North Carolina General Statutes
Article 3B - State Health Plan for Teachers and State Employees.
§ 135-48.5 - Health benefit trust funds created.

135-48.5. Health benefit trust funds created.
(a) There are hereby established two health benefit trust funds, to be known as the Public Employee Health Benefit Fund and the Health Benefit Reserve Fund for the payment of hospital and medical benefits. As used in this section, the term "health benefit trust funds" refers to the fund type described under G.S. 143C-1-3(a)(10).
All premiums, fees, charges, rebates, refunds or any other receipts including, but not limited to, earnings on investments, occurring or arising in connection with health benefits programs established by this Article, shall be deposited into the Public Employee Health Benefit Fund. Disbursements from the Fund shall include any and all amounts required to pay the benefits and administrative costs of such programs as may be determined by the Executive Administrator and Board of Trustees.
Any unencumbered balance in excess of prepaid premiums or charges in the Public Employee Health Benefit Fund at the end of each fiscal year shall be used in the following order:
(1) First, to provide an actuarially determined Health Benefit Reserve Fund for incurred but unpresented claims.
(2) Second, an amount determined by the State Treasurer, subject to approval by the Board of Trustees, that does not exceed twenty-five percent (25%) of any unencumbered balance remaining after providing for incurred but unpresented claims may be transferred to the Retiree Health Benefit Fund, established under G.S. 135-7(f). Upon the direction and approval of, and in the amount specified by, the State Treasurer, the Office of State Budget Management shall transfer the amount in accordance with this subdivision.
(3) Third, to reduce the premiums required in providing the benefits of the health benefits programs.
(4) Fourth, to improve the plan, as may be provided by the State Treasurer, subject to approval by the Board of Trustees.
The balance in the Health Benefits Reserve Fund may be transferred from time to time to the Public Employee Health Benefit Fund to provide for any deficiency occurring therein. The Public Employee Health Benefit Fund and the Health Benefit Reserve Fund shall be deposited with the State Treasurer and invested as provided in G.S. 147-69.2 and G.S. 147-69.3.
(b) Disbursement from the Public Employee Health Benefit Fund may be made by warrant drawn on the State Treasurer by the Executive Administrator, or the Executive Administrator and Board of Trustees may by contract authorize the Claims Processors to draw the warrant.
(c) Repealed by Session Laws 2012-173, s. 3(b), effective January 1, 2013. (1981 (Reg. Sess., 1982), c. 1398, s. 6; 1985, c. 732, ss. 43, 63; 1985 (Reg. Sess., 1986), c. 1020, s. 20; 1997-468, s. 3; 1998-1, s. 4(d); 2008-107, s. 10.13(a); 2008-168, ss. 1(a), 2(a), (l); 2011-85, s. 2.5(e); 2012-173, s. 3(b); 2020-48, s. 2.2(b).)

Structure North Carolina General Statutes

North Carolina General Statutes

Chapter 135 - Retirement System for Teachers and State Employees; Social Security; State Health Plan for Teachers and State Employees

Article 3B - State Health Plan for Teachers and State Employees.

§ 135-48.1 - General definitions.

§ 135-48.2 - Undertaking.

§ 135-48.3 - Right to amend.

§ 135-48.4 - Conflict with federal law.

§ 135-48.5 - Health benefit trust funds created.

§ 135-48.8 - Statements of public interest.

§ 135-48.10 - Confidentiality of information and medical records; provider contracts.

§ 135-48.12 - Committee on Actuarial Valuation of Retired Employees' Health Benefits.

§ 135-48.15 - Whistle-blower protections related to the State Health Plan.

§ 135-48.16 - Fraud detection and audit programs.

§ 135-48.20 - Board of Trustees established.

§ 135-48.21 - Board officers, quorum, meetings.

§ 135-48.22 - Board powers and duties.

§ 135-48.23 - Executive Administrator.

§ 135-48.24 - Administrative review.

§ 135-48.25 - Rules.

§ 135-48.27 - Reports to the General Assembly; General Assembly access to information.

§ 135-48.28 - Auditing of the Plan.

§ 135-48.30 - Powers and duties of the State Treasurer.

§ 135-48.32 - Contracts to provide benefits.

§ 135-48.33 - Contracting provisions; large contract review by Board of Trustees and Attorney General, auditing, no cost plus contracts.

§ 135-48.34 - Contracts not subject to Article 3 of Chapter 143 of the General Statutes.

§ 135-48.35 - Contract disputes not contested case under the Administrative Procedure Act, Chapter 150B of the General Statutes.

§ 135-48.37 - Liability of third person; right of subrogation; right of first recovery.

§ 135-48.37A - Employing unit cooperation in collection of amounts owed to Plan.

§ 135-48.38 - Persons eligible for Medicare; optional participation in other Medicare products.

§ 135-48.39 - Operations during state of disaster or emergency.

§ 135-48.40 - Categories of eligibility.

§ 135-48.41 - Additional eligibility provisions.

§ 135-48.42 - Enrollment.

§ 135-48.43 - Effective dates of coverage.

§ 135-48.44 - Cessation of coverage.

§ 135-48.45 - Conversion.

§ 135-48.46 - Settlement agreements by employing units.

§ 135-48.47 - Participation in State Health Plan by local government employees and dependents.

§ 135-48.49 - IRC Sections 6055 and 6056 regulatory reporting.

§ 135-48.50 - Coverage mandates.

§ 135-48.51 - Coverage and operational mandates related to Chapter 58 of the General Statutes.

§ 135-48.52 - General limitations and exclusions.

§ 135-48.54 - Optional participation for charter schools operated by private nonprofit corporations or municipalities.

§ 135-48.56 - Education of covered active and retired employees.

§ 135-48.57 - Payments for county or city ambulance service.

§ 135-48.58 - Premiums for firefighters, rescue squad workers, and members of National Guard.