§ 58-51-120. Coverage of children.

417 words·~2 min read·/nc/chapter-58/58-51-120

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)No health insurer shall deny enrollment of a child under the health benefit plan of the child's parent on any of the following grounds:

(1)The child was born out of wedlock.

(2)The child is not claimed as a dependent on the parent's federal income tax return.

(3)The child does not reside with the parent or in the insurer's service area.

(b)If a parent is required by a court or administrative order to provide health benefit plan coverage for a child, and the parent is eligible for family health benefit plan coverage through a health insurer, the health insurer:

(1)Must allow the parent to enroll, under the family coverage, a child who is otherwise eligible for the coverage without regard to any enrollment season restrictions.

(2)Must enroll the child under family coverage upon application of the child's other parent or the Department of Health and Human Services in connection with its administration of the Medical Assistance or Child Support Enforcement Program if the parent is enrolled but fails to make application to obtain coverage for the child.

(3)May not disenroll or eliminate coverage of the child unless the health insurer is provided satisfactory written evidence that:

a. The court or administrative order is no longer in effect; or

b. The child is or will be enrolled in comparable health benefit plan coverage through another health insurer, which coverage will take effect not later than the effective date of disenrollment.

(c)If a child has health benefit plan coverage through the health insurer of a noncustodial parent, that health insurer shall do all of the following:

(1)Provide such information to the custodial parent as may be necessary for the child to obtain benefits through that coverage.

(2)Permit the custodial parent (or the health care provider, with the custodial parent's approval) to submit claims for covered services without the approval of the noncustodial parent.

(3)Make payments on claims submitted in accordance with subdivision

(2)of this subsection directly to the custodial parent, the provider, or the Department of Health and Human Services.

(d)No health insurer may impose requirements on any State agency that has been assigned the rights of an individual eligible for medical assistance under Medicaid and covered for health benefits from the insurer that are different from requirements applicable to an agent or assignee of any other individual so covered. (1993 (Reg. Sess., 1994), c. 644, s. 1; 1997-443, s. 11A.118(a).)