SUBCHAPTER 2D –DISABILITY SALARY CONTINUATION PLAN

 

SECTION .0100 ‑ GENERAL PROVISIONS

 

20 NCAC 02D .0101         GENERAL INFORMATION

 

History Note:        Authority G.S. 135‑6(f); 135‑32; 135‑34;

Eff. February 1, 1976;

Readopted Eff. September 21, 1977;

Amended Eff. December 1, 1982; October 29, 1979;

Repealed Eff. August 1, 1988.

 

20 NCAC 02D .0102         PURPOSES: FUNCTIONS: AND DUTIES

20 NCAC 02D .0103         AUTHORITY TO APPOINT ADVISORY COMMITTEE

 

History Note:        Authority G.S. 135‑6(f); 135‑33;

Eff. February 1, 1976;

Readopted Eff. September 21, 1977;

Repealed Eff. December 1, 1982.

 

SECTION .0200 ‑ DISABILITY SALARY CONTINUATION PLAN

 

 

20 NCAC 02D .0201         DEFINITIONS

20 NCAC 02D .0202         MEMBERSHIP

20 NCAC 02D .0203         CONTRIBUTIONS

20 NCAC 02D .0204         BENEFITS

20 NCAC 02D .0205         REHABILITATION

20 NCAC 02D .0206         PHYSICAL EXAMINATION

20 NCAC 02D .0207         PAYMENT OF CLAIMS

20 NCAC 02D .0208         ASSIGNMENT

20 NCAC 02D .0209         MANAGEMENT OF FUNDS

 

History Note:        Authority G.S. 135‑34; 135‑6(f);

Eff. February 1, 1976;

Readopted Eff. September 21, 1977;

Amended Eff. October 29, 1979;

Repealed Eff. August 1, 1988.

 

20 NCAC 02D .0210         TERMINATION OF THE PLAN

 

History Note:        Authority G.S. 135‑34; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

20 NCAC 02D .0211         AGREEMENT

20 NCAC 02D .0212         EMPLOYEE DISABILITY FUND

20 NCAC 02D .0213         FORMS

20 NCAC 02D .0214         INSTRUCTIONS FOR USE OF FORMS

 

History Note:        Authority G.S. 135‑34; 135‑6(f);

Eff. February 1, 1976;

Readopted Eff. September 21, 1977;

Repealed Eff. August 1, 1988.

 

SECTION .0300 ‑ HOSPITAL AND MEDICAL CARE BENEFITS

 

 

20 NCAC 02D .0301         CONTRACT

20 NCAC 02D .0302         PROGRAM PROVISIONS

 

History Note:        Authority G.S. 135‑6(f); 135‑33;

Eff. February 1, 1976;

Readopted Eff. September 21, 1977;

Amended Eff. October 29, 1979; July 1, 1978;

Repealed Eff. December 1, 1982.

 

20 NCAC 02D .0303         EFFECTIVE DATES

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

20 NCAC 02D .0304         CONTRIBUTION RATE

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Readopted Eff. September 21, 1977;

Repealed Eff. July 1, 1978.

 

20 NCAC 02D .0305         TYPES OF COVERAGE

20 NCAC 02D .0306         SPLIT CONTRACT

 

History Note:        Authority G.S. 135‑6(f); 135‑33;

Eff. February 1, 1976;

Readopted Eff. September 21, 1977;

Repealed Eff. December 1, 1982.

 

20 NCAC 02D .0307         SUPPLEMENTARY PLANS

20 NCAC 02D .0308         RETIREMENT

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

20 NCAC 02D .0309         PAYMENT

20 NCAC 02D .0310         ELIGIBILITY

 

History Note:        Authority G.S. 135‑6(f); 135‑33; 135‑33.1; 135‑36;

Eff. February 1, 1976;

Readopted Eff. September 21, 1977;

Amended Eff. October 29, 1979;

Repealed Eff. December 1, 1982.

 

20 NCAC 02D .0311         OPEN ENROLLMENT

20 NCAC 02D .0312         AGENT

20 NCAC 02D .0313         CHANGES: BENEFIT PLANS

20 NCAC 02D .0314         ENROLLMENT AND ADMINISTRATION

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

20 NCAC 02D .0315         FILING OF CLAIMS

20 NCAC 02D .0316         CHANGES IN FAMILY STATUS

20 NCAC 02D .0317         SEPARATION FROM SERVICE

20 NCAC 02D .0318         LEAVE OF ABSENCE

 

History Note:        Authority G.S. 135‑6(f); 135‑33;

Eff. February 1, 1976;

Readopted Eff. September 21, 1977;

Repealed Eff. December 1, 1982.

 

20 NCAC 02D .0319         DOCUMENTS ATTACHED

20 NCAC 02D .0320         TERMINATION

20 NCAC 02D .0321         TERMINATION OF CERTIFICATES

20 NCAC 02D .0322         PREVIOUS CONTRACT

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

SECTION .0400 ‑ EXPERIENCE RATING AGREEMENT

 

 

20 NCAC 02D .0401         BENEFIT ADMINISTRATION

20 NCAC 02D .0402         RETENTION

20 NCAC 02D .0403         INCURRED CLAIMS EXPENSE

20 NCAC 02D .0404         PROJECTED EXPENSE RATIO

20 NCAC 02D .0405         STABILIZATION RESERVES

20 NCAC 02D .0406         RATING PROCEDURES

20 NCAC 02D .0407         ACCOUNTING

20 NCAC 02D .0408         AGREEMENT INTENT

20 NCAC 02D .0409         ANNUAL REPORTS

20 NCAC 02D .0410         RETENTION

20 NCAC 02D .0411         INCOME AND CLAIMS EXPERIENCE

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

SECTION .0500 ‑ COORDINATION OF BENEFITS

 

 

20 NCAC 02D .0501         BENEFITS PROVISION

20 NCAC 02D .0502         DEFINITIONS

20 NCAC 02D .0503         EFFECT ON BENEFITS

20 NCAC 02D .0504         IMPLEMENTATION

20 NCAC 02D .0505         FACILITY OF PAYMENT

20 NCAC 02D .0506         RIGHT OF RECOVERY

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

SECTION .0600 ‑ INPATIENT HOSPITAL BENEFITS

 

 

20 NCAC 02D .0601         DAYS AVAILABLE

20 NCAC 02D .0602         BENEFITS IN CONTRACTING HOSPITALS

20 NCAC 02D .0603         BENEFITS: NONCONTRACTING HOSPITALS

20 NCAC 02D .0604         BENEFITS IN OUT‑OF‑STATE HOSPITALS

20 NCAC 02D .0605         GENERAL PROVISIONS

20 NCAC 02D .0606         SKILLED NURSING FACILITY

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

SECTION .0700 ‑ OUTPATIENT BENEFITS

 

 

20 NCAC 02D .0701         BENEFIT PROVISION

20 NCAC 02D .0702         ACCIDENTAL INJURY

20 NCAC 02D .0703         MEDICAL EMERGENCIES

20 NCAC 02D .0704         HOSPITAL OPERATIONS

20 NCAC 02D .0705         RADIATION THERAPY

20 NCAC 02D .0706         PATHOLOGICAL EXAMINATION

20 NCAC 02D .0707         TESTS AND PROCEDURES

20 NCAC 02D .0708         GENERAL PROVISIONS

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

SECTION .0800 ‑ SURGICAL BENEFITS

 

 

20 NCAC 02D .0801         SCOPE OF SERVICES

20 NCAC 02D .0802         BASIS OF BENEFIT ALLOWANCES

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

SECTION .0900 ‑ INPATIENT MEDICAL BENEFITS

 

 

20 NCAC 02D .0901         SCOPE OF SERVICES

20 NCAC 02D .0902         DURATION OF BENEFITS

20 NCAC 02D .0903         BASIS OF BENEFIT ALLOWANCES

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

SECTION .1000 ‑ MAJOR MEDICAL BENEFITS

 

 

20 NCAC 02D .1001         MAXIMUM BENEFITS

20 NCAC 02D .1002         DEDUCTIBLE AMOUNTS

20 NCAC 02D .1003         BENEFIT PERIOD

20 NCAC 02D .1004         BENEFITS

20 NCAC 02D .1005         LIMITATIONS AND EXCLUSIONS FOR MAJOR MEDICAL BENEFITS

20 NCAC 02D .1006         GENERAL PROVISIONS

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.

 

SECTION .1100 ‑ TERMS AND CONDITIONS

 

 

20 NCAC 02D .1101         DEFINITIONS

20 NCAC 02D .1102         MATERNITY PROVISIONS

20 NCAC 02D .1103         EXCLUSION: BASIC AND MAJOR MEDICAL BENEFITS

20 NCAC 02D .1104         MISREPRESENTATION

20 NCAC 02D .1105         TERMINATION OF GROUP COVERAGE

20 NCAC 02D .1106         MODIFICATION

20 NCAC 02D .1107         TERMINATION UPON DEATH

20 NCAC 02D .1108         TERMINATION UPON MARRIAGE: AGE LIMIT

20 NCAC 02D .1109         TERMINATION WITHOUT CLAIM PREJUDICE

20 NCAC 02D .1110         CONVERSION FROM GROUP TO NONGROUP COVERAGE

20 NCAC 02D .1111         NONGROUP TO GROUP COVERAGE

20 NCAC 02D .1112         COVERAGE CHANGE APPLICATION

20 NCAC 02D .1113         EXTENDED MATERNITY BENEFITS

20 NCAC 02D .1114         GENERAL PROVISIONS

20 NCAC 02D .1115         WAITING PERIODS

 

History Note:        Authority G.S. 135‑33; 135‑6(f);

Eff. February 1, 1976;

Repealed Eff. September 21, 1977.