North Carolina Administrative Code
Title 11 - INSURANCE
Chapter 18 - MUTIPLE EMPLOYER WELFARE ARRANGEMENTS
Section 18 .0112 - CLAIMS PAYMENTS
Current through Register Vol. 39, No. 6, September 16, 2024
In order to assure that all valid claims for payments for benefits provided are paid within a reasonable time, the following standards apply:
(1) Each MEWA shall pay within 30 days of receipt by the MEWA or its administrator, if applicable, all valid claims for benefits.
(2) If the MEWA requires additional information, the MEWA shall request such additional information in writing within the 30-day period; and upon receipt of the additional information, the claim shall be paid within 30 days of receipt of the additional information.
(3) If the claim is denied, the MEWA shall provide the reason or reasons for the denial in writing to the claimant and the claimant's health care provider.
Authority
G.S.
58-2-40(1);
58-49-40;
58-49-50;
Eff. July 1,
1992;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. December 16,
2014.
