11 NCAC 12 .1301             DEFINITIONS

(a)  As used in this Section, unless the context clearly indicates otherwise:

(1)           "Act" means the North Carolina Small Employer Group Health Coverage Reform Act described in G.S. 58‑50‑100.

(2)           "Carrier" means a small employer carrier.

(3)           "Extra eligible" means an individual who is not an eligible employee or a dependent of an eligible employee who is insured under the health benefit plan of a small employer.

(4)           "New entrant" means an eligible employee, or the dependent of an eligible employee, who becomes part of an employer group after the initial period for enrollment in a health benefit plan.

(5)           "Nonstatutory plan" means any health benefit plan subject to the Act other than the statutory plans.

(6)           "Policy anniversary" or "plan anniversary" means the annual anniversary of the issuance of a health benefit plan. If a plan is issued through a multiple employer trust, "policy anniversary" or "plan anniversary" means the annual anniversary of the issuance of the health benefit plan to the small employer.

(7)           "Previously declined group" means a group whose application for coverage was declined for any reason by a carrier after January 1, 1992, and before August 14, 1992.

(8)           "Previously declined individual" means an individual whose application for coverage for a health benefit plan was declined by a carrier before August 14, 1992.

(9)           "Producer" means an insurance agent or insurance broker licensed under Article 33 of G.S. Chapter 58.

(10)         "Statutory plan" means the basic or standard health care plan.

(b)  The definitions contained in G.S. 58‑50‑110 are incorporated into this Section by reference.


History Note:        Authority G.S. 58‑2‑40(1);

Temporary Adoption Eff. December 21, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner;

Eff. April 1, 1993;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.