GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2011
SESSION LAW 2012-173
HOUSE BILL 1085
AN ACT to, for the state health plan for teachers and state employees, which covers retirees within the Retirement System, (1) amend the definition of "dependent child" in order to comply with the affordable care act, (2) limit enrollment without a qualifying event to the annual enrollment period, (3) repeal the optional program of long-term care benefits, and (4) make a clarifying change related to coinsurance.
The General Assembly of North Carolina enacts:
SECTION 1. G.S. 135-48.1(9) reads as rewritten:
"(9) Dependent child. - Subject to the eligibility requirements of subsections (a) and (b) of G.S. 135-48.41, any of the following up to the first month following the dependent child's 26th birthday:
a. A natural or legally adopted child or children of the employee, whether or not the child is living with the employee.
b.
A foster child or children of the employee, whether or not the child is living
with the employee, as long as the employee is legally responsible for the
child's maintenance and support.employee.
c.
A child for which an employee is a court-appointed guardian, as long as the
employee is legally responsible for the child's maintenance and support.guardian.
d. A stepchild of a member who is married to the stepchild's natural parent.
e. Repealed by Session Laws 2011-96, s. 3(a), effective July 1, 2011."
SECTION 2.(a) G.S. 135-48.41(g) reads as rewritten:
"(g)
An eligible surviving spouse and any eligible surviving dependent child of a
deceased retiree, teacher, State employee, member of the General Assembly,
former member of the General Assembly, or Disability Income Plan beneficiary
shall be eligible for group benefits under this section without waiting periods
for preexisting conditions provided coverage is elected within 90 days after
the death of the former plan member. Coverage may be elected at a later time, during
an annual enrollment period, but willmembers 19 years of age and
older may be subject to the 12-month waiting period for preexisting
conditions and will be effective the first day of the month following receipt
of the application."
SECTION 2.(b) G.S. 135-48.42 reads as rewritten:
"§ 135-48.42. Enrollment.
(a)
Except as otherwise required by applicable federal law, new employees must be
given the opportunity to enroll or decline enrollment for themselves and their
dependents within 30 days from the date of employment or from first becoming
eligible on a partially contributory basis. Coverage may become effective on
the first day of the month following date of entry on payroll or on the first
day of the following month. New employees age 19 and older not enrolling
themselves and their dependents age 19 and older within 30 days, or not adding
dependents when first eligible as provided herein may enroll on the first
day of any monthduring annual enrollment, but willmay
be subject to a 12-month waiting period for preexisting health conditions,
except for employees who elect to change their coverage in accordance with
rules established by the State Treasurer for optional or alternative plans
available under the Plan. Children born to covered employees having coverage
type (2) or (3), as outlined in G.S. 135-48.43(d) shall be automatically
covered at the time of birth without any waiting period for preexisting health
conditions. Children born to covered employees having coverage type (1) shall be
automatically covered at birth without any waiting period for preexisting
health conditions so long as the claims processor receives notification within
30 days of the date of birth that the employee desires to change from coverage
(1) to coverage type (2) or (3), provided that the employee pays any additional
premium required by the coverage type selected retroactive to the first day of
the month in which the child was born.
(b)
Except as otherwise required by applicable federal law, newly acquired
dependents (spouse/child) age 19 and older enrolled within 30 days of becoming
an eligible dependent will not be subject to the 12-month waiting period for
preexisting conditions. A dependent can become qualifiedfirst
eligible due to marriage, adoption, legal guardianship, entering a
foster child relationship, and at the beginning of each legislative session
(applies only to enrolled legislators). Effective date for newly acquired
dependents if application was made within the 30 days can be the first day of
the following month. Effective date for an adopted child can be date of
adoption, or date of placement in the adoptive parents' home, or the first of
the month following the date of adoption or placement. Firefighters, rescue
squad workers, and members of the National Guard, and their eligible
dependents, are subject to the same terms and conditions as are new employees
and their dependents covered by this subdivision. Enrollments in these
circumstances must occur within 30 days of eligibility to enroll.
(c)
Eligible employees younger than age 19 and dependents younger than age 19 may
be enrolled at any timeduring annual enrollment and shall not be
subject to any waiting period for a preexisting condition.
(d) When an eligible or enrolled member applies to enroll the member's eligible dependent child or spouse, the member shall provide the documentation required by the Plan to verify the dependent's eligibility for coverage.
(e) Eligible employees may only change their elections, including adding or removing dependents, during the Plan year due to a qualifying event as defined under federal law."
SECTION 2.(c) G.S. 135-48.43 reads as rewritten:
"§ 135-48.43. Effective dates of coverage.
(a) Employees and Retired Employees. -
(1) Employees and retired employees covered under the Predecessor Plan will continue to be covered, subject to the terms hereof.
(2) New employees may apply for coverage to be effective on the first day of the month following employment, or on a like date the following month if the employee has enrolled.
(3)
Employees age 19 or older not enrolling or adding dependents age 19 and older
when first eligible in accordance with G.S. 135-48.42 may enroll later on
the first of any following monthduring annual enrollment, but willmay
be subject to a 12-month waiting period for a preexisting health condition,
except employees who elect to change their coverage in accordance with rules
adopted by the State Treasurer for optional alternative plans offered under the
Plan.
…
(b) Waiting Periods and Preexisting Conditions. -
(1) New employees and dependents age 19 and older enrolling when first eligible are subject to no waiting period for preexisting conditions under the Plan.
(2)
Employees age 19 or older not enrolling or not adding dependents age 19 and
older when first eligible may enroll later on the first of any following
month, during annual enrollment, but will enrollees age 19
or older may be subject to a twelve-month waiting period for preexisting
conditions except as provided in subdivision (a)(3) of this section. The
waiting period under this subdivision is subject to applicable federal law.
…
(c) Dependents of Employees and Retired Employees. -
…
(5)
Employees not adding dependents age 19 and older when first eligible may enroll
later on the first of any following month, during annual enrollment, but
dependents will may be subject to a 12-month waiting period for
preexisting health conditions except as provided in subdivision (a)(3) of this
section.
…."
SECTION 3.(a) The title of Article 3B of Chapter 135 of the General Statutes reads as rewritten:
"Article 3B.
State Health Plan for
Teachers and State Employees; Long-term Care Benefits.Employees."
SECTION 3.(b) G.S. 135-48.5(c) is repealed.
SECTION 3.(c) Subdivisions (15) and (16) of G.S. 135-48.30 are repealed.
SECTION 3.(d) Part 6 of Article 3B of Chapter 135 of the General Statutes is repealed.
SECTION 3.(e) An employee, retired employee, or dependent enrolled under long-term care under Part 6 of Article 3B of Chapter 136 of the General Statutes at the time of that Part's repeal shall be entitled to a conversion to a nongroup plan of long-term care benefits. The Executive Administrator and Board of Trustees of the Plan shall determine how those conversion rights shall be administered.
SECTION 3.(f) Any unencumbered administrative fees collected by the Plan under Part 6 of Article 3B of Chapter 135 of the General Statutes are transferred to the Public Employee Health Benefit Fund created under G.S. 135-48.5(a).
SECTION 4.(a) G.S. 135-48.22(2) reads as rewritten:
"(2) Approve premium rates, co-pays, deductibles, and coinsurance percentages and maximums for the Plan, as provided in G.S. 135-48.30(a)(2)."
SECTION 4.(b) G.S. 135-48.30(2) reads as rewritten:
"(2) Set benefits, premium rates, co-pays, deductibles, and coinsurance percentages and maximums, subject to approval by the Board of Trustees. In setting premium rates, the State Treasurer may set a partially contributory rate of zero dollars, subject to approval by the Board of Trustees."
SECTION 5. G.S. 135-48.3 reads as rewritten:
"§ 135-48.3. Right to amend.
The General Assembly reserves the
right to alter, amend, or repeal Parts 2 and 3 of this Article."
SECTION 6. This act becomes effective July 1, 2012, except that Sections 3(a), 3(b), 3(c), 3(d), and 3(f) become effective January 1, 2013.
In the General Assembly read three times and ratified this the 29th day of June, 2012.
s/ Neal Hunt
Presiding Officer of the Senate
s/ Paul Stam
Presiding Officer of the House of Representatives
s/ Beverly E. Perdue
Governor
Approved 4:45 p.m. this 12th day of July, 2012