§ 58-53-90. Basic coverage plans. - North Carolina Statutes

§58‑53‑90.  Basic coverage plans.

(a)        Subject to theprovisions of this Article, if the group insurance policy from which conversionis made insures the employee or member for basic hospital and surgical expenseinsurance, the employee or member shall be entitled to obtain a convertedpolicy providing, at his option, coverage on an expense incurred basis underany of the following plans:

(1)        Plan A:

a.         Hospital room andboard daily expense benefits in a maximum dollar amount approximating theaverage semiprivate rate charged in the major metropolitan area of this State,for a maximum duration of 70 days;

b.         Miscellaneoushospital expense benefits up to a maximum amount of 10 times the hospital roomand board daily expense benefits; and

c.         Surgical expense benefitsaccording to a surgical procedures schedule consistent with those customarilyoffered by the insurer under group or individual health insurance policies andproviding a maximum benefit of eight hundred dollars ($800.00).

(2)        Plan B:

            Identical to PlanA, except that (i) the maximum hospital room and board daily expense benefit isseventy‑five percent (75%) of the corresponding Plan A maximum and (ii)the surgical schedule maximum is six hundred dollars ($600.00).

(3)        Plan C:

            Identical to PlanA, except that (i) the maximum hospital room and board daily expense benefit isfifty percent (50%) of the corresponding Plan A maximum and (ii) the surgicalschedule maximum is four hundred dollars ($400.00).

(b)        The maximum dollaramount for the maximum hospital room and board daily expense benefit of Plan Ashall be determined by the Commissioner and may be redetermined by him fromtime to time as to converted policies issued subsequent to suchredetermination. Such redetermination shall not be made more often than once inthree years. The Plan A maximum, and the corresponding maximums in Plans B andC, shall be rounded to the nearest multiple ten dollars ($10.00), provided thatrounding may be to the next higher or lower multiple of ten dollars ($10.00) ifotherwise exactly midway between. (1981, c. 706, s. 1.)