reglab/statecodes huggingface dataset:
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-701 - Licensed Health Care Providers

(a)    (1)    This subsection applies to each individual or group health insurance policy, contract, or certificate that is:
(i)    delivered or issued for delivery in the State by an insurer or nonprofit health service plan; and
(ii)    issued, renewed, amended, or reissued on or after July 1, 1984.
(2)    Notwithstanding any other provision of a policy, contract, or certificate subject to this subsection, if the policy, contract, or certificate provides for reimbursement for a service that is within the lawful scope of practice of a health care provider licensed under the Health Occupations Article, the insured or any other person covered by or entitled to reimbursement under the policy, contract, or certificate is entitled to reimbursement for the service.
(b)    An individual or group disability insurance policy or contract that is delivered or issued for delivery in the State may not contain a provision that precludes a licensed health care provider from attesting to the rendition of service that is within the lawful scope of practice of the attesting provider.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-702 - Dentists, Physicians, and Podiatrists Under Self-Funded Group Insurance Plans

(a)    This section applies to each self-funded group insurance plan that:
(1)    (i)    is formed by an order, society, or association that is incorporated or has a main office in the State; or
(ii)    covers individuals who reside or work in the State; and
(2)    is issued, renewed, amended, or reissued on or after July 1, 1972.
(b)    Notwithstanding any other provision of a self-funded group insurance plan subject to this section, if the plan provides for reimbursement for a service that is within the lawful scope of practice of a physician, dentist, or podiatrist, the plan may not prohibit a person covered by the plan from being reimbursed for the service regardless of whether the service is performed by a physician, dentist, or podiatrist.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-703 - Certified Nurse Practitioners

(a)    In this section, “certified nurse practitioner” means a licensed registered nurse who has:
(1)    completed a nurse practitioner program approved by the State Board of Nursing; and
(2)    passed an examination approved by the State Board of Nursing.
(b)    Each insurer that proposes to issue, renew, amend, or reissue an individual, group, or blanket health insurance policy in the State that is written on an expense-incurred basis shall offer the option of providing benefits for expenses that arise from services rendered by a certified nurse practitioner.
(c)    Each nonprofit health service plan that proposes to issue, renew, amend, or reissue a health insurance policy in the State shall offer the option of providing benefits for expenses that arise from services rendered by a certified nurse practitioner.
(d)    The insurer or nonprofit health service plan may limit the coverage offered under this section for services provided by a certified nurse practitioner while working under the direct supervision of a physician.
(e)    The utilization of health insurance benefits provided under this section for services rendered by a certified nurse practitioner is subject to review by a peer review committee appointed by the State Board of Nursing.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-704 - Licensed Professional Counselors

(a)    This section applies to each individual, group, or blanket health insurance policy, contract, or certificate of an insurer or nonprofit health service plan that:
(1)    (i)    is delivered or issued for delivery in the State;
(ii)    is issued to a group that is incorporated or has a main office in the State; or
(iii)    covers individuals who reside or work in the State; and
(2)    is issued, renewed, amended, or reissued on or after October 1, 2003.
(b)    If a policy, contract, or certificate subject to this section provides for reimbursement for a service that is within the lawful scope of practice of a licensed clinical professional counselor, a licensed clinical marriage and family therapist, a licensed clinical alcohol and drug counselor, or a licensed clinical professional art therapist, the insured or any other person covered by the policy or certificate is entitled to reimbursement for the service.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-705 - Chiropractors

For the purposes of a policy of health insurance or other insurance, a chiropractor is entitled to compensation for those services that the chiropractor is licensed to perform under the Health Occupations Article and that the chiropractor has rendered to an insured.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-706 - Dietitians and Nutritionists

(a)    (1)    Subject to subsection (c) of this section, a policy, contract, or certificate described in § 15–701(a) of this subtitle may provide for reimbursement under § 15–701(a) of this subtitle for usual, customary, and reasonable charges for services rendered by a dietitian or nutritionist licensed under the Health Occupations Article if a licensed physician determines that the services are medically necessary for the treatment of cardiovascular disease, diabetes, prediabetes, obesity, malnutrition, cancer, cerebral vascular disease, or kidney disease.
(2)    Application of this subsection is limited to six visits with a dietitian or nutritionist during a 12–month period for each condition described in paragraph (1) of this subsection and to services for the treatment of obesity only if provided in conjunction with the treatment of a condition described in paragraph (1) of this subsection.
(b)    This section does not require a policy, contract, or certificate described in § 15–701(a) of this subtitle to provide coverage for services rendered by a nutritionist or dietitian.
(c)    If a service covered under a policy, contract, or certificate described in § 15–701(a) of this subtitle is provided to a hospital patient by a dietitian or nutritionist:
(1)    the usual, customary, and reasonable charges of the dietitian or nutritionist shall be included in the patient’s hospital charges; and
(2)    the dietitian or nutritionist may not bill the patient separately for the service.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-707 - Licensed Certified Social Workers

(a)    This section applies to each individual, group, or blanket health insurance policy of an insurer or nonprofit health service plan that:
(1)    (i)    is delivered or issued for delivery in the State;
(ii)    is issued to a group that is incorporated or has a main office in the State; or
(iii)    covers individuals who reside or work in the State; and
(2)    is issued, renewed, amended, or reissued on or after January 1, 1978.
(b)    If a policy or certificate subject to this section provides for reimbursement for a service that is within the lawful scope of practice of a licensed certified social worker, the insured or any other person covered by the policy or certificate is entitled to reimbursement for the service regardless of whether the service is performed by a physician or licensed certified social worker-clinical.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-708 - Nurse Anesthetists

(a)    In this section, “nurse anesthetist” means a registered nurse who is certified as a nurse anesthetist by:
(1)    the Council on Certification of Nurse Anesthetists; or
(2)    the Council on Recertification of Nurse Anesthetists.
(b)    This section applies to each individual, group, or blanket health insurance policy, contract, or certificate of an insurer or nonprofit health service plan that:
(1)    (i)    is issued or delivered in the State;
(ii)    is issued to a group that is incorporated or has a main office in the State; or
(iii)    covers individuals who reside or work in the State;
(2)    is issued, renewed, amended, or reissued on or after July 1, 1984; and
(3)    if issued by an insurer, is written on an expense-incurred basis.
(c)    Notwithstanding any other provision of a policy, contract, or certificate subject to this section, if the policy, contract, or certificate provides for reimbursement for a service that is within the lawful scope of practice of a nurse anesthetist, the insured or any other person covered by the policy, contract, or certificate is entitled to reimbursement for the service regardless of whether the service is performed by a physician or nurse anesthetist.
(d)    A policy that provides benefits under this section for services rendered by a nurse anesthetist may not require, as a condition for the payment of benefits, that the nurse anesthetist be employed by a physician.
(e)    The utilization of health insurance benefits provided under this section for services rendered by a nurse anesthetist is subject to review by a peer review committee appointed by the State Board of Nursing.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-709 - Nurse Midwives

(a)    In this section, “nurse midwife” means a licensed registered nurse who is certified as a nurse midwife by the American College of Nurse-Midwives.
(b)    Each insurer that proposes to issue, renew, amend, or reissue an individual, group, or blanket health insurance policy in the State that is written on an expense-incurred basis shall offer the option of providing benefits for expenses that arise from services rendered by a nurse midwife.
(c)    Each nonprofit health service plan that proposes to issue, renew, amend, or reissue a health insurance policy in the State shall offer the option of providing benefits for expenses that arise from services rendered by a nurse midwife.
(d)    (1)    This subsection applies to each individual, group, or blanket health insurance policy, contract, or certificate of an insurer or nonprofit health service plan that:
(i)    1.    is issued or delivered in the State;
2.    is issued to a group that is incorporated or has a main office in the State; or
3.    covers individuals who reside or work in the State;
(ii)    is issued, renewed, amended, or reissued on or after July 1, 1979; and
(iii)    if issued by an insurer, is written on an expense-incurred basis.
(2)    Notwithstanding any other provision of a policy, contract, or certificate subject to this subsection, if the policy, contract, or certificate provides for reimbursement for a service that is within the lawful scope of practice of a nurse midwife, the insured or any other person covered by the policy, contract, or certificate is entitled to reimbursement for the service regardless of whether the service is performed by a physician or nurse midwife.
(e)    A policy that provides benefits under this section for services rendered by a nurse midwife may not require, as a condition for the payment of benefits, that the nurse midwife be employed by a physician or act under a physician’s orders.
(f)    The utilization of health insurance benefits provided under this section for services rendered by a nurse midwife is subject to review by a peer review committee appointed by the State Board of Nursing.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-710 - Optometrists

(a)    This section applies to each individual or group health insurance policy or certificate of an insurer that:
(1)    is issued or delivered in the State;
(2)    is issued to a group that is incorporated or has a main office in the State; or
(3)    covers individuals who reside or work in the State.
(b)    Each policy or certificate subject to this section that provides for reimbursement for a service that is within the lawful scope of practice of an optometrist licensed under the Health Occupations Article shall require the insurer to reimburse the insured or any other person covered by the policy or certificate for the service performed by the optometrist in accordance with the other provisions of the policy or certificate.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-711 - Physical Therapists

(a)    This section applies to each individual or group health insurance policy or contract that is:
(1)    delivered or issued for delivery in the State by an insurer or nonprofit health service plan; and
(2)    issued, renewed, amended, or reissued on or after October 1, 1993.
(b)    An insurer or nonprofit health service plan may not impose a time limit on the receipt of services covered under a policy or contract subject to this section that are provided during the policy or contract period by a physical therapist licensed under the Health Occupations Article.
(c)    This section does not prohibit an insurer or nonprofit health service plan from imposing a limit on the number of visits with a licensed physical therapist that are allowed under a policy or contract.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-712 - Physician Assistants

Notwithstanding § 15-701(a) of this subtitle, unless a policy, contract, or certificate described in § 15-701(a) of this subtitle expressly provides for reimbursement for a service that is within the lawful scope of practice of a physician assistant certified under the Health Occupations Article, the provisions of the Health Occupations Article that govern the certification and regulation of physician assistants may not be construed to entitle the insured or any other person covered by the policy, contract, or certificate to reimbursement for the service.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-713 - Podiatrists

(a)    This section applies to individual, group, or blanket health insurance policies and contracts delivered or issued for delivery in the State by insurers, nonprofit health service plans, and health maintenance organizations.
(b)    Notwithstanding any other provision of an individual, group, or blanket health insurance policy or contract subject to this section, if the policy or contract provides for reimbursement for a service that is within the lawful scope of practice of a licensed podiatrist, the insured or any other person covered by or entitled to reimbursement under the policy or contract is entitled to the same amount of reimbursement for the service regardless of whether the service is performed by a physician or licensed podiatrist.
(c)    This section does not prohibit, and may not be construed as prohibiting, the determination of reimbursement based on the geographic location of the delivery of service, the preeminent qualifications of a physician or podiatrist, or the need to provide services in an underserved area of the State.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-714 - Psychologists

(a)    This section applies to each individual or group health insurance policy, contract, or certificate that:
(1)    (i)    is issued or delivered in the State;
(ii)    is issued to a group that is incorporated or has a main office in the State; or
(iii)    covers individuals who reside or work in the State; and
(2)    is issued, renewed, amended, or reissued on or after July 1, 1972.
(b)    Notwithstanding any other provision of a policy, contract, or certificate subject to this section, if the policy, contract, or certificate provides for reimbursement for a service that is within the lawful scope of practice of a licensed psychologist, the insured or any other person covered by the policy, contract, or certificate is entitled to reimbursement for the service regardless of whether the service is performed by a physician or licensed psychologist.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-715 - Community Health Resource

(a)    This section applies to each individual or group health insurance policy or contract that is issued or delivered in the State by an insurer, nonprofit health service plan, or health maintenance organization.
(b)    To the extent required under federal law, an insurer, nonprofit health service plan, or health maintenance organization shall reimburse a community health resource, as defined in § 19-2101 of the Health - General Article, for covered services provided to the insured or any other person covered by the policy or contract.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 7 - Required Reimbursement for Services of Health Care Providers › Section 15-716 - Administration of Self-Administered Medications, Maintenance Injectable Medications, and Injectable Medications for Treatment of Sexually Transmitted Infections by Licensed Pharmacists

(a)    This section applies to individual, group, or blanket health insurance policies and contracts delivered or issued for delivery in the State by insurers, nonprofit health service plans, and health maintenance organizations that provide coverage for patient assessment regarding, and administration of, self–administered medications, maintenance injectable medications, and injectable medications for treatment of sexually transmitted infections.
(b)    An entity subject to this section shall provide coverage for services rendered by a licensed pharmacist under § 12–509 of the Health Occupations Article to an individual who is covered under a policy or contract issued or delivered by the entity, to the same extent as services rendered by any other licensed health care practitioner, for patient assessment regarding and in administering self–administered medications, maintenance injectable medications, or injectable medications for treatment of sexually transmitted infections.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-801 - Benefits for Alzheimer's Disease and Care of Elderly Individuals

(a)    This section applies to:
(1)    insurers that propose to issue or deliver in the State group or blanket health insurance policies that are written on an expense-incurred basis; and
(2)    nonprofit health service plans that propose to issue or deliver in the State group medical or major medical contracts that are written on an expense-incurred basis.
(b)    An entity subject to this section shall offer the policyholder the option of providing benefits for expenses arising from the care, including nursing home care and intermediate or custodial nursing care, of individuals who have Alzheimer’s disease.
(c)    An entity subject to this section shall offer the policyholder the option of providing benefits for expenses arising from the care of elderly individuals, including nursing home care and intermediate or custodial nursing care of elderly individuals who have any disease, other than Alzheimer’s disease, that is designated in regulations adopted by the Commissioner.
(d)    An entity subject to this section may establish reasonable limits on the benefits offered under this section, including copayment and deductible provisions and maximum annual and lifetime dollar limits.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-803 - Payments for Blood Products

(a)    An insurer or nonprofit health service plan that issues or delivers an individual, group, or blanket health insurance policy or contract in the State, or a health maintenance organization that issues or delivers an individual or group contract in the State, may not exclude payments for blood products, both derivatives and components, that otherwise would be covered under the health insurance contract.
(b)    This section does not apply to whole blood or concentrated red blood cells.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-804 - Coverage for Off-Label Use of Drugs

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Medical literature” means scientific studies published in a peer–reviewed national professional medical journal.
(3)    “Off–label use” means the prescription of a drug for a treatment other than those treatments stated in the labeling approved by the federal Food and Drug Administration.
(4)    “Standard reference compendia” means any authoritative compendia as recognized periodically by the federal Secretary of Health and Human Services or the Commissioner.
(b)    This section does not:
(1)    alter any law that limits the coverage of drugs that have not been approved by the federal Food and Drug Administration;
(2)    require coverage of a drug if the federal Food and Drug Administration has determined use of the drug to be contraindicated; or
(3)    require coverage of experimental drugs not approved for any indication by the federal Food and Drug Administration.
(c)    (1)    This subsection applies to each health insurance policy or contract that is delivered or issued for delivery in the State to an employer or individual on a group or individual basis, including a contract issued by a health maintenance organization.
(2)    A policy or contract subject to this subsection that provides coverage for drugs may not exclude coverage of a drug for an off–label use of the drug if the drug is recognized for treatment in any of the standard reference compendia or in the medical literature.
(3)    Coverage of a drug required by this subsection also includes medically necessary services associated with the administration of the drug.
(d)    The Commissioner may direct a person, including a health maintenance organization, that issues a health insurance policy or contract to make payments required by this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-805 - Reimbursement for Pharmaceutical Products

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Authorized prescriber” means a licensed dentist, licensed physician, or licensed podiatrist who is authorized under the Health Occupations Article to prescribe a pharmaceutical product.
(3)    “Pharmaceutical product” means a drug or medicine that may be prescribed by an authorized prescriber.
(b)    This section does not apply to a policy or contract that is issued to an employer under a collective bargaining agreement.
(c)    (1)    This subsection applies to each policy or contract that is issued or delivered in the State to an employer or individual by an insurer or nonprofit health service plan and that provides group or individual hospital, medical, or surgical benefits.
(2)    A policy or contract subject to this subsection that provides reimbursement for a pharmaceutical product prescribed by an authorized prescriber may not establish the amount of reimbursement to the insured or the insured’s beneficiary, including copayments and deductibles, based on the identity, practicing specialty, or occupation of the authorized prescriber.
(d)    (1)    This subsection applies to each individual or group policy or contract that is issued or delivered in the State to an employer or individual by an insurer or nonprofit health service plan and that provides benefits for pharmaceutical products.
(2)    A policy or contract subject to this subsection may not impose a copayment, deductible, or other condition on an insured or certificate holder who uses the services of a community pharmacy that is not imposed when the insured or certificate holder uses the services of a mail order pharmacy, if the benefits are provided under the same program, policy, or contract.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-807 - Coverage for Medical Foods and Modified Food Products

(a)    (1)    In this section the following words have the meanings indicated.
(2)    (i)    “Inherited metabolic disease” means a disease caused by an inherited abnormality of body chemistry.
(ii)    “Inherited metabolic disease” includes a disease for which the State screens newborn babies.
(3)    (i)    “Low protein modified food product” means a food product that is:
1.    specially formulated to have less than 1 gram of protein per serving; and
2.    intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease.
(ii)    “Low protein modified food product” does not include a natural food that is naturally low in protein.
(4)    “Medical food” means a food that is:
(i)    intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation; and
(ii)    formulated to be consumed or administered enterally under the direction of a physician.
(b)    This section applies to each individual hospital or major medical insurance policy, group or blanket health insurance policy, and nonprofit health service plan that:
(1)    is delivered or issued for delivery in the State;
(2)    is written on an expense-incurred basis; and
(3)    provides coverage for a family member of the insured.
(c)    A policy or plan subject to this section shall include under the family member coverage, coverage for medical foods and low protein modified food products for the treatment of inherited metabolic diseases if the medical foods or low protein modified food products are:
(1)    prescribed as medically necessary for the therapeutic treatment of inherited metabolic diseases; and
(2)    administered under the direction of a physician.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-808 - Benefits for Home Health Care

(a)    In this section, “home health care” means the continued care and treatment of a covered individual if:
(1)    institutionalization of the individual would have been required if home health care was not provided; and
(2)    the individual’s physician establishes and approves in writing the plan of treatment covering the home health care service.
(b)    This section applies to each individual, group, or blanket health insurance policy that is issued or delivered in the State by an insurer or nonprofit health service plan.
(c)    A policy subject to this section that provides coverage for inpatient hospital care on an expense-incurred basis shall provide benefits for the expenses of home health care that is provided by a person licensed under the Health Occupations Article.
(d)    Home health care shall be provided by:
(1)    a hospital that has a valid operating certificate and is certified to provide home health care services; or
(2)    a public or private health service or agency that is licensed as a home health agency under Title 19, Subtitle 4 of the Health - General Article to provide coordinated home health care.
(e)    (1)    A contract may limit the number of home health care visits, but not to fewer than 40 visits in a calendar year or in a continuous 12-month period for each individual covered under the contract.
(2)    In determining the benefits for home health care available to a covered individual:
(i)    each visit by a member of a home health care team is considered one home health care visit; and
(ii)    up to 4 hours of home health care service is considered one home health care visit.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-809 - Benefits for Hospice Care Services

(a)    (1)    Each insurer that issues or delivers individual health insurance policies in the State that are written on an expense-incurred basis shall offer benefits for hospice care services to its insureds.
(2)    Each insurer that issues or delivers group or blanket health insurance policies or contracts in the State that are written on an expense-incurred basis shall offer benefits for hospice care services to its policyholders or beneficiaries.
(b)    Each nonprofit health service plan shall offer benefits for hospice care services to its subscribers.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-810.1 - Coverage for Standard Fertility Preservation Procedures

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Iatrogenic infertility” means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.
(3)    “Medical treatment that may directly or indirectly cause iatrogenic infertility” means medical treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American College of Obstetricians and Gynecologists, or the American Society of Clinical Oncology.
(4)    (i)    “Standard fertility preservation procedures” means procedures to preserve fertility that are consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American College of Obstetricians and Gynecologists, or the American Society of Clinical Oncology.
(ii)    “Standard fertility preservation procedures” includes sperm and oocyte cryopreservation and evaluations, laboratory assessments, medications, and treatments associated with sperm and oocyte cryopreservation.
(iii)    “Standard fertility preservation procedures” does not include the storage of sperm or oocytes.
(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 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)    Except as provided in subsection (d) of this section, an entity subject to this section shall provide coverage for standard fertility preservation procedures:
(1)    performed on a policyholder or subscriber or on the covered dependent of a policyholder or subscriber; and
(2)    that are medically necessary to preserve fertility for a policyholder or subscriber or for the covered dependent of a policyholder or subscriber due to a need for medical treatment that may directly or indirectly cause iatrogenic infertility.
(d)    An entity subject to this section may not be required to provide coverage under subsection (c) of this section to a religious organization that requests and receives an exclusion from in vitro fertilization coverage under § 15–810(i) of this subtitle.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-811 - Hospitalization Benefits for Childbirth

(a)    Each insurer and nonprofit health service plan that issues or delivers an individual, group, or blanket health insurance policy in the State that provides hospitalization benefits for normal pregnancy shall provide hospitalization benefits for childbirth to the same extent as the hospitalization benefits provided in the policy for any covered illness.
(b)    (1)    In addition to the provisions of subsection (a) of this section and § 15-812 of this subtitle, whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, the insurer or nonprofit health service plan shall pay the cost of additional hospitalization for the newborn for up to 4 days.
(2)    The attending physician or certified nurse midwife of the mother, or designee of the attending physician or certified nurse midwife, shall provide notice to the mother of the provisions of paragraph (1) of this subsection.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-813 - Benefits for Disability Caused by Pregnancy or Childbirth

(a)    This section applies to each group or blanket health insurance policy that:
(1)    is issued or delivered in the State;
(2)    is issued or delivered to an entity that is incorporated or has a main office in the State; or
(3)    covers individuals who reside or work in the State.
(b)    Each insurer that proposes to issue a policy subject to this section that provides benefits for temporary disability shall offer the policyholder the option of providing benefits for temporary disability caused or contributed to by pregnancy or childbirth.
(c)    The benefits under this section shall be provided to the same extent and on the same terms as the benefits provided for any other covered disability.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-814 - Coverage for Breast Cancer Screenings

(a)    In this section, “digital tomosynthesis” means a radiologic procedure that involves the acquisition of projection images over the stationary breast to produce cross–sectional digital three–dimensional images of the breast.
(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)    Subject to paragraph (2) of this subsection, an entity subject to this section shall provide coverage for breast cancer screening in accordance with the latest screening guidelines issued by the American Cancer Society.
(2)    The coverage required under this section shall include coverage for digital tomosynthesis that, under accepted standards in the practice of medicine, the treating physician determines is medically appropriate and necessary for an enrollee or insured.
(d)    An entity subject to this section is not required to cover breast cancer screenings used to identify breast cancer in asymptomatic women that are provided by a facility that is not accredited by the American College of Radiology or certified or licensed under a program established by the State.
(e)    (1)    An entity subject to this section may not impose a deductible on the coverage required under this section.
(2)    Each health insurance policy and certificate issued by an entity subject to this section shall contain a notice of the prohibition established by paragraph (1) of this subsection in a form approved by the Commissioner.
(3)    An entity subject to this section may not impose a copayment or coinsurance requirement for digital tomosynthesis that is greater than a copayment or coinsurance requirement for other breast cancer screenings for which coverage is required under this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-815 - Coverage for Reconstructive Breast Surgery

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Mastectomy” means the surgical removal of all or part of a breast.
(3)    (i)    “Reconstructive breast surgery” means surgery performed as a result of a mastectomy to reestablish symmetry between the two breasts.
(ii)    “Reconstructive breast surgery” includes augmentation mammoplasty, reduction mammoplasty, and mastopexy.
(b)    This section applies to contracts issued by:
(1)    insurers and nonprofit health service plans that provide medical and surgical benefits to individuals or groups on an expense–incurred basis under health insurance contracts that are issued or delivered in the State; and
(2)    health maintenance organizations that provide medical and surgical benefits to individuals or groups under contracts that are issued or delivered in the State.
(c)    A contract subject to this section shall provide coverage for:
(1)    reconstructive breast surgery, including coverage for all stages of reconstructive breast surgery performed on a nondiseased breast to establish symmetry with the diseased breast when reconstructive breast surgery is performed on the diseased breast; and
(2)    physical complications of all stages of mastectomy, including lymphedemas, in a manner determined in consultation with the attending physician and the patient.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-816 - Benefits for Routine Gynecological 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:
(1)    shall classify an obstetrician/gynecologist as a primary care provider; or
(2)    if the obstetrician/gynecologist chooses not to be a primary care provider, shall allow a woman to receive routine gynecological care from an in-network obstetrician/gynecologist without requiring the woman to visit a primary care provider first, if:
(i)    the care is medically necessary, including care that is routine;
(ii)    after each visit for gynecological care, the obstetrician/gynecologist communicates with the woman’s primary care provider about any diagnosis or treatment rendered; and
(iii)    the obstetrician/gynecologist confers with the primary care provider before performing any diagnostic procedure that is not routine gynecological care rendered during an annual visit.
(c)    If an entity subject to this section classifies an obstetrician/gynecologist as a primary care provider as provided in subsection (b) of this section, and a woman does not choose an obstetrician/gynecologist as the woman’s primary care provider, the entity shall allow the woman an annual visit to an in-network obstetrician/gynecologist for routine gynecological care without requiring the woman to visit the woman’s primary care provider first, whether or not the primary care provider is qualified to and regularly does provide routine gynecological care.
(d)    (1)    An entity subject to this section shall allow a woman to receive medically necessary, routine obstetric and gynecological care from an in-network, certified nurse midwife or any other in-network provider authorized under the Health Occupations Article to provide obstetric and gynecological services without first requiring the woman to visit a primary care provider.
(2)    A certified nurse midwife or other nonphysician provider authorized under the Health Occupations Article to provide obstetric and gynecological services shall consult with an obstetrician/gynecologist with whom the certified nurse midwife or other provider has a collaborative agreement, in accordance with the collaborative agreement, regarding any care rendered under this subsection.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-818 - Benefits for Treatment of Cleft Lip and Cleft Palate

(a)    This section applies to:
(1)    each individual or group hospital or major medical insurance policy or certificate that is delivered or issued for delivery in the State by an insurer and is written on an expense–incurred basis;
(2)    each individual or group medical or major medical contract, policy, or certificate that is delivered or issued for delivery in the State by a nonprofit health service plan; and
(3)    each contract that provides hospital, medical, or surgical benefits to individuals or groups and is issued or delivered in the State by a health maintenance organization.
(b)    A policy, contract, or certificate subject to this section shall include benefits for inpatient or outpatient expenses arising from orthodontics, oral surgery, and otologic, audiological, and speech/language treatment involved in the management of the birth defect known as cleft lip or cleft palate or both.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-819 - Coverage for Outpatient Services and Second Opinions

(a)    This section applies to:
(1)    each individual, group, or blanket health insurance policy that is issued or delivered in the State by an insurer; and
(2)    each contract or certificate that is issued or delivered in the State by a nonprofit health service plan.
(b)    A policy, contract, or certificate subject to this section that provides coverage for an inpatient service in an acute general hospital shall provide coverage for:
(1)    a corresponding outpatient service that is provided to the insured instead of the inpatient service because of the denial, after review under a utilization review program, of a request by the attending physician for an inpatient admission; and
(2)    an objective second opinion given to the insured when required by a utilization review program under § 19-319 of the Health - General Article.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-820 - Benefits for Orthopedic Braces

(a)    In this section, “orthopedic brace” means a rigid or semi–rigid device that is used to:
(1)    support a weak or deformed body member; or
(2)    restrict or eliminate motion in a diseased or injured part of the body.
(b)    Each health insurance contract that is delivered or issued for delivery in the State by a nonprofit health service plan and that provides hospital benefits shall provide benefits for orthopedic braces.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-821 - Diagnostic and Surgical Procedures for Bones of Face, Neck, and Head

(a)    This section applies to each policy or contract that is issued or delivered in the State to an employer or individual by an insurer or nonprofit health service plan.
(b)    (1)    A policy or contract subject to this section that provides coverage on a group or individual basis for a diagnostic or surgical procedure involving a bone or joint of the skeletal structure may not exclude or deny coverage for the same diagnostic or surgical procedure involving a bone or joint of the face, neck, or head if, under the accepted standards of the profession of the health care provider rendering the service, the procedure is medically necessary to treat a condition caused by a congenital deformity, disease, or injury.
(2)    This subsection does not apply to intraoral prosthetic devices.
(c)    (1)    This section does not affect any other coverage required under this article or restrict the scope of coverage under a policy or contract subject to this section.
(2)    This section is not intended to encourage surgical procedures over appropriate nonsurgical procedures, or to prohibit the continued coverage of nonsurgical procedures in the treatment of a bone or joint of the face, neck, or head.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-822 - Coverage for Diabetes Equipment, Supplies, and Self-Management Training

(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 all medically appropriate and necessary diabetes equipment, diabetes supplies, and diabetes outpatient self–management training and educational services, including medical nutrition therapy, that the insured’s or enrollee’s treating physician or other appropriately licensed health care provider, or a physician who specializes in the treatment of diabetes, certifies are necessary for the treatment of:
(1)    insulin–using diabetes;
(2)    noninsulin–using diabetes;
(3)    elevated or impaired blood glucose levels induced by pregnancy; or
(4)    consistent with the American Diabetes Association’s standards, elevated or impaired blood glucose levels induced by prediabetes.
(c)    If certified as necessary under subsection (b) of this section, the diabetes outpatient self–management training and educational services, including medical nutrition therapy, to be provided to the insured or enrollee shall be provided through a program supervised by an appropriately licensed, registered, or certified health care provider whose scope of practice includes diabetes education or management.
(d)    (1)    Subject to paragraph (2) of this subsection, and except as provided in paragraph (3) 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)    Except as provided in paragraph (3) of this subsection, 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.
(3)    (i)    Except as provided in subparagraph (ii) of this paragraph, an entity subject to this section may not impose a deductible, copayment, or coinsurance requirement on diabetes test strips.
(ii)    If an insured or enrollee is covered under a high–deductible health plan, as defined in 26 U.S.C. § 223, an entity subject to this section may subject diabetes test strips to the deductible requirement of the high–deductible health plan.
(e)    An entity subject to this section may not reduce or eliminate coverages in its health insurance policies or contracts due to the requirements of this section.