GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H D
HOUSE BILL DRH30049-MR-50
Short Title: Increase Access for Small Employers/Insurance. (Public)
Sponsors: Representative Paré.
Referred to:
*DRH30049 -MR-50*
A BILL TO BE ENTITLED 1
AN ACT INCREASING SMALL EMPLOYER ACCESS TO STOP LOSS, CATASTROPHIC, 2
AND REINSURANCE COVERAGE. 3
The General Assembly of North Carolina enacts: 4
SECTION 1. G.S. 58-50-130(a)(5) reads as rewritten: 5
"(5) No small employer carrier, insurer, subsidiary of an insurer, or controlled 6
individual of an insurance holding company shall provide stop loss, 7
catastrophic, or reinsurance coverage to small employers who employ fewer 8
than 12 five eligible employees that does not comply with the underwriting, 9
rating, and other applicable standards in this Act. An insurer shall not issue a 10
stop loss health insurance policy to any person, firm, corporation, partnership, 11
or association defined as a small employer that does any of the following: 12
a. Provides direct coverage of health expenses payable to an individual. 13
b. Has an annual attachment point for claims incurred per individual that 14
is lower than twenty thousand dollars ($20,000) for plan years 15
beginning in 2013. For subsequent policy years, the amount shall be 16
indexed using the Consumer Price Index for Medical Services for All 17
Urban Consumers for the South Region and shall be rounded to the 18
nearest whole thousand dollars. The index factor shall be the index as 19
of July of the year preceding the change divided by the index as of July 20
2012. 21
c. Has an annual aggregate attachment point lower than the greater of 22
one of the following: 23
1. One hundred twenty percent (120%) of expected claims. 24
2. Twenty thousand dollars ($20,000) for plan years beginning in 25
2013. For subsequent policy years, the amount shall be indexed 26
using the Consumer Price Index for Medical Services for All 27
Urban Consumers for the South Region and shall be rounded 28
to the nearest whole thousand dollars. The index factor shall be 29
the index as of July of the year preceding the change divided 30
by the index as of July 2012. 31
Nothing in this subsection prohibits an insurer from providing additional 32
incentives to small employers with benefits promoting a medical home or 33
benefits that provide health care screenings, are focused on outcomes and key 34
performance indicators, or are reimbursed on an outcomes basis rather than a 35
fee-for-service basis." 36
H.B. 156
Feb 18, 2025
HOUSE PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
Page 2 DRH30049-MR-50
SECTION 2. This act becomes effective October 1, 2025, and applies to contracts 1
issued, renewed, or amended on or after that date. 2