reglab/statecodes huggingface dataset:
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-822.1 - Limit on Amount Individuals Pay in Copayments or Coinsurance for Covered Prescription Insulin Drug -- Payment Amount

** TAKES EFFECT JANUARY 1, 2023 PER CHAPTER 405 OF 2022 **
(a)    (1)    This section applies to:
(i)    insurers and nonprofit health service plans that provide coverage for prescription drugs and devices to individuals or groups under health insurance policies or contracts that are delivered in the State; and
(ii)    health maintenance organizations that provide coverage for prescription drugs and devices to individuals or groups under 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 and devices through a pharmacy benefits manager is subject to the requirements of this section.
(b)    An entity subject to this section shall limit the amount a covered individual is required to pay in copayments or coinsurance for a covered prescription insulin drug to not more than $30 for a 30–day supply, regardless of the amount or type of insulin needed to fill the covered individual’s prescription.
(c)    An entity subject to this section may set the amount a covered individual is required to pay to an amount that is less than the payment amount limit under subsection (b) of this section.
(d)    A contract between an entity subject to this section, or a pharmacy benefits manager through which the entity provides coverage for prescription drugs and devices, and a pharmacy or the pharmacy’s contracting agent, may not:
(1)    authorize a party to the contract to charge a covered individual an amount that is more than the payment amount limit under subsection (b) of this section;
(2)    require a pharmacy to collect from a covered individual an amount that is more than the payment amount limit under subsection (b) of this section; or
(3)    require a covered individual to pay an amount that is more than the payment amount limit under subsection (b) of this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-823 - Coverage for Osteoporosis Prevention and Treatment

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Bone mass measurement” means a radiologic or radioisotopic procedure or other scientifically proven technology performed on a qualified individual for the purpose of identifying bone mass or detecting bone loss.
(3)    “Qualified individual” means:
(i)    an estrogen deficient individual at clinical risk for osteoporosis;
(ii)    an individual with a specific sign suggestive of spinal osteoporosis, including roentgenographic osteopenia or roentgenographic evidence suggestive of collapse, wedging, or ballooning of one or more thoracic or lumbar vertebral bodies, who is a candidate for therapeutic intervention or for an extensive diagnostic evaluation for metabolic bone disease;
(iii)    an individual receiving long–term glucocorticoid (steroid) therapy;
(iv)    an individual with primary hyperparathyroidism; or
(v)    an individual being monitored to assess the response to or efficacy of an approved osteoporosis drug therapy.
(b)    This section applies to:
(1)    each individual hospital or major medical insurance policy of an insurer that is delivered or issued for delivery in the State and is written on an expense–incurred basis;
(2)    each group or blanket health insurance policy of an insurer that is issued or delivered in the State and is written on an expense–incurred basis;
(3)    each individual or group medical or major medical contract or certificate of a nonprofit health service plan that is issued or delivered in the State and is written on an expense–incurred basis; and
(4)    each individual or group contract of a health maintenance organization that is issued or delivered in the State.
(c)    A policy, contract, or certificate subject to this section shall include coverage for qualified individuals for reimbursement for bone mass measurement for the prevention, diagnosis, and treatment of osteoporosis when the bone mass measurement is requested by a health care provider for the qualified individual.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-824 - Coverage for Maintenance Drugs

(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)    “Maintenance drug” means a drug anticipated to be required for 6 months or more to treat a chronic condition.
(b)    This section applies to:
(1)    insurers and nonprofit health service plans that provide coverage for drugs under health insurance policies or contracts that are delivered or issued for delivery in the State to employers or individuals on a group or individual basis; and
(2)    health maintenance organizations that provide coverage for drugs under contracts that are delivered or issued for delivery in the State to employers or individuals on a group or individual basis.
(c)    This section does not apply to an insured or enrollee who is a resident of a nursing home.
(d)    (1)    An entity subject to this section shall allow an insured or enrollee, if authorized by an authorized prescriber, to receive up to a 90-day supply of a maintenance drug in a single dispensing of the prescription.
(2)    The provisions of paragraph (1) of this subsection do not apply to the first prescription or change in a prescription for a maintenance drug that the authorized prescriber prescribes for the insured or enrollee.
(e)    Whenever an entity subject to this section increases the co-payment for a single dispensing of a prescription in a supply in excess of 30 days, the entity shall also proportionately increase the dispensing fee to the pharmacist for the prescription.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-825 - Coverage for Detection of Prostate Cancer

(a)    This section applies to:
(1)    insurers and nonprofit health service plans that provide inpatient 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 inpatient 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 the expenses incurred in conducting a medically recognized diagnostic examination which shall include a digital rectal exam and a blood test called the prostate–specific antigen (PSA) test:
(1)    for men who are between 40 and 75 years of age;
(2)    when used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment;
(3)    when used for staging in determining the need for a bone scan in patients with prostate cancer; or
(4)    when used for male patients who are at high risk for prostate cancer.
(c)    Subject to federal guidance on the preventive care safe harbor for the absence of a preventive care deductible provided for under 26 U.S.C. § 223(c)(2)(C), an entity subject to this section may not apply a deductible, a copayment, or coinsurance to coverage for preventive care screening services for prostate cancer, which shall include a digital rectal exam and a blood test called the prostate–specific antigen (PSA) test in accordance with subsection (b) of this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-826 - Coverage for Prescription Drugs

(a)    This section applies to:
(1)    insurers and nonprofit health service plans that provide coverage for prescription drugs under 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 contracts that are issued or delivered in the State.
(b)    An entity subject to this section:
(1)    shall provide coverage for any contraceptive drug or device that is approved by the United States Food and Drug Administration for use as a contraceptive and that is obtained under a prescription written by an authorized prescriber as defined in § 12-101 of the Health Occupations Article;
(2)    shall provide coverage for the insertion or removal, and any medically necessary examination associated with the use, of such contraceptive drug or device; and
(3)    may not impose a different copayment or coinsurance for a contraceptive drug or device than is imposed for any other prescription.
(c)    (1)    A religious organization may request and an entity subject to this section shall grant the request for an exclusion from coverage under the policy, plan, or contract for the coverage required under subsection (b) of this section if the required coverage conflicts with the religious organization’s bona fide religious beliefs and practices.
(2)    A religious organization that obtains an exclusion under paragraph (1) of this subsection shall provide its employees reasonable and timely notice of the exclusion.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-826.2 - Coverage for Male Sterilization

(a)    (1)    In this subsection, “group” means a group that is not a group covered under a health insurance policy or contract or under a health maintenance organization contract issued or delivered to a small employer, as defined in § 31–101 of this article.
(2)    This subsection applies to:
(i)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and
(ii)    health maintenance organizations that provide hospital, medical, or surgical benefits to groups under contracts that are issued or delivered in the State.
(3)    This subsection does not apply to an organization that requests and receives an exclusion from coverage under § 15–826(c) of this subtitle.
(4)    An entity subject to this subsection shall provide coverage for male sterilization.
(b)    (1)    This subsection applies to:
(i)    insurers and nonprofit health service plans that provide coverage for male sterilization 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 male sterilization under individual or group contracts that are issued or delivered in the State.
(2)    Except with respect to a health benefit plan that is a grandfathered health plan, as defined in § 1251 of the Affordable Care Act, an entity subject to this subsection may not apply a copayment, coinsurance requirement, or deductible to coverage for male sterilization.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-826.3 - Coverage for Fertility Awareness-Based Methods

(a)    In this section, “fertility awareness–based methods” means methods of identifying times of fertility and infertility by an individual to avoid pregnancy, including:
(1)    cervical mucus methods;
(2)    sympto–thermal or sympto–hormonal methods;
(3)    the standard days method; and
(4)    the lactational amenorrhea method.
(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 instruction by a licensed health care provider on fertility awareness–based methods.
(d)    Except with respect to a health benefit plan that is a grandfathered health plan, as defined in § 1251 of the Affordable Care Act, an entity subject to this section may not apply a copayment, coinsurance requirement, or deductible to the coverage required under this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-828 - Coverage for Charges Related to Dental Care

(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, 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 general anesthesia and associated hospital or ambulatory facility charges in conjunction with dental care provided to an enrollee or insured if the enrollee or insured:
(1)    (i)    is 7 years of age or younger or is developmentally disabled;
(ii)    is an individual for whom a successful result cannot be expected from dental care provided under local anesthesia because of a physical, intellectual, or other medically compromising condition of the enrollee or insured; and
(iii)    is an individual for whom a superior result can be expected from dental care provided under general anesthesia; or
(2)    (i)    is an extremely uncooperative, fearful, or uncommunicative child who is 17 years of age or younger with dental needs of such magnitude that treatment should not be delayed or deferred; and
(ii)    is an individual for whom lack of treatment can be expected to result in oral pain, infection, loss of teeth, or other increased oral or dental morbidity.
(c)    An entity subject to this section may require prior authorization for general anesthesia and associated hospital or ambulatory facility charges for dental care in the same manner that prior authorization is required for these benefits in connection with other covered medical care.
(d)    An entity subject to this section may restrict coverage for general anesthesia and associated hospital or ambulatory facility charges to dental care that is provided by:
(1)    a fully accredited specialist in pediatric dentistry;
(2)    a fully accredited specialist in oral and maxillofacial surgery; and
(3)    a dentist to whom hospital privileges have been granted.
(e)    The provisions of this section may not be construed to require coverage for the dental care for which the general anesthesia is provided.
(f)    The provisions of this section do not apply to dental care rendered for temporal mandibular joint disorders.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-829 - Coverage for Detection of Chlamydia

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Chlamydia screening test” means any laboratory test that:
(i)    specifically detects for infection by one or more agents of chlamydia trachomatis; and
(ii)    is approved for this purpose by the federal Food and Drug Administration.
(3)    “Human papillomavirus screening test” means any laboratory test that:
(i)    specifically detects for infection by one or more agents of the human papillomavirus; and
(ii)    is approved for this purpose by the federal Food and Drug Administration.
(4)    “Multiple risk factors” means having a prior history of a sexually transmitted disease, new or multiple sex partners, inconsistent use of barrier contraceptives, or cervical ectopy.
(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:
(1)    provide coverage for an annual routine chlamydia screening test for:
(i)    women who are:
1.    under the age of 20 years if they are sexually active; and
2.    at least 20 years old if they have multiple risk factors; and
(ii)    men who have multiple risk factors; and
(2)    provide coverage for a human papillomavirus screening at the testing intervals outlined in the recommendations for cervical cytology screening developed by the American College of Obstetricians and Gynecologists.
(d)    (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.
(e)    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.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-832 - Coverage for Removal of Testicle

(a)    This section applies to:
(1)    insurers and nonprofit health service plans that provide inpatient 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 inpatient hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.
(b)    For a patient who receives less than 48 hours of inpatient hospitalization following the surgical removal of a testicle, or who undergoes the surgical removal of a testicle on an outpatient basis, an entity subject to this section shall provide coverage for:
(1)    one home visit scheduled to occur within 24 hours after discharge from the hospital or outpatient health care facility; and
(2)    an additional home visit if prescribed by the patient’s attending physician.
(c)    Each entity subject to this section shall provide notice annually to its enrollees and insureds about the coverage required under this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-832.1 - Inpatient Hospitalization Coverage Following Mastectomy

(a)    In this section, “mastectomy” means the surgical removal of all or part of a breast as a result of breast cancer.
(b)    This section applies to:
(1)    insurers and nonprofit health service plans that provide inpatient 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 inpatient 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 the cost of inpatient hospitalization services for a patient for a minimum of 48 hours following a mastectomy.
(d)    A patient may request a shorter length of stay than that provided in subsection (c) of this section if the patient decides, in consultation with the patient’s attending physician, that less time is needed for recovery.
(e)    (1)    For a patient who receives less than 48 hours of inpatient hospitalization following a mastectomy or who undergoes a mastectomy on an outpatient basis, an entity subject to this section shall provide coverage for:
(i)    one home visit scheduled to occur within 24 hours after discharge from the hospital or outpatient health care facility; and
(ii)    an additional home visit if prescribed by the patient’s attending physician.
(2)    For a patient who remains in the hospital for at least the length of time provided under subsection (c) of this section, an entity subject to this section shall provide coverage for a home visit if prescribed by the attending physician.
(f)    An entity subject to this section may not deny, limit, or otherwise impair the participation of an attending physician under contract with the entity in providing health care services to enrollees or insureds for:
(1)    advocating the interest of a mastectomy patient through the entity’s utilization review or appeals system;
(2)    advocating more than 48 hours of inpatient hospital care for a patient with complications related to a mastectomy; or
(3)    prescribing a home visit under subsection (e)(1)(ii) or (2) of this section.
(g)    An entity subject to this section may not refuse reimbursement under subsection (e)(1) of this section if the services do not occur within the time specified.
(h)    An entity subject to this section shall provide notice annually to insureds and enrollees about the coverage provided by this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-834 - Coverage for Prostheses

(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 a prosthesis that has been prescribed by a physician for an enrollee or insured who has undergone a mastectomy and has not had breast reconstruction.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-835 - Required Coverage for Habilitative Services

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Habilitative services” means services and devices, including occupational therapy, physical therapy, and speech therapy, that help a child keep, learn, or improve skills and functioning for daily living.
(3)    “Managed care system” means a method that an insurer, a nonprofit health service plan, or a health maintenance organization uses to review and preauthorize a treatment plan that a health care practitioner develops for a covered person using a variety of cost containment methods to control utilization, quality, and claims.
(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:
(i)    shall provide coverage of habilitative services for insureds and enrollees who are children until at least the end of the month in which the insured or enrollee turns 19 years old; and
(ii)    may do so through a managed care system.
(2)    An entity subject to this section is not required to provide reimbursement for habilitative services delivered through early intervention or school services.
(d)    An entity subject to this section shall provide notice annually to its insureds and enrollees about the coverage required under this section:
(1)    in print; and
(2)    on its Web site.
(e)    Beginning November 1, 2013, a determination by an entity subject to this section of whether habilitative services covered under this section are medically necessary and appropriate to treat autism and autism spectrum disorders shall be made in accordance with regulations adopted by the Commissioner.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-836 - Hair Prosthesis

(a)    This section applies to:
(1)    insurers and nonprofit health service plans that provide inpatient 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 inpatient hospital, medical, or 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, an entity subject to this section shall provide, for an enrollee or insured whose hair loss results from chemotherapy or radiation treatment for cancer, coverage for one hair prosthesis.
(2)    The cost of a hair prosthesis required under paragraph (1) of this subsection may not exceed $350.
(c)    To be covered under this section, a hair prosthesis must be prescribed by the oncologist in attendance.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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 and § 15–822.1 of this subtitle, 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.
2023 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.