§ 58-53-70. Exclusions. - North Carolina Statutes

§58‑53‑70.  Exclusions.

An insurer shall not berequired to issue a converted policy covering any person if such person is orcan be covered by Medicare. Furthermore, an insurer shall not be required toissue a converted policy covering any person if:

(1)        a.         Suchperson is covered for similar benefits by another hospital, surgical, medicalor major medical expense insurance policy, or hospital or medical servicesubscriber contract or medical practice or other prepayment plan, or by anyother plan or program;

b.         Such person is orcould be covered for similar benefits, whether or not covered for suchbenefits, under any arrangement of coverage for individuals in a group, whetherinsured or uninsured; or

c.         Similar benefits areprovided for or available to such person, whether or not covered for suchbenefits, by reason of any State or federal law; and

(2)        The benefits undersources of the kind referred to in subdivision (1)a of this section for suchperson, or benefits provided or available under sources of the kind referred toin subdivisions (1)b and (1)c of this section for such person, together withthe converted policy's benefits would result in overinsurance according to theinsurer's standards for overinsurance; or

(3)        An enrollee'senrollment in a health maintenance organization has been terminated for causein accord with the terms of the enrollee's evidence of coverage or the healthmaintenance organization's contract with the group. (1981, c. 706, s. 1; 1991, c.195, s. 2.)