AN ACT establishing a supplemental insurance policy for first responders diagnosed with mental health conditions.

The General Assembly of North Carolina enacts:

SECTION 1.  Chapter 58 of the General Statutes is amended by adding a new Article to read:

Article 86B.

First Responders Mental Healthcare Plan Act.

§ 58‑86B‑1.  Short title.

This Article shall be known and may be cited as the First Responders Mental Healthcare Plan Act.

§ 58‑86B‑2.  First responder mental health care benefits plan.

A first responder mental health care benefits plan is established and shall be administered by the Department of Insurance. The plan shall be a supplemental insurance policy that provides benefits required under this Article to eligible first responders with a diagnosis of a mental condition outlined in this Article. The program aims to promote healing and the return to service of first responders.

§ 58‑86B‑3.  Definitions.

The following definitions apply in this Article:

(1)        911 dispatcher. – A public safety telecommunicator or dispatcher at a primary public safety answering point (PSAP) as defined in G.S. 143B‑1400 or at any public safety agency to which 911 calls are transferred from a primary PSAP as defined in G.S. 143B‑1400 for dispatch of appropriate public safety agencies.

(2)        Eligible mental condition. – Stress, mental injury, or mental illness that is medically diagnosed as an anxiety disorder, conduct disorder, depressive disorder, obsessive‑compulsive and related disorder, sleep‑wake disorder, or trauma and stressor‑related disorder as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

(3)        Emergency medical technicians and emergency medical dispatchers. – As defined in G.S. 131E‑155 and includes the Director of EMS.

(4)        Firefighter. – As defined in G.S. 58‑84‑5 and includes fire dispatchers, fire inspectors, and fire marshals.

(5)        First responder. – A law enforcement officer, firefighter, 911 dispatcher, emergency medical technician employed by a State or local government, detention officer employed by a local government, correctional or probation officer employed by the State, or a volunteer firefighter meeting the requirements of G.S. 58‑84.5. Included in this definition are first responders employed by nongovernmental entities.

(6)        Law enforcement officer. – As defined in G.S. 115B‑1 and includes police dispatchers, police investigators, sheriff's deputies, bailiffs, corrections officers, detention officers, and jailers.

§ 58‑86B‑4.  Eligibility.

To be eligible to receive benefits, first responders shall meet all of the following:

(1)        Be currently employed as a first responder, regardless of the date of original diagnosis.

(2)        Be diagnosed by a healthcare provider, who establishes with a reasonable degree of medical certainty that the condition is the result of a singular incident or accumulative effect of employment‑related activities.

(3)        Have a diagnosed condition that resulted from the first responder acting within the scope of his or her employment as a first responder.

A first responder is not eligible to receive benefits under this Article if receiving benefits related to a mental condition under the North Carolina Workers' Compensation Act.

§ 58‑86B‑5.  Benefits under mental health care plan.

The following benefits are available under the mental health care plan:

(1)        Medical costs reimbursement. – Eligible first responders shall receive reimbursement of up to five thousand dollars ($5,000) per 12‑month period for any out‑of‑pocket medical expenses incurred, including deductibles, copayments, or coinsurance costs, for an eligible mental condition. Receipts of out‑of‑pocket expenses must be produced to receive this benefit. This benefit may not be used in conjunction with the disability benefit under this section.

(2)        Salary benefit. – If a first responder's treatment plan requires leave from employment as determined by a healthcare provider, either through Family Medical Leave (FMLA) or a local government program, and sufficient proof is provided to the insurance carrier, the Department, or other applicable payor that this leave is necessary, a full‑time first responder shall receive a monthly benefit that is either (i) equal to seventy‑five percent (75%) of the first responder's monthly salary or (ii) five thousand dollars ($5,000) a month, whichever is less. This benefit may only be used 12 workweeks in a 12‑month period. This benefit may be used in conjunction with the medical costs reimbursement benefit under this section.

(3)        Disability benefit. – Upon sufficient proof to the insurance carrier, the Department, or other applicable payor of (i) total disability resulting from the diagnosis of an eligible mental condition or (ii) that the eligible mental condition precludes the first responder from serving as a first responder, the following disability benefits shall be paid to a first responder beginning six months after the total disability or inability to perform the duties of a first responder, whichever applies:

a.         For a full‑time first responder who is not a volunteer firefighter. – A monthly benefit that is either (i) equal to seventy‑five percent (75%) of the first responder's monthly salary or (ii) five thousand dollars ($5,000) a month, whichever is less.

b.         For a first responder who is a volunteer firefighter. – A monthly benefit of one thousand five hundred dollars ($1,500).

§ 58‑86B‑6.  Limitations on disability benefits.

The following limitations apply to the disability benefits under this Article:

(1)        Disability benefits shall continue for no more than 36 consecutive months.

(2)        Any first responder receiving disability benefits may be required to have his or her condition reevaluated to determine if that first responder has regained the ability to perform the duties of a first responder. If reevaluation indicates the first responder has regained the ability to perform the duties of a first responder, then the monthly disability benefits shall cease on the last day of the month the reevaluation was conducted.

(3)        If there is no reevaluation performed under subdivision (2) of this section, but the first responder's healthcare provider determines that the first responder is again able to perform the duties of a first responder, then the disability benefits shall cease on the last day of the month the healthcare provider made the determination.

(4)        If a first responder returns to work as a first responder before exhaustion of the 36 months of disability benefits that the first responder may receive under this section, and if there is a subsequent recurrence of disability caused by an eligible mental condition that again precludes the first responder from performing the duties of a first responder, then the first responder shall be entitled to any remaining monthly disability benefits, not to exceed 36 months in total.

(5)        The monthly disability benefit shall be subordinate to any other benefit paid from any source to the first responder solely for a disability related to the eligible mental condition diagnosis, so long as that source is not private insurance purchased solely by the first responder. Disability benefits under this Article shall be limited to the difference between the benefit amount paid by the other source and the amounts specified in this Article.

SECTION 2.  This act becomes effective January 1, 2026.