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North Carolina - Compensation & Benefit Legislation

NORTH CAROLINA - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverage within the State.

 

NORTH CAROLINA - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of birth of adopted and foster children is included in state's newborn health care mandate.

 

Preventive care for children: No.

 

(North Carolina Stat. Sections 58-51-25, 58-51-30, 58-51-125)

 

NORTH CAROLINA - ALCOHOLISM & DRUG ABUSE

Employer option.

 

Minimum yearly inpatient coverage: $8,000 per 12 months for inpatient and outpatient combined.

 

Minimum yearly outpatient coverage: $8,000 per 12 months for inpatient and outpatient combined.

 

Minimum lifetime coverage: $16,000.

 

(North Carolina Gen. Stat. Section 58-51-50)

 

NORTH CAROLINA - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: No. Follows FUTA.

 

NORTH CAROLINA - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

NORTH CAROLINA - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits. Based on 1986 National Association of Insurance Commissioner Rules model. (North Carolina Admin. Code tit. 11,R.12.0514)

 

NORTH CAROLINA - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

NORTH CAROLINA - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

Who is Covered by Statute: Individuals who are employees of examiner or applicants for employment with examiner and who are requested or required by examiner to submit to controlled substance examination.

 

Applicant Testing: Applicant testing is allowed.

 

Employee Testing: Employee testing is allowed.

 

How Test Results are Used: State has no statutory requirements.

 

Enforcement of Statutes: State pursues violation of statute.

 

Employer Penalties: Any examiner who violates the provisions of this article shall be subject to a civil penalty of up to $250 per examinee, with the maximum not to exceed $1,000 per investigation by the Commissioner of Labor or the Commissioner's authorized representatives.

 

Who Pays for Testing: State has no statutory requirements.

 

Employee Assistance Benefits: State has no statutory requirements.

 

Other Requirements: None.

 

(North Carolina Gen. Stat. Sections 95-230 et seq.))

 

NORTH CAROLINA - GROUP HEALTH CODE ADDITIONS (MANDATED)

Alcoholism and Drug Abuse: Insurers may not deny coverage or charge higher premiums for persons with alcohol or drug dependency. (North Carolina General Stat. Sections 58-51-55, 58-65-90, 58-67-75.) Insurers must offer group or blanket policyholders coverage for chemical dependency no less favorable than benefits for physical illness. (North Carolina Gen. Stat. Sections 58-51-50(b), 58-65-75(b), 58-67-70(b).) Group policies that provide benefits for chemical dependency and alcohol or drug treatment must cover at least $8,000 of the cost over the life of the contract. (North Carolina Gen. 58-51-50(c)m 58-51-50(e), 58-65-75( c), 58-65-75( e), 58-67-70( c), 58-67-70( e).)

 

Bone Mass Measurement: Insurers, including preferred provider contracts, hospital or medical service plans, and HMOs, must cover bone mass measurement for the diagnosis and evaluation of osteoporosis or low bone mass. Such measurement must be provided by a qualified individual and be a scientifically proven and approved method. The same deductibles, coinsurance, and other limitations as apply to similar services covered under the plan shall apply to coverage for bone mass measurement. A plan may provide that a measurement will be covered only if 23 months have passed since the previous measurement was performed. Measurements may be performed more frequently if medically necessary. (North Carolina Gen. 58-3-174)

 

Coverage Continuation and Conversion: Group policies must provide continuation rights to employees terminating employment and their dependents. (North Carolina Gen. Stat. Section 58-53-5.) Group policies must provide conversion rights to employees whose coverage is terminated for themselves and their dependents. (North Carolina Gen. Stat. Sections 58-53-45, 58-53-65.) Conversion rights must extend to spouses and dependents when eligibility ceases due to death of the insured or dissolution of marriage. (North Carolina Gen. Stat. Section 58-53-110.)

 

Handicapped Dependents: Coverage for dependent children cannot be terminated while a child is incapable of employment due to mental retardation or physical handicap and chiefly dependent on the insured. Such dependents cannot be excluded from coverage and rates must be the same as for other dependents. (North Carolina Gen. Stat. Sections 58-51-25, 58-51-35.)

 

Mental Health: Insurers may not deny coverage for physical illness or injury or charge higher premiums for persons with alcohol or drug dependency. (North Carolina Gen. Stat. Sections 58-51-55, 58-65-90, 58-67-75.)

 

Policies for Small Employers: Providers of health insurance to small employers (employers with no more than 49 nor fewer than 2 eligible employees) must offer coverage to all eligible employees and their dependents. Coverage shall not be offered to only certain individuals except in the case of late enrollees. (North Carolina Gen. Stat. Section 58-50-110(22); and 58-50-130-(a)(6).) Except for late enrollees, pre-existing condition provisions may not limit or exclude coverage for more than 12 months following the insured's effective date of coverage and must define pre-existing conditions as "conditions for which medical advice or treatment was received or recommended or that could be medically documented 12 months before the effective date of the person's coverage." (North Carolina General Stat. Section 58-50-130(a)(1).) The provider may not modify the health benefit plan through riders, endorsements, or otherwise to restrict or exclude coverage for certain diseases or medical conditions otherwise covered by the plan.

 

Pre-existing Conditions: Provisions for pre-existing conditions apply to eligible individuals or dependents who had previous, continuous health care coverage under another plan to a date not more than 60 days prior to the effective date of the new health or HMO coverage, exclusive of any applicable waiting period. (H1202, 1995) (North Carolina Gen. Stat. Section 58-50-130(a)(2).)

 

Procedures Involving Bones of Face, Neck, or Head: Group policies including HMOs must cover procedures involving any bone or joint of the jaw, face, or head; procedures covered must be medically necessary to treat conditions which prevent normal functioning of particular bones or joints. (H594, 1995) (North Carolina Gen. Stat. Section 58-3-121.)

 

Providers: Optometrists, podiatrists, dentists, chiropractors, nurses: Costs for services must be covered if the service is within the provider's scope of services, and the service is covered by the policy. (North Carolina Gen. Stat. Sections 58-50-25, 58-50-30.) Tax supported institutions: Policies covering hospital or physician charges must cover the costs of services rendered by a licensed state tax-supported institution, including charges for medical care of cerebral palsy, orthopedic and crippling disabilities, mental and nervous diseases or disorders, mental retardation, alcoholism and drug or chemical dependency, and respiratory illness, on a basis no less favorable than that which would apply to a private institution or provider. (North Carolina Gen. Stat. Sections 58-51-40, 58-65-65.) Pastoral counselors: Insurers must provide benefits for services provided for treatment of chemical dependency by fee-based practicing pastoral counselors certified by the North Carolina State Board of Examiners of Fee-Based Practicing Pastoral Counselors. (S751, 1995) (North Carolina Gen. Stat. Section 135-40.7A( c).)

 

Sickle Cell or Hemoglobin C Trait: Insurers may not deny coverage or charge higher premiums for persons with the sickle cell or hemoglobin C trait. (North Carolina Gen. Stat. Sections 58-51-45, 58-65-70.)

 

NORTH CAROLINA - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

 

NORTH CAROLINA - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: No.

 

Percent of employees who must elect coverage (if employees pay part of premium): No statutory requirements.

 

Percent of employees who must be covered if employer pays all of premium: 100%.

 

Minimum number of employees in group plan: 10.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): 31.

 

Mandatory conversion: Yes.

 

Other provisions: None.

 

(North Carolina Gen. Stat. Sections 58-58-135, 58-58-140)

 

NORTH CAROLINA - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Columbus Day (or 2nd Monday in October), Thanksgiving. Other: If holiday falls on Sunday, following Monday is a holiday. (North Carolina Gen. Stat. Sections 103-4, 103-7, 103-9, 103-10)

 

NORTH CAROLINA - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

NORTH CAROLINA - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Employer may be liable for reasonable damages and reinstatement.

 

Other Requirements: Wrongfully discharged employee must file civil suit within 1 year of discharge. (North Carolina Gen. Stat. Section 9-32.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: No, but witness will be entitled to employer intercession services to seek cooperation with criminal justice system.

 

Remedies and Penalties: State reports no statutory requirements.

 

Other Requirements: State reports no statutory requirements.

 

NORTH CAROLINA - LEAVES OF ABSENCE

Employers Subject to Leave Laws: All employers.

 

Criteria for Eligibility: Any employee who is a parent/guardian of a school age child.

 

Maximum length of leave: 4 hours per year.

 

Paid Leave: State does not require paid leave.

 

Acceptable Reasons for Leave: Involvement in child's school.

 

Employment Guarantees After Leave: Employer may not take adverse action against employee taking leave.

 

Use of Vacation or other Time-off Benefits: State reports no statutory requirements.

 

Certification Required: Employer may require certification.

 

Effect Of Leave on Other Benefits: Not applicable.

 

Effect of Seniority Accrual During Leave: Not applicable.

 

Minimum Requirements for Notification to Employer: Employer may request 48 hours notice.

 

Conditions for Denial of a Request For Leave: State has no statutory requirements.

 

(North Carolina Gen. Stat. Section 95-28.3.)

 

See U.S. Federal Family and Medical Leave Act

 

NORTH CAROLINA - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

NORTH CAROLINA - MANDATED PROVIDERS

Optometrists, chiropractors, dentists, psychologists, podiatrists, and social workers. Mandatory coverage for registered nurses and pharmacists. Direct access to an obstetrician/gynecologist is mandatory. (North Carolina Gen. Stat. Sections 58-50-25, 58-50-30, 58-51-38)

 

NORTH CAROLINA - MENTAL HEALTH CARE

State reports no statutory requirements.

 

NORTH CAROLINA - MINIMUM WAGE

Refer to the Federal minimum wage: $5.15 per hour (effective September 1, 1997).

 

Exemptions: Certain professionals, agriculture workers, domestics, outside sales, students (sub-minimum wage of 90% of minimum wage), and apprentices (sub-minimum wage of 90% of minimum wage). Handicapped workers in special environments may be exempt by regulation. (North Carolina Gen. Stat. Sections 95-25.3, 95-25.14)

 

See U.S. Minimum Wage

 

NORTH CAROLINA - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: All employees and rehires.

 

Exempt from reporting: No exemptions.

 

Form(s) to file: W-4 form or equivalent.

 

Filing deadline: Within 20 days of hire.

 

Employer information to be included: Name, address, federal TIN, and state unemployment insurance number.

 

Employee information to be included: Name, address, and SSN.

 

Penalty for failure to report: Civil penalty not to exceed $25, if conspiracy, $500.

 

(N.C. gen. Stat. 110-129.2)

 

NORTH CAROLINA - NEWBORN CARE MANDATE

Mandated coverage.

 

Preventive care for children: No. (North Carolina Stat. Sections 58-51-25, 58-51-30, 58-51-125)

 

NORTH CAROLINA - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

NORTH CAROLINA - PRE-EXISTING CONDITIONS

For insurance plans offered to small employers, pre-existing condition provision may not limit coverage beyond 12 months following the initial effective date. (North Carolina Gen. Stat. Ann. Sections 58-50-50-110, 58-50-120, 58-50-125, 58-50-130, 58-50-155)

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

NORTH CAROLINA - PROTECTED CLASSIFICATIONS

Age:  Yes, age 40 and over.

Race:  Yes.

Color: Yes.

National Origin: Yes.

Ancestry:  No specific law. State has expressed policy against discrimination.

Religion:  Yes.

Sex:   Yes.

Pregnancy:  No specific law. State has expressed policy against discrimination.

Sexual Harassment:  No specific law. State has expressed policy against discrimination.

 

(N.C. Gen. Stat. Sections 126-16, 126-36, 168A-3. Statute applies to public employment only.)

 

NORTH CAROLINA - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

NORTH CAROLINA - SHORT TERM DISABILITY CODE ADDITIONS

State does not require employer or employee participation in short term disability plans.

 

NORTH CAROLINA - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Payday.

 

Date due if employee resigns: Payday.

 

Wages: Yes. (Wages include severance, commissions, bonuses, and other amounts when employer has policy of making such payments.)

 

Vacation Pay: Yes.

 

Holiday: Yes.

 

Sick leave: Yes.

 

Severance: Yes, wages include severance when employer has policy of making such payments.

 

(North Carolina Gen. Stat. Sections 95-25.2, 95-25.7. Note: U.S. Court of Appeals, 4th Circuit, has ruled North Carolina's statute on severance pay is preempted by ERISA. Holland v. Burlington Industries, Inc. 772 F.2d 1140 (4th Cir. 1985), aff'd 477 U.S. 901 (1986))

 

NORTH CAROLINA - UNEMPLOYMENT TAX

Employer Contributions (Effective January 1, 2000):

 

 

Voluntary Contribution Provision: Yes. Within 30 days of mailing notice.

 

(North Carolina General Stat. Section 96-9.)

 

NORTH CAROLINA - VACATION PAY

See TERMINATION & SEVERANCE PAY (above)

 

NORTH CAROLINA - VOTING TIME OFF

State reports no statutory requirements.

 

NORTH CAROLINA - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employers of 3 or more employees and all employments with exposure to radiation. Corporate officers count toward total number of employees, but may reject coverage. Elective as to partner or sole proprietor.

 

Public Employers: Mandatory coverage to all public employments, public and quasi-public corporations, and elected officials.

 

Exceptions: Farm labor, domestic servants, casual workers, railroad workers, voluntary ski patrol persons, individual sawmill or logging operators with fewer that 10 employees who operate less than 60 days over a 6-month period.

 

Special Coverage Provisions: Voluntary as to casual employees, domestic servants, and employers with fewer that 3 employees. Mandatory as to agricultural employer with 10 or more full-time non-seasonal workers. Contractor must certify that their sub-contractor has secured compensation. If sub-contractor has no employees, they may waive coverage.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)