Refusal to Provide Medical Services

ABORTION REFUSAL CLAUSE

North Carolina allows certain individuals or entities to refuse to provide abortion services.

To whom does the refusal clause apply? Physicians, nurses, hospitals, and other health care institutions.

What does the refusal clause allow? No physician licensed to practice medicine in the state and no nurse who objects on moral, ethical, or religious grounds may be required to participate in medical procedures that result in an abortion. The refusal of a physician to participate may not be a basis for civil liability, disciplinary action, or other recriminatory action. No hospital or other health care institution may be required to provide abortion services.

Does the law require the refusing entity to notify the persons affected? No.

Are there circumstances under which a refusal clause may not be exercised? No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services? No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive health services, information, or referrals if an individual and/or entity exercises a refusal clause? No.

N.C. Gen. Stat. Ann. §§ 14-45.1(e), (f) (Enacted 1967; Last Amended 1997).

INSURANCE COVERAGE FOR CONTRACEPTION REFUSAL CLAUSE

Although North Carolina law requires health insurance plans that cover prescription drugs to provide equitable coverage for contraception, certain employers and/or insurers may require that their plans exclude coverage for contraception.

To whom does the refusal clause apply? Religious employers for whom prescription contraceptive drugs or devices are contrary to their religious tenets.

What does the refusal clause allow? A religious employer may require issuers of its health insurance plans to exclude coverage for contraception.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? No. The law narrowly defines the term "religious employer" as a tax exempt entity that is organized and operated for religious purposes, has a primary purpose of inculcation of religious values, and primarily employs persons who share the religious tenets of the entity. This narrow definition is appropriately limited in scope, applying to religious entities but not broad-based entities that operate in the public sphere.

Does the law require that the persons affected by the refusal be notified? Yes. An insurer providing health benefit plans to a religious employer exercising a religious refusal must provide written notice of the exclusion to each insured. The notice must appear in the plan, application, and sales brochure for the plan.

Are there circumstances under which a refusal clause may not be exercised? Yes. A refusal clause may not be used to exclude coverage for prescription drugs ordered for reasons other than contraception or for prescription contraception that is necessary to preserve the life or health of an insured.

Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause? No.

N.C. Gen. Stat. Ann. §§ 58-3-178, 58-50-155 (Enacted 1999).

PHARMACIST REFUSAL CLAUSE

North Carolina allows pharmacists to refuse to fill or refill prescriptions.

To whom does the refusal clause apply? Pharmacists.

What does the refusal clause allow? Pharmacists or dispensers of devices and medical equipment may refuse to fill or refill a prescription order if, in the pharmacist's professional judgment, it would be harmful to the recipient, is not in the recipient's best interest, or if there is a question as to its validity.

Does the law require the refusing entity to notify the persons affected? No.

Are there circumstances under which a refusal clause may not be exercised? No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for prescription services? No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive health services, information, or referrals if an individual and/or entity exercises a refusal clause? No.

N.C. Admin. Code. tit 21, § 46.1801.