§ 58-68-35. Prohibiting discrimination against individual participants and beneficiaries based on health status. - North Carolina Statutes

§ 58‑68‑35. Prohibiting discrimination against individual participants and beneficiariesbased on health status.

(a)        In Eligibility ToEnroll. –

(1)        In general. –Subject to subdivision (2) of this subsection, a group health insurer shall notestablish rules for eligibility, including continued eligibility, of anyindividual to enroll under the terms of the health insurer's plan based on anyof the following health status‑related factors in relation to theindividual or a dependent of the individual:

a.         Health status.

b.         Medical condition(including both physical and mental illnesses).

c.         Claims experience.

d.         Receipt of healthcare.

e.         Medical history.

f.          Geneticinformation.

g.         Evidence ofinsurability (including conditions arising out of acts of domestic violence).

h.         Disability.

(2)        No application tobenefits or exclusions. – To the extent consistent with G.S. 58‑68‑30,subdivision (1) of this subsection shall not be construed:

a.         To require a grouphealth insurance plan to provide particular benefits other than those providedunder the terms of the plan, or

b.         To prevent the planfrom establishing limitations or restrictions on the amount, level, extent, ornature of the benefits or coverage for similarly situated individuals enrolledin the plan.

(3)        Construction. – Forthe purposes of subdivision (1) of this subsection, rules for eligibility toenroll under a plan include rules defining any applicable waiting periods forthe enrollment.

(b)        In PremiumContributions. –

(1)        In general. – Agroup health insurance plan shall not require any individual (as a condition ofenrollment or continued enrollment under the plan) to pay a premium orcontribution that is greater than the premium or contribution for a similarlysituated individual enrolled in the plan on the basis of any health status‑relatedfactor in relation to the individual or to an individual enrolled under theplan as a dependent of individual.

(2)        Construction. –Nothing in subdivision (1) of this subsection shall be construed:

a.         To restrict theamount that an employer may be charged for coverage under a group healthinsurance plan; or

b.         To prevent a grouphealth insurer from establishing premium discounts or modifying otherwiseapplicable copayments or deductibles in return for adherence to programs ofhealth promotion and disease prevention. (1997‑259, s. 1(c).)