GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2017
H D
HOUSE BILL DRH20016-MR-37A* (02/08)
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Short Title: State Health Plan Administrative Changes.-AB |
(Public) |
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Sponsors: |
Representatives Dobson, Corbin, Clampitt, and Henson (Primary Sponsors). |
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Referred to: |
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A BILL TO BE ENTITLED
AN ACT to make clarifying and administrative changes to the laws relating to the North Carolina state health plan for teachers and state employees.
The General Assembly of North Carolina enacts:
SECTION 1. G.S. 135‑48.44(a) reads as rewritten:
"§ 135‑48.44. Cessation of coverage.
(a) Coverage under this Plan of an employee and his or her surviving spouse or eligible dependent children or of a retired employee and his or her surviving spouse or eligible dependent children shall cease on the earliest of the following dates:
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(6) The last day of the month in which a covered individual is found to have knowingly and willfully made or caused to be made a false statement or false representation of a material fact regarding eligibility or enrollment information or in a claim for reimbursement of medical services under the Plan. The State Treasurer may make an exception to the provisions of this subdivision when persons subject to this subdivision have had a cessation of coverage for a period of five years and have made a full and complete restitution to the Plan for all fraudulent claim amounts. Nothing in this subdivision shall be construed to obligate the State Treasurer to make an exception as allowed for under this subdivision.
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SECTION 2. G.S. 135‑48.40(c)(2) reads as rewritten:
"(2) Employees and members
of the General Assembly with 10 but less than 20 years of retirement service
credit provided the employees were first hired on or after October 1, 2006, and
the members first took office on or after February 1, 2007. For such future
retirees, the State shall pay fifty percent (50%) of the Plan's total employer
premiums. Individual retirees shall pay the balance of the total premiums not
paid by the State.State unless prohibited by law. The total premium
is the sum of the Plan's total employer premium contribution rate plus the
employee or retiree's contribution for individual and dependent coverage."
SECTION 3.(a) G.S. 135‑48.42(a) reads as rewritten:
"(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 or other 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 during annual enrollment, but
may 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 Plan
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 birth and 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."
SECTION 3.(b) This section becomes effective October 1, 2017, and applies to children born to covered employees on or after that date.
SECTION 4. G.S. 135‑48.5(a) reads as rewritten:
"(a) There are hereby established two health benefit trust funds, to be known as the Public Employee Health Benefit Fund and the Health Benefit Reserve Fund for the payment of hospital and medical benefits. As used in this section, the term "health benefit trust funds" refers to the fund type described under G.S. 143C‑1‑3(a)(10).
All premiums, fees, charges, rebates, refunds or any other receipts including, but not limited to, earnings on investments, occurring or arising in connection with health benefits programs established by this Article, shall be deposited into the Public Employee Health Benefit Fund. Disbursements from the Fund shall include any and all amounts required to pay the benefits and administrative costs of such programs as may be determined by the Executive Administrator and Board of Trustees.
Any unencumbered balance in excess
of prepaid premiums or charges in the Public Employee Health Benefit Fund at
the end of each fiscal year shall be used first, in the following
order:
(1) First, to provide an actuarially determined
Health Benefit Reserve Fund for incurred but unpresented claims, second, claims.
(2) Second, up to fifty percent (50%) of any unencumbered balance remaining after providing for incurred but unpresented claims may be set aside by the State Treasurer, subject to approval by the Board of Trustees, to reduce the State's unfunded actuarial accrued liability for post‑employment retiree health benefits.
(3) Third, to reduce the premiums required in
providing the benefits of the health benefits programs, and third programs.
(4) Fourth, to improve the plan, as may be
provided by the General Assembly.State Treasurer, subject to approval
by the Board of Trustees.
The balance in the Health Benefits Reserve Fund may be transferred from time to time to the Public Employee Health Benefit Fund to provide for any deficiency occurring therein. The Public Employee Health Benefit Fund and the Health Benefit Reserve Fund shall be deposited with the State Treasurer and invested as provided in G.S. 147‑69.2 and 147‑69.3."
SECTION 5. G.S. 135‑48.22 is amended by adding a new subdivision to read:
"(7) Approve set‑asides to reduce the State's unfunded actuarial accrued liability for post‑employment retiree health benefits as provided in G.S. 135‑48.5(a) and G.S. 135‑48.30(a)(18)."
SECTION 6. G.S. 135‑48.30(a) is amended by adding a new subdivision to read:
"(18) Set aside funds from the Public Employee Health Benefit Fund to reduce the State unfunded actuarial accrued liability for post‑employment retiree health benefits as provided in G.S. 135‑48.5(a), subject to approval by the Board of Trustees."
SECTION 7. G.S. 135‑48.20 is amended by adding a new subsection to read:
"(n) Immunity. – Except to the extent provided under Article 31A of Chapter 143 of the General Statutes and to the extent of insurance coverage purchased pursuant to G.S. 58‑32‑15, a person serving on the Board of Trustees shall be immune individually from civil liability for monetary damages for any act, or failure to act, arising out of that service, except where any of the following apply:
(1) The person was not acting within the scope of that person's official duties.
(2) The person was not acting in good faith.
(3) The person committed gross negligence or willful or wanton misconduct that resulted in damages or injury.
(4) The person derived an improper personal financial benefit, either directly or indirectly, from the transaction.
(5) The person incurred the liability from the operation of a motor vehicle."
SECTION 8. This act is effective when it becomes law.