§ 58-53-90. Basic coverage plans.

342 words·~2 min read·/nc/chapter-58/58-53-90

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

(a)Subject to the provisions of this Article, if the group insurance policy from which conversion is made insures the employee or member for basic hospital and surgical expense insurance, the employee or member shall be entitled to obtain a converted policy providing, at his option, coverage on an expense incurred basis under any of the following plans:

(1)Plan A:

a. Hospital room and board daily expense benefits in a maximum dollar amount approximating the average semiprivate rate charged in the major metropolitan area of this State, for a maximum duration of 70 days;

b. Miscellaneous hospital expense benefits up to a maximum amount of 10 times the hospital room and board daily expense benefits; and

c. Surgical expense benefits according to a surgical procedures schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of eight hundred dollars ($800.00).

(2)Plan B:

Identical to Plan A, except that

(i)the maximum hospital room and board daily expense benefit is seventy-five percent (75%) of the corresponding Plan A maximum and

(ii)the surgical schedule maximum is six hundred dollars ($600.00).

(3)Plan C:

Identical to Plan A, except that

(i)the maximum hospital room and board daily expense benefit is fifty percent (50%) of the corresponding Plan A maximum and

(ii)the surgical schedule maximum is four hundred dollars ($400.00).

(b)The maximum dollar amount for the maximum hospital room and board daily expense benefit of Plan A shall be determined by the Commissioner and may be redetermined by him from time to time as to converted policies issued subsequent to such redetermination. Such redetermination shall not be made more often than once in three years. The Plan A maximum, and the corresponding maximums in Plans B and C, shall be rounded to the nearest multiple ten dollars ($10.00), provided that rounding may be to the next higher or lower multiple of ten dollars ($10.00) if otherwise exactly midway between. (1981, c. 706, s. 1.)