§ 58-68-55. Exclusion of certain plans. - North Carolina Statutes

3.  Exclusion of Plans.

§ 58‑68‑55. Exclusion of certain plans.

(a)        Exception forCertain Benefits. – The requirements of Subparts 1 and 2 of this Part do notapply to any group health insurance coverage in relation to its provision ofexcepted benefits described in G.S. 58‑68‑25(b)(1).

(b)        Exception forCertain Benefits if Certain Conditions Met. –

(1)        Limited, exceptedbenefits. – The requirements of Subparts 1 and 2 of this Part do not apply toany group health insurance plan in relation to its provision of exceptedbenefits described in G.S. 58‑68‑25(b)(2) if the benefits:

a.         Are provided under aseparate policy, certificate, or contract of insurance; or

b.         Are otherwise not anintegral part of the plan.

(2)        Noncoordinated,excepted benefits. – The requirements of Subparts 1 and 2 of this Part do notapply to any group health insurance plan in relation to its provision ofexcepted benefits described in G.S. 58‑68‑25(b)(3) if all of thefollowing conditions are met:

a.         The benefits areprovided under a separate policy, certificate, or contract of insurance.

b.         There is nocoordination between the provision of the benefits and any exclusion ofbenefits under any group health insurance plan maintained by the samepolicyholder.

c.         The benefits arepaid with respect to an event without regard to whether benefits are providedwith respect to that event under any group health insurance plan maintained bythe same policyholder.

(3)        Supplemental,excepted benefits. – The requirements of this Part do not apply to any grouphealth insurance plan in relation to its provision of excepted benefitsdescribed in G.S. 58‑68‑25(b)(4) if the benefits are provided undera separate policy, certificate, or contract of insurance. (1997‑259,s. 1(c).)