(a)        Exception for Certain Benefits. – The requirements of Subparts 1 and 2 of this Part do not apply to any group health insurance coverage in relation to its provision of excepted benefits described in N.C. Gen. Stat. § 58-68-25(b)(1).

(b)        Exception for Certain Benefits if Certain Conditions Met. –

(1)        Limited, excepted benefits. – The requirements of Subparts 1 and 2 of this Part do not apply to any group health insurance plan in relation to its provision of excepted benefits described in N.C. Gen. Stat. § 58-68-25(b)(2) if the benefits:

a.         Are provided under a separate policy, certificate, or contract of insurance; or

b.         Are otherwise not an integral part of the plan.

(2)        Noncoordinated, excepted benefits. – The requirements of Subparts 1 and 2 of this Part do not apply to any group health insurance plan in relation to its provision of excepted benefits described in N.C. Gen. Stat. § 58-68-25(b)(3) if all of the following conditions are met:

a.         The benefits are provided under a separate policy, certificate, or contract of insurance.

b.         There is no coordination between the provision of the benefits and any exclusion of benefits under any group health insurance plan maintained by the same policyholder.

c.         The benefits are paid with respect to an event without regard to whether benefits are provided with respect to that event under any group health insurance plan maintained by the same policyholder.

(3)        Supplemental, excepted benefits. – The requirements of this Part do not apply to any group health insurance plan in relation to its provision of excepted benefits described in N.C. Gen. Stat. § 58-68-25(b)(4) if the benefits are provided under a separate policy, certificate, or contract of insurance. (1997-259, s. 1(c).)

Terms Used In North Carolina General Statutes 58-68-55

  • Contract: A legal written agreement that becomes binding when signed.
  • following: when used by way of reference to any section of a statute, shall be construed to mean the section next preceding or next following that in which such reference is made; unless when some other section is expressly designated in such reference. See North Carolina General Statutes 12-3