North Carolina insurance laws

What it would do: Enacts the Voluntary Portable Benefits Plan Act allowing hiring parties to voluntarily contribute funds to portable benefit accounts for independent contractors to purchase health insurance, retirement, disability, and other benefits, with contributions not treated as evidence of employment status.

What it would do: Creates the Consumers in Crisis Protection Act regulating consumer legal funding companies that provide cash advances against future settlement or judgment proceeds. Requires registration with the Insurance Commissioner, limits charges to 18% plus 3.5% servicing fee per six-month period, prohibits attorney referral fees, and makes transactions nonrecourse.

What it would do: Clarifies permitted insurance trade practices by allowing insurers and producers to offer value-added products or services, noncash gifts up to $250 per policy term, and conduct drawings or raffles without violating rebate prohibitions, subject to specified conditions and non-discriminatory application.

What it would do: Revises health insurance utilization review procedures to require faster determinations (48 hours for non-urgent, 24 hours for urgent services), mandate physician involvement in noncertifications, establish provider exemptions for high approval rates, and require insurers to report utilization review statistics to the Commissioner.

What it would do: Clarifies that the $50 cap on insurance referral fees paid to unlicensed individuals applies to referrals to licensed insurance agents or brokers under G.S. 58-33-26(c1)(6), and excludes title insurance from this cap. Effective October 1, 2025.

What it would do: Requires health benefit plans and Medicaid to cover biomarker testing for diagnosis, treatment, and monitoring when supported by FDA approval, Medicare determinations, or clinical practice guidelines. Establishes utilization review timelines of 24 hours for urgent services and 72 hours for non-urgent services.

What it would do: Requires health insurers to cover diagnostic and supplemental breast cancer imaging with cost-sharing no less favorable than screening mammography, and prohibits non-contracted healthcare providers from billing patients above insurer reimbursement rates for these services, effective October 1, 2025.

What it would do: Requires health insurers to reimburse out-of-network ambulance services at 100% of local government rates, or if none exist, the lesser of 400% of Medicare rates or billed charges, and limits covered person cost-sharing to $100 or 10% of the reimbursement rate.

What it would do: Requires insurance institutions and agents to notify applicants or policyholders and obtain written consent before collecting or using vehicle telematics data, allow revocation of consent at any time with effectuation within 24 hours, and treats violations as unfair trade practices.

What it would do: Requires health benefit plans to cover prosthetic and orthotic devices, materials, instruction, and repairs as determined medically necessary by healthcare providers, including custom devices for activities and health maximization. Repeals state emergency care coverage requirements duplicative of federal law.

What it would do: Reduces the minimum number of eligible employees required for small employers to access stop loss, catastrophic, and reinsurance coverage from 12 to 5 employees, while maintaining existing underwriting standards and attachment point requirements.

What it would do: Amends North Carolina's Professional Employer Organization Act by adding definitions for audited GAAP financial statements, tangible net worth, and working capital; modifying group licensure requirements; extending the timeframe for financial statements from 90 to 120 days; and revising application and licensing procedures.

What it would do: Revises the Insurance Guaranty Association Act to include cybersecurity insurance coverage, clarify covered claim definitions and limits, expand the Association's powers to contest settlements and defend claims on the merits, and modify recovery rights against high-net-worth insureds.

What it would do: Requires health insurers offering coverage for transcranial magnetic stimulation to cover all procedures performed by properly licensed healthcare providers within their scope of practice, and prohibits penalizing providers based on medical specialty, while allowing insurers to determine coverage indications, requirements, and reimbursement rates.

What it would do: Regulates pharmacy benefits managers by prohibiting spread pricing, requiring concessions be passed to insurers, establishing specialty pharmacy accreditation standards, clarifying pharmacy-of-choice rights, and strengthening pharmacy audit protections including limits on audit scope and recoupment procedures.

What it would do: Prohibits insurers from discriminating against living organ donors in health and life insurance. Provides a tax credit up to $5,000 for unreimbursed organ donation expenses and grants state employees up to 30 days paid leave for organ donation or 7 days for bone marrow donation.

What it would do: Requires health benefit plans covering prescription eye drops to also cover early refills if the patient requests after using 70% of a 30-day supply or after 21 days, provided refills do not exceed the prescriber's limit. Appropriates $100,000 annually for the State Health Plan to provide this coverage.

What it would do: Allows pharmacists to order and perform CLIA-waived tests to treat influenza using statewide protocols, and requires health insurers to cover pharmacist-provided healthcare services performed within the pharmacist's scope of practice on the same basis as equivalent services by other healthcare providers.

What it would do: Increases the damage thresholds for accidents under the Safe Driver Incentive Plan: major accidents from $3,850 to $5,975, intermediate accidents from $2,300-$3,850 to $3,570-$5,975, and minor accidents from $2,300 to $3,570. Effective October 1, 2025 for accidents occurring on or after that date.

What it would do: Adds any cancer diagnosis that qualified a firefighter for benefits under the Firefighters' Cancer Insurance Program to the list of cancers presumed to be killed in the line of duty under the Public Safety Employees' Death Benefits Act, and appropriates $2,000,000 annually for 2025-2027 to fund related death benefits.

What it would do: Prohibits occupational and state agency licensing boards from denying licensure based solely on moral turpitude convictions. Requires boards to consider specific factors including crime severity, date, applicant age, rehabilitation efforts, and nexus to job duties before denying licenses for any criminal conviction.

What it would do: Requires any legislation containing new health benefit mandates to repeal an equal number of existing mandates and appropriate recurring funds for the mandate's cost. Applies these requirements to the State Health Plan for Teachers and State Employees effective 30 days after enactment.

What it would do: Directs the North Carolina Rate Bureau to establish a named driver exclusion endorsement for persons receiving foster care and allows foster parents to terminate such endorsements when they no longer provide foster care. Establishes a financial assistance program to help pay for motor vehicle liability insurance for foster children and appropriates one million dollars for fiscal year 2026-2027.

What it would do: Caps prescription drug cost-sharing at $2,000 annually, requires in-network rates at network facilities, restricts out-of-network penalties, includes ground ambulance services in essential health benefits, limits hospital collections practices, and requires hospitals and surgical facilities to report pricing data and provide good-faith estimates for shoppable services.

What it would do: Prohibits insurers from using credit scoring as the sole basis for terminating policies or applying rate deviations for noncommercial motor vehicle and residential property insurance. Requires insurers to provide 60 days' notice before charging higher rates and mandates annual publication of detailed insurance data by geography and demographic categories.