reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-837 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-837 - Colorectal Cancer Screening Coverage

    (a)    This section applies to:        (1)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies or contracts that are issued or delivered in the State; and        (2)    health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.    (b)    An entity subject to this section shall provide coverage for colorectal cancer screening in accordance with the latest screening guidelines issued by the American Cancer Society.    (c)    (1)    Subject to paragraph (2) of this subsection, the coverage required under this section may be subject to a copayment or coinsurance requirement or deductible that an entity subject to this section imposes for similar coverages under the same policy or contract.        (2)    The copayment or coinsurance requirement or deductible imposed under paragraph (1) of this subsection may not be greater than the copayment or coinsurance requirement or deductible imposed by the entity for similar coverages.    (d)    Nothing in this section may be construed to prohibit an entity subject to this section from providing coverages that are greater than or more favorable to an insured or enrollee than the coverage required under this section.
MD. Insurance Code Ann. §  15-838 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-838 - Hearing Aid Coverage for a Minor Child

    (a)    This section applies to:        (1)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and        (2)    health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.    (b)    (1)    In this subsection, “hearing aid” means a device that:            (i)    is of a design and circuitry to optimize audibility and listening skills in the environment commonly experienced by children; and            (ii)    is nondisposable.        (2)    An entity subject to this section shall provide coverage for hearing aids for a minor child who is covered under a policy or contract if the hearing aids are prescribed, fitted, and dispensed by a licensed audiologist.        (3)    (i)    An entity subject to this section may limit the benefit payable under paragraph (2) of this subsection to $1,400 per hearing aid for each hearing–impaired ear every 36 months.            (ii)    An insured or enrolled individual may choose a hearing aid that is priced higher than the benefit payable under this subsection and may pay the difference between the price of the hearing aid and the benefit payable under this subsection, without financial or contractual penalty to the provider of the hearing aid.    (c)    This section does not prohibit an entity subject to this section from providing coverage that is greater or more favorable to an insured or enrolled individual than the coverage required under this section.    (d)    If an entity subject to this section provides coverage for hearing aids to an insured or enrolled individual who is not a minor child, and if the policy or contract of the insured or enrolled individual has a dollar limit on the hearing aid benefit, the entity shall allow the individual to:        (1)    choose a hearing aid that is priced higher than the benefit payable under the policy or contract; and        (2)    pay the difference between the price of the hearing aid and the dollar limit on the hearing aid benefit.
MD. Insurance Code Ann. §  15-839 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-839 - Coverage for Treatment of Morbid Obesity

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Body mass index” means a practical marker that is used to assess the degree of obesity and is calculated by dividing the weight in kilograms by the height in meters squared.        (3)    “Morbid obesity” means a body mass index that is:            (i)    greater than 40 kilograms per meter squared; or            (ii)    equal to or greater than 35 kilograms per meter squared with a comorbid medical condition, including hypertension, a cardiopulmonary condition, sleep apnea, or diabetes.    (b)    This section applies to:        (1)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies or contracts that are issued or delivered in the State;        (2)    health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State; and        (3)    managed care organizations, as defined in § 15-101 of the Health - General Article.    (c)    An entity subject to this section shall provide coverage for the surgical treatment of morbid obesity that is:        (1)    recognized by the National Institutes of Health as effective for the long-term reversal of morbid obesity; and        (2)    consistent with guidelines approved by the National Institutes of Health.    (d)    An entity subject to this section shall provide the benefits required under this section to the same extent as for other medically necessary surgical procedures under the enrollee’s or insured’s contract or policy with the entity.
MD. Insurance Code Ann. §  15-840 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-840 - Coverage for Medically Necessary Residential Crisis Services

    (a)    In this section, “residential crisis services” means intensive mental health and support services that are:        (1)    provided to a child or an adult with a mental illness who is experiencing or is at risk of a psychiatric crisis that would impair the individual’s ability to function in the community;        (2)    designed to prevent a psychiatric inpatient admission, provide an alternative to psychiatric inpatient admission, or shorten the length of inpatient stay;        (3)    provided out of the individual’s residence on a short–term basis in a community–based residential setting; and        (4)    provided by entities that are licensed by the Maryland Department of Health to provide residential crisis services.    (b)    This section applies to:        (1)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and        (2)    health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.    (c)    (1)    An entity subject to this section shall provide coverage for medically necessary residential crisis services.        (2)    The services required under this section may be delivered under a managed care system.
MD. Insurance Code Ann. §  15-841 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-841 - Coverage for Smoking Cessation Treatment

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Authorized prescriber” has the meaning stated in § 12-101 of the Health Occupations Article.        (3)    (i)    “Nicotine replacement therapy” means a product that:                1.    is used to deliver nicotine to an individual attempting to cease the use of tobacco products; and                2.    is obtained under a prescription written by an authorized prescriber.            (ii)    “Nicotine replacement therapy” does not include any over-the-counter product that may be obtained without a prescription.        (4)    “Tobacco product” has the meaning stated in § 10-101 of the Criminal Law Article.    (b)    (1)    This subsection applies to:            (i)    insurers and nonprofit health service plans that provide coverage for prescription drugs to individuals or groups under health insurance policies or contracts that are issued or delivered in the State; and            (ii)    health maintenance organizations that provide coverage for prescription drugs to individuals or groups under contracts that are issued or delivered in the State.        (2)    An entity subject to this subsection shall provide coverage for:            (i)    except for a drug that may be obtained over-the-counter without a prescription, any drug that:                1.    is approved by the United States Food and Drug Administration as an aid for the cessation of the use of tobacco products; and                2.    is obtained under a prescription written by an authorized prescriber; and            (ii)    two 90-day courses of nicotine replacement therapy during each policy year.        (3)    An entity subject to this subsection may not impose a different copayment or coinsurance requirement for a drug or nicotine replacement therapy provided under paragraph (2) of this subsection than is imposed for any other comparable prescription.
MD. Insurance Code Ann. §  15-842 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-842 - Copayment or Coinsurance for Prescription Drugs and Devices Limited

    (a)    (1)    This section applies to:            (i)    insurers and nonprofit health service plans that provide coverage for prescription drugs and devices under health insurance policies or contracts that are issued or delivered in the State; and            (ii)    health maintenance organizations that provide coverage for prescription drugs and devices under contracts that are issued or delivered in the State.        (2)    An insurer, nonprofit health service plan, or health maintenance organization that provides coverage for prescription drugs and devices through a pharmacy benefits manager is subject to the requirements of this section.    (b)    An entity subject to this section may not impose a copayment or coinsurance requirement for a covered prescription drug or device that exceeds the retail price of the prescription drug or device.
MD. Insurance Code Ann. §  15-843 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-843 - Coverage for Amino Acid-Based Elemental Formula

    (a)    This section applies to:        (1)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies that are issued or delivered in the State; and        (2)    health maintenance organizations that provide hospital, medical, and surgical benefits to individuals or groups under contracts that are issued or delivered in the State.    (b)    (1)    Subject to paragraph (2) of this subsection, a policy or plan subject to this section shall include, under the family member coverage, coverage for amino acid–based elemental formula, regardless of delivery method, for the diagnosis and treatment of:            (i)    Immunoglobulin E and non–Immunoglobulin E mediated allergies to multiple food proteins;            (ii)    severe food protein induced enterocolitis syndrome;            (iii)    eosinophilic disorders, as evidenced by the results of a biopsy; and            (iv)    impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract.        (2)    Subject to paragraph (3) of this subsection, the coverage required under paragraph (1) of this subsection is required if the ordering physician has issued a written order stating that the amino acid–based elemental formula is medically necessary for the treatment of a disease or disorder listed in paragraph (1) of this subsection.        (3)    In accordance with Subtitle 10A of this title, a private review agent, acting on behalf of an insurer, nonprofit health service plan, or health maintenance organization, may review the ordering physician’s determination of the medical necessity of the amino acid–based elemental formula for the treatment of a disease or disorder listed in paragraph (1) of this subsection.
MD. Insurance Code Ann. §  15-844 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-844 - Benefits for Prosthetic Devices

    (a)    In this section, “prosthetic device” means an artificial device to replace, in whole or in part, a leg, an arm, or an eye.    (b)    This section applies to:        (1)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and        (2)    health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.    (c)    An entity subject to this section shall provide coverage for:        (1)    prosthetic devices;        (2)    components of prosthetic devices; and        (3)    repairs to prosthetic devices.    (d)    The covered benefits under this section may not be subject to a higher copayment or coinsurance requirement than the copayment or coinsurance for primary care benefits covered under the policy or contract of the insured or enrollee.    (e)    An entity subject to this section may not impose an annual or lifetime dollar maximum on coverage required under this section separate from any annual or lifetime dollar maximum that applies in the aggregate to all covered benefits under the policy or contract of the insured or enrollee.    (f)    An entity subject to this section may not establish requirements for medical necessity or appropriateness for the coverage required under this section that are more restrictive than the indications and limitations of coverage and medical necessity  established under the Medicare Coverage Database.
MD. Insurance Code Ann. §  15-845 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-845 - Coverage for Refills of Prescription Eye Drops

    (a)    This section applies to:        (1)    insurers and nonprofit health service plans that provide coverage for prescription eye drops under health insurance policies or contracts that are issued or delivered in the State; and        (2)    health maintenance organizations that provide coverage for prescription eye drops under contracts that are issued or delivered in the State.    (b)    An entity subject to this section shall provide coverage for a refill of prescription eye drops:        (1)    in accordance with guidance for early refills of topical ophthalmic products provided to Medicare Part D plan sponsors by the Centers for Medicare and Medicaid Services; and        (2)    if:            (i)    the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed;            (ii)    the refill requested by the insured does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner; and            (iii)    the prescription eye drops prescribed by the health care practitioner are a covered benefit under the policy or contract of the insured.
MD. Insurance Code Ann. §  15-846 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-846 - Coverage for Cancer Chemotherapy

    (a)    In this section, “cancer chemotherapy” means medication that is prescribed by a licensed physician to kill or slow the growth of cancer cells.    (b)    This section applies to:        (1)    insurers and nonprofit health service plans that provide coverage for both orally administered cancer chemotherapy and cancer chemotherapy that is administered intravenously or by injection under health insurance policies or contracts that are issued or delivered in the State; and        (2)    health maintenance organizations that provide coverage for both orally administered cancer chemotherapy and cancer chemotherapy that is administered intravenously or by injection under contracts that are issued or delivered in the State.    (c)    An entity subject to this section may not impose dollar limits, copayments, deductibles, or coinsurance requirements on coverage for orally administered cancer chemotherapy that are less favorable to an insured or enrollee than the dollar limits, copayments, deductibles, or coinsurance requirements that apply to coverage for cancer chemotherapy that is administered intravenously or by injection.    (d)    An entity subject to this section may not reclassify cancer chemotherapy or increase a copayment, deductible, coinsurance requirement, or other out–of–pocket expense imposed on cancer chemotherapy to achieve compliance with this section.
MD. Insurance Code Ann. §  15-847.1 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-847.1 - Copayment or Coinsurance Limits for Certain Drugs -- Annual Increase Regulated

    (a)    This section applies to:        (1)    insurers and nonprofit health service plans that provide coverage for prescription drugs under individual, group, or blanket health insurance policies or contracts that are issued or delivered in the State; and        (2)    health maintenance organizations that provide coverage for prescription drugs under individual group contracts that are issued or delivered in the State.    (b)    (1)    Subject to paragraph (2) of this subsection, an entity subject to this section may not impose a copayment or coinsurance requirement on a prescription drug prescribed to treat diabetes, HIV, or AIDS that exceeds $150 for up to a 30–day supply of the drug.        (2)    On July 1 each year, the limit on the copayment or coinsurance requirement on a prescription drug prescribed to treat diabetes, HIV, or AIDS shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the March Consumer Price Index for All Urban Consumers, Washington Metropolitan Area, from the U.S. Department of Labor, Bureau of Labor Statistics.
MD. Insurance Code Ann. §  15-848 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-848 - Coverage for Ostomy Equipment and Supplies

    (a)    This section applies to:        (1)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and        (2)    health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.    (b)    This section does not apply to a policy or contract issued or delivered by an entity subject to this section that provides the essential health benefits required under § 1302(a) of the Affordable Care Act.    (c)    An entity subject to this section shall provide coverage for all medically appropriate and necessary equipment and supplies used for the treatment of ostomies, including flanges, collection bags, clamps, irrigation devices, sanitizing products, ostomy rings, ostomy belts, and catheters used for drainage of urostomies.    (d)    (1)    Subject to paragraph (2) of this subsection, the coverage required under this section may be subject to the annual deductibles or coinsurance requirements imposed by an entity subject to this section for similar coverages under the same health insurance policy or contract.        (2)    The annual deductibles or coinsurance requirements imposed under paragraph (1) of this subsection for the coverage required under this section may not be greater than the annual deductibles or coinsurance requirements imposed by the entity for similar coverages.
MD. Insurance Code Ann. §  15-849 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-849 - Coverage for Abuse-Deterrent Opioid Analgesic Drug Products

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Abuse–deterrent opioid analgesic drug product” means a brand name or generic opioid analgesic drug product approved by the U.S. Food and Drug Administration with abuse–deterrent labeling that indicates the drug product is expected to result in a meaningful reduction in abuse.        (3)    “Opioid analgesic drug product” means a drug product that contains an opioid agonist and is indicated by the U.S. Food and Drug Administration for the treatment of pain, regardless of whether the drug product:            (i)    is in immediate release or extended release form; or            (ii)    contains other drug substances.    (b)    (1)    This section applies to:            (i)    insurers and nonprofit health service plans that provide coverage for prescription drugs under individual, group, or blanket health insurance policies or contracts that are issued or delivered in the State; and            (ii)    health maintenance organizations that provide coverage for prescription drugs under individual or group contracts that are issued or delivered in the State.        (2)    An insurer, a nonprofit health service plan, or a health maintenance organization that provides coverage for prescription drugs through a pharmacy benefits manager is subject to the requirements of this section.    (c)    (1)    An entity subject to this section shall provide coverage for:            (i)    at least two brand name abuse–deterrent opioid analgesic drug products, each containing different analgesic ingredients, on the lowest cost tier for brand name prescription drugs on the entity’s formulary for prescription drug coverage; and            (ii)    if available, at least two generic abuse–deterrent opioid analgesic drug products, each containing different analgesic ingredients, on the lowest cost tier for generic drugs on the entity’s formulary for prescription drug coverage.        (2)    An entity subject to this section may not require an insured or an enrollee to first use an opioid analgesic drug product without abuse–deterrent labeling before providing coverage for an abuse–deterrent opioid analgesic drug product covered on the entity’s formulary for prescription drug coverage.    (d)    Notwithstanding subsection (c)(2) of this section, an entity subject to this section may undertake utilization review, including preauthorization, for an abuse–deterrent opioid analgesic drug product covered by the entity, if the same utilization review requirements are applied to non–abuse–deterrent opioid analgesic drug products covered by the entity in the same formulary tier as the abuse–deterrent opioid analgesic product.