§ 58-57-115. Family leave credit insurance standards; policy provisions.
§58‑57‑115. Family leave credit insurance standards; policyprovisions.
(a) Definitions. Asused in this section:
(1) "Fosterchild" means a minor (i) over whom a guardian has been appointed by theclerk of superior court of any county in North Carolina; or (ii) the primary orsole custody of whom has been assigned by order of a court of competentjurisdiction.
(2) "Immediatefamily member" means a spouse, child (natural, adopted, or foster), orparent of the insured person.
(3) "Placement inthe foster home" means physically residing with the insured personappointed as the guardian or custodian of a foster child or children as long asthe insured person has assumed the legal obligation for total or partialsupport of the foster child or children with the intent that the foster childor children reside with the insured person on more than a temporary or short‑termbasis.
(b) Coverage. Insurers may provide coverage for loss of income because of a voluntary,employer‑approved leave of absence granted upon the occurrence of any ofthe qualifying events in subsection (d) of this section. The insured personshall not be required to meet any federal requirements in order to qualify forbenefits provided by this coverage. Benefits shall be paid to the creditor toreduce the insured person's indebtedness.
(c) Eligibility. Coverage may be provided or offered to any debtor who has not yet reached hisor her 71st birthday and has been working for wages for at least 30 hours perweek for the past five consecutive weeks.
(d) Qualifying Events. Benefits shall be paid only for the following qualifying events:
(1) An accidentinvolving sickness of, or incapacitation of, an immediate family member thatrequires the insured person to attend to the family member's needs.
(2) Birth of a child orchildren of the insured person.
(3) Adoption of a childor children of the insured person.
(4) Placement in thefoster home of a foster child or children.
(5) The insured person'sprincipal residence is in a federally declared disaster area.
(6) The insured personis called to active military duty.
(7) The insured personis called to petit or grand jury duty.
(e) Exclusions. Coverage shall not contain any exclusions except:
(1) Retirement of theinsured person from employment.
(2) Voluntaryresignation of the insured person from employment.
(3) Seasonalunemployment of the insured person.
(4) Involuntaryunemployment of the insured person.
(5) Disability of theinsured person.
(6) Employmenttermination because of willful or criminal misconduct of the insured person.
(f) Notice. Theinsurer shall send a notice to the insured person at the insured person's homeaddress to inform the insured person that benefits have been paid, includingthe dates and the amount of payment. The notice shall be sent to the insuredperson within 60 days after the last day of the benefit period.
(g) Minimum Amounts. The minimum monthly benefit amount shall be level for the entire benefitperiod. The minimum monthly benefit amount shall equal or exceed the minimummonthly payment required by the creditor, plus the premium charge for thecoverage attributable to the benefit period.
(h) MiscellaneousProvisions. Any waiting period for benefits shall not exceed 30 days. Theinsured shall provide satisfactory evidence of employer approval of qualifiedleave. Lump‑sum benefits may be paid. Refunds of unearned single premiumsshall be equal to the pro rata unearned gross premium.
(i) Rates. Premiumrates shall be actuarially demonstrated to generate a sixty percent (60%)incurred loss ratio. Joint coverage rates shall be one and two‑thirds (1 2/3) times the approved single rate. Rates shall be filed for approval beforethey can be used.
(j) Reports. ByMarch 31 of each year every insurer writing family leave coverage shall file astatistical report of the past calendar year's actuarial experience for thatcoverage. The report shall demonstrate the actual experience loss ratio for thecalendar year and shall include the: number of insureds, total earned premium,total number of incurred claims, total incurred claims, total number ofincurred claims for each qualifying event, average monthly benefit per claimfor each qualifying event, and premium refunds. (1999‑351, s. 5.1.)