§ 58-50-205. Minimum Pool benefits. - North Carolina Statutes

§ 58‑50‑205. Minimum Pool benefits.

(a)        The Pool shalloffer at least two types of benefit plans for individuals eligible under G.S.58‑50‑195, including preferred provider organizations withdifferent levels of deductibles and cost‑sharing, and at least one choiceof a health savings account. The covered services and benefit levels may varybetween the types of benefit plans, but at least two types of benefit plansmust, at a minimum, cover the benefits and services outlined in the NationalAssociation of Insurance Commissioners' (NAIC) Model Health Pool forUninsurable Individuals Act and be consistent with comprehensive coveragegenerally available to persons who are eligible for individual health insuranceother than Medicare. All benefit plans offered by the Pool shall includedisease or case management services.

(b)        The Board, upon therecommendation of the Executive Director, shall adopt rules regarding thelifetime limits and per individual combined coinsurance and deductibles for thehealth insurance products offered by the Pool. The initial rules shall includenot less than one million dollars ($1,000,000) lifetime limit and a combinedannual limit of up to five thousand dollars ($5,000) per individual oncoinsurance and deductibles. The Board, upon recommendation of the ExecutiveDirector, shall adopt rules adjusting these limitations at least once everyfive years to reflect changes in the medical component of the Consumer PriceIndex. When adopting or adjusting lifetime limits the Board may establishcategories of diseases that may be more seriously impacted by the lifetimelimits than other diseases covered under the Pool. (2007‑532, s. 1.1.)