reglab/housing_qa huggingface dataset:
NC Gen Stat § 58-3-175 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-175 - Direct payment to government agencies.

 58-3-175. Direct payment to government agencies.(a) As used in this section, "health benefit plan" has the same meaning as in G.S. 58-50-110(11) and includes the State Health Plan for Teachers and State Employees and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes.(b) Every entity providing or administering a health benefit plan covering persons in this State shall make payment for health care services covered by the health benefit plan that are provided by any State, county, or city agency, directly to the agency providing the services.(c) This section does not apply to the extent the agency providing the services has been paid for the services by or on behalf of the person receiving the services.(d) Nothing in this section shall require any entity providing or administering a health benefit plan covering persons in this State to pay any agency directly:(1) If the agency is outside of the health benefit plan's service area;(2) If the entity operates a program by which it only pays the health care provider directly upon the acceptance of certain rates and the agency does not accept said rates; or(3) If the entity operates a program by which it provides, authorizes, or arranges for a covered person to receive health care from a designated provider or refers the covered person to a designated provider, and the agency is not a designated provider. (1993, c. 41, s. 1; 2007-298, s. 8.4; 2007-323, s. 28.22A(o); 2007-345, s. 12.)
NC Gen Stat § 58-3-176 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-176 - Treatment discussions not limited.

 58-3-176. Treatment discussions not limited.(a) An insurer shall not limit either of the following:(1) The participating plan provider's ability to discuss with an enrollee the clinical treatment options medically available, the risks associated with the treatments, or a recommended course of treatment.(2) The participating plan provider's professional obligations to patients as specified under the provider's professional license.(b) Nothing in this section shall be construed to expand or revise the scope of benefits covered by a health benefit plan.(c) As used in this section:(1) "Health benefit plan" means any of the following if written by an insurer: an accident and health insurance policy or certificate; a nonprofit hospital or medical service corporation contract; a health maintenance organization subscriber contract; or a plan provided by a multiple employer welfare arrangement. "Health benefit plan" does not mean any plan implemented or administered through the Department of Health and Human Services 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 or nursing home care.e. Medicare supplement.f. Specified disease.g. Dental or vision.h. Coverage issued as a supplement to liability insurance.i. Workers' compensation.j. Medical payments under automobile or homeowners insurance.k. Hospital income or indemnity.l. Insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability policy or equivalent self-insurance.(2) "Insurer" means an entity that writes a health benefit plan and that is an insurance company subject to this Chapter, a service corporation under Article 65 of this Chapter, a health maintenance organization under Article 67 of this Chapter, or a multiple employer welfare arrangement under Article 50A of this Chapter.  (1997-443, s. 11A.122; 1997-474, s. 1; 2019-202, s. 8.)
NC Gen Stat § 58-3-179 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-179 - Coverage for colorectal cancer screening.

 58-3-179. Coverage for colorectal cancer screening.(a) Every health benefit plan, as defined in G.S. 58-3-167, shall provide coverage for colorectal cancer examinations and laboratory tests for cancer, in accordance with the most recently published American Cancer Society guidelines or guidelines adopted by the North Carolina Advisory Committee on Cancer Coordination and Control for colorectal cancer screening, for any nonsymptomatic covered individual who is:(1) At least 50 years of age, or(2) Less than 50 years of age and at high risk for colorectal cancer according to the most recently published colorectal cancer screening guidelines of the American Cancer Society or guidelines adopted by the North Carolina Advisory Committee on Cancer Coordination and Control.The same deductibles, coinsurance, and other limitations as apply to similar services covered under the plan apply to coverage for colorectal examinations and laboratory tests required to be covered under this section.(b) Reserved for future codification purposes. (2001-116, s. 1.)
NC Gen Stat § 58-3-180 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-180 - Motor vehicle repairs; selection by claimant.

 58-3-180. Motor vehicle repairs; selection by claimant.(a) A policy covering damage to a motor vehicle shall allow the claimant to select the repair service or source for the repair of the damage.(b) The amount determined by the insurer to be payable under a policy covering damage to a motor vehicle shall be paid regardless of the repair service or source selected by the claimant.(b1) No insurer or insurer representative shall recommend the use of a particular motor vehicle repair service without clearly informing the claimant that (i) the claimant is under no obligation to use the recommended repair service, (ii) the claimant may use the repair service of the claimant's choice, (iii) the amount determined by the insurer to be payable under the policy will be paid regardless of whether or not the claimant uses the recommended repair service, and (iv) that the insurer or insurer representative has, at the time the recommendations are made, a financial interest in the recommended motor vehicle repair service. No insurer shall require that the insured or claimant must have a damaged vehicle repaired at an insurer-owned motor vehicle repair service.(b2) The provisions of subsection (b1) of this section shall be included in nonfleet private passenger motor vehicle insurance policy forms promulgated by the Bureau and approved by the Commissioner.(c) Any person who violates this section is subject to the applicable provisions of G.S. 58-2-70 and G.S. 58-33-46, provided that the maximum civil penalty that can be assessed under G.S. 58-2-70(d) for a violation of this section is two thousand dollars ($2,000).(d) As used in this section, "insurer representative" includes an insurance agent, limited representative, broker, adjuster, and appraiser. (1993, c. 525, s. 2; 2001-203, s. 26; 2001-451, s. 1; 2003-395, s. 1.)
NC Gen Stat § 58-3-181 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-181 - Synchronization of prescription refills.

 58-3-181. Synchronization of prescription refills.(a) Every health benefit plan that provides coverage for prescription drugs shall provide for synchronization of medication when it is agreed among the insured, the provider, and a pharmacist that synchronization of multiple prescriptions for the treatment of a chronic illness is in the best interest of the insured for the management or treatment of a chronic illness, provided all of the following apply:(1) The medications are covered by the clinical coverage policy.(2) The medications are used for treatment and management of chronic conditions, and the medications are subject to refills.(3) The medications are not a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone.(4) The medications meet all prior authorization criteria specific to the medications at the time of the synchronization request.(5) The medications are of a formulation that can be effectively split over required short-fill periods to achieve synchronization.(6) The medications do not have quantity limits or dose optimization criteria or requirements that would be violated in fulfilling synchronization.(b) When applicable to permit synchronization, the health benefit plan shall apply a prorated daily cost-sharing rate to any medication dispensed by a network pharmacy pursuant to this section. Any dispensing fee shall not be prorated and shall be based on an individual prescription filled or refilled.(c) The following definitions apply in this section:(1) Health benefit plan. - As defined in G.S. 58-3-167. The phrase also applies to limited-scope dental and vision insurance.(2) Health care provider or provider. - As defined in G.S. 58-3-225(a)(4).(3) Insured. - An individual who is eligible to receive benefits from the health benefit plan.(4) Insurer. - As defined in G.S. 58-3-225(a)(5).  (2015-241, s. 20.2(a).)
NC Gen Stat § 58-3-185 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-185 - Lien created for payment of past-due child support obligations.

 58-3-185. Lien created for payment of past-due child support obligations.(a) In the event that the Department of Health and Human Services or any other obligee, as defined in G.S. 110-129, provides written notification to an insurance company authorized to issue policies of insurance pursuant to this Chapter that a claimant or beneficiary under a contract of insurance owes past-due child support and accompanies this information with a certified copy of the court order ordering support together with proof that the claimant or beneficiary is past due in meeting this obligation, there is created a lien upon any insurance proceeds in favor of the Department or obligee. This section shall apply only in those instances in which there is a nonrecurring payment of a lump-sum amount equal to or in excess of three thousand dollars ($3,000) or periodic payments with an aggregate amount that equals or exceeds three thousand dollars ($3,000).(b) Liens arising under this section shall be subordinate to liens upon insurance proceeds for personal injuries arising under Article 9 of Chapter 44 of the General Statutes and valid health care provider claims covered by health benefit plans as defined in G.S. 58-3-172. As used in this section, the term health benefit plans does not include disability income insurance. (1995, c. 538, s. 6(a); 1995 (Reg. Sess., 1996), c. 674, ss. 1, 2; 1997-443, s. 11A.118(a).)
NC Gen Stat § 58-3-191 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-191 - Managed care reporting and disclosure requirements.

 58-3-191. Managed care reporting and disclosure requirements.(a) Repealed by Session Laws 2015-92, s. 6, effective June 19, 2015.(b) Disclosure requirements. - Each health benefit plan shall provide the following applicable information to plan participants and bona fide prospective participants upon request:(1) The evidence of coverage (G.S. 58-67-50), subscriber contract (G.S. 58-65-60, 58-65-140), health insurance policy (G.S. 58-51-80, 58-50-125, 58-50-126, 58-50-55), or the contract and benefit summary of any other type of health benefit plan;(2) An explanation of the utilization review criteria and treatment protocol under which treatments are provided for conditions specified by the prospective participant. This explanation shall be in writing if so requested;(3) If denied a recommended treatment, written reasons for the denial and an explanation of the utilization review criteria or treatment protocol upon which the denial was based;(4) The plan's formularies, restricted access drugs or devices as defined in G.S. 58-3-221, or prior approval requirements for obtaining prescription drugs, whether a particular drug or therapeutic class of drugs is excluded from its formulary, and the circumstances under which a nonformulary drug may be covered; and(5) The plan's procedures and medically based criteria for determining whether a specified procedure, test, or treatment is experimental.(b1) Repealed by Session Laws 2015-92, s. 6, effective June 19, 2015.(c) For purposes of this section, "health benefit plan" or "plan" means (i) health maintenance organization (HMO) subscriber contracts and (ii) insurance company or hospital and medical service corporation preferred provider benefit plans as defined in G.S. 58-50-56.  (1997-480, s. 1; 1997-519, s. 1.1; 2001-334, s. 2.2; 2001-446, s. 2.1; 2006-154, s. 13; 2008-124, s. 10.1; 2015-92, s. 6.)
NC Gen Stat § 58-3-223 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-223 - Managed care access to specialist care.

 58-3-223. Managed care access to specialist care.(a) Each insurer offering a health benefit plan that does not allow direct access to all in-plan specialists shall develop and maintain written policies and procedures by which an insured may receive an extended or standing referral to an in-plan specialist. The insurer shall provide for an extended or standing referral to a specialist if the insured has a serious or chronic degenerative, disabling, or life-threatening disease or condition, which in the opinion of the insured's primary care physician, in consultation with the specialist, requires ongoing specialty care. The extended or standing referral shall be for a period not to exceed 12 months and shall be made under a treatment plan coordinated with the insurer in consultation with the primary care physician, the specialist, and the insured or the insured's designee.(b) As used in this section:(1) "Health benefit plan" has the meaning applied in G.S. 58-3-167.(2) "Insurer" has the meaning applied in G.S. 58-3-167.(3) "Serious or chronic degenerative, disabling, or life-threatening disease or condition" means a disease or condition, which in the opinion of the patient's treating primary care physician and specialist, requires frequent and periodic monitoring and consultation with the specialist on an ongoing basis.(4) "Specialist" includes a subspecialist. (1999-168, s. 1; 2001-446, s. 1.2.)
NC Gen Stat § 58-3-230 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-230 - Uniform provider credentialing.

 58-3-230. Uniform provider credentialing.(a) An insurer that provides a health benefit plan and that credentials providers for its networks shall maintain a process to assess and verify the qualifications of a licensed health care practitioner within 60 days of receipt of a completed provider credentialing application form approved by the Commissioner. If the insurer has not approved or denied the provider credentialing application form within 60 days of receipt of the completed application, upon receipt of a written request from the applicant and within five business days of its receipt, the insurer shall issue a temporary credential to the applicant if the applicant has a valid North Carolina professional or occupational license to provide the health care services to which the credential would apply. The insurer shall not issue a temporary credential if the applicant has reported on the application a history of medical malpractice claims, a history of substance abuse or mental health issues, or a history of Medical Board disciplinary action. The temporary credential shall be effective upon issuance and shall remain in effect until the provider's credentialing application is approved or denied by the insurer. When a health care practitioner joins a practice that is under contract with an insurer to participate in a health benefit plan, the effective date of the health care practitioner's participation in the health benefit plan network shall be the date the insurer approves the practitioner's credentialing application.(b) The Commissioner shall by rule adopt a uniform provider credentialing application form that will provide health benefit plans with the information necessary to adequately assess and verify the qualifications of an applicant. The Commissioner may update the uniform provider credentialing application form, as necessary. No insurer that provides a health benefit plan may require an applicant to submit information that is not required by the uniform provider credentialing application form.(c) As used in this section, the terms "health benefit plan" and "insurer" shall have the meaning provided under G.S. 58-3-167.  (2001-172, s. 1; 2002-126, s. 6.9(a); 2005-223, s. 9; 2009-487, s. 1.)
NC Gen Stat § 58-3-235 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-235 - Selection of specialist as primary care provider.

 58-3-235. Selection of specialist as primary care provider.(a) Each insurer that offers a health benefit plan shall have a procedure by which an insured diagnosed with a serious or chronic degenerative, disabling, or life-threatening disease or condition, either of which requires specialized medical care may select as his or her primary care physician a specialist with expertise in treating the disease or condition who shall be responsible for and capable of providing and coordinating the insured's primary and specialty care. If the insurer determines that the insured's care would not be appropriately coordinated by that specialist, the insurer may deny access to that specialist as a primary care provider.(b) The selection of the specialist shall be made under a treatment plan approved by the insurer, in consultation with the specialist and the insured or the insured's designee and after notice to the insured's primary care provider, if any. The specialist may provide ongoing care to the insured and may authorize such referrals, procedures, tests, and other medical services as the insured's primary care provider would otherwise be allowed to provide or authorize, subject to the terms of the treatment plan. Services provided by a specialist who is providing and coordinating primary and specialty care remain subject to utilization review and other requirements of the insurer, including its requirements for primary care providers. (2001-446, s. 1.3.)
NC Gen Stat § 58-3-240 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-240 - Direct access to pediatrician for minors.

 58-3-240. Direct access to pediatrician for minors.Each insurer offering a health benefit plan that uses a network of contracting health care providers shall allow an insured to choose a contracting pediatrician in the network as the primary care provider for the insured's children under the age of 18 and covered under the policy. (2001-446, s. 1.4.)
NC Gen Stat § 58-3-245 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 3 - General Regulations for Insurance.|§ 58-3-245 - Provider directories; cost tools for insured.

 58-3-245. Provider directories; cost tools for insured.(a) Every health benefit plan utilizing a provider network shall maintain a provider directory that includes a listing of network providers available to insureds and shall update the listing no less frequently than once a year. In addition, every health benefit plan shall maintain a telephone system and may maintain an electronic or on-line system through which insureds can access up-to-date network information. The health benefit plan shall ensure that a patient is provided accurate and current information on each provider's network status through the telephone system and any electronic or online system. If the health benefit plan produces printed directories, the directories shall contain language disclosing the date of publication, frequency of updates, that the directory listing may not contain the latest network information, and contact information for accessing up-to-date network information.(b) Each directory listing shall include the following network information:(1) The provider's name, address, telephone number, and, if applicable, area of specialty.(2) Whether the provider may be selected as a primary care provider.(3) To the extent known to the health benefit plan, an indication of whether the provider:a. Is or is not currently accepting new patients.b. Has any other restrictions that would limit an insured's access to that provider.(c) The directory listing shall include all of the types of participating providers. Upon a participating provider's written request, the insurer shall also list in the directory, as part of the participating provider's listing, the names of any allied health professionals who provide primary care services under the supervision of the participating provider and whose services are covered by virtue of the insurer's contract with the supervising participating provider and whose credentials have been verified by the supervising participating provider. These allied health professionals shall be listed as a part of the directory listing for the participating provider upon receipt of a certification by the supervising participating provider that the credentials of the allied health professional have been verified consistent with the requirements for the type of information required to be verified under G.S. 58-3-230.(d) A health care provider shall provide to a patient or prospective patient, upon request, information on that provider's network status with a particular health benefit plan.  (2001-446, s. 2.2; 2013-382, s. 13.4.)