It has been a busy month at the NC General Assembly with legislators working to advance as many key pieces of legislation before the May 13th crossover deadline.
A key piece of legislation SB 228, Allow Employers to Offer EPO Plans, was approved in both the Senate Commerce and Insurance and Senate Health Care Committees and now heads to the Rules Committee . This EPO legislation would make it possible for Agents to market and sell EPO plans in NC ultimately expanding plan access and options to employers. EPO’s are currently offered in a majority of the states but not yet in NC. These plans would give employers the option to select these in-network only plans and benefit from the cost competitiveness. NCAHU supports legislation that expands employer plan options and lowers costs. In support of this bill we were asked to speak before the Senate Commerce and Insurance committee to voice our support.
On Thursday April 22nd, we delivered the following remarks:
"The North Carolina Association of Health Underwriters is the trade association for health insurance agents and brokers. We are the employer and employee facing arm for employee benefits. Our association also includes agents focused on bringing healthcare to individuals outside of an employer sponsored plan, through the Federal Marketplace and Medicare/Medicaid. Our agents and brokers help health care consumers navigate the complexity of the healthcare market through education, providing resources, enrollment assistance and then we help them navigating their plan after enrollment. NCAHU supports initiatives that lowers costs, preserves quality and integrity, brings choice, competition and access to the NC healthcare market. This association supports SB228. By passing this bill you will effectively broaden the scope of benefit plan options. You will be giving employers and employees an additional choice for a lower cost benefit plans. Thank you for the opportunity to speak in support of this bill today."
Update on bills we are currently watching : SB 257 Medication Cost Transparency, to prohibit organizations from establishing or operating PBM's for health benefit plans in the State without being licensed. This legislation was approved by the Senate Health Care Committee. The bill deals with pharmacy benefit manager (PBM) regulation. In addition to providing for licensure for PBMs, the bill addresses the following: Consumer protections, including issues surrounding shipping costs Pharmacist and pharmacy provisions, including retaliation protections and retroactive denial of filed claims Maximum allowable cost appeals PBM network requirements HIPAA protections Enforcement of the proposed provisions The bill now goes to the Senate Commerce and Insurance Committee.
SB 347 Captive Insurance Amendments, this bill would amend statutes related to captive insurance This legislation makes changes addressing the areas of confidentiality, audit exemptions/financial analysis, governing board changes, and tax changes to the laws governing captive insurance arrangements. The bill was approved by the Senate Finance and Rules Committee and will be voted on by the full Senate.
HB 149 Improving Health Care through Telehealth, to establish guidelines and requirements regarding the coverage of health care services delivered through telehealth for health benefit plans offered in the State Passed the House on 5/6 referred to the Senate SB 228 Allowing Employers to Offer EPO Benefit Plans, to allow a health care provider offering an exclusive provider benefit plan This legislation was approved in both the Senate Commerce and Insurance and Senate Health Care Committees. It was amended by Commerce and Insurance into a standalone statute to provide EPO plans for the fully-insured market. In Senate Health Care, the bill was further amended to add a provision requiring insurers to include a clear statement in any application and benefit booklets for EPO plans that out-of-network coverage for insureds in an EPO plan only applies for emergency services and medically-necessary covered services, when an in-network provider is not reasonably available. The bill now goes to the Rules Committee.
SB 505 Medical Billing Transparency This legislation was debated and approved in the Senate Commerce and Insurance Committee. It requires in-network facilities to notify the insured if there are out-of-network providers who may be part of the provision of services. It requires 72 hours notification for scheduled procedures, day-of notice for procedures not scheduled prior to 72 hours, and notice as soon as reasonably possible in an emergency. The bill also requires cost estimates for services rendered by out-of-network providers. The Committee unanimously approved the bill, which now goes to the Senate Rules Committee. We are also monitoring the following: HB 747 Merge NC Choice & Medicaid SB 85 Allow Vision Service Plans SB 248 Additional Information on Health Insurance Cards Until next month! Michelle Wilson-Reynolds Chair, GAAC.