GENERAL ASSEMBLY OF NORTH CAROLINA
1993 SESSION
CHAPTER 547
AN ACT TO AFFECT THE TEACHERS' AND STATE EMPLOYEES' COMPREHENSIVE MAJOR MEDICAL PLAN.
The General Assembly of North Carolina enacts:
Section 1. G.S. 135-40.4 reads as rewritten:
"§ 135-40.4. Benefits in general.
(a) In the event a covered person, as a result of accidental bodily injury, disease or pregnancy, incurs covered expenses, the Plan will pay benefits up to the amounts described in G.S. 135-40.5 through G.S. 135-40.9.
The Plan is divided into two parts. The first part includes certain benefits which are not subject to a deductible or coinsurance. The second part is a comprehensive plan and includes those benefits which are subject to both a two hundred fifty dollars ($250.00) deductible for each covered individual to an aggregate maximum of seven hundred fifty dollars ($750.00) per family and coinsurance of 80%/20%. There is a limit on out-of-pocket expenses under the second part.
Notwithstanding the provisions of this Article, the Executive
Administrator and Board of Trustees of the Teachers' and State Employees'
Comprehensive Major Medical Plan may begin the process of negotiating
prospective rates of charges that are to be allowed under the Plan with
preferred providers of institutional and professional medical care and
services. contract with providers of institutional and professional
medical care and services to established preferred provider networks. The
design, adoption, and implementation of such preferred provider contracts and
networks are not subject to the requirements of Chapter 143 of the General
Statutes, provided that for any hospital preferred provider network all
hospitals will have an opportunity to contract with the Plan if they meet the
contract requirements. The Executive Administrator and Board of
Trustees shall, under the provisions of G.S. 135-39.5(12), pursue such
preferred provider contracts on a timely basis and shall make monthly reports
as requested to the President of the Senate, the President Pro
Tempore of the Senate, the Speaker of the House of Representatives, and the
Committee on Employee Hospital and Medical Benefits on its progress in negotiating
such prospective rates for allowable charges. preferred provider
contracts. The Executive Administrator and Board of Trustees shall
implement a refined diagnostic-related grouping or diagnostic-related
grouping-based reimbursement system for hospitals as soon as practicable, but
no later than January 1, 1995.
(b) As used in this section the term 'preferred provider contracts or networks' includes, but is not limited to, a refined diagnostic-related grouping or diagnostic-related grouping-based system of reimbursement for hospitals."
Sec. 2. This act becomes effective July 1, 1993, and shall not apply to any litigation or administrative proceedings pending prior to that date.
In the General Assembly read three times and ratified this the 24th day of July, 1993.
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Marc Basnight
President Pro Tempore of the Senate
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Daniel Blue, Jr.
Speaker of the House of Representatives