposed committee substitute was introduced on this bill on Wednesday, June 26, 2019.
    • This bill passed in the Senate Commerce and Insurance on Thursday, June 27, 2019.
  • Rules
    • Section 12 of this bill was debated during the comitteee.
    • NCMS voiced concern during the public comment period.
    • This bill passed Senate on July 1, 2019 and will now move to the Senate floor.
  • Health
    • This bill was rereferrd to the Senate Health Care Committee.
    • Sen. Perry (R-Leonor) introduced an amendedment to remove Section 12 othe bill.
    • This bill passed on July 2, 2019 and will now go back to Senate Rules for a vote.
    • This bill went back to the Senate Rules Committee and passed on July 8, 2019.

This bill passed in the Senate with a vote of 48-0 on July 9, 2019.

This bill was withdrawn from the House calendar on July 10, 2019. This bill was calendared to be heard in the House on July 17, 2019.

The House concurred with the Senate with a vote of 117-0.

This bill will now be sent to Governor Cooper.