2005 North Carolina Code - General Statutes § 58-50-120. Small Employer Carrier Committee.

§ 58‑50‑120.  Small Employer Carrier Committee.

(a)       The Commissioner shall appoint the Small Employer Carrier Committee with fair representation of (i) risk‑assuming carriers and reinsuring carriers; (ii) the insurance agent and small employer communities; and (iii) consumers who are served by plans covered by this Act.  Two‑thirds of the Committee shall be appointed from among representatives of small employer carriers.

(b)       Subject to the Commissioner's approval, the Committee shall recommend the form and level of coverages to be made available by small employer carriers in accordance with the provisions of G.S. 58‑50‑125(a).  The Committee shall recommend benefit levels, cost‑sharing factors, exclusions, and limitations for the basic and standard health care plans.  One basic health care plan and one standard health care plan shall contain benefit and cost‑sharing levels that are consistent with the basic method of operation and the benefit plans of HMOs, including any restrictions imposed by federal law.  The Committee shall submit the plans to the Commissioner for approval within 180 days after the Committee's appointment according to this section.  The plans may include cost containment features such as:  utilization review of health care services, including review of medical necessity of hospital and physician services; case management benefit alternatives; selective contracting with hospitals, physicians, and other health care providers; reasonable benefit differentials applicable to participating and nonparticipating providers; and other managed care provisions.

(c)       To assure the broadest availability of health benefit plans to small employers, the Committee shall recommend for the Commissioner's approval, market conduct and other requirements for carriers, agents, brokers, and third‑party administrators, including requirements developed as a result of a request by the Commissioner, relating to the following:

(1)       Registration by each carrier with the Department of its intention to be a small employer carrier under this Act.

(2)       Publication by the Department, the Committee, or the Pool of a list of all small employer carriers, including a potential requirement applicable to agents, brokers, third‑party administrators, and carriers that no health benefit plan may be sold to a small employer by a carrier not so identified as a small employer carrier.

(3)       The availability of a broadly publicized toll‑free telephone number for access by small employers to information concerning this Act.

(4)       To the extent deemed to be necessary by the Committee to assure the fair distribution of high‑risk individuals and groups among carriers, periodic reports by carriers, agents, brokers, and third‑party administrators about health benefit plans issued; provided that reporting requirements shall be limited to information concerning case characteristics and numbers of health benefit plans in various categories marketed or issued to small employers.

(5)       Registration by agents, brokers, and third‑party administrators of their intention to be such for health benefit plans marketed to small employers under this Act.

(6)       Methods concerning periodic demonstration by small employer carriers, agents, brokers, and third‑party administrators that they are marketing and issuing health benefit plans to small employers in fulfillment of the purposes of this Act.

(7)       Establishing standards for those conditions under which a carrier would not be required to write business received from a particular agent or broker.

(d)       Within three years after September 1, 1991, the Committee shall conduct a study of the effectiveness of the provisions of this Act, recommend further improvements to achieve greater stability, accessibility, and affordability in the small employer marketplace, and submit it to the Commissioner. (1991, c. 630, s. 1.)