A BILL TO BE ENTITLED
AN ACT to require the State Health Plan for Teachers and State Employees to refund premiums paid when the Plan did not actually provide coverage.
The General Assembly of North Carolina enacts:
SECTION 1.  Part 3 of Article 3A of Chapter 135 of the General Statutes is amended by adding a new section to read:
"§ 135‑45.12A.  Refund of premiums.
The Plan shall refund premiums to a subscriber who paid premiums during months in which the subscriber or a dependent was not actually covered under the Plan due to ineligibility. When refunding premiums, the Plan may deduct (i) the amount of ineligible claims paid by the Plan during the period in which the subscriber or dependent was not actually covered under the Plan and (ii) reasonable administrative costs directly related to a subscriber's failure to notify the Plan of a coverage category change in a timely manner.
Regardless of the amount of a refund, a subscriber may still owe the Plan reimbursement for claims paid during the period in which the subscriber or dependent was not covered under the Plan.
The Plan is not required to refund premiums under this section in cases of fraud."
SECTION 2.  This act becomes effective July 1, 2008.