§ 58-50-155. Standard and basic health care plan coverages. - North Carolina Statutes

§ 58‑50‑155. Standard and basic health care plan coverages.

(a)        NotwithstandingG.S. 58‑50‑125(c), the standard health plan developed and approvedunder G.S. 58‑50‑125 shall provide coverage for all of thefollowing:

(1)        Mammograms andexaminations and laboratory tests for the screening for the early detection ofcervical cancer at least equal to the coverage required by G.S. 58‑51‑57.

(2)        Prostate‑specificantigen (PSA) tests or equivalent tests for the presence of prostate cancer atleast equal to the coverage required by G.S. 58‑51‑58.

(3)        Reconstructivebreast surgery resulting from a mastectomy at least equal to the coveragerequired by G.S. 58‑51‑62.

(4)        For a qualifiedindividual, scientifically proven bone mass measurement for the diagnosis andevaluation of osteoporosis or low bone mass at least equal to the coveragerequired by G.S. 58‑3‑174.

(5)        Prescribedcontraceptive drugs or devices that prevent pregnancy and that are approved bythe United States Food and Drug Administration for use as contraceptives, oroutpatient contraceptive services at least equal to the coverage required byG.S. 58‑3‑178, if the plan covers prescription drugs or devices, oroutpatient services, as applicable. The same exceptions and exclusions as areprovided under G.S. 58‑3‑178 apply to standard plans developed andapproved under G.S. 58‑50‑125.

(6)        Colorectal cancerexaminations and laboratory tests at least equal to the coverage required byG.S. 58‑3‑179.

(7)        Surveillance testsat least equal to coverage required by G.S. 58‑3‑270.

(8)        Treatment of mentalillness that is at least equal to the coverage required by G.S. 58‑3‑220.Nothing in this subdivision prevents an insurer from applying utilizationreview criteria to determine medical necessity as defined in G.S. 58‑50‑61as long as it does so in accordance with all requirements for utilizationreview programs and medical necessity determinations specified in that section,including the offering of an insurer appeal process and, where applicable,health benefit plan external review as provided for in Part 4 of Article 50 ofChapter 58 of the General Statutes.

(a1),(a2)     Repealed bySession Laws 1999‑197, s. 2.

(b)        NotwithstandingG.S. 58‑50‑125(c), in developing and approving the plans under G.S.58‑50‑125, the Committee and Commissioner shall give dueconsideration to cost‑effective and life‑saving health careservices and to cost‑effective health care providers. (1991, c. 490, s. 5; 1993, c.269, s. 4; 1997‑312, s. 4; 1997‑456, s. 40(b); 1999‑197, s.2; 1999‑231, ss. 2, 2.1; 1999‑456, s. 15(b)‑(d); 2001‑116,s. 2; 2003‑186, s. 1; 2003‑223, s. 2; 2007‑268, s. 5.)