North Carolina General Statutes 58-3-247. Insurance identification card
(a) Every insurer offering a health benefit plan as defined under N.C. Gen. Stat. § 58-3-167 shall provide the health benefit plan subscriber or members with an insurance identification card. The card shall contain, at a minimum, all of the following information:
(1) The subscriber’s name and identification number.
Terms Used In North Carolina General Statutes 58-3-247
- following: when used by way of reference to any section of a statute, shall be construed to mean the section next preceding or next following that in which such reference is made; unless when some other section is expressly designated in such reference. See North Carolina General Statutes 12-3
(2) The member’s name and identification number, if applicable and different from the subscriber’s name and identification number.
(3) The group number.
(4) The name of the organization issuing the policy, the name of the organization administering the policy, and the name of the network, whichever applies.
(5) The effective date of health benefits plan coverage or the date the card is issued if it is after the effective date.
(6) The address where claims are to be filed and, if applicable, the electronic claims filing payor identification number.
(7) The policyholder’s obligations with regard to copayments, if applicable, for at least all of the following:
a. Primary care office visit.
b. Specialty care office visit.
c. Urgent care visit.
d. Emergency room visit.
(8) The phone number or website address whereby the subscriber, member, or service provider, in compliance with privacy rules under the Health Insurance Portability and Accountability Act may readily obtain the following:
a. Confirmation of eligibility.
b. Benefits verification in order to estimate patient financial responsibility.
c. Prior authorization for services and procedures.
d. The list of participating providers in the network.
e. The employer group number.
f. Special mental health medical benefits under the health plan, if applicable.
(9) An indication of whether the health benefit plan is a fully insured or self-funded plan. Plans that are fully insured shall be noted by using the phrase “fully insured” to indicate to the consumer that the Department is able to provide assistance regarding the regulation of the plan.
(b) The insurance identification card must be designed such that if the card is photocopied or electronically scanned, the resulting image is clearly legible. The identification card must present the information in a readily identifiable manner or, alternatively, the information may be embedded on the card and available through magnetic stripe or smart card. The information may also be provided through other electronic technology. (2007-362, s. 2; 2021-30, s. 1(a).)