§ 135-45.2. Eligibility. - North Carolina Statutes

§ 135‑45.2. Eligibility.

(a)        NoncontributoryCoverage. – The following persons are eligible for coverage under the Plan, ona noncontributory basis, subject to the provisions of G.S. 135‑45.4:

(1)        All permanent full‑timeemployees of an employing unit who meet the following conditions:

a.         Paid from general orspecial State funds, or

b.         Paid from non‑Statefunds and in a group for which his or her employing unit has agreed to providecoverage.

Employeesof State agencies, departments, institutions, boards, and commissions nototherwise covered by the Plan who are employed in permanent job positions on arecurring basis and who work 30 or more hours per week for nine or more monthsper calendar year are covered by the provisions of this subdivision.

(2)        Permanent hourlyemployees as defined in G.S. 126‑5(c4) who work at least one‑halfof the workdays of each pay period.

(3)        Retired teachers,State employees, members of the General Assembly, and retired State lawenforcement officers who retired under the Law Enforcement Officers' RetirementSystem prior to January 1, 1985. Except as otherwise provided in thissubdivision, on and after January 1, 1988, a retiring employee or retiree musthave completed at least five years of contributory retirement service with anemploying unit prior to retirement from any State‑supported retirementsystem in order to be eligible for group benefits under this Part as a retiredemployee or retiree. For employees first hired on and after October 1, 2006,and members of the General Assembly first taking office on and after February1, 2007, future coverage as retired employees and retired members of theGeneral Assembly is subject to a requirement that the future retiree have 20 ormore years of retirement service credit in order to be covered by theprovisions of this subdivision.

(4)        Surviving spousesof:

a.         Deceased retiredemployees, provided the death of the former plan member occurred prior toOctober 1, 1986; and

b.         Deceased teachers,State employees, and members of the General Assembly who are receiving asurvivor's alternate benefit under any of the State‑supported retirementprograms, provided the death of the former plan member occurred prior toOctober 1, 1986.

(5)        Employees of theGeneral Assembly, not otherwise covered by this section, as determined by theLegislative Services Commission, except for legislative interns and pages.

(6)        Members of theGeneral Assembly.

(7)        Notwithstanding theprovisions of subsection (e) of this section, employees on official leave ofabsence while completing a full‑time program in school administration inan approved program as a Principal Fellow in accordance with Article 5C ofChapter 116 of the General Statutes.

(8)        Notwithstanding theprovisions of G.S. G.S. 135‑45.12 employees formerly covered by theprovisions of this section, other than retired employees, who have beenemployed for 12 or more months by an employing unit and whose jobs areeliminated because of a reduction, in total or in part, in the funds used tosupport the job or its responsibilities, provided the employees were covered bythe Plan at the time of separation from service resulting from a jobelimination. Employees covered by this subsection shall be covered for a periodof up to 12 months following a separation from service because of a jobelimination.

(9)        Any member enrolledpursuant to subdivision (1) or (2) of this subsection who is on approved leaveof absence with pay or receiving workers' compensation.

(10)      Employees on approvedFamily and Medical Leave.

(b)        PartiallyContributory. – The following persons are eligible for coverage under the Planon a partially contributory basis subject to the provisions of G.S. 135‑45.4:

(1)        A school employee ina job‑sharing position as defined in G.S. 135‑45.4. If these employeeselect to participate in the Plan, the employing unit shall pay fifty percent(50%) of the Plan's total noncontributory premiums. Individual employees shallpay the balance of the total noncontributory premiums not paid by the employingunit.

(2)        Subject to theprovisions of G.S. 135‑45.4, employees and members of the GeneralAssembly with 10 but less than 20 years of retirement service credit providedthe employees were first hired on or after October 1, 2006, and the membersfirst took office on or after February 1, 2007. For such future retirees, theState shall pay fifty percent (50%) of the Plan's total noncontributorypremiums. Individual retirees shall pay the balance of the totalnoncontributory premiums not paid by the State.

(c)        Fully Contributory.– The following person shall be eligible for coverage under the Plan, on afully contributory basis, subject to the provisions of G.S. 135‑45.4:

(1)        Former members ofthe General Assembly who enroll before October 1, 1986.

(2)        For enrollmentsafter September 30, 1986, former members of the General Assembly if coveredunder the Plan at termination of membership in the General Assembly. To beeligible for coverage as a former member of the General Assembly, applicationmust be made within 30 days of the end of the term of office. Only members ofthe General Assembly covered by the Plan at the end of the term of office areeligible. If application is not made within the specified time period, themember forfeits eligibility.

(3)        Surviving spouses ofdeceased former members of the General Assembly who enroll before October 1,1986.

(4)        Employees of theGeneral Assembly, not otherwise covered by this section, as determined by theLegislative Services Commission, except for legislative interns and pages.

(5)        For enrollmentsafter September 30, 1986, surviving spouses of deceased former members of theGeneral Assembly, if covered under the Plan at the time of death of the formermember of the General Assembly.

(6)        All permanent part‑timeemployees (designated as half‑time or more) of an employing unit whomeets the conditions outlined in subdivision (a)(1)a. above, and who are notcovered by the provisions of G.S. 135‑45.2(a)(1).

(7)        The spouses andeligible dependent children of enrolled teachers, State employees, retirees,former members of the General Assembly, former employees covered by theprovisions of G.S. 135‑45.2(a)(8), Disability Income Plan beneficiaries,enrolled continuation members, and members of the General Assembly. Spouses ofsurviving dependents are not eligible, nor are dependent children if they werenot covered at the time of the member's death. Surviving spouses may covertheir dependent children provided the children were enrolled at the time of themember's death or enroll within 90 days of the member's death.

(8)        Blind personslicensed by the State to operate vending facilities under contract with theDepartment of Health and Human Services, Division of Services for the Blind andits successors, who are:

a.         Operating such avending facility;

b.         Former operators ofsuch a vending facility whose service as an operator would have made theseoperators eligible for an early or service retirement allowance under Article 1of this Chapter had they been members of the Retirement System; and

c.         Former operators ofsuch a vending facility who attain five or more years of service as operatorsand who become eligible for and receive a disability benefit under the SocialSecurity Act upon cessation of service as an operator.

Spouses,dependent children, surviving spouses, and surviving dependent children of suchmembers are not eligible for coverage.

(9)        Surviving spouses ofdeceased retirees and surviving spouses of deceased teachers, State employees,and members of the General Assembly provided the death of the former Planmember occurred after September 30, 1986, and the surviving spouse was coveredunder the Plan at the time of death.

(10)      Any eligibledependent child of the deceased retiree, teacher, State employee, member of theGeneral Assembly, former member of the General Assembly, or Disability IncomePlan beneficiary, provided the child was covered at the time of death of theretiree, teacher, State employee, member of the General Assembly, former memberof the General Assembly, or Disability Income Plan beneficiary, (or was inposse at the time and is covered at birth under this Part), or was coveredunder the Plan on September 30, 1986. An eligible surviving dependent child canremain covered until age 19, or age 26 if a full‑time student, or indefinitelyif certified as incapacitated under G.S. 135‑45.1(5)b.

(11)      Retired teachers,State employees, and members of the General Assembly with less than 10 years ofretirement service credit, provided the teachers and State employees were firsthired on or after October 1, 2006, and the members first took office on orafter February 1, 2007.

(12)      Notwithstanding theprovisions of G.S. 135‑45.12 former employees covered by the provisionsof G.S. 135‑45.2 and their spouses and eligible dependent children whowere covered by the Plan at the time of the former employees' separation fromservice pursuant to G.S. 135‑45.2, following expiration of the formeremployees' coverage provided by G.S. 135‑45.2. Election of coverage underthis subdivision shall be made within 90 days after the termination of coverageprovided under G.S. 135‑45.2.

(13)      Firefighters, rescuesquad workers, and members of the National Guard, their eligible spouses, andeligible dependent children.

(d)        A foster child iscovered as a dependent child (i) if living in a regular parent‑childrelationship with the expectation that the employee will continue to rear thechild into adulthood, (ii) if at the time of enrollment, or at the time afoster child relationship is established, whichever occurs first, the employeeapplies for coverage for such child and submits evidence of a bona fide fosterchild relationship, identifying the foster child by name and setting forth allrelevant aspects of the relationship, (iii) if the claims processor accepts thefoster child as a participant through a separate written document identifyingthe foster child by name and specifically recognizing the foster childrelationship, and (iv) if at the time a claim is incurred, the foster childrelationship, as identified by the employee, continues to exist. Childrenplaced in a home by a welfare agency which obtains control of, and provides formaintenance of the child, are not eligible participants.

Coverage of a dependent childmay be extended beyond the 19th birthday under the following conditions:

(1)        If the dependent isa full‑time student, through the end of the month following the student's26th birthday. As used in this section, a full‑time student is a studentwho is pursuing a course of study that represents at least the normal workloadof a full‑time student at a school or college accredited by the state ofjurisdiction. In accordance with applicable federal law, coverage of a fulltime student that loses full‑time status due to illness or injury may beextended for one year from the effective date of the loss of full‑timestatus provided that the student was enrolled at the time of the onset of theillness or injury.

(2)        The dependent isphysically or mentally incapacitated to the extent that he or she is incapableof earning a living and (i) such handicap developed or began to develop beforethe dependent's 19th birthday, or (ii) such handicap developed or began todevelop before the dependent's 26th birthday if the dependent was covered bythe Plan in accordance with G.S. 135‑45.2(5)a.

(e)        No person shall beeligible for coverage as a dependent if eligible as an employee or retiredemployee, except when a spouse is eligible on a fully contributory basis. Inaddition, no person shall be eligible for coverage as a dependent of more thanone employee or retired employee at the same time.

(f)         Former employeeswho are receiving disability retirement benefits or disability income benefitspursuant to Article 6 of Chapter 135 of the General Statutes, provided theformer employee has at least five years of retirement membership service, shallbe eligible for the benefit provisions of this Plan, as set forth in this Part,on a noncontributory basis. Such coverage shall terminate as of the end of themonth in which such former employee is no longer eligible for disabilityretirement benefits or disability income benefits pursuant to Article 6 of thisChapter.

(g)        Employees onofficial leave of absence without pay may elect to continue this group coverageat group cost provided that they pay the full employee and employercontribution through the employing unit during the leave period.

(h)        For the support ofthe benefits made available to any member vested at the time of retirement,their spouses or surviving spouses, and the surviving spouses of employees whoare receiving a survivor's alternate benefit under G.S. 135‑5(m) of thoseassociations listed in G.S. 135‑27(a), licensing and examining boardsunder G.S. 135‑1.1, the North Carolina State Art Society, Inc., and theNorth Carolina Symphony Society, Inc., each association, organization or boardshall pay to the Plan the full cost of providing these benefits under thissection as determined by the Board of Trustees of the State Health Plan forTeachers and State Employees. In addition, each association, organization orboard shall pay to the Plan an amount equal to the cost of the benefitsprovided under this section to presently retired members of each association,organization or board since such benefits became available at no cost to theretired member. This subsection applies only to those individuals employedprior to July 1, 1983, as provided in G.S. 135‑27(d).

(i)         An eligiblesurviving spouse and any eligible surviving dependent child of a deceasedretiree, teacher, State employee, member of the General Assembly, former memberof the General Assembly, or Disability Income Plan beneficiary shall beeligible for group benefits under this section without waiting periods forpreexisting conditions provided coverage is elected within 90 days after thedeath of the former plan member. Coverage may be elected at a later time, butwill be subject to the 12‑month waiting period for preexisting conditionsand will be effective the first day of the month following receipt of the application.

(j)         No person shall beeligible for coverage as an employee or retired employee or as a dependent ofan employee or retired employee upon a finding by the Executive Administratoror Board of Trustees or by a court of competent jurisdiction that the employeeor dependent knowingly and willfully made or caused to be made a falsestatement or false representation of a material fact in a claim forreimbursement of medical services under the Plan or in any representation orattestation to the Plan.

The Executive Administratorand Board of Trustees may make an exception to the provisions of thissubsection when persons subject to this subsection have had a cessation ofcoverage for a period of five years and have made a full and completerestitution to the Plan for all fraudulent claim amounts. Nothing in thissubsection shall be construed to obligate the Executive Administrator and Boardof Trustees to make an exception as allowed for under this subsection.

(k)        Any employeereceiving benefits pursuant to Article 6 of this Chapter when the employee hasless than five years of retirement membership service, or an employee on leavewithout pay due to illness or injury for up to 12 months, is entitled tocontinued coverage under the Plan for the employee and any eligible dependentsby paying one hundred percent (100%) of the cost.  (1981 (Reg. Sess., 1982), c.1398, s. 6; 1983, c. 499; c. 761, ss. 252‑255; c. 867, s. 4; c. 922, s.5; 1985, c. 400, ss. 5, 6; 1985 (Reg. Sess., 1986), c. 1020, s. 29(a)‑(l);1987, c. 738, ss. 29(n), 36(a), 36(b); c. 809, ss. 3, 4; c. 857, ss. 11(a),11.1, 11.2, 12; 1989, c. 752, s. 22(e), (f); 1989 (Reg. Sess., 1990), c. 1074,s. 22(a); 1993, c. 321, s. 85(b); 1995, c. 278, s. 1; c. 507, ss. 7.21(a)‑(c),7.28(a)‑(c); 1997‑443, s. 11A.118(a); 1997‑512, ss. 17, 19‑27;1999‑237, s. 28.29(f); 2000‑141, ss. 6(a), (b); 2000‑184, ss.1(a),(b), 3; 2001‑487, s. 86(a); 2002‑174, s. 4; 2003‑358, s.4; 2004‑124, s. 31.21(b); 2004‑199, s. 34(b); 2005‑276, s.29.31(e); 2006‑174, ss. 1, 2, 3; 2007‑323, s. 28.22A(g1), (o); 2007‑345,s. 12; 2008‑168, ss. 1(a), 3(a), (f); 2008‑194, s. 6(b); 2009‑16,s. 3(b); 2009‑281, s. 1; 2009‑570, s. 43.2; 2009‑571, s.3(a), (d).)