GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1997

S	3 

SENATE BILL 434
Corrected Copy 3/21/97
Pensions & Retirement and Insurance Committee Substitute Adopted 4/24/97

Short Title:  National Guard Health Benefits.	(Public)

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Sponsors:

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Referred to:  Appropriations.

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March 20, 1997

A BILL TO BE ENTITLED
AN ACT TO PROVIDE HEALTH BENEFITS FOR NATIONAL GUARD MEMBERS AND THEIR ELIGIBLE DEPENDENTS WHO DO NOT HAVE ACCESS TO COMPREHENSIVE GROUP HEALTH BENEFITS BY ALLOWING VOLUNTARY PARTICIPATION IN THE TEACHERS' AND STATE EMPLOYEES' COMPREHENSIVE MAJOR MEDICAL PLAN.
The General Assembly of North Carolina enacts:
Section 1.  G.S. 135-40 is amended by adding a new subsection to read:
"( a1)	The State of North Carolina deems it to be in the public interest for members of the North Carolina national guard and certain of their dependents who are not eligible for any other type of comprehensive group health insurance or other comprehensive group health benefits to be given the opportunity to participate in the benefits provided by the North Carolina Teachers' and State Employees' Comprehensive Major Medical Plan.  Coverage under the Plan shall be voluntary for eligible members of the national guard who elect participation in the Plan for themselves and their eligible dependents."
Section 2.  G.S. 135-40.1(3) reads as rewritten: 
"(3)	Dependent Child. – A natural, legally adopted, or foster child of the employee and/or spouse, unmarried, up to the first of the month following his or her 19th birthday, whether or not the child is living with the employee, as long as the employee is legally responsible for such child's maintenance and support. Dependent child shall also include any child under age 19 who has reached his or her 18th birthday, provided the employee was legally responsible for such child's maintenance and support on his or her 18th birthday.
		A foster child is covered (i) if living in a regular parent-child relationship with the expectation that the employee will continue to rear the child into adulthood, (ii) if at the time of enrollment, or at the time a foster child relationship is established, whichever occurs first, the employee applies for coverage for such child and submits evidence of a bona fide foster child relationship, identifying the foster child by name and setting forth all relevant aspects of the relationship, (iii) if the Claims Processor accepts the foster child as a participant through a separate written document identifying the foster child by name and specifically recognizing the foster child relationship, and (iv) if at the time a claim is incurred, the foster child relationship, as identified by the employee, continues to exist. Children placed in a home by a welfare agency which obtains control of, and provides for maintenance of, the child(ren), are not eligible participants.
		Coverage may be extended beyond the 19th birthday under the following conditions:
a.	If the dependent is a full-time student, between the ages of 19 and 26, who is pursuing a course of study that represents at least the normal workload of a full-time student at a school or college accredited by the state of jurisdiction.
b.	The dependent is physically or mentally incapacitated to the extent that he or she is incapable of earning a living and (i) such handicap developed or began to develop before the dependent's 19th birthday, or (ii) such handicap developed or began to develop before the dependent's 26th birthday if the dependent was covered by the Plan in accordance with G.S. 135-40.1(3)a.
		Dependent children of national guard members are subject to the same terms and conditions as are other dependent children covered by this subdivision."
Section 3.  G.S. 135-40.1(6) reads as rewritten:
"(6)	Employing Unit. – A North Carolina School System; Community College; State Department, Agency or Institution; Administrative Office of the Courts; or Association or Examining Board whose employees are eligible for membership in a State-Supported Retirement System. An employing unit also shall mean a charter school in accordance with Part 6A of Chapter 115C of the General Statutes whose employees are deemed to be public employees and members of a State-Supported Retirement System.  North Carolina national guard units are deemed to be employing units for the purpose of providing benefits under this Article."
Section 4.  G.S. 135-40.1(7) reads as rewritten:
"(7)	Enrollment. – New employees must enroll themselves and their dependents within 30 days from the date of employment. Coverage may become effective on the first day of the month following date of entry on payroll or on the first day of the following month. New employees not enrolling themselves and their dependents within 30 days, or not adding dependents when first eligible as provided herein may enroll on the first day of any month but will be subject to a 12-month waiting period for preexisting health conditions, except for employees who elect to change their coverage in accordance with rules established by the Executive Administrator and Board of Trustees for optional prepaid hospital and medical benefit plans. Children born to covered employees having coverage type (2), or (3), as outlined in G.S. 135-40.3(d) shall be automatically covered at the time of birth without any waiting period for preexisting health conditions. Children born to covered employees having coverage type (1) shall be automatically covered at birth without any waiting period for preexisting health conditions so long as the Claims Processor receives notification within 30 days of the date of birth that the employee desires to change from coverage (1) to coverage type (2), or (3), provided that the employee pays any additional premium required by the coverage type selected retroactive to the first day of the month in which the child was born.  National guard members and their eligible dependents are subject to the same terms and conditions as are new employees and their dependents covered by this subdivision.  Enrollments in these circumstances must occur within 30 days of eligibility to enroll."
Section 5.  G.S. 135-40.1 is amended by adding a new subdivision to read:
"(13b)	National guard members. –  Members of the North Carolina army and air national guard who are not eligible for any type of comprehensive group health insurance or other comprehensive group health benefit coverage.  Members of the North Carolina army and air national guard include those who are actively serving in the national guard as well as former members of the national guard who have completed 20 or more years of service in the national guard but have not attained the minimum age to begin receipt of a uniformed service military retirement benefit.  Comprehensive group health insurance and other benefit coverage consists of inpatient and outpatient hospital and medical benefits, as well as other outpatient medical services, prescription drugs, medical supplies and equipment that are generally available in the health insurance market.  Comprehensive group health insurance and other benefit coverage includes Medicare benefits, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) Benefits, and other Uniformed Service health benefits.  North Carolina national guard units shall certify the eligibility of their members to the Plan for their participation in its benefits prior to enrollment."
Section 6.  G.S. 135-40.2(b) is amended by adding a new subdivision to read:
"(13)	National guard members, their eligible spouses, and eligible dependent children."
Section 7.  G.S. 135-40.3 is amended by adding a new subsection to read:
"( f)	National guard members are subject to the same terms and conditions of this section as are employees.  Eligible dependents of national guard members are subject to the same terms and conditions of this section as are dependents of employees."
Section 8.  G.S. 135-39.6A reads as rewritten:
"§ 135-39.6A.  Premiums set.
The Executive Administrator and Board of Trustees shall, from time to time, establish premium rates for the Comprehensive Major Medical Plan except as they may be established by the General Assembly in the Current Operations Appropriations Act, and establish regulations for payment of the premiums.  Premium rates shall be established for coverages where Medicare is the primary payer of health benefits separate and apart from the rates established for coverages where Medicare is not the primary payer of health benefits.
In setting premiums for national guard members and their eligible dependents, the Executive Administrator and Board of Trustees shall establish rates separate from those affecting other members of the Plan.  These separate premium rates shall include rate factors for incurred but unreported claim costs, for the effects of adverse selection from voluntary participation in the Plan, and for any other actuarially determined measures needed to protect the financial integrity of the Plan for the benefit of its served employees, retired employees, and their eligible dependents."
Section 9.  This act becomes effective July 1, 1998.