HB 456, the "No Surprises for Ambulance Services Act," prevents unexpected high costs for ambulance services by requiring health insurance companies to cover both emergency and non-emergency ground ambulance transport without surprise bills. Specifically, it caps out-of-network cost-sharing (like copays or deductibles) for ambulance services at 110% of what would apply for in-network providers, ensuring patients aren’t charged more for using an ambulance outside their insurance network. This directly affects insured individuals who use ambulance services, especially in emergencies or when they cannot choose a network provider. The law also mandates insurers to clearly disclose coverage details for emergency services, including cost-sharing and how to access care.
SB 572 requires health benefit plans that cover fertility treatment to remove annual or lifetime limits on ovulation medications and ovulation induction cycles, treating these medications the same as other prescription drugs. It applies to both private health plans (effective October 2025) and North Carolina’s State Health Plan for Teachers and State Employees (effective January 2026), which must eliminate such limits for in-network services. The bill does not mandate fertility treatment coverage but ensures existing coverage for ovulation medications faces no stricter restrictions than standard prescriptions. State funding of $300,000 (2025-26) and $600,000 (2026-27) will cover increased costs for the state health plan.
SB 566 updates North Carolina's health insurance laws to require equal coverage for substance use disorder treatment as for physical health conditions. It replaces outdated terms like "chemical dependency" with "substance use disorder" in state statutes and mandates that medical necessity determinations for addiction treatment must use the same clinical criteria applied to physical health conditions. This directly affects health insurers offering group plans and patients seeking addiction treatment, ensuring they face no stricter coverage limits than for other medical issues. The bill aligns North Carolina's requirements with federal mental health parity law (the Paul Wellstone Act) by explicitly including substance use disorders under coverage parity rules.
SB 467, the "Right to Reproductive Freedom Act," codifies protections from the Supreme Court's *Roe v. Wade* and *Planned Parenthood v. Casey* rulings into North Carolina law. It prohibits the state from imposing "undue burdens" on abortion access before fetal viability (approximately 24 weeks), allowing restrictions only to preserve life or health after viability. The bill updates consent rules to let minors consent to abortion care without parental notification (under specific medical circumstances), clarifies healthcare provider immunity, and requires health insurance plans to cover abortion-related complications even if they don’t cover the procedure itself. This directly affects all patients seeking abortion services in North Carolina, particularly those facing prior barriers like young people, low-income individuals, and rural residents.
SB 522, the "Thrive at Midlife Act," requires all health insurance plans in North Carolina to cover specific healthcare services for women aged 40-65, including menopause care, bone density screenings, heart disease prevention, diabetes management, cancer screenings, mental health support, and telehealth. It also expands Medicaid coverage for these services and allocates $10 million annually (2025-2027) to fund grants for community health centers serving uninsured midlife women, prioritizing rural and underserved areas. The bill creates tax credits for individuals and businesses covering qualified midlife healthcare expenses like prescription medications, screenings, and mental health services. These provisions aim to improve access to preventive and specialized care for midlife women while requiring insurers to limit copays and deductibles for covered services to federal preventive care standards.
SB 553, titled "Save More Tatas Act," requires health insurance plans in North Carolina to cover diagnostic breast cancer imaging (such as ultrasounds and MRIs) with the same cost-sharing (like copays and deductibles) as routine mammograms, directly affecting women needing these services. It updates mammogram coverage rules to include annual screenings for high-risk individuals (e.g., those with a family history of breast cancer or dense breast tissue) and mandates that facilities meet accreditation standards. The bill also appropriates $3.6 million for the 2025-2026 fiscal year to support mammography services in rural areas and for the State Health Plan. This legislation aims to improve access to breast cancer diagnostic care without increasing patient out-of-pocket costs.
SB 536, the Birth Freedom Act, requires all health insurance plans in North Carolina to cover maternity care at home or birthing centers on the same terms as hospital births. It mandates that Medicaid beneficiaries also receive full coverage for these options starting July 2025, with providers reimbursed at 90% of standard hospital rates for similar care. The bill allocates $150,000 to expand access to birthing center care under the State Health Plan for public employees, including potential subsidies for beneficiaries. These changes directly affect health insurers, Medicaid, birthing centers, and individuals seeking non-hospital maternity options.
HB 509, the Right to Reproductive Freedom Act, codifies the constitutional protections for abortion access established in Roe v. Wade and Planned Parenthood v. Casey by prohibiting North Carolina from imposing restrictions that create an undue burden before fetal viability. The bill allows state restrictions only after fetal viability to preserve life or health and defines "undue burden" as any substantial obstacle to accessing abortion care. It removes barriers such as unnecessary parental consent requirements for minors and expands the scope of healthcare providers (including nurse practitioners and certified nurse midwives) who can perform or assist with abortion care. Additionally, the bill requires health insurance plans to cover abortion services and related complications, ensuring broader access for insured individuals.
SB 418 authorizes North Carolina's Commissioner of Insurance to establish and operate a state-run health benefits exchange, creating a marketplace for residents to shop for health insurance plans compliant with federal law. The bill gives the Commissioner authority to set rules, apply for federal funding, and form advisory committees to manage the exchange, with $100,000 appropriated for 2025-2026 to launch it. This directly affects North Carolinians seeking health insurance, providing an alternative to the federal marketplace. The exchange must align with the federal Affordable Care Act, and the bill explicitly prohibits state agencies from pursuing a federal "Partnership" model without legislative approval.
HB 629 extends the deadline for North Carolina's Primary Care Payment Reform Task Force from May 1, 2024, to December 31, 2026. The task force studies primary care spending across Medicaid, the State Health Plan, and commercial insurance to evaluate system adequacy, define primary care services, and identify data collection methods. This extension allows the task force additional time to complete its analysis and submit reports to legislative committees, directly affecting state agencies like the Department of Health and Human Services responsible for implementing the study.
