Bill > H456

This bill aims to improve health insurance coverage for ambulance services in North Carolina by establishing clearer guidelines for emergency and non-emergency ground ambulance transportation. The bill expands existing emergency service coverage regulations to explicitly include ambulance transportation, allowing insurers to cover transportation to a medically appropriate location for screening and stabilization. For emergency services, insurers cannot require prior authorization if a reasonable person would believe an emergency exists, and cost-sharing must be consistent regardless of whether the provider is in-network. The bill introduces a new provision for non-emergency ground ambulance transportation, stipulating that when services are provided by an out-of-network provider, insurers cannot charge more than 110% of the in-network cost-sharing amount. The legislation also requires insurers to provide clear information to covered persons about emergency service coverage, appropriate use of emergency services, cost-sharing provisions, and access procedures. The bill will become effective on October 1, 2025, for insurance contracts issued or renewed after that date, and the State Health Plan will be required to adopt these new ambulance service coverage requirements. Additionally, the state has appropriated $1 million annually for the 2025-2027 fiscal biennium to support the implementation of these new coverage requirements.

Budget and Finance

https://www.ncleg.gov/BillLookUp/2025/H456