H649 Summary

• Eliminates requirements for small employer carriers to issue basic and standard health benefit plans; non-grandfathered plans must be terminated by January 1, 2014, with 90-day notice to affected parties.

• Repeals five sections of the Small Employer Group Health Coverage Reform Act (G.S. 58-50-126, 127, 135, 155, 156) and modifies definitions to distinguish between grandfathered and nongrandfathered group health plans effective January 1, 2014.

• Establishes separate premium rating rules for nongrandfathered plans using a statewide risk pool with adjustments limited to age (3:1 ratio), family vs. individual coverage, geographic areas, and tobacco use (1.2:1 ratio).

• Expands stop loss insurance availability for small employers by raising the definition of "small employer" from 50 to 100 employees and establishing minimum attachment points of $20,000 per individual and 120% of expected claims for aggregate coverage.

• Requires the Department of Insurance to adopt rules for oversight of insurers and third-party administrators administering stop loss coverage and to annually publish attachment point amounts.