PARRIS N. GLENDENING, Governor

Ch, 35

15-821. DIAGNOSTIC AND SURGICAL PROCEDURES FOR BONES OF FACE, NECK, AND
HEAD.

(A) SCOPE OF SECTION.

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) EXCLUSION OR DENIAL OF COVERAGE PROHIBITED.

(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) EFFECT AND INTENT OF SECTION.

(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.

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

In subsection (b)(1) of this section, the reference to a "health care" provider
is added for clarity and consistency with the terminology used throughout this
subtitle.

Also in subsection (b)(1) of this section, the former reference to the "same"
coverage is deleted as unnecessary in light of the reference to coverage for the
"same" diagnostic or surgical procedure.

In subsection (c)(1) of this section, the reference to a policy or contract
"subject to this section" is substituted for the former reference to a policy or
contract "issued or delivered in this State to an employer or an individual by
an insurer or a nonprofit health service plan" in light of subsection (a) of this
section.

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

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