§ 58-3-122. Anesthesia and hospital charges necessary for safe and effective administration of dental procedures for young children, persons with serious mental or physical conditions, and persons wit - North Carolina Statutes

§ 58‑3‑122. Anesthesia and hospital charges necessary for safe and effective administrationof dental procedures for young children, persons with serious mental orphysical conditions, and persons with significant behavioral problems; coveragein health benefit plans.

(a)        All health benefitplans shall provide coverage for payment of anesthesia and hospital or facilitycharges for services performed in a hospital or ambulatory surgical facility inconnection with dental procedures for children below the age of nine years,persons with serious mental or physical conditions, and persons withsignificant behavioral problems, where the provider treating the patientinvolved certifies that, because of the patient's age or condition or problem,hospitalization or general anesthesia is required in order to safely andeffectively perform the procedures. The same deductibles, coinsurance, networkrequirements, medical necessity provisions, and other limitations as apply tophysical illness benefits under the health benefit plan shall apply to coveragefor anesthesia and hospital or facility charges required to be covered underthis section.

(b)        As used in thissection, the term:

(1)        "Health benefitplan" means an accident and health insurance policy or certificate; a nonprofithospital or medical service corporation contract; a health maintenanceorganization subscriber contract; a plan provided by a multiple employerwelfare arrangement; or a plan provided by another benefit arrangement, to theextent permitted by the Employee Retirement Income Security Act of 1974, asamended, or by any waiver of or other exception to that Act provided underfederal law or regulation. "Health benefit plan" does not mean anyplan implemented or administered by the North Carolina Department of Health andHuman Services or the United States Department of Health and Human Services, orany successor agency, or its representatives. "Health benefit plan"also does not mean any of the following kinds of insurance:

a.         Accident.

b.         Credit.

c.         Disability income.

d.         Long‑term careor nursing home care.

e.         Medicare supplement.

f.          Specified disease.

g.         Dental or vision.

h.         Coverage issued as asupplement to liability insurance.

i.          Workers'compensation.

j.          Medical paymentsunder automobile or homeowners.

k.         Hospital income orindemnity.

l.          Insurance underwhich benefits are payable with or without regard to fault and that isstatutorily required to be contained in any liability policy or equivalent self‑insurance.

(2)        "Insurer"includes an insurance company subject to this Chapter, a service corporationorganized under Article 65 of this Chapter, a health maintenance organizationorganized under Article 67 of this Chapter, or a multiple employer welfarearrangement subject to Article 49 of this Chapter. (1999‑134, s. 1.)