A BILL TO BE ENTITLED
AN ACT TO REQUIRE equity IN HEALTH INSURANCE COVERAGE FOR MENTAL ILLNESS.
The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 58‑51‑55 reads as rewritten:
"§ 58‑51‑55.  No discrimination against mentally ill and chemically dependent individuals.
(a)	Definitions. – As used in this section, the term:
(1)	'Mental illness' has the same meaning as defined in G.S. 122C‑3(21), with a mental disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM‑IV, or a subsequent edition published by the American Psychiatric Association, except those mental disorders coded in the DSM‑IV or subsequent editions as substance‑related disorders (291.0 through 292.9 and 303.0 through 305.9) and those coded as 'V' codes.
(2)	'Chemical dependency' has the same meaning as defined in G.S. 58‑51‑50
with a diagnosis found in the Diagnostic and Statistical Manual of Mental Disorders DSM‑3‑R or the International Classification of Diseases ICD/9/CM, or a later edition of those manuals.
(b)	Coverage of Physical Illness. – No insurance company licensed in this State under this Chapter shall, solely because an individual to be insured has or had a mental illness or chemical dependency:
(1)	Refuse to issue or deliver to that individual any policy that affords benefits or coverages for any medical treatment or service for physical illness or injury;
(2)	Have a higher premium rate or charge for physical illness or injury coverages or benefits for that individual; or
(3)	Reduce physical illness or injury coverages or benefits for that individual.
								(c)	Chemical Dependency Coverage Not Required. – Nothing in this section requires an insurer to offer coverage for chemical dependency, except as provided in G.S. 58‑51‑50.
(d)	Applicability. – This section applies only to group health insurance contracts, other than excepted benefits as defined in G.S. 58‑68‑25, covering more than 25 employees. For purposes of this section, "group health insurance contracts" include MEWAs, as defined in G.S. 58‑49‑30(a)."
SECTION 2.  Article 3 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58‑3‑220.  Mental illness benefits coverage.
(a)	Mental Health Equity Requirement. – An insurer shall provide in each group health benefit plan benefits for the necessary care and treatment of mental illness that are no less favorable than benefits for physical illness generally. Benefits for treatment of mental illness shall be subject to the same limits as benefits for physical illness generally. For purposes of this subsection, 'limits' includes durational limits, deductibles, coinsurance factors, co‑payments, maximum out‑of‑pocket limits, annual and lifetime dollar limits, and any other dollar limits or fees for covered services.
(b)	Weighted Average. – If a health benefit plan contains annual limits, lifetime limits, co‑payments, deductibles, or coinsurance only on selected physical illness and injury benefits, and these benefits do not represent substantially all of the physical illness and injury benefits under the health benefit plan, then the insurer may impose limits on the mental health benefits based on a weighted average of the respective annual, lifetime, co‑payment, deductible, or coinsurance limits on the selected physical illness and injury benefits. The weighted average shall be calculated in accordance with rules adopted by the Commissioner.
(c)	Nothing in this section prevents an insurer from applying utilization review criteria to determine medical necessity as defined in G.S. 58‑50‑61 as long as it does so in accordance with all requirements for utilization review 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 of Chapter 58 of the General Statutes.
(d)	Definitions. – As used in this section:
(1)	'Health benefit plan' has the same meaning as in G.S. 58‑3‑167 and includes the Teachers' and State Employees' Comprehensive Major Medical Plan (Plan) and the Plan's optional PPO program.
(2)	'Insurer' has the same meaning as in G.S. 58‑3‑167.
(3)	'Mental illness' has the same meaning as in G.S. 122C‑3(21), with a mental disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM‑IV, or subsequent editions published by the American Psychiatric Association, except those mental disorders coded in the DSM‑IV or subsequent editions as substance‑related disorders (291.0 through 292.9 and 303.0 through 305.9) and those coded as 'V' codes.
(e)	Applicability. – This section applies only to group health benefit plans covering more than 25 employees."
SECTION 3.  G.S. 58‑65‑90 reads as rewritten:
"§ 58‑65‑90.  No discrimination against mentally ill and chemically dependent individuals.
(a)	Definitions. – As used in this section, the term:
(1)	'Mental illness' has the same meaning as defined in G.S. 122C‑3(21), with a mental disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM‑IV, or subsequent editions published by the American Psychiatric Association, except those mental disorders coded in the DSM‑IV or subsequent editions as substance‑related disorders (291.0 through 292.9 and 303.0 through 305.9) and those coded as 'V' codes.
(2)	'Chemical dependency' has the same meaning as defined in G.S. 58‑65‑75
with a diagnosis found in the Diagnostic and Statistical Manual of Mental Disorders DSM‑3‑R or the International Classification of Diseases ICD/9/CM, or a later edition of those manuals. 
(b)	Coverage of Physical Illness. – No service corporation governed by this Chapter shall, solely because an individual to be insured has or had a mental illness or chemical dependency:
(1)	Refuse to issue or deliver to that individual any individual or group subscriber contract in this State that affords benefits or coverage for medical treatment or service for physical illness or injury;
(2)	Have a higher premium rate or charge for physical illness or injury coverages or benefits for that individual; or
(3)	Reduce physical illness or injury coverages or benefits for that individual.
								(c)	Chemical Dependency Coverage Not Required. – Nothing in this section requires a service corporation to offer coverage for chemical dependency, except as provided in G.S. 58‑65‑75.
(d)	Applicability. –This section applies only to subscriber contracts, other than excepted benefits as defined in G.S. 58‑68‑25, covering more than  25 employees."
SECTION 4.  G.S. 58‑67‑75 reads as rewritten:
"§ 58‑67‑75.  No discrimination against mentally ill and chemically dependent individuals.
(a)	Definitions. – As used in this section, the term:
(1)	'Mental illness' has the same meaning as defined in G.S. 122C‑3(21), with a mental disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM‑IV, or subsequent editions published by the American Psychiatric Association, except those mental disorders coded in the DSM‑IV or subsequent editions as substance‑related disorders (291.0 through 292.9 and 303.0 through 305.9) and those coded as 'V' codes.
(2)	'Chemical dependency' has the same meaning as defined in G.S. 58‑67‑70
with a diagnosis found in the Diagnostic and Statistical Manual of Mental Disorders DSM‑3‑R or the International Classification of Diseases ICD/9/CM, or a later edition of those manuals.
(b)	Coverage of Physical Illness. – No health maintenance organization governed by this Chapter shall, solely because an individual has or had a mental illness or chemical dependency:
(1)	Refuse to enroll that individual in any health care plan covering physical illness or injury;
(2)	Have a higher premium rate or charge for physical illness or injury coverages or benefits for that individual; or
(3)	Reduce physical illness or injury coverages or benefits for that individual.
								(c)	Chemical Dependency Coverage Not Required. – Nothing in this section requires an HMO to offer coverage for chemical dependency, except as provided in G.S. 58‑67‑70.
(d)	Applicability. – This section applies only to group contracts, other than excepted benefits as defined in G.S. 58‑68‑25, covering more than  25 employees. "
SECTION 5.  G.S. 58‑50‑155 reads as rewritten:
"§ 58‑50‑155.  Standard and basic health care plan coverages.
(a)	Notwithstanding G.S. 58‑50‑125(c), the standard health plan developed and approved under G.S. 58‑50‑125 shall provide coverage for all of the following:
(1)	Mammograms and pap smears at least equal to the coverage required by G.S. 58‑51‑57.
(2)	Prostate‑specific antigen (PSA) tests or equivalent tests for the presence of prostate cancer at least equal to the coverage required by G.S. 58‑51‑58.
(3)	Reconstructive breast surgery resulting from a mastectomy at least equal to the coverage required by G.S. 58‑51‑62.
(4)	For a qualified individual, scientifically proven bone mass measurement for the diagnosis and evaluation of osteoporosis or low bone mass at least equal to the coverage required by G.S. 58‑3‑174.
(5)	Prescribed contraceptive drugs or devices that prevent pregnancy and that are approved by the United States Food and Drug Administration for use as contraceptives, or outpatient contraceptive services at least equal to the coverage required by G.S. 58‑3‑178, if the plan covers prescription drugs or devices, or outpatient services, as applicable. The same exceptions and exclusions as are provided under G.S. 58‑3‑178 apply to standard plans developed and approved under G.S. 58‑50‑125.
(6)	Colorectal cancer examinations and laboratory tests at least equal to the coverage required by G.S. 58‑3‑179.
(7)	Treatment of mental illness that is at least equal to the coverage required by G.S. 58‑3‑220. Nothing in this subdivision prevents an insurer from applying utilization review criteria to determine medical necessity as defined in G.S. 58‑50‑61 as long as it does so in accordance with all requirements for utilization review 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 of Chapter 58 of the General Statutes.(a1),	(a2) Repealed by Session Laws 1999‑197, s. 2.
(b)	Notwithstanding G.S. 58‑50‑125(c), in developing and approving the plans under G.S. 58‑50‑125, the Committee and Commissioner shall give due consideration to cost‑effective and life‑saving health care services and to cost‑effective health care providers."
SECTION 6.  This act becomes effective January 1, 2008, and applies to health benefit plans that are delivered, issued for delivery, or renewed on and after that date.  For purposes of this act, renewal of a health benefit policy, contract, or plan is presumed to occur on each anniversary of the date on which coverage was first effective on the person or persons covered by the health benefit plan.