2005 North Carolina Code - General Statutes § 58-67-75. No discrimination against the mentally ill and chemically dependent.

§ 58‑67‑75.  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. 58‑67‑70

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 health maintenance organization governed by this Chapter shall, solely because an individual has or had a mental illness or chemical dependency:

(1)       Refuse to enroll that individual in any health care plan covering 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 health care plan 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 plan, without distinguishing the mental health benefits.

(2)       If the plan contains lifetime 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 plan, the HMO 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 plan 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 plan, the HMO 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 plan may distinguish between mental illness benefits and physical injury or illness benefits with respect to other terms of the plan, including coinsurance, limits on provider visits or days of coverage, and requirements relating to medical necessity.

(5)       If the HMO offers two or more benefit package options under a plan, each package must comply with this subsection.

(6)       This subsection does not apply to a health benefit plan if the HMO can demonstrate to the Commissioner that compliance will increase the cost of the plan 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 an HMO to offer coverage for mental illness or chemical dependency, except as provided in G.S. 58‑67‑70.

(d)       Applicability. – Subsection (b1) of this section applies only to group 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. 2; 1991, c. 720, s. 83; 1997‑259, s. 23; 1999‑132, s. 4.4.)