2010 North Carolina Code
Chapter 58 Insurance.
Article 50 - General Accident and Health Insurance Regulations.
58-50-155. Standard and basic health care plan coverages.

58‑50‑155. Standard and basic health care plan coverages.

(a) Notwithstanding G.S. 58‑50‑125(c), the standard health plan developed and approved under G.S. 58‑50‑125 shall provide coverage for all of the following:

(1) Mammograms and examinations and laboratory tests for the screening for the early detection of cervical cancer at least equal to the coverage required by G.S. 58‑51‑57.

(2) Prostate‑specific antigen (PSA) tests or equivalent tests for the presence of prostate cancer at least equal to the coverage required by G.S. 58‑51‑58.

(3) Reconstructive breast surgery resulting from a mastectomy at least equal to the coverage required by G.S. 58‑51‑62.

(4) For a qualified individual, scientifically proven bone mass measurement for the diagnosis and evaluation of osteoporosis or low bone mass at least equal to the coverage required by G.S. 58‑3‑174.

(5) Prescribed contraceptive drugs or devices that prevent pregnancy and that are approved by the United States Food and Drug Administration for use as contraceptives, or outpatient contraceptive services at least equal to the coverage required by G.S. 58‑3‑178, if the plan covers prescription drugs or devices, or outpatient services, as applicable. The same exceptions and exclusions as are provided under G.S. 58‑3‑178 apply to standard plans developed and approved under G.S. 58‑50‑125.

(6) Colorectal cancer examinations and laboratory tests at least equal to the coverage required by G.S. 58‑3‑179.

(7) Surveillance tests at least equal to coverage required by G.S. 58‑3‑270.

(8) Treatment of mental illness that is at least equal to the coverage required by G.S. 58‑3‑220. Nothing in this subdivision prevents an insurer from applying utilization review criteria to determine medical necessity as defined in G.S. 58‑50‑61 as long as it does so in accordance with all requirements for utilization review programs and medical necessity determinations specified in that section, including the offering of an insurer appeal process and, where applicable, health benefit plan external review as provided for in Part 4 of Article 50 of Chapter 58 of the General Statutes.

(a1),(a2) Repealed by Session Laws 1999‑197, s. 2.

(b) Notwithstanding G.S. 58‑50‑125(c), in developing and approving the plans under G.S. 58‑50‑125, the Committee and Commissioner shall give due consideration to cost‑effective and life‑saving health care services and to cost‑effective health care providers. (1991, c. 490, s. 5; 1993, c. 269, s. 4; 1997‑312, s. 4; 1997‑456, s. 40(b); 1999‑197, s. 2; 1999‑231, ss. 2, 2.1; 1999‑456, s. 15(b)‑(d); 2001‑116, s. 2; 2003‑186, s. 1; 2003‑223, s. 2; 2007‑268, s. 5.)