PARRIS N. GLENDENING, Governor

Ch. 35

(II) IS WRITTEN ON AN EXPENSE-INCURRED BASIS; AND

(3) EACH INDIVIDUAL OR GROUP MEDICAL OR MAJOR MEDICAL
CONTRACT OR CERTIFICATE OF A NONPROFIT HEALTH SERVICE PLAN THAT:

(I) IS ISSUED OR DELIVERED IN THE STATE; OR

(II) COVERS INDIVIDUALS WHO RESIDE AND WORK IN THE STATE.

(B) EXCLUSION OF BENEFITS PROHIBITED.

(1) A POLICY, CONTRACT, OR CERTIFICATE SUBJECT TO THIS SECTION
THAT PROVIDES PREGNANCY-RELATED BENEFITS MAY NOT EXCLUDE BENEFITS
FOR ALL OUTPATIENT EXPENSES ARISING FROM IN VITRO FERTILIZATION
PROCEDURES PERFORMED ON THE POLICYHOLDER, SUBSCRIBER, OR CERTIFICATE
HOLDER, OR DEPENDENT SPOUSE OF THE POLICYHOLDER, SUBSCRIBER, OR
CERTIFICATE HOLDER.

(2) THE BENEFITS UNDER THIS SUBSECTION SHALL BE PROVIDED TO
THE SAME EXTENT AS THE BENEFITS PROVIDED FOR OTHER PREGNANCY-RELATED
PROCEDURES.

(C) CONDITIONS FOR PROVISION OF BENEFITS.
SUBSECTION (B) OF THIS SECTION APPLIES IF:

(1) THE PATIENT IS THE POLICYHOLDER, SUBSCRIBER, OR
CERTIFICATE HOLDER, OR A COVERED DEPENDENT OF THE POLICYHOLDER,
SUBSCRIBER, OR CERTIFICATE HOLDER;

(2) THE PATIENT'S OOCYTES ARE FERTILIZED WITH THE PATIENT'S
SPOUSE'S SPERM;

(3) (I) THE PATIENT AND THE PATIENT'S SPOUSE HAVE A HISTORY OF
INFERTILITY OF AT LEAST 5 YEARS' DURATION; OR

(II) THE INFERTILITY IS ASSOCIATED WITH ANY OF THE
FOLLOWING MEDICAL CONDITIONS:

1. ENDOMETRIOSIS;

2. EXPOSURE IN UTERO TO DIETHYLSTILBESTROL,
COMMONLY KNOWN AS DES; OR

3. BLOCKAGE OF, OR SURGICAL REMOVAL OF, ONE OR
BOTH FALLOPIAN TUBES (LATERAL OR BILATERAL SALPINGECTOMY);

(4) THE PATIENT HAS BEEN UNABLE TO ATTAIN A SUCCESSFUL
PREGNANCY THROUGH A LESS COSTLY INFERTILITY TREATMENT FOR WHICH
COVERAGE IS AVAILABLE UNDER THE POLICY, CONTRACT, OR CERTIFICATE; AND

(5) THE IN VITRO FERTILIZATION PROCEDURES ARE PERFORMED AT
MEDICAL FACILITIES THAT CONFORM TO THE AMERICAN COLLEGE OF

- 1081 -