SB 159/HB 177 – State Health Plan Administrative Changes
Primary Senate Sponsors: Sen. Joyce Krawiec (R-Davie, Forsyth); Rep. Jim Burgin (R-Harnett, Johnston, Lee); Rep. Jim Perry (R-Lenoir, Wayne)
Primary House Sponsors: Rep. Donny Lambeth (R-Forsyth); Rep. Allen McNeill (R-Moore, Randolph); Rep. Pat Hurley (R-Randolph)
Summary
This bill would make the following technical and administrative changes to the laws related to the State Health Plan:
- Requires the Board of Trustees to approve Plan contracts in excess of $5M (was previously $500,000).
- Eliminates prohibition against dependent child eligibility for coverage under the Plan if the child is eligible for employer-based health care outside of the Plan, other than a parent’s claim.
- Permits coverage of a dependent disabled child to be extended beyond the child’s 26th birthday if the child was covered by the Plan on the child’s 26th
- Modifies the administrative review process for appealed claims by eliminating participation by the Plan’s Board of Trustees.
- Authorizes the Executive Administrator to make binding decisions on matters determined not to be subject to external review.
- Removes obligation to provide written summaries regarding administrative review decisions to employing units, health benefit representatives, relevant health care providers, or any other parties requesting a written summary.
Movement
SB 159
Filed – 2/25/2021
HB 177
Filed – 2/25/2021