GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1999

H	1 

HOUSE BILL 1123*

Short Title:  State Health Plan Amendments.	(Public)

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Sponsors: Representatives Mosley; Baddour, Barefoot, Cox, Sutton, and Womble.

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Referred to:  Insurance.

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April 15, 1999

A BILL TO BE ENTITLED
AN ACT TO PROVIDE THAT THE TEACHERS' AND STATE EMPLOYEES' COMPREHENSIVE MAJOR MEDICAL PLAN PROVIDES BENEFITS ON A CALENDAR YEAR BASIS, AND TO PROVIDE FOR A PRESCRIPTION DRUG CARD BENEFIT
The General Assembly of North Carolina enacts:
Section 1.  G.S. 135-40.1(7b) reads as rewritten:
"(7b)	Fiscal Year. – The period beginning January 1 and ending on December 31."
Section 2.  Notwithstanding G.S. 135-40.1(7b), the period from July 1, 1999, through December 31, 2000, shall be a fiscal year.  For that period, any deductibles and aggregate maximums under Article 3 of Chapter 135 of the General Statutes which are calculated on a fiscal year basis shall, for the special 18-month fiscal year, under this section shall be applied at one hundred fifty percent (150%) of the stated statutory amounts.
Section 3.  The Executive Administrator of the Teachers' and State Employees' Comprehensive Major Medical Plan shall provide an open enrollment period for Prepaid Plans (HMOs) under G.S. 135-39.5B for coverage either:
(1)	 October 1, 1999, through December 31, 2000; or
(2)	 October 1, 2000, through December 31, 2001,
so as to align the HMO plan year with that of the State Health Plan.
Section 4. The introductory language of G.S. 135-40.6 reads as rewritten:
"§ 135-40.6.  Benefits subject to deductible and coinsurance (comprehensive benefits).
Other than prescription drugs under subdivision (8)a. of this section, the following benefits are subject to a deductible of two hundred fifty dollars ($250.00) per covered individual to an aggregate maximum of seven hundred fifty dollars ($750.00) per family per fiscal year and are payable on the basis of eighty percent (80%) by the Plan and twenty percent (20%) by the covered individual up to a maximum of one thousand dollars ($1,000) out-of-pocket per fiscal year:"
Section 5. G.S. 135-40.6(8)a. reads as rewritten:
a.	Prescription Drugs: The Plan's allowable charges for prescription legend drugs to be used outside of a hospital or skilled nursing facility are ninety percent (90%) of the average wholesale price.  Each covered individual shall pay ten dollars ($10.00) for each generic drug, fifteen dollars  ($15.00) for each brand-name drug, and an additional five dollars ($5.00) for a brand-name drug for which there is a generic equivalent. There is no deductible or percentage co-payment by the covered individual. A dispensing fee for qualified providers shall be determined by the Executive Administrator and Board of Trustees. A prescription legend drug is defined as an article the label of which, under the Federal Food, Drug, and Cosmetic Act, is required to bear the legend: "Caution: Federal Law Prohibits Dispensing Without Prescription.”Such articles may not be sold to or purchased by the public without a prescription order. Benefits are provided for insulin even though prescription is not required."
Section 6.  G.S. 135-40.8(a) reads as rewritten:
"(a)	For the balance of any fiscal year after each eligible employee, retired employee, or dependent satisfies the cash deductible, the Plan pays eighty percent (80%) of the eligible expenses outlined in G.S. 135-40.6, other than prescription drugs covered under G.S. 135-40.6(8)a. The covered individual is then responsible for the remaining twenty percent (20%) until one thousand dollars ($1,000), in excess of the deductible, has been paid out-of-pocket.  The Plan then pays one hundred percent (100%) of the remaining covered expenses."
Section 7. Sections 5 and 6 of this act become effective July 1, 1999.  The remainder of this act is effective when it becomes law.