Current through Register Vol. 39, No. 6, September 16, 2024
(a) The
following are unfair or deceptive acts or practices in the business of
insurance:
(1) To deny, refuse to issue,
renew or reissue, cancel or otherwise terminate a health benefit plan, or
restrict or exclude health benefit plan coverage or add a premium differential
to any health benefit plan on the basis of the applicant's or insured's abuse
status;
(2) To exclude or limit
coverage for losses or deny a claim incurred by an insured on the basis of the
insured's abuse status;
(3) To
request information relating to acts of abuse or an applicant's or insured's
abuse status, or make use of that information, however obtained, except for the
limited purposes of complying with legal obligations or verifying a person's
claim to be a subject of abuse; or
(4) To terminate group coverage for a subject
of abuse because coverage was originally issued in the name of the abuser and
the abuser has divorced, separated from, or lost custody of the subject of
abuse, or the abuser's coverage has terminated voluntarily or involuntarily.
Nothing in this Rule prohibits the insurer or insurance professional from
requiring the subject of abuse to pay the full premium for coverage under the
health benefit plan or from requiring as a condition of coverage that the
subject of abuse reside or work within the insurer's service area, if the
requirements are applied to all insureds of the insurer or insurance
professional. The health carrier or insurance professional may terminate group
coverage after the continuation coverage required by this subsection has been
in force for 18 months, if it offers conversion to an individual plan as
provided in Part 2 of Article 53 of Chapter 58 of the General Statutes. The
continuation coverage required by this section shall be satisfied by coverage
required under P.L.
99-272, the Consolidated Omnibus Budget
Reconciliation Act (COBRA) of 1985, or under state continuation coverage
required under Part 1 of Article 53 of Chapter 58 of the General Statutes, and
is not intended to be in addition to coverage provided under COBRA or state
continuation. Nothing in this Subparagraph is intended to supersede or
interfere with the provisions of
G.S.
58-68-60 when the subject of abuse is an
"eligible individual" as defined in
G.S.
58-68-60(b).
(b) Subparagraph (a)(3) of this
Rule does not prohibit an insurer or insurance professional from asking about a
medical condition or from using medical information to underwrite or to carry
out its duties under the policy, even if the medical information is related to
a medical condition that the insurer or insurance professional knows or has
reason to know is abuse-related, to the extent otherwise permitted under this
Rule and other applicable law.
Authority
G.S.
58-2-40;
58-53-5;
58-63-65;
58-68-60;
Eff. April
1, 2010;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. May 1, 2018.
