Ch. 35

1997 LAWS OF MARYLAND

(II) "RECONSTRUCTIVE BREAST SURGERY" INCLUDES
AUGMENTATION MAMMOPLASTY, REDUCTION MAMMOPLASTY, AND MASTOPEXY.

(B) SCOPE OF SECTION.
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) COVERAGE REQUIRED.

AN ENTITY SUBJECT TO THIS SECTION SHALL PROVIDE COVERAGE FOR
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.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, § 490GG.

In subsection (b)(1) of this section, the reference to hospital, medical, or
surgical benefits provided "under health insurance policies" issued or
delivered in the State is added for clarity.

In subsection (b)(2) of this section, the reference to health maintenance
organizations "that provide hospital, medical, or surgical benefits to
individuals or groups under contracts that are issued or delivered in the State"
is added to clarify the applicability of this section. Consequently, the former
reference to insurers and nonprofit health service plans that provide benefits
on an expense-incurred basis as "including" health maintenance organizations
is deleted for accuracy since a health maintenance organization is not
considered to be either an insurer or a nonprofit health service plan and does
not provide benefits on an expense-incurred basis.

In subsection (c) of this section, the former phrase "resulting from a
mastectomy" is deleted as unnecessary in light of the definition of
"reconstructive breast surgery" in subsection (a)(3)(i) of this section.

Defined terms: "Health insurance" § 1-101
"Insurer" § 1-101
"Policy" § 1-101

15-816. BENEFITS FOR ROUTINE GYNECOLOGICAL CARE.
(A) SCOPE OF SECTION.

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