Repeals subsections (b), (c), (d), and (j) of GS 58-3-220, concerning large employer group health plan minimum required benefits and durational limits.

Recodifies subsection (h) of GS 58-3-220 as subsection (a1) of GS 58-3-220.

Amends GS 58-3-220(a) by requiring all health benefit plans to provide coverage for necessary care and treatment of mental health conditions that are no less favorable than the benefits for the necessary care and treatment of physical health conditions (was, no less favorable than benefits for physical illness generally). Makes technical changes, conforming changes, and eliminates the use of illness and substitutes it with health or health condition(s) throughout. Removes definition of mental illness.

Amends GS 58-3-220(a1) by changing the defined term from mental illness to mental health condition and eliminating substance related disorders from those mental health conditions excluded from the meaning of the term. Makes technical changes to the definition as well. Makes technical changes to the definitions for health benefit plan, insurer, and medical necessity.

Amends GS 58-3-220(g) and GS 58-50-61(d1) concerning utilization review criteria to determine medical necessity by making technical changes and requiring that clinical review criteria and assessment of medical necessity for a treatment modality for any mental health condition, including substance use disorders, be consistent with the review criteria and assessments used to determine the medical necessity of non-mental health conditions. Specifies that for substance use disorders, medical necessity is determined by reliance on the most recent American Society of Addiction Medicine criteria alone.

Amends GS 58-3-220(i) by applying all applicable federal law to all health benefit plans (was, a requirement for group health benefit plans that cover both medical and surgical benefits and mental health benefits to follow applicable standards of Subtitle B of Title V of Public Law 110-343, with respect to mental health benefits).

Makes technical and conforming changes to GS 58-50-61(d).

Amends GS 58-50-61(d2) to require an insurer or its utilization review organization (was, insurer only) to follow certain criteria in issuing a utilization review decision. Makes technical changes to the subsection.

Requires the State Treasurer and Executive Administrator of the State Health Plan (SHP) to review all SHP practices, contracts with, and practices of any third party conducting utilization review on behalf of the SHP, to ensure compliance with GS 58-50-61, as amended no later than the start of the next plan year.

Mandates that the Revisor of Statutes replace the phrase chemical dependency with the phrase substance use disorder in all listed statutes.

Repeals GS 58-51-50 (coverage for chemical dependency treatment), GS 58-51-55(a)(2) (chemical dependency definition), GS 58-51-55(c) (specifying that the statute does not require insurer to offer coverage for chemical dependency), GS 58-65-75 (group insurance coverage for chemical dependency), GS 58-65-90(a)(2) (defining chemical dependency), GS 58-65-90(c) (not requiring service corporations to offer coverage for chemical dependency), GS 58-67-70 (concerning a health maintenance organization's coverage for chemical dependency), GS 58-67-75(a)(2) (chemical dependency definition), and GS 58-67-75(c) (not requiring HMO to offer coverage for chemical dependency).

Makes conforming changes to GS 58-3-192(a)(2).

Effective October 1, 2025, and applies to insurance contracts issued, renewed, or amended on or after that date.