§ 135-47. (Repealed effective July 1, 2010) Administration and processing of Program claims. - North Carolina Statutes

Part 5. Health Insurance Programfor Children.

§ 135‑47.  (Repealedeffective July 1, 2010) Administration and processing of Program claims.

(a)        The State of NorthCarolina undertakes to make available a health insurance program for children(Program), which shall be called North Carolina Health Choice for Children. TheProgram shall provide comprehensive acute medical care to low‑income,uninsured children who are residents of this State and who meet the eligibilityrequirements established for the Program under Part 8 of Article 2 of Chapter108A of the General Statutes. Except as provided in this Part, the Programshall be administered by the Department of Health and Human Services inaccordance with Part 8 of Article 2 of Chapter 108A of the General Statutes andas required under applicable federal law.

(a1)      Notwithstanding anyother provision of law, the Secretary of the Department of Health and HumanServices shall delegate the responsibility for the administration andprocessing of claims for benefits provided under the Program to the ExecutiveAdministrator and Board of Trustees of the State Health Plan for Teachers andState Employees (hereinafter called the "Plan") until such date, butnot later than July 1, 2010, the Secretary determines that the Department isprepared to assume some or all of these responsibilities. In administering theprocessing of claims for benefits, the Executive Administrator and Board ofTrustees shall have the same type of powers and duties as provided for thesepurposes under the Predecessor Plan. For the purposes of this Part,"Predecessor Plan" means the "North Carolina Teachers' and StateEmployees' Comprehensive Major Medical Plan in effect prior to July 1,2008." The claims payments shall be made against accounts maintained bythe Department of Health and Human Services. The Executive Administrator andBoard of Trustees shall establish premium rates for benefits provided underthis Part. The Department of Health and Human Services shall, from State andfederal appropriations and from any other funds made available for the Program,make payments to the Plan as determined by the Plan for its administration,claims processing, and other services delegated by the Secretary to providecoverage for acute medical care for children eligible for benefits providedunder the Program. The Plan shall not incur any financial obligations for theProgram in excess of the amount of funds that the Plan receives for theProgram.

(b)        The benefitsprovided under the Program shall be equivalent to the Teachers' and StateEmployees' Comprehensive Major Medical Plan (hereafter "PredecessorPlan") in effect through June 30, 2008, and as provided under Part 8 ofArticle 2 of Chapter 108A of the General Statutes. To the extent there is a conflictbetween the provisions of Part 8 of Article 2 of Chapter 108A and thePredecessor Plan pertaining to eligibility, fees, deductibles, copayments, andlifetime maximum benefits, and other cost‑sharing charges, the provisionsof Part 8 of Article 2 of Chapter 108A shall control. In administering thebenefits provided by this Part, the Executive Administrator and Board ofTrustees shall have the same type of powers and duties that are provided underthe Predecessor Plan for hospital and medical benefits.

(c)        The benefitsauthorized by this Part are available only to children who are residents ofthis State and who meet the eligibility requirements established for theProgram under Part 8 of Article 2 of Chapter 108A of the General Statutes.  (1998‑1, s. 4(a); 2007‑323,s. 28.22A(i); 2008‑107, s. 10.13(b), (n); 2008‑168, ss. 1(a),4(a).)