§ 58‑51‑17. Portability for accident and health insurance.
(a) Rules Relating toCrediting Previous Coverage.
(1) Creditable coveragedefined. For the purposes of this section, "creditable coverage"means, with respect to an individual, coverage of the individual under any ofthe following:
a. A group health planas defined in G.S. 58‑68‑25(a)(4b).
b. Health insurancecoverage without regard to whether the coverage is offered in the group market,the individual market, or otherwise.
c. Part A or part B oftitle XVIII of the Social Security Act.
d. Title XIX of theSocial Security Act, other than coverage consisting solely of benefits undersection 1928.
e. Chapter 55 of title10, United States Code.
f. A medical careprogram of the Indian Health Service or of a tribal organization.
g. A State healthbenefits risk pool.
h. A health planoffered under chapter 89 of title 5, United States Code.
i. A public healthplan (as defined in federal regulations).
j. A health benefitplan under section 5(e) of the Peace Corps Act (22 U.S.C. § 2504(e)).
k. Title XXI of theSocial Security Act (State Children's Health Insurance Program).
"Creditablecoverage" does not include coverage consisting solely of coverage ofexcepted benefits as described in G.S. 58‑68‑25(b). However, short‑termlimited‑duration health insurance coverage shall be considered creditablecoverage for purposes of this section.
(2) Not counting periodsbefore significant breaks in coverage.
a. In general. Aperiod of creditable coverage shall not be counted, with respect to enrollmentof an individual under an individual health insurance plan, if, after theperiod and before the enrollment date, there was a 63‑day period duringall of which the individual was not covered under any creditable coverage.
b. Waiting period nottreated as a break in coverage. For the purposes of sub‑subdivision a.of this subdivision and subdivision (b)(3) of this section, any period that anindividual is in a waiting period, as defined in G.S. 58‑68‑30(b)(4)c.,for any coverage under an individual health insurance plan shall not be takeninto account in determining the continuous period under sub‑subdivisiona. of this subdivision.
c. For an individualwho elects COBRA continuation coverage during the second election periodprovided under the Trade Act of 2002, the days between the date the individuallost group health plan coverage and the first day of the second COBRA electionperiod shall not be considered when determining whether a significant break incoverage has occurred.
(3) Method of creditingcoverage. An individual health insurer shall count a period of creditablecoverage without regard to the specific benefits covered during the period.
(4) Establishment ofperiod. Periods of creditable coverage for an individual shall be establishedthrough presentation of certifications described in subsection (c) of thissection or in another manner that is specified in regulations.
(5) Determination ofcreditable coverage.
a. Determination withinreasonable time. If an individual health insurer receives creditable coverageinformation under subsection (c) of this section, the insurer shall, within areasonable time following receipt of the information, make a determinationregarding the amount of the individual's creditable coverage and the length ofany exclusion that remains. Whether this determination is made within areasonable time depends on the relevant facts and circumstances. Relevant factsand circumstances include whether a plan's application of a preexisting conditionexclusion would prevent an individual from having access to urgent medicalcare.
b. No time limit onpresenting evidence of creditable coverage. An individual health insurershall not impose any limit on the amount of time that an individual has topresent a certificate or other evidence of creditable coverage.
(b) Exceptions.
(1) Exclusion notapplicable to certain newborns. Subject to subdivision (3) of thissubsection, an individual health insurer shall not impose any preexistingcondition exclusion in the case of an individual who, as of the last day of the30‑day period beginning with the individual's date of birth, is coveredunder creditable coverage.
(2) Exclusion notapplicable to certain adopted children. Subject to subdivision (3) of thissubsection, an individual health insurer shall not impose any preexistingcondition exclusion in the case of a child who is adopted or placed foradoption before attaining 18 years of age and who, as of the last day of the 30‑dayperiod beginning on the date of the adoption or placement for adoption, iscovered under creditable coverage. The previous sentence does not apply tocoverage before the date of the adoption or placement for adoption.
(3) Loss if break incoverage. Subdivisions (1) and (2) of this subsection shall no longer applyto an individual after the end of the first 63‑day period during all ofwhich the individual was not covered under any creditable coverage.
(c) Certifications andDisclosure of Coverage.
(1) In general. Anindividual health insurer shall provide the certification described in thissubdivision (i) at the time an individual ceases to be covered under the plan,and (ii) on the request on behalf of an individual made not later than 24months after the date of cessation of the coverage described in clause (i) ofthis subdivision, whichever is later.
(2) Certification. Thecertification described in this subdivision is a written certification of (i)the period of creditable coverage of the individual under the plan and (ii) anywaiting period and affiliation period, if applicable, imposed with respect tothe individual for any coverage under the plan.
(d) Applicability. Thissection applies to all health benefit plans of individual health insurancecoverage delivered or issued for delivery in this State, including certificatesissued under group policies that are delivered or issued for delivery in thisState. This section also applies to certificates issued under a policy issuedand delivered to a trust or association outside this State and covering personsresiding in this State. (2007‑298, s. 2.2; 2009‑382, ss. 1, 9, 10.)
§ 58‑51‑17. Portability for accident and health insurance.
(a) Rules Relating toCrediting Previous Coverage.
(1) Creditable coveragedefined. For the purposes of this section, "creditable coverage"means, with respect to an individual, coverage of the individual under any ofthe following:
a. A group health planas defined in G.S. 58‑68‑25(a)(4b).
b. Health insurancecoverage without regard to whether the coverage is offered in the group market,the individual market, or otherwise.
c. Part A or part B oftitle XVIII of the Social Security Act.
d. Title XIX of theSocial Security Act, other than coverage consisting solely of benefits undersection 1928.
e. Chapter 55 of title10, United States Code.
f. A medical careprogram of the Indian Health Service or of a tribal organization.
g. A State healthbenefits risk pool.
h. A health planoffered under chapter 89 of title 5, United States Code.
i. A public healthplan (as defined in federal regulations).
j. A health benefitplan under section 5(e) of the Peace Corps Act (22 U.S.C. § 2504(e)).
k. Title XXI of theSocial Security Act (State Children's Health Insurance Program).
"Creditablecoverage" does not include coverage consisting solely of coverage ofexcepted benefits as described in G.S. 58‑68‑25(b). However, short‑termlimited‑duration health insurance coverage shall be considered creditablecoverage for purposes of this section.
(2) Not counting periodsbefore significant breaks in coverage.
a. In general. Aperiod of creditable coverage shall not be counted, with respect to enrollmentof an individual under an individual health insurance plan, if, after theperiod and before the enrollment date, there was a 63‑day period duringall of which the individual was not covered under any creditable coverage.
b. Waiting period nottreated as a break in coverage. For the purposes of sub‑subdivision a.of this subdivision and subdivision (b)(3) of this section, any period that anindividual is in a waiting period, as defined in G.S. 58‑68‑30(b)(4)c.,for any coverage under an individual health insurance plan shall not be takeninto account in determining the continuous period under sub‑subdivisiona. of this subdivision.
c. For an individualwho elects COBRA continuation coverage during the second election periodprovided under the Trade Act of 2002, the days between the date the individuallost group health plan coverage and the first day of the second COBRA electionperiod shall not be considered when determining whether a significant break incoverage has occurred.
(3) Method of creditingcoverage. An individual health insurer shall count a period of creditablecoverage without regard to the specific benefits covered during the period.
(4) Establishment ofperiod. Periods of creditable coverage for an individual shall be establishedthrough presentation of certifications described in subsection (c) of thissection or in another manner that is specified in regulations.
(5) Determination ofcreditable coverage.
a. Determination withinreasonable time. If an individual health insurer receives creditable coverageinformation under subsection (c) of this section, the insurer shall, within areasonable time following receipt of the information, make a determinationregarding the amount of the individual's creditable coverage and the length ofany exclusion that remains. Whether this determination is made within areasonable time depends on the relevant facts and circumstances. Relevant factsand circumstances include whether a plan's application of a preexisting conditionexclusion would prevent an individual from having access to urgent medicalcare.
b. No time limit onpresenting evidence of creditable coverage. An individual health insurershall not impose any limit on the amount of time that an individual has topresent a certificate or other evidence of creditable coverage.
(b) Exceptions.
(1) Exclusion notapplicable to certain newborns. Subject to subdivision (3) of thissubsection, an individual health insurer shall not impose any preexistingcondition exclusion in the case of an individual who, as of the last day of the30‑day period beginning with the individual's date of birth, is coveredunder creditable coverage.
(2) Exclusion notapplicable to certain adopted children. Subject to subdivision (3) of thissubsection, an individual health insurer shall not impose any preexistingcondition exclusion in the case of a child who is adopted or placed foradoption before attaining 18 years of age and who, as of the last day of the 30‑dayperiod beginning on the date of the adoption or placement for adoption, iscovered under creditable coverage. The previous sentence does not apply tocoverage before the date of the adoption or placement for adoption.
(3) Loss if break incoverage. Subdivisions (1) and (2) of this subsection shall no longer applyto an individual after the end of the first 63‑day period during all ofwhich the individual was not covered under any creditable coverage.
(c) Certifications andDisclosure of Coverage.
(1) In general. Anindividual health insurer shall provide the certification described in thissubdivision (i) at the time an individual ceases to be covered under the plan,and (ii) on the request on behalf of an individual made not later than 24months after the date of cessation of the coverage described in clause (i) ofthis subdivision, whichever is later.
(2) Certification. Thecertification described in this subdivision is a written certification of (i)the period of creditable coverage of the individual under the plan and (ii) anywaiting period and affiliation period, if applicable, imposed with respect tothe individual for any coverage under the plan.
(d) Applicability. Thissection applies to all health benefit plans of individual health insurancecoverage delivered or issued for delivery in this State, including certificatesissued under group policies that are delivered or issued for delivery in thisState. This section also applies to certificates issued under a policy issuedand delivered to a trust or association outside this State and covering personsresiding in this State. (2007‑298, s. 2.2; 2009‑382, ss. 1, 9, 10.)
§ 58‑51‑17. Portability for accident and health insurance.
(a) Rules Relating toCrediting Previous Coverage.
(1) Creditable coveragedefined. For the purposes of this section, "creditable coverage"means, with respect to an individual, coverage of the individual under any ofthe following:
a. A group health planas defined in G.S. 58‑68‑25(a)(4b).
b. Health insurancecoverage without regard to whether the coverage is offered in the group market,the individual market, or otherwise.
c. Part A or part B oftitle XVIII of the Social Security Act.
d. Title XIX of theSocial Security Act, other than coverage consisting solely of benefits undersection 1928.
e. Chapter 55 of title10, United States Code.
f. A medical careprogram of the Indian Health Service or of a tribal organization.
g. A State healthbenefits risk pool.
h. A health planoffered under chapter 89 of title 5, United States Code.
i. A public healthplan (as defined in federal regulations).
j. A health benefitplan under section 5(e) of the Peace Corps Act (22 U.S.C. § 2504(e)).
k. Title XXI of theSocial Security Act (State Children's Health Insurance Program).
"Creditablecoverage" does not include coverage consisting solely of coverage ofexcepted benefits as described in G.S. 58‑68‑25(b). However, short‑termlimited‑duration health insurance coverage shall be considered creditablecoverage for purposes of this section.
(2) Not counting periodsbefore significant breaks in coverage.
a. In general. Aperiod of creditable coverage shall not be counted, with respect to enrollmentof an individual under an individual health insurance plan, if, after theperiod and before the enrollment date, there was a 63‑day period duringall of which the individual was not covered under any creditable coverage.
b. Waiting period nottreated as a break in coverage. For the purposes of sub‑subdivision a.of this subdivision and subdivision (b)(3) of this section, any period that anindividual is in a waiting period, as defined in G.S. 58‑68‑30(b)(4)c.,for any coverage under an individual health insurance plan shall not be takeninto account in determining the continuous period under sub‑subdivisiona. of this subdivision.
c. For an individualwho elects COBRA continuation coverage during the second election periodprovided under the Trade Act of 2002, the days between the date the individuallost group health plan coverage and the first day of the second COBRA electionperiod shall not be considered when determining whether a significant break incoverage has occurred.
(3) Method of creditingcoverage. An individual health insurer shall count a period of creditablecoverage without regard to the specific benefits covered during the period.
(4) Establishment ofperiod. Periods of creditable coverage for an individual shall be establishedthrough presentation of certifications described in subsection (c) of thissection or in another manner that is specified in regulations.
(5) Determination ofcreditable coverage.
a. Determination withinreasonable time. If an individual health insurer receives creditable coverageinformation under subsection (c) of this section, the insurer shall, within areasonable time following receipt of the information, make a determinationregarding the amount of the individual's creditable coverage and the length ofany exclusion that remains. Whether this determination is made within areasonable time depends on the relevant facts and circumstances. Relevant factsand circumstances include whether a plan's application of a preexisting conditionexclusion would prevent an individual from having access to urgent medicalcare.
b. No time limit onpresenting evidence of creditable coverage. An individual health insurershall not impose any limit on the amount of time that an individual has topresent a certificate or other evidence of creditable coverage.
(b) Exceptions.
(1) Exclusion notapplicable to certain newborns. Subject to subdivision (3) of thissubsection, an individual health insurer shall not impose any preexistingcondition exclusion in the case of an individual who, as of the last day of the30‑day period beginning with the individual's date of birth, is coveredunder creditable coverage.
(2) Exclusion notapplicable to certain adopted children. Subject to subdivision (3) of thissubsection, an individual health insurer shall not impose any preexistingcondition exclusion in the case of a child who is adopted or placed foradoption before attaining 18 years of age and who, as of the last day of the 30‑dayperiod beginning on the date of the adoption or placement for adoption, iscovered under creditable coverage. The previous sentence does not apply tocoverage before the date of the adoption or placement for adoption.
(3) Loss if break incoverage. Subdivisions (1) and (2) of this subsection shall no longer applyto an individual after the end of the first 63‑day period during all ofwhich the individual was not covered under any creditable coverage.
(c) Certifications andDisclosure of Coverage.
(1) In general. Anindividual health insurer shall provide the certification described in thissubdivision (i) at the time an individual ceases to be covered under the plan,and (ii) on the request on behalf of an individual made not later than 24months after the date of cessation of the coverage described in clause (i) ofthis subdivision, whichever is later.
(2) Certification. Thecertification described in this subdivision is a written certification of (i)the period of creditable coverage of the individual under the plan and (ii) anywaiting period and affiliation period, if applicable, imposed with respect tothe individual for any coverage under the plan.
(d) Applicability. Thissection applies to all health benefit plans of individual health insurancecoverage delivered or issued for delivery in this State, including certificatesissued under group policies that are delivered or issued for delivery in thisState. This section also applies to certificates issued under a policy issuedand delivered to a trust or association outside this State and covering personsresiding in this State. (2007‑298, s. 2.2; 2009‑382, ss. 1, 9, 10.)
