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Bill Summary · HB 463

HB 463 — First Responders Mental Health Plan Act (Summary)

Main purpose

Establishes a supplemental mental health benefits plan for eligible first responders diagnosed with specified mental conditions. The program’s stated goal is to promote healing and facilitate return to service by reimbursing treatment costs, providing short-term salary replacement, and offering longer-term disability pay where appropriate.

Key provisions

  • Creates a “First Responder Mental Health Care Benefits Plan” administered by the North Carolina Department of Insurance (Article 86B, Chapter 58).
  • Defines eligible mental conditions as medically diagnosed anxiety disorders, conduct disorders, depressive disorders, obsessive‑compulsive and related disorders, sleep‑wake disorders, and trauma- and stressor-related disorders (per current DSM definitions).
  • Specifies covered first responder categories: law enforcement officers, firefighters (including volunteers meeting statute), 911 dispatchers, EMTs, detention/correction/probation officers, and similar positions — including those employed by non‑governmental entities.
  • Excludes persons receiving mental‑health related benefits under the North Carolina Workers’ Compensation Act.

Benefits and limits

  1. Medical costs reimbursement

    • Up to $5,000 per 12‑month period for out‑of‑pocket medical expenses (deductibles, copays, coinsurance) for an eligible mental condition (receipts required).
    • Not payable concurrently with the disability benefit.

  2. Salary (short‑term) benefit

    • When leave is medically required (FMLA or local leave) and documented, a full‑time first responder may receive either:
      • 75% of monthly salary, or
      • $5,000 per month,
      • whichever is less.
    • Usable for up to 12 workweeks in a 12‑month period.
    • May be combined with medical costs reimbursement.

  3. Disability benefit

    • Payable after 6 months of total disability or inability to perform first‑responder duties:
      • Full‑time non‑volunteer: 75% of monthly salary or $5,000/month (whichever lesser).
      • Volunteer firefighter: $1,500/month.
    • Benefit is limited to 36 consecutive months maximum.
    • Benefits are subordinate to other disability payments (except private insurance purchased solely by the first responder) — the plan pays the difference up to the statutory amount.
    • Periodic reevaluation is authorized; benefits cease if the individual is found able to resume duties.

Eligibility criteria (summary)

  • Must be currently employed as a first responder (regardless of original diagnosis date).
  • Diagnosis must be established by a healthcare provider with a reasonable degree of medical certainty as resulting from a singular incident or cumulative employment‑related activities and arising within the scope of employment.
  • Not eligible if already receiving mental‑health benefits under State workers’ compensation.

Administration, implementation & timeline

  • The Department of Insurance administers the plan and insurance payments.
  • The statutory text specifies the act’s effective date as January 1, 2026 (i.e., benefits and program operations would start after enactment and that date).

Who is affected

  • Primary beneficiaries: active first responders (career and qualifying volunteer firefighters) in listed categories who suffer qualifying employment‑related mental conditions.
  • Employers, insurers, and the Department of Insurance will have implementation and administrative roles; the act potentially affects payroll/leave practices and coordination with other benefit programs (including workers’ compensation and private disability insurance).

Notes on status and fiscal impact

  • The bill text establishes statutory benefit levels and limits; fiscal impacts (cost to state, insurers, employers) are not detailed in the bill text and would depend on enrollment, claim rates, and funding/insurance mechanisms established by the Department of Insurance.

Compiled from official sources — confirm details with the bill’s official record.

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