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This page lists some of the action toward parity compliance undertaken by North Carolina regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org.

Action in the Regulatory Arena

2018

Primary Focus: Student Health Insurance
Agency: Department of Insurance
Title/Description: Student Health Insurance
Citation: North Carolina Department of Insurance Notice
Summary: Insurers are required to submit an attestation as part of their form filing of compliance with the federal Mental Health Parity and Addiction Equity Act (MHPAEA). Insurers must certify that the benefits across designated categories in all plans (including cost sharing variations) comply with the MHPAEA and any regulations, including with regard to financial requirements and treatment limitations. The categories are: Inpatient (in and out of network), Outpatient (in and out of network), Emergency Care, and Prescription Drugs.
Effective Date: March 3, 2017
Notes: N/A

4/2015

The North Carolina Department of Insurance (NCDOI) issued a bulletinrelevant to parity to plans that provide student health coverage for the 2015-2016 school year. Among other things, the bulletin requires plans certify that they comply with the Federal Parity Law.

12/2013

The NCDOI released a question and answer document that had information relevant to parity (page 4, question 6). It states that plans will have to comply with the Federal Parity Law in 2014, with grandfathered plans needing to comply after 7/1/2014, if they provide behavioral health coverage.

8/2012

Jean Holliday, the Regulatory Project Manager and Health Care Reform Supervisor at the NCDOI gave a presentation about parity that included an overview of the Federal Parity Law, how the Affordable Care Act applies the Federal Parity Law to non-grandfathered small employer fully-insured plans and individual plans, and North Carolina’s insurance laws that are relevant to parity. The relevant North Carolina insurance laws are also summarized at the bottom of this page.

4/2012

A report was prepared for the NCDOI about the state’s options for benchmark plans for providing essential health benefits. The report covered many topics, but does contain several charts showing whether various plans meet the requirements of the Federal Parity Law (these can be found on pages A-3, A-12, A-22, and A-25).

North Carolina Parity Law

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.

Mental Health

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.

Substance Use Disorders

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.

State Employees

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.

Non-Discrimination in Physical Health

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

Get Support

North Carolina Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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