State Codes and Statutes

Statutes > North-carolina > Chapter_58 > GS_58-3-178

§58‑3‑178.  Coverage for prescription contraceptive drugs or devicesand for outpatient contraceptive services; exemption for religious employers.

(a)        Except as providedin subsection (e) of this section, every insurer providing a health benefitplan that provides coverage for prescription drugs or devices shall providecoverage for prescription contraceptive drugs or devices. Coverage shallinclude coverage for the insertion or removal of and any medically necessaryexamination associated with the use of the prescribed contraceptive drug ordevice. Except as otherwise provided in this subsection, the same deductibles,coinsurance, and other limitations as apply to prescription drugs or devicescovered under the health benefit plan shall apply to coverage for prescribedcontraceptive drugs or devices. A health benefit plan may require that thetotal coinsurance, based on the useful life of the drug or device, be paid inadvance for those drugs or devices that are inserted or prescribed and do nothave to be refilled on a periodic basis.

(b)        Every insurerproviding a health benefit plan that provides coverage for outpatient servicesprovided by a health care professional shall provide coverage for outpatientcontraceptive services. The same deductibles, coinsurance, and otherlimitations as apply to outpatient services covered under the health benefitplan shall apply to coverage for outpatient contraceptive services.

(c)        As used in thissection, the term:

(1)        "Health benefitplan" means an accident and health insurance policy or certificate; anonprofit hospital or medical service corporation contract; a healthmaintenance organization subscriber contract; a plan provided by a multipleemployer welfare arrangement; or a plan provided by another benefit arrangement,to the extent permitted by the Employee Retirement Income Security Act of 1974,as amended, 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.

m.        Short‑termlimited duration health insurance policies as defined in Part 144 of Title 45of the Code of Federal Regulations.

(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, and a multiple employer welfarearrangement subject to Article 49 of this Chapter.

(3)        "Outpatientcontraceptive services" means consultations, examinations, procedures, andmedical services provided on an outpatient basis and related to the use ofcontraceptive methods to prevent pregnancy.

(4)        "Prescribedcontraceptive drugs or devices" means drugs or devices that preventpregnancy and that are approved by the United States Food and DrugAdministration for use as contraceptives and obtained under a prescriptionwritten by a health care provider authorized to prescribe medications under thelaws of this State. Prescription drugs or devices required to be covered underthis section shall not include:

a.         The prescriptiondrug known as "RU‑486" or any "equivalent drugproduct" as defined in G.S. 90‑85.27(1).

b.         The prescriptiondrug marketed under the name "Preven" or any "equivalent drugproduct" as defined in G.S. 90‑85.27(1).

(d)        A health benefitplan subject to this section shall not do any of the following:

(1)        Deny eligibility orcontinued eligibility to enroll or to renew coverage under the terms of thehealth benefit plan, solely for the purpose of avoiding the requirements ofthis section.

(2)        Provide monetarypayments or rebates to an individual participant or beneficiary to encouragethe individual participant or beneficiary to accept less than the minimumprotections available under this section.

(3)        Penalize or otherwisereduce or limit the reimbursement of an attending provider because the providerprescribed contraceptive drugs or devices, or provided contraceptive servicesin accordance with this section.

(4)        Provide incentives,monetary or otherwise, to an attending provider to induce the provider towithhold from an individual participant or beneficiary contraceptive drugs,devices, or services.

(e)        A religiousemployer may request an insurer providing a health benefit plan to provide tothe religious employer a health benefit plan that excludes coverage forprescription contraceptive drugs or devices that are contrary to the employer'sreligious tenets. Upon request, the insurer shall provide the requested healthbenefit plan. An insurer providing a health benefit plan requested by areligious employer pursuant to this section shall provide written notice toeach person covered under the health benefit plan that prescriptioncontraceptive drugs or devices are excluded from coverage pursuant to thissection at the request of the employer. The notice shall appear, in not lessthan 10‑point type, in the health benefit plan, application, and salesbrochure for the health benefit plan. Nothing in this subsection authorizes ahealth benefit plan to exclude coverage for prescription drugs ordered by ahealth care provider with prescriptive authority for reasons other thancontraceptive purposes, or for prescription contraception that is necessary topreserve the life or health of a person covered under the plan. As used in thissubsection, the term "religious employer" means an entity for whichall of the following are true:

(1)        The entity isorganized and operated for religious purposes and is tax exempt under section501(c)(3) of the U.S. Internal Revenue Code.

(2)        The inculcation ofreligious values is one of the primary purposes of the entity.

(3)        The entity employsprimarily persons who share the religious tenets of the entity. (1999‑231,s. 1; 1999‑456, s. 15(a).)

State Codes and Statutes

Statutes > North-carolina > Chapter_58 > GS_58-3-178

§58‑3‑178.  Coverage for prescription contraceptive drugs or devicesand for outpatient contraceptive services; exemption for religious employers.

(a)        Except as providedin subsection (e) of this section, every insurer providing a health benefitplan that provides coverage for prescription drugs or devices shall providecoverage for prescription contraceptive drugs or devices. Coverage shallinclude coverage for the insertion or removal of and any medically necessaryexamination associated with the use of the prescribed contraceptive drug ordevice. Except as otherwise provided in this subsection, the same deductibles,coinsurance, and other limitations as apply to prescription drugs or devicescovered under the health benefit plan shall apply to coverage for prescribedcontraceptive drugs or devices. A health benefit plan may require that thetotal coinsurance, based on the useful life of the drug or device, be paid inadvance for those drugs or devices that are inserted or prescribed and do nothave to be refilled on a periodic basis.

(b)        Every insurerproviding a health benefit plan that provides coverage for outpatient servicesprovided by a health care professional shall provide coverage for outpatientcontraceptive services. The same deductibles, coinsurance, and otherlimitations as apply to outpatient services covered under the health benefitplan shall apply to coverage for outpatient contraceptive services.

(c)        As used in thissection, the term:

(1)        "Health benefitplan" means an accident and health insurance policy or certificate; anonprofit hospital or medical service corporation contract; a healthmaintenance organization subscriber contract; a plan provided by a multipleemployer welfare arrangement; or a plan provided by another benefit arrangement,to the extent permitted by the Employee Retirement Income Security Act of 1974,as amended, 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.

m.        Short‑termlimited duration health insurance policies as defined in Part 144 of Title 45of the Code of Federal Regulations.

(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, and a multiple employer welfarearrangement subject to Article 49 of this Chapter.

(3)        "Outpatientcontraceptive services" means consultations, examinations, procedures, andmedical services provided on an outpatient basis and related to the use ofcontraceptive methods to prevent pregnancy.

(4)        "Prescribedcontraceptive drugs or devices" means drugs or devices that preventpregnancy and that are approved by the United States Food and DrugAdministration for use as contraceptives and obtained under a prescriptionwritten by a health care provider authorized to prescribe medications under thelaws of this State. Prescription drugs or devices required to be covered underthis section shall not include:

a.         The prescriptiondrug known as "RU‑486" or any "equivalent drugproduct" as defined in G.S. 90‑85.27(1).

b.         The prescriptiondrug marketed under the name "Preven" or any "equivalent drugproduct" as defined in G.S. 90‑85.27(1).

(d)        A health benefitplan subject to this section shall not do any of the following:

(1)        Deny eligibility orcontinued eligibility to enroll or to renew coverage under the terms of thehealth benefit plan, solely for the purpose of avoiding the requirements ofthis section.

(2)        Provide monetarypayments or rebates to an individual participant or beneficiary to encouragethe individual participant or beneficiary to accept less than the minimumprotections available under this section.

(3)        Penalize or otherwisereduce or limit the reimbursement of an attending provider because the providerprescribed contraceptive drugs or devices, or provided contraceptive servicesin accordance with this section.

(4)        Provide incentives,monetary or otherwise, to an attending provider to induce the provider towithhold from an individual participant or beneficiary contraceptive drugs,devices, or services.

(e)        A religiousemployer may request an insurer providing a health benefit plan to provide tothe religious employer a health benefit plan that excludes coverage forprescription contraceptive drugs or devices that are contrary to the employer'sreligious tenets. Upon request, the insurer shall provide the requested healthbenefit plan. An insurer providing a health benefit plan requested by areligious employer pursuant to this section shall provide written notice toeach person covered under the health benefit plan that prescriptioncontraceptive drugs or devices are excluded from coverage pursuant to thissection at the request of the employer. The notice shall appear, in not lessthan 10‑point type, in the health benefit plan, application, and salesbrochure for the health benefit plan. Nothing in this subsection authorizes ahealth benefit plan to exclude coverage for prescription drugs ordered by ahealth care provider with prescriptive authority for reasons other thancontraceptive purposes, or for prescription contraception that is necessary topreserve the life or health of a person covered under the plan. As used in thissubsection, the term "religious employer" means an entity for whichall of the following are true:

(1)        The entity isorganized and operated for religious purposes and is tax exempt under section501(c)(3) of the U.S. Internal Revenue Code.

(2)        The inculcation ofreligious values is one of the primary purposes of the entity.

(3)        The entity employsprimarily persons who share the religious tenets of the entity. (1999‑231,s. 1; 1999‑456, s. 15(a).)


State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_58 > GS_58-3-178

§58‑3‑178.  Coverage for prescription contraceptive drugs or devicesand for outpatient contraceptive services; exemption for religious employers.

(a)        Except as providedin subsection (e) of this section, every insurer providing a health benefitplan that provides coverage for prescription drugs or devices shall providecoverage for prescription contraceptive drugs or devices. Coverage shallinclude coverage for the insertion or removal of and any medically necessaryexamination associated with the use of the prescribed contraceptive drug ordevice. Except as otherwise provided in this subsection, the same deductibles,coinsurance, and other limitations as apply to prescription drugs or devicescovered under the health benefit plan shall apply to coverage for prescribedcontraceptive drugs or devices. A health benefit plan may require that thetotal coinsurance, based on the useful life of the drug or device, be paid inadvance for those drugs or devices that are inserted or prescribed and do nothave to be refilled on a periodic basis.

(b)        Every insurerproviding a health benefit plan that provides coverage for outpatient servicesprovided by a health care professional shall provide coverage for outpatientcontraceptive services. The same deductibles, coinsurance, and otherlimitations as apply to outpatient services covered under the health benefitplan shall apply to coverage for outpatient contraceptive services.

(c)        As used in thissection, the term:

(1)        "Health benefitplan" means an accident and health insurance policy or certificate; anonprofit hospital or medical service corporation contract; a healthmaintenance organization subscriber contract; a plan provided by a multipleemployer welfare arrangement; or a plan provided by another benefit arrangement,to the extent permitted by the Employee Retirement Income Security Act of 1974,as amended, 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.

m.        Short‑termlimited duration health insurance policies as defined in Part 144 of Title 45of the Code of Federal Regulations.

(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, and a multiple employer welfarearrangement subject to Article 49 of this Chapter.

(3)        "Outpatientcontraceptive services" means consultations, examinations, procedures, andmedical services provided on an outpatient basis and related to the use ofcontraceptive methods to prevent pregnancy.

(4)        "Prescribedcontraceptive drugs or devices" means drugs or devices that preventpregnancy and that are approved by the United States Food and DrugAdministration for use as contraceptives and obtained under a prescriptionwritten by a health care provider authorized to prescribe medications under thelaws of this State. Prescription drugs or devices required to be covered underthis section shall not include:

a.         The prescriptiondrug known as "RU‑486" or any "equivalent drugproduct" as defined in G.S. 90‑85.27(1).

b.         The prescriptiondrug marketed under the name "Preven" or any "equivalent drugproduct" as defined in G.S. 90‑85.27(1).

(d)        A health benefitplan subject to this section shall not do any of the following:

(1)        Deny eligibility orcontinued eligibility to enroll or to renew coverage under the terms of thehealth benefit plan, solely for the purpose of avoiding the requirements ofthis section.

(2)        Provide monetarypayments or rebates to an individual participant or beneficiary to encouragethe individual participant or beneficiary to accept less than the minimumprotections available under this section.

(3)        Penalize or otherwisereduce or limit the reimbursement of an attending provider because the providerprescribed contraceptive drugs or devices, or provided contraceptive servicesin accordance with this section.

(4)        Provide incentives,monetary or otherwise, to an attending provider to induce the provider towithhold from an individual participant or beneficiary contraceptive drugs,devices, or services.

(e)        A religiousemployer may request an insurer providing a health benefit plan to provide tothe religious employer a health benefit plan that excludes coverage forprescription contraceptive drugs or devices that are contrary to the employer'sreligious tenets. Upon request, the insurer shall provide the requested healthbenefit plan. An insurer providing a health benefit plan requested by areligious employer pursuant to this section shall provide written notice toeach person covered under the health benefit plan that prescriptioncontraceptive drugs or devices are excluded from coverage pursuant to thissection at the request of the employer. The notice shall appear, in not lessthan 10‑point type, in the health benefit plan, application, and salesbrochure for the health benefit plan. Nothing in this subsection authorizes ahealth benefit plan to exclude coverage for prescription drugs ordered by ahealth care provider with prescriptive authority for reasons other thancontraceptive purposes, or for prescription contraception that is necessary topreserve the life or health of a person covered under the plan. As used in thissubsection, the term "religious employer" means an entity for whichall of the following are true:

(1)        The entity isorganized and operated for religious purposes and is tax exempt under section501(c)(3) of the U.S. Internal Revenue Code.

(2)        The inculcation ofreligious values is one of the primary purposes of the entity.

(3)        The entity employsprimarily persons who share the religious tenets of the entity. (1999‑231,s. 1; 1999‑456, s. 15(a).)