Ch. 673

LAWS OF MARYLAND

CHAPTER 673

(House Bill 612)

AN ACT concerning

Health Insurance - Reimbursement for Health Services

FOR the purpose of requiring prohibiting a group or individual
health insurance contract or policy issued by an insurer or
a nonprofit health service plan that provides coverage for
any diagnostic or surgical procedure involving a bone or
joint of the skeletal structure to provide from excluding or
denying the same coverage for the same diagnostic or
surgical procedure involving a any other bone or joint of
the face, neck, or head skeletal structure face, neck, or
head under certain conditions; specifying an exception to
the requirement; providing that this Act may not be
construed to encourage certain procedures over certain other
procedures, or to prohibit the continued coverage of a
certain procedure; and generally relating to coverage for
diagnostic or surgical procedures involving the face, neck,
or head skeletal structure face, neck, or head.

BY adding to

Article 48A - Insurance Code

Section 490K

Annotated Code of Maryland

(1986 Replacement Volume and 1988 Supplement)

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:

Article 48A - Insurance Code

490K.

(A) EVERY A CONTRACT OR POLICY ISSUED OR DELIVERED IN THIS
STATE TO AN EMPLOYER OR AN INDIVIDUAL BY AN INSURER OR NONPROFIT
HEALTH SERVICE PLAN THAT PROVIDES COVERAGE ON A GROUP OR
INDIVIDUAL BASIS FOR ANY DIAGNOSTIC OR SURGICAL PROCEDURE
INVOLVING A BONE OR JOINT OF THE SKELETAL STRUCTURE SHALL PROVIDE
MAY NOT EXCLUDE OR DENY THE SAME COVERAGE FOR THE SAME DIAGNOSTIC
OR SURGICAL PROCEDURE, EXCLUDING INTRAORAL PROSTHETIC DEVICES,
INVOLVING A ANY OTHER BONE OR JOINT OF THE FACE, NECK, OR HEAD
SKELETAL STRUCTURE FACE, NECK , OR HEAD, PROVIDED THAT IN THE
JUDGMENT OF A LICENSEE OF THE SAME PROFESSION AS IF UNDER THE
ACCEPTED STANDARDS OF THE PROFESSION OF THE PROVIDER RENDERING
THE SERVICE, THE PROCEDURE IS MEDICALLY NECESSARY TO TREAT A
CONDITION CAUSED BY CONGENITAL DEFORMITY, DISEASE, OR INJURY.

- 3934 -