North Carolina § 135-48 - 50. Coverage mandates.

§ 135-48. 50. Coverage mandates.

The Plan shall provide coverage subject to the following coverage mandates: Abortion coverage. - The Plan shall not provide coverage for abortions for which State funds could not be used under G.S. 143C-6-5.5. The Plan shall, however, provide coverage for subsequent complications or related charges arising from an abortion not covered under this subdivision. Immunizations. - The Plan shall pay one hundred percent (100%) of allowable medical charges for immunizations for the prevention of contagious diseases as generally accepted medical practices would dictate when directed by a credentialed provider as determined by the claims processor. Insulin. - Prescription benefits shall be provided for insulin even though a prescription is not required. Mental health parity. - Benefits for the treatment of mental illness and chemical dependency are covered by the Plan and shall be subject to the same deductibles, durational limits, and coinsurance factors as are benefits for physical illness generally. Nothing in this subdivision, however, shall prohibit the Plan from requiring the most cost-effective treatment setting to be utilized by a person undergoing necessary care and treatment for chemical dependency. [Reserved.] Permissive coverage extension. - If a covered service becomes excluded from coverage under the Plan, the Executive Administrator and Claims Processor may, in the event of exceptional situations creating undue hardships or adverse medical conditions, allow persons enrolled in the Plan to remain covered by the Plan's previous coverage for up to three months after the effective date of the change in coverage, provided the persons so enrolled had been undergoing a continuous plan of specific treatment initiated within three months prior to the effective date of the change in coverage. Reconstructive surgery. - Charges for cosmetic surgery or treatment required for correction of damage caused by accidental injury sustained by the covered individual while coverage under this plan is in force on his or her account or to correct congenital deformities or anomalies shall not be excluded if they otherwise qualify as covered medical expenses. Reconstructive breast surgery following mastectomy, as those terms are defined in G.S. 58-51-62, shall be covered. History (2011-85, s. 2.10; 2011-145, s. 29.23(c); 2012-194, s. 32.) Editor's Note. - Session Laws 2011-85, s. 2.10 enacted G.S. 135-48.50 in the coded bill drafting format provided by G.S. 120-20.1 , with two subdivisions reserved. In both locations, the word "reserved" was underlined. Later during the 2011 Regular Session, Session Laws 2011-145, s. 29.23(c), inserted the current language in subdivision (1), but the word "reserved" was not lined out, resulting in superfluous language. Session Laws 2012-194, s. 32, removed the superfluous language "Reserved." Session Laws 2011-145, s. 29.23(b), provides: "Effective until January 1, 2012, the provisions of G.S. 135-45.8(21) and (22) do not apply to complications or related charges from an abortion not covered under G.S. 143C-6-5 .5, as enacted by subsection (a) of this section." Session Laws 2011-145, s. 1.1, provides: "This act shall be known as the 'Current Operations and Capital Improvements Appropriations Act of 2011.'" Session Laws 2011-145, s. 32.2, provides: "Except for statutory changes or other provisions that clearly indicate an intention to have effects beyond the 2011-2013 fiscal biennium, the textual provisions of this act apply only to funds appropriated for, and activities occurring during, the 2011-2013 fiscal biennium." Session Laws 2011-145, s. 32.5, is a severability clause. Subdivision (5) has been set out as [Reserved] at the direction of the Revisor of Statutes. The word "Reserved" was in subdivisions (1) and (5) of this section as enacted, but were removed by the 2012 amendment to correct that error. Effect of Amendments. - Session Laws 2011-145, s. 29.23(c), effective January 1, 2012, substituted the current text in (1) for "Reserved." Session Laws 2011-145, s. 29.23(c), effective January 1, 2012, added subdivision (1). Session Laws 2012-194, s. 32, effective July 17, 2012, in subdivision (1), deleted "Reserved." at the end; and deleted subdivision (5), which read: "Reserved."