2005 North Carolina Code - General Statutes § 58-65-90. No discrimination against the mentally ill and chemically dependent.

§ 58‑65‑90.  No discrimination against the mentally ill and chemically dependent.

(a)       Definitions. – As used in this section, the term:

(1)       "Mental illness" has the same meaning as defined in G.S. 122C‑3(21); and

(2)       "Chemical dependency" has the same meaning as defined in G.S. 58‑65‑75

with a diagnosis found in the Diagnostic and Statistical Manual of Mental Disorders DSM‑3‑R or the International Classification of Diseases ICD/9/CM, or a later edition of those manuals.

(b)       Coverage of Physical Illness. – No service corporation governed by this Chapter shall, solely because an individual to be insured has or had a mental illness or chemical dependency:

(1)       Refuse to issue or deliver to that individual any individual or group subscriber contract in this State that affords benefits or coverage for medical treatment or service for physical illness or injury;

(2)       Have a higher premium rate or charge for physical illness or injury coverages or benefits for that individual; or

(3)       Reduce physical illness or injury coverages or benefits for that individual.

(b1)     Coverage of Mental Illness. – A subscriber contract that covers both physical illness or injury and mental illness may not impose a lesser lifetime or annual dollar limitation on the mental health benefits than on the physical illness or injury benefits, subject to the following:

(1)       A lifetime limit or annual limit may be made applicable to all benefits under the subscriber contract, without distinguishing the mental health benefits.

(2)       If the subscriber contract contains lifetime limits only on selected physical illness or injury benefits, and these benefits do not represent substantially all of the physical illness and injury benefits under the subscriber contract, the service corporation may impose a lifetime limit on the mental health benefits that is based on a weighted average of the respective lifetime limits on the selected physical illness and injury benefits. The weighted average shall be calculated in accordance with rules adopted by the Commissioner.

(3)       If the subscriber contract contains annual limits only on selected physical illness and injury benefits, and these benefits do not represent substantially all of the physical illness and injury benefits under the subscriber contract, the service corporation may impose an annual limit on the mental health benefits that is based on a weighted average of the respective annual limits on the selected physical illness and injury benefits. The weighted average shall be calculated in accordance with rules adopted by the Commissioner.

(4)       Except as otherwise provided in this section, the subscriber contract may distinguish between mental illness benefits and physical injury or illness benefits with respect to other terms of the subscriber contract, including coinsurance, limits on provider visits or days of coverage, and requirements relating to medical necessity.

(5)       If the service corporation offers two or more benefit package options under a subscriber contract, each package must comply with this subsection.

(6)       This subsection does not apply to a subscriber contract if the service corporation can demonstrate to the Commissioner that compliance will increase the cost of the subscriber contract by one percent (1%) or more.

(7)       This subsection expires October 1, 2001, but the expiration does not affect services rendered before that date.

(c)       Mental Illness or Chemical Dependency Coverage Not Required. – Nothing in this section requires a service corporation to offer coverage for mental illness or chemical dependency, except as provided in G.S. 58‑65‑75.

(d)       Applicability. – Subsection (b1) of this section applies only to subscriber contracts, other than excepted benefits as defined in G.S. 58‑68‑25, covering more than 50 employees. The remainder of this section applies only to group contracts covering 20 or more employees. (1989, c. 369, s. 1; 1991, c. 720, s. 82; 1997‑259, s. 22; 1999‑132, s. 4.3.)