A BILL TO BE ENTITLED
AN ACT to establish protections for individuals with preexisting conditions who seek to obtain health insurance coverage.
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:
"§ 58‑3‑26.  Preexisting conditions; health benefit plans.
(a)	The following definitions apply in this section:
(1)	Health benefit plan. – As defined in G.S. 58‑3‑167. The phrase also applies to limited‑scope dental and vision insurance.
(2)	Preexisting exclusion. – A limitation or exclusion of benefits based on the fact that a condition was present before the effective date of the coverage, or the date of denial if coverage is denied, under a health benefit plan, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that date.
(b)	An insurer offering a health benefit plan, including individual, large group, or small group health coverage, in this State shall not impose any preexisting condition exclusions with respect to coverage under the health benefit plan.
(c)	Each insurer that offers a health benefit plan in this State must accept every employer and every individual in the State who is eligible for the coverage and who applies for the coverage.
(d)	An insurer shall develop the premium rates for all health benefit plans offered in this State based on the only following case characteristics:
(1)	Whether the health benefit plan covers an individual or family. If the coverage is family coverage in the individual or small group market, the insurer shall apply the rating variations permitted under this subsection based on the portion of premium that is attributable to each family member covered under the health benefit plan in accordance with rules adopted by the Commissioner.
(2)	The geographic rating area, established in accordance with federal law.
(3)	The age of the insured individuals, except that the rate shall not vary by more than three to one for adults.
(4)	The tobacco use of the insured individuals, except that the rate must not vary by more than one and one‑fifteenth to one.
(e)	An insurer shall not adjust the premium charged for any health benefit plan offered in this State on the individual or small group market more frequently than annually unless the change is made to reflect any of the following:
(1)	With respect to a health benefit plan offered in the small group market, changes to the enrollment of the small employer.
(2)	Changes to the family composition of the insured.
(3)	With respect to a health benefit plan offered in the individual market, changes in the geographic rating area of an insured or changes in the tobacco use of an insured, as provided for in subsection (d) of this section.
(4)	Changes to the health benefit plan requested by the insured or the small employer.
(5)	Changes required by federal law or regulations or otherwise expressly permitted by State law."
SECTION 2.  The Department of Insurance may adopt rules to implement and administer this act and to ensure that rating practices used by insurers are consistent with this act.
SECTION 3.  This act is effective when it becomes law.