Federal & State Regulations | HIPAA - North Carolina | J. J. Keller® Compliance Network

State Info

Summary of differences between federal and state regulations

Federal HIPAA portability provisions limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances.

States are allowed to go beyond the federal requirements. North Carolina adopts the federal requirements. There are some elements worth noting, however.

The term “employee” is defined (under North Carolina General Statutes) as a nonseasonal person who works on a full-time basis, with a normal work week of 30 or more hours and who is otherwise eligible for coverage, but does not include a person who works on a part-time, temporary, or substitute basis.

In North Carolina, small employer groups are those with 1 to 50 employees large employer groups are those with more than 50 employees.

Employers with 2 to 50 employees must be offered any small group health plan insurers offer to other small employers, including what are known as the “standard” and “basic” plans.

Under North Carolina law, self-employed persons (with no employees) are considered to be small groups.

Small employers cannot be refused coverage because of the health status of their employees or employees’ dependents. However, a small group can be charged higher premiums.