(a) Eligibility. – The employees and dependents of employees of local government units are eligible to participate in the State Health Plan, as provided in this section.
Terms Used In North Carolina General Statutes 135-48.47
- 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 15A-941
- Plan: includes all comprehensive health benefit plans offered under the Plan. See North Carolina General Statutes 135-48.1
- state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories, so called; and the words "United States" shall be construed to include the said district and territories and all dependencies. See North Carolina General Statutes 15A-941
Employees and dependents participating under this section are not guaranteed participation in the Plan, and participation is contingent on their respective local government units (i) electing to participate in the Plan and (ii) complying with the provisions of this section and this Article, as well as any policies adopted by the Plan.
(b) Participation Requirements. – A local government unit may elect to participate in the State Health Plan. Participation shall be governed by the following:
(1) In order to participate, a local government unit must do the following:
a. Pass a valid resolution expressing the local government’s desire to participate in the Plan.
b. Enter into a memorandum of understanding with the Plan that acknowledges the conditions of this section and this Article.
c. Provide at least 90 days’ notice to the Plan prior to entry and complete the requirements of this subdivision at least 60 days prior to entry.
(2) In order to participate, a local government unit and its employees must meet the federal requirements to participate in a governmental plan. The Plan may refuse participation to persons who would jeopardize the Plan’s qualification as a governmental plan under federal law.
(2a) The Plan shall admit any local government unit that meets the administrative and legal requirements of this section, regardless of the claims experience of the local government unit group or the financial impact on the Plan.
(3) A local government unit shall determine the eligibility of its employees and employees’ dependents.
(3a) The premiums employees pay to the local government unit for their own coverage shall conform to the premiums in the structure set by the Plan. The premiums employees pay to the local government unit for coverage of their dependents may be determined by the local government unit but may not exceed the premiums set by the Plan.
(4) Premiums for coverage and Plan options shall be the same as those offered to State employees and dependents on a fully contributory basis.
(5) The local government unit shall pay all premiums for all covered individuals directly to the Plan or the Plan’s designee.
(c) Enrollment Limitation. – Local governments may elect to participate until the number of employees and dependents of employees of local governments enrolled in the Plan reaches 16,000, after which time no additional local governments may join the Plan. Any local government electing to participate must have less than 1,000 employees and dependents enrolled in health coverage at the time the local government provides notice to the Plan of its desire to participate.
(d) Local governments participating in the Plan as of April 1, 2016, may elect to withdraw from participating in the Plan effective January 1, 2017. Notice of withdrawal must be given by the local government to the Plan no later than September 15, 2016. ?(2014-75, s. 3; 2014-105, s. 1; 2015-112, s. 2; 2016-104, ss. 4, 5(a), 6.)