N.C. Gen. Stat. § 135-48.30

(15) , (16) Repealed by Session Laws 2012-173, s. 3(c), effective January 1, 2013.

(16) The State Treasurer may delegate his or her powers and duties under this section to the Executive Administrator, the Board of Trustees, and employees of the Plan. In delegating powers or duties, however, the State Treasurer maintains the responsibility for the performance of those powers or duties.

(17) Optionally offer Medicare-related options under G.S. 135-48.38.

History

(2011-85, s. 2.10; 2012-173, s. 3(c), 4(b); 2020-3, s. 4.21(a).)

Deductible, Coinsurance, and Co-payment Adjustments. - Session Laws 2011-85, s. 1.3(a), provides: "Effective July 1, 2011, the Executive Administrator shall make the following changes to deductibles, coinsurance maximums, and co-payments under the Basic and Standard PPO Plans:

"(1) Basic Plan (70/30):

"a. Increase the in-network annual deductible to nine hundred thirty-three dollars ($933.00) for member-only coverage and to one thousand eight hundred sixty-six dollars ($1,866) for the out-of-network annual deductible for member-only coverage. The aggregate maximum annual deductible for employee-child and employee-family coverage shall be three times the member-only annual deductibles.

"b. Increase the in-network coinsurance maximum to three thousand seven hundred ninety-three dollars ($3,793) for member-only coverage and to seven thousand five hundred eighty-six dollars ($7,586) for member-only out-of-network maximum coinsurance. The aggregate maximum coinsurance for employee-child and employee-family coverage shall be three times the member-only coinsurance maximums.

"c. Increase the in-network urgent care co-payment to eighty-seven dollars ($87.00) per covered individual.

"d. Increase the in-network primary care co-payment to thirty-five dollars ($35.00) per covered individual.

"e. Increase the in-network specialist co-payment to eighty-one dollars ($81.00) per covered individual, except that for mental health and substance abuse services, chiropractic services, and physical therapy, occupational therapy, and speech therapy services, the in-network specialist co-payment shall be sixty-four dollars ($64.00) per covered individual.

"f. Increase the in-network and out-of-network inpatient co-payment to two hundred ninety-one dollars ($291.00) per covered individual.

"g. Increase the in-network and out-of-network emergency room co-payment to two hundred ninety-one dollars ($291.00) per covered individual.

"h. Increase prescription drug co-payments as required under G.S. 135-45.6(b)(1) as amended by this section.

"i. Except as otherwise provided in this act, co-payments and coinsurance for coverage not otherwise listed in this subdivision shall remain as applicable in the 2010-2011 benefit year.

"(2) Standard Plan (80/20):

"a. Increase the in-network annual deductible to seven hundred dollars ($700.00) for member-only coverage and to one thousand four hundred dollars ($1,400) for the member-only out-of-network annual deductible. The aggregate maximum annual deductible for employee-child and employee-family coverage shall be three times the member-only annual deductibles.

"b. Increase the in-network coinsurance maximum to three thousand two hundred ten dollars ($3,210) for member-only coverage and to six thousand four hundred twenty dollars ($6,420) for member-only out-of-network maximum coinsurance. The aggregate maximum coinsurance for employee-child and employee-family coverage shall be three times the member-only coinsurance maximums.

"c. Increase the in-network urgent care co-payment to eighty-seven dollars ($87.00) per covered individual.

"d. Increase the in-network primary care co-payment to thirty dollars ($30.00) per covered individual.

"e. Increase the in-network specialist co-payment to seventy dollars ($70.00) per covered individual, except that for mental health and substance abuse services, chiropractic services, and physical therapy, occupational therapy, and speech therapy services, the in-network specialist co-payment shall be fifty-two dollars ($52.00) per covered individual.

"f. Increase the in-network and out-of-network inpatient co-payment to two hundred thirty-three dollars ($233.00) per covered individual.

"g. Increase the in-network and out-of-network emergency room co-payment to two hundred thirty-three dollars ($233.00) per covered individual.

"h. Increase prescription drug co-pays as required under G.S. 135-45.6(b)(1) as amended by this act.

"i. Except as otherwise provided in this act, co-payments and coinsurance for coverage not otherwise listed in this subdivision shall remain as applicable in the 2010-2011 benefit year."

Session Laws 2011-85, s. 2.11(b), effective January 1, 2012, provides:

"Sections 1.2 and 1.3(a) of this act are repealed."

Session Laws 2011-96, s. 2(e), provides: "Credits toward deductibles and coinsurance maximums that Plan members earn for services incurred during the months of July and August of 2011 shall be carried forward and applied toward meeting the new deductibles and coinsurance maximums for the period beginning September 1, 2011. If a Plan member fully meets his or her deductible or coinsurance maximum during the months of July and August of 2011, then that Plan member shall receive credit for the amount of the deductible or coinsurance maximum that the Plan member met during that time, but shall then be subject to meeting any additional amounts required by the new deductible and coinsurance maximums effective September 1, 2011."

Premium Adjustments. - For premium rates for partially contributory coverage and premium adjustments for contributory coverage, see Session Laws 2011-85, s. 1.2(a) and (b), and related provisions, noted under G.S. 135-48.40.