GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2001
S	1
SENATE BILL 66*

 
 
Short Title:	Health Benefit Plan Disclosure.	()	
Sponsors:	Senators Wellons, Harris, Dannelly; and Dalton.	
Referred to:	Insurance and Consumer Protection.	
February 6, 2001

A BILL TO BE ENTITLED
AN ACT TO PROVIDE FOR HEALTH BENEFIT PLAN DISCLOSURE TO AND SUMMARY PLAN INFORMATION FOR PROSPECTIVE INSUREDS.

The General Assembly of North Carolina enacts:
SECTION 1.  Article 3 of Chapter 58 of the General Statutes is amended by adding a new section to read:
"§ 58-3-240.  Health benefit plan disclosure and summary plan information.
An insurer shall provide every prospective applicant and prospective enrollee with a clear and concise description of the coverage provided by the insurer's health benefit plan. The description shall be printed on a form prescribed by the Commissioner. The description shall specify:
(1)	Definitions of terms used in the health benefit plan.
(2)	A brief description of the principal benefits and coverage provided, including any coverage exclusions or limitations.
(3)	A brief description of how coverage determinations are made, including whether factors other than medical necessity and coverage exclusions and limitations are considered.
(4)	A brief explanation of insurer and insured payment responsibilities, including how plan allowances, such as 'usual and customary charges', are developed.
(5)	A brief explanation of provider network limitations and requirements, including requirements for the use of sub-networks, prior authorization or precertification, and the arrangements of tertiary and quaternary care.
(6)	Tax and health plan accreditation status of the insurer.
(7)	A statement that the outline is a summary of the health benefit plan and that the health benefit plan should be examined to determine specific health benefit plan provisions."
SECTION 2.  This act is effective when it becomes law. This act applies to all health benefit plans that are delivered, issued for delivery, or renewed on or after January 1, 2003.