§ 58-65-75. Coverage for chemical dependency treatment.
§ 58‑65‑75. 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 groupinsurance certificate or group subscriber contract under any hospital ormedical plan governed by this Article and Article 66 of this Chapter that isissued, renewed, or amended on or after January 1, 1985, shall offer to itsinsureds benefits for the necessary care and treatment of chemical dependencythat are not less favorable than benefits for physical illness generally.Except as provided in subsection (c) of this section, benefits for chemicaldependency shall be subject to the same durational limits, dollar limits,deductibles, and coinsurance factors as are benefits for physical illnessgenerally.
(c) Every groupinsurance certificate or group subscriber contract that provides benefits forchemical dependency treatment and that provides total annual benefits for allillnesses in excess of eight thousand dollars ($8,000) is subject to thefollowing conditions:
(1) The certificate 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 certificate 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 thecertificate or contract.
(d) Provisions forbenefits for necessary care and treatment of chemical dependency in groupcertificates or group contracts shall provide for 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 facilities or programs; and
(3) Duly licensedphysicians and duly licensed psychologists and certified professionals workingunder the direct supervision of such physicians or psychologists in facilitiesdescribed in (1) and (2) above and in day/night programs or outpatienttreatment facilities licensed after July 1, 1984, under Article 2 of GeneralStatutes Chapter 122C. After January 1, 1995, "duly licensedpsychologists" shall be defined as licensed psychologists who holdpermanent licensure and certification as health services provider psychologistissued by the North Carolina Psychology Board.
Provided, however, that nothingin this subsection shall prohibit any certificate or contract from requiringthe most cost effective treatment setting to be utilized by the personundergoing necessary care and treatment for chemical dependency.
(e) Coverage forchemical dependency treatment as described in this section shall not beapplicable to any group certificate holder or group subscriber contract holderwho rejects the coverage 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. 8; 1985, c. 589, s. 43(a), (b); 1989, c. 175, s. 2; 1991, c. 720, s.64; 1993, c. 375, s. 5; 2009‑382, s. 21.)