Senate Bill 837 Summary

• Requires prepaid health plans (PHPs) providing Medicaid and NC Health Choice services to obtain a license from the Department of Insurance and establishes regulatory oversight authority.

• Establishes minimum capital and surplus requirements of $1,000,000 or risk-based capital amount (whichever is greater) and initial working capital of $1,500,000, with deposits of $500,000 required for enrollee protection.

• Mandates PHPs maintain insolvency protection plans including reinsurance, reserves, or letters of credit to ensure continuation of benefits for enrollees through contract periods and inpatient facility discharge.

• Grants the Commissioner of Insurance authority to examine PHPs at least every five years, suspend or revoke licenses for non-compliance or financial instability, and enforce regulations through cease and desist orders and civil injunctions.

• Exempts existing licensed health organizations in North Carolina from these requirements if their solvency requirements equal or exceed the Article's standards.