§ 58-67-125. Enrollment period. - North Carolina Statutes

§58‑67‑125.  Enrollment period.

(a)        In the event of aninsolvency of an HMO upon order of the Commissioner, all other carriers thatparticipated in the enrollment process with the insolvent HMO at a group's lastregular enrollment period shall offer such group's enrollees of the insolventHMO a 30‑day enrollment period commencing upon the date of insolvency. Each carrier shall offer such enrollees of the insolvent HMO the same coveragesand rates that it had offered to the enrollees of the group at its last regularenrollment period.

(b)        If no other carrierhad been offered to some groups enrolled in the insolvent HMO, or if theCommissioner determines that the other health benefit plan or plans lacksufficient health care delivery resources to assure that health care serviceswill be available and accessible to all of the group enrollees of the insolventHMO, then the Commissioner shall allocate the insolvent HMO's group contractsfor such groups among all other HMOs that operate within a portion of the insolventHMO's service area, taking into consideration the health care deliveryresources of each HMO.  Each HMO to which a group or groups are so allocatedshall offer such group or groups that HMO's existing coverage that is mostsimilar to each group's coverage with the insolvent HMO at rates determined inaccordance with the successor HMO's existing rating methodology.

(c)        The Commissionershall also allocate the insolvent HMO's nongroup enrollees who are unable toobtain other coverage among all HMOs that operate within a portion of theinsolvent HMO's service area, taking into consideration the health caredelivery resources of each such HMO.  Each HMO to which nongroup enrollees areallocated shall offer such nongroup enrollees that HMO's existing coverage forindividual or conversion coverage as determined by his type of coverage in theinsolvent HMO at rates determined in accordance with the successor HMO'sexisting rating methodology.  Successor HMOs that do not offer direct nongroupenrollment may aggregate all of the allocated nongroup enrollees into one groupfor rating and coverage purposes. (1989, c. 776, s. 13.)