Ch. 356

1997 LAWS OF MARYLAND

(1) INSURERS AND NONPROFIT HEALTH SERVICE PLANS THAT PROVIDE
INPATIENT 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

INPATIENT 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
EXPENSES INCURRED IN CONDUCTING AN ANNUAL MEDICALLY RECOGNIZED
DIAGNOSTIC EXAMINATION, WHICH INCLUDES A DIGITAL RECTAL EXAMINATION
AND A BLOOD TEST CALLED THE PROSTATE-SPECIFIC ANTIGEN (PSA) TEST, ON
ENROLLEES AND INSUREDS WHO ARE;

MEN AGE 50 OR OLDER AND ASYMPTOMATIC; AND

(2) MEN AGE 40 OR OLDER WITH A FAMILY HISTORY OF PROSTATE
CANCER OR OTHER PROSTATE CANCER RISK FACTORS.

(B) AN ENTITY SUBJECT TO THIS SECTION SHALL PROVIDE COVERAGE FOR
THE EXPENSES INCURRED IN CONDUCTING A MEDICALLY RECOGNIZED
DIAGNOSTIC EXAMINATION WHICH SHALL INCLUDE A DIGITAL RECTAL EXAM AND
A BLOOD TEST CALLED THE PROSTATE-SPECIFIC ANTIGEN (PSA) TEST:

(1) FOR MEN WHO ARE BETWEEN 40 AND 75 YEARS OF AGE;

(2) WHEN USED FOR THE PURPOSE OF GUIDING PATIENT
MANAGEMENT IN MONITORING THE RESPONSE TO PROSTATE CANCER TREATMENT:

(3) WHEN USED FOR STAGING IN DETERMINING THE NEED FOR A BONE
SCAN IN PATIENTS WITH PROSTATE CANCER: OR

(4) WHEN USED FOR MALE PATIENTS WHO ARE AT HIGH RISK FOR
PROSTATE CANCER.

(C) AN ENTITY SUBJECT TO THIS SECTION SHALL PROVIDE THE BENEFITS
REQUIRED UNDER THIS SECTION TO THE SAME EXTENT AS FOR ANY OTHER
MEDICAL CONDITION UNDER THE ENROLLEE'S OR INSURED'S CONTRACT OR
POLICY WITH THE ENTITY.

Article - Health - General

19-706.

(N) THE PROVISIONS OF § 15-822 OF THE INSURANCE ARTICLE SHALL APPLY
TO HEALTH MAINTENANCE ORGANIZATIONS.

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 1997.

Approved May 8, 1997.

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