§ 58-3-121. Discrimination against coverage of certain bones and joints prohibited. - North Carolina Statutes

§58‑3‑121.  Discrimination against coverage of certain bones andjoints prohibited.

(a)        Discriminationagainst coverage of procedures involving bones or joints of the jaw, face, orhead is prohibited in any health benefit plan. Whenever a health benefit planprovides coverage on a group or individual basis for diagnostic, therapeutic,or surgical procedures involving bones or joints of the human skeletalstructure, that plan may not exclude or deny the same coverage for proceduresinvolving any bone or joint of the jaw, face, or head, so long as the procedureis medically necessary to treat a condition which prevents normal functioningof the particular bone or joint involved and the condition is caused bycongenital deformity, disease, or traumatic injury. The coverage required bythis section involving bones or joints of the jaw, face, or head shall besubject to the same conditions and limitations as are applicable to coverage ofprocedures involving other bones and joints of the human skeletal structure.

(b)        For purposes ofthis section, in providing coverage for the treatment of conditions of the jaw(temporomandibular joint), authorized therapeutic procedures shall includesplinting and use of intraoral prosthetic appliances to reposition the bones.Payment for these therapeutic procedures, and for procedures involved in anyother nonsurgical treatment of temporomandibular joint dysfunction, may besubjected to a reasonable lifetime maximum dollar amount. Nothing in thissubsection shall require a health benefit plan to cover orthodontic braces,crowns, bridges, dentures, treatment for periodontal disease, dental root formimplants, or root canals.

(c)        For purposes ofthis section, "health benefit plan" means accident and healthinsurance policies or certificates; nonprofit hospital or medical servicecorporation contracts; health, hospital, or medical service corporation plancontracts; health maintenance (HMO) subscriber contracts; and plans provided bya MEWA or plans provided by other benefit arrangements, to the extent permittedby ERISA. (1995, c. 483, s. 1.)