State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_131E > GS_131E-301

§ 131E‑301. Insolvency.

(a)        In the event of an insolvency of a PSO upon order of theDivision, all providers that were sponsoring providers of the PSO within theprevious 12 months from the order of the Division shall, for 30 days after theorder, offer all beneficiaries enrolled with the insolvent PSO, coveredservices without charge other than for any applicable co‑payments,deductibles, or coinsurance permitted to be charged to beneficiaries under thePSO's Medicare contract.

(b)        If the Division determines that the sponsoring providerslack sufficient health care delivery resources to assure that health careservices will be available and accessible to all of the beneficiaries of theinsolvent PSO, then, in the event the Health Care Financing Administration ofthe United States Department of Health and Human Services fails to make suchallocations in a timely manner, the Division shall allocate the insolvent PSO'scontracts for these groups among all other PSOs that operate within a portionof the insolvent PSO's service area, taking into consideration the health caredelivery resources of each PSO. Each PSO to which beneficiaries are soallocated by the Division shall offer such group or groups that PSO's existingcoverage that is most similar to each beneficiary's coverage with the insolventPSO at rates determined in accordance with the successor PSO's existing ratingmethodology.

(c)        Taking into consideration the health care delivery resourcesof each such PSO, then in the event the Health Care Financing Administration ofthe United States Department of Health and Human Services fails to make suchallocations in a timely manner, the Division shall also allocate among all PSOsthat operate within a portion of the insolvent PSO's service area the insolventPSO's beneficiaries who are unable to obtain other coverage. Each PSO to whichbeneficiaries are so allocated by the Division shall offer such beneficiariesthat PSO's existing coverage for individual or conversion coverage asdetermined by the beneficiary's type of coverage in the insolvent PSO at ratesdetermined in accordance with the successor PSO's Medicare contract. (1998‑227, s. 1.)