GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 2011

H                                                                                                                                                   D

HOUSE DRH50057-ME-22  (02/09)

Short Title:        Amend Health Insurance Risk Pool Statutes.		(Public)
Sponsors:	Representative Dockham.
Referred to:

A BILL TO BE ENTITLED

AN ACT to amend the health insurance risk pool statutes.

The General Assembly of North Carolina enacts:

SECTION 1.  G.S. 58-50-180(e)(4a) reads as rewritten:

"(e)       The Pool shall have the general powers and authority granted under the laws of this State to health insurers and the specific authority to do all of the following:

…

(4a)      Provide premium subsidies if federal grant funds are available for individuals with incomes up to three hundred percent (300%) of the federal poverty guidelines and where the Board deems it is fiscally prudent to do so. Premium subsidies may come from the following sources:

a. Federal grants made to the Pool for premium subsidies.

b. The Pool's own funds, not to exceed the amount of the most recent year for which the Pool received a federal grant award under sub-subdivision a. of this subdivision."

SECTION 2.  G.S. 55-50-190(b) is amended by adding a new subdivision to read:

"(b)      The Pool shall determine the standard risk rate by considering the premium rates charged by other insurers offering health insurance coverage to individuals. The standard risk rate shall be established using reasonable actuarial techniques and shall reflect anticipated experience and expenses for the coverage. Pool rates shall be one hundred fifty percent (150%) to two hundred percent (200%) one hundred twenty-five percent (125%) to one hundred seventy-five percent (175%) of rates established as applicable for individual standard rates and shall be adjusted annually, at the time of annual renewal."

SECTION 3.  G.S. 58-50-195(a) is amended by adding a new subdivision to read:

"(a)       Any individual who is and continues to be a resident of this State is eligible for Pool coverage if the individual provides evidence of any of the following:

…

(8) The individual is eligible for and has not exhausted current COBRA health insurance coverage at a rate exceeding the Pool rate and provides evidence of eligibility for Pool coverage under any of the subdivisions (1) through (4) of this subsection."

SECTION 4.  G.S. 58-50-210(a) reads as rewritten:

"(a)       Except as otherwise provided by law, Pool coverage shall exclude charges or expenses incurred during the first 12 six months following the effective date of coverage as to any condition for which medical advice, care, or treatment was recommended or received as to such conditions during the 12-month period immediately preceding the effective date of coverage, except that no preexisting condition exclusion shall be applied to a federally defined eligible individual or an individual who is eligible for the Pool because of his or her eligibility for the credit for health insurance costs under the Trade Adjustment Assistance Reform Act of 2002, section 35 of the Internal Revenue Code of 1986, pursuant to G.S. 58-50-195(a)(6)."

SECTION 5.  This act becomes effective October 1, 2011.