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ROBERT L. EHRLICH, JR., Governor Ch. 287
(iii) authorization for offering the modified plan only by those
persons who offer the Comprehensive Standard Health Benefit Plan adopted in
accordance with item (1) of this subsection.
(b) The Commission shall require that the minimum benefits allowed to be
offered in the Standard Plan:
(1) by a health maintenance organization, shall include at least the
actuarial equivalent of the minimum benefits required to be offered by a federally
qualified health maintenance organization; and
(2) by an insurer or nonprofit health service plan on an
expense-incurred basis, shall be actuarially equivalent to at least the minimum
benefits required to be offered under item (1) of this subsection.
(C) THE COMMISSION SHALL REQUIRE THAT THE BENEFITS ALLOWED TO BE
OFFERED IN THE LIMITED PLAN SHALL INCLUDE;
(1) INPATIENT HOSPITALIZATION COVERAGE FOR;
(I) THE FIRST 10 DAYS OF INPATIENT HOSPITAL AND
PROFESSIONAL SERVICES COVERAGE PER YEAR, WHETHER FOR MENTAL OR
PHYSICAL ILLNESS; OR
(II) THE FIRST 10 DAYS OF INPATIENT HOSPITAL AND
PROFESSIONAL SERVICES COVERAGE PER YEAR FOR PHYSICAL ILLNESS ONLY;
(2) TEN OFFICE VISITS WITH A LICENSED HEALTH CARE PROVIDER FOR
EACH INSURED PER YEAR FOR PREVENTIVE CARE AND THE DIAGNOSIS AND
TREATMENT OF ANY ILLNESS OR INJURY, INCLUDING REASONABLE COVERAGE OF
MEDICALLY NECESSARY LABORATORY AND DIAGNOSTIC PROCEDURES;
(3) OUTPATIENT SURGICAL PROCEDURES PROVIDED IN A HOSPITAL OR
FREESTANDING AMBULATORY SURGICAL FACILITY;
(4) REASONABLE COVERAGE OF PRENATAL CARE, INCLUDING:
(I) FOR PRENATAL OFFICE VISITS, A MINIMUM OF;
1. ONE VISIT PER MONTH DURING THE FIRST TWO
TRIMESTERS OF PREGNANCY;
2. TWO VISITS PER MONTH DURING THE 7TH AND 8TH
MONTHS OF PREGNANCY; AND
3. ONE VISIT PER WEEK DURING THE 9TH MONTH AND
UNTIL TERM; AND
(II) ALL NECESSARY AND APPROPRIATE SCREENINGS, PHYSICAL
EXAMINATIONS, LABORATORY AND DIAGNOSTIC PROCEDURES, AND PRENATAL
COUNSELING THAT A LICENSED HEALTH CARE PROVIDER DETERMINES ARE
NECESSARY;
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