§ 58-51-50. Coverage for chemical dependency treatment.
§ 58‑51‑50. Coverage for chemical dependency treatment.
(a) As used in thissection, the term "chemical dependency" means the pathological use orabuse of alcohol or other drugs in a manner or to a degree that produces animpairment in personal, social or occupational functioning and which may, butneed not, include a pattern of tolerance and withdrawal.
(b) Every insurer thatwrites a policy or contract of group or blanket health insurance or group orblanket accident and health insurance that is issued, renewed, or amended on orafter January 1, 1985, shall offer to its insureds benefits for the necessarycare and treatment of chemical dependency that are not less favorable thanbenefits for physical illness generally. Except as provided in subsection (c)of this section, benefits for treatment of chemical dependency shall be subjectto the same durational limits, dollar limits, deductibles, and coinsurancefactors as are benefits for physical illness generally.
(c) Every group policyor group contract of insurance that provides benefits for chemical dependencytreatment and that provides total annual benefits for all illnesses in excessof eight thousand dollars ($8,000) is subject to the following conditions:
(1) The policy orcontract shall provide, for each 12‑month period, a minimum benefit ofeight thousand dollars ($8,000) for the necessary care and treatment ofchemical dependency.
(2) The policy orcontract shall provide a minimum benefit of sixteen thousand dollars ($16,000)for the necessary care and treatment of chemical dependency for the life of thepolicy or contract.
(d) Provisions forbenefits for necessary care and treatment of chemical dependency in grouppolicies or group contracts of insurance shall provide benefit payments for thefollowing providers of necessary care and treatment of chemical dependency:
(1) The following unitsof a general hospital licensed under Article 5 of General Statutes Chapter131E:
a. Chemical dependencyunits in facilities licensed after October 1, 1984;
b. Medical units;
c. Psychiatric units;and
(2) The followingfacilities or programs licensed after July 1, 1984, under Article 2 of GeneralStatutes Chapter 122C:
a. Chemical dependencyunits in psychiatric hospitals;
b. Chemical dependencyhospitals;
c. Residential chemicaldependency treatment facilities;
d. Social settingdetoxification facilities or programs;
e. Medicaldetoxification or programs; and
(3) Duly licensedphysicians and duly licensed practicing psychologists and certifiedprofessionals working under the direct supervision of such physicians orpsychologists in facilities described in (1) and (2) above and in day/nightprograms or outpatient treatment facilities licensed after July 1, 1984, underArticle 2 of General Statutes Chapter 122C.
Provided, however, that nothingin this subsection shall prohibit any policy or contract of insurance fromrequiring the most cost effective treatment setting to be utilized by theperson undergoing necessary care and treatment for chemical dependency.
(e) Coverage forchemical dependency treatment as described in this section shall not beapplicable to any group policy holder or group contract holder who rejects thecoverage in writing.
(f) Notwithstandingany other provisions of this section, a group health benefit plan that coversboth medical and surgical benefits and chemical dependency treatment benefitsshall, with respect to the chemical dependency treatment benefits, comply withall applicable standards of Subtitle B of Title V of Public Law 110‑343,known as the Paul Wellstone and Pete Domenici Mental Health Parity andAddiction Equity Act of 2008.
(g) Subsection (f) ofthis section applies only to a group health benefit plan covering a largeemployer as defined in G.S. 58‑68‑25(a)(10). (1983 (Reg. Sess., 1984), c.1110, s. 7; 1985, c. 589, s. 43(a), (b); 1989, c. 175, s. 1; 1991, c. 720, s.64; 2009‑382, s. 20.)