North Carolina

There are two sections in the state insurance law about parity. One section applies to mental health conditions, and another section applies to substance use disorders. There is also a section in the state law for state employees that is relevant to parity.

There is another section that forbids plans from discriminating against people with behavioral health conditions in their physical health treatment.

This section of the law applies to large employer fully-insured plans and small employer fully-insured plans.

This section requires plans to use financial requirements, annual maximums, and lifetime maximums for mental health services that are “no less favorable” than those used for other medical services. However, if plans use many different forms of these for varying physical health services, the Commissioner of the North Carolina Department of Insurance may use a mathematical formula (pdf | Get Adobe® Reader®) to determine what they should be for mental health treatment.

For treatment of the following conditions, annual limits have to be the same as those used for treatment of other medical conditions:

• Bipolar Disorder
• Major Depressive Disorder
• Obsessive Compulsive Disorder
• Paranoid and Other Psychotic Disorder
• Schizoaffective Disorder
• Schizophrenia
• Post-Traumatic Stress Disorder
• Anorexia Nervosa
• Bulimia

For all other mental health conditions in the DSM (except for substance use disorders), plans must cover 30 office visits for outpatient care and 30 days of inpatient care or a combination of inpatient care and outpatient care that could be measured in days (like partial hospitalization ).

This section also requires large employer fully-insured plans to comply with the Federal Parity Law.

This section requires large employer fully-insured plans and small employer fully-insured plans to offer optional coverage for substance use disorder services. Employers are not required to choose a plan that includes this coverage.

The section requires that plans use annual limits, deductibles, and coinsurance for substance use disorder services that “not less favorable” than those used for other medical services.

Plans are required to have an annual maximum of at least $8,000 and a lifetime maximum of $16,000.

Large employer fully-insured plans are required to comply with the Federal Parity Law.

This section requires the health insurance plan for state employees and public school teachers to use deductibles, coinsurance, annual limits, and lifetime limits for behavioral health services that are the same as those used for other medical services.

This section forbids large employer fully-insured plans and small employer fully-insured plans from covering physical health services for a person with a behavioral health condition differently than they would for people without behavioral health conditions. Plans cannot do the following:

• Deny medical coverage to a person with a behavioral health condition
• Charge higher premiums to a person with a behavioral health condition
• Reduce physical illness coverage to a person with a behavioral health condition