§ 58-67-85. Master group contracts, filing requirement; required and prohibited provisions. - North Carolina Statutes

§ 58‑67‑85. Master group contracts, filing requirement; required and prohibited provisions.

(a)        A healthmaintenance organization may issue a master group contract with the approval ofthe Commissioner of Insurance provided the contract and the individualcertificates issued to members of the group, shall comply in substance to theother provisions of this Article. Any such contract may provide for theadjustment of the rate of the premium or benefits conferred as provided in thecontract, and in accordance with an adjustment schedule filed with and approvedby the Commissioner of Insurance. If the master group contract is issued,altered or modified, the enrollees' contracts issued in pursuance thereof arealtered or modified accordingly, all laws and clauses in the enrollees'contracts to the contrary notwithstanding. Nothing in this Article shall beconstrued to prohibit or prevent the same. Forms of such contract shall at alltimes be furnished upon request of enrollees thereto.

(b),       (c) Repealed bySession Laws 1997‑259, s. 18.

(d)        Employees shall beadded to the master group coverage no later than 90 days after their first dayof employment. Employment shall be considered continuous and not be consideredbroken except for unexcused absences from work for reasons other than illnessor injury. The term "employee" is defined as a nonseasonal person whoworks on a full‑time basis, with a normal work week of 30 or more hoursand who is otherwise eligible for coverage, but does not include a person whoworks on a part‑time, temporary, or substitute basis.

(d1)      When determiningemployee eligibility for a large employer, as defined in G.S. 58‑68‑25(10),an individual proprietor, owner, or operator shall be defined as an"employee" for the purpose of obtaining coverage under the employeegroup health plan and shall not be held to a minimum workweek requirement asimposed on other eligible employees.

(e)        Whenever anemployer master group contract replaces another group contract, whether thecontract was issued by a corporation under Articles 1 through 67 of thisChapter, the liability of the succeeding corporation for insuring personscovered under the previous group contract is:

(1)        Each person who iseligible for coverage in accordance with the succeeding corporation's plan ofbenefits with respect to classes eligible and activity at work andnonconfinement rules must be covered by the succeeding corporation's plan ofbenefits; and

(2)        Each person notcovered under the succeeding corporation's plan of benefits in accordance with(e)(1) must nevertheless be covered by the succeeding corporation if thatperson was validly covered, including benefit extension, under the prior planon the date of discontinuance and if the person is a member of the class ofpersons eligible for coverage under the succeeding corporation's plan. (1989, c. 775, s. 5; 1991, c.720, ss. 38, 88; 1991 (Reg. Sess., 1992), c. 837, s. 4; 1993, c. 408, ss. 5,5.1; 1995, c. 507, s. 23A.1(f); 1997‑259, s. 18; 2005‑223, s.2(b).)