State Law

North Carolina Gen. Statutes-Chapter 58-Article 50. General Accident and Health Insurance Regulations

08/10/2023 North Carolina Sections 58-50-270 and 58-50-280

Section58-50-270. Definitions; Section 58-50-280. Contract amendments

Amendments, Fee Schedules, Termination

See bold sections below:

 Section 58-50-270. Definitions

Unless the context clearly requires otherwise, the following definitions apply in this Part.

(1) “Amendment” — Any change to the terms of a contract, including terms incorporated by reference, that modifies fee schedules. A change required by federal or State law, rule, regulation, administrative hearing, or court order is not an amendment.

(2) “Contract” — An agreement between an insurer and a health care provider for the provision of health care services by the provider on a preferred or in-network basis.

(3) “Health benefit plan” — A policy, certificate, contract, or plan as defined in G.S. 58-3-167.

(3a) “Health care provider” — An individual who is licensed, certified, or otherwise authorized under Chapter 90 or Chapter 90B of the General Statutes or under the laws of another state to provide health care services in the ordinary course of business or practice of a profession or in an approved education or training program and a facility that is licensed under Chapter 131E or Chapter 122C of the General Statutes or is owned or operated by the State of North Carolina in which health care services are provided to patients.

(4) “Insurer” — An entity as defined in G.S. 58-3-227(a)(4).


Section 58-50-280. Contract Amendments

(a) A health benefit plan or insurer shall send any proposed contract amendment to the notice contact of a health care provider pursuant to G.S. 58-50-275. The proposed amendment shall be dated, labeled “Amendment,” signed by the health benefit plan or insurer, and include an effective date for the proposed amendment.

(b) A health care provider receiving a proposed amendment shall be given at least 60 days from the date of receipt to object to the proposed amendment. The proposed amendment shall be effective upon the health care provider failing to object in writing within 60 days.

(c) If a health care provider objects to a proposed amendment, then the proposed amendment is not effective and the initiating health benefit plan or insurer shall be entitled to terminate the contract upon 60 days written notice to the health care provider.

(d) Nothing in this Part prohibits a health care provider and insurer from negotiating contract terms that provide for mutual consent to an amendment, a process for reaching mutual consent, or alternative notice contacts.