§ 15-814
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/md/insurance/15-814A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–814.
(a)In this section, “digital tomosynthesis” means a radiologic procedure that involves the acquisition of projection images over the stationary breast to produce cross–sectional digital three–dimensional images of the breast.
(b)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 or contracts 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.
(1)Subject to paragraph
(2)of this subsection, an entity subject to this section shall provide coverage for breast cancer screening in accordance with the latest screening guidelines issued by the American Cancer Society.
(2)The coverage required under this section shall include coverage for digital tomosynthesis that, under accepted standards in the practice of medicine, the treating physician determines is medically appropriate and necessary for an enrollee or insured.
(d)An entity subject to this section is not required to cover breast cancer screenings used to identify breast cancer in asymptomatic women that are provided by a facility that is not accredited by the American College of Radiology or certified or licensed under a program established by the State.
(1)An entity subject to this section may not impose a deductible on the coverage required under this section.
(2)Each health insurance policy and certificate issued by an entity subject to this section shall contain a notice of the prohibition established by paragraph
(1)of this subsection in a form approved by the Commissioner.
(3)An entity subject to this section may not impose a copayment or coinsurance requirement for digital tomosynthesis that is greater than a copayment or coinsurance requirement for other breast cancer screenings for which coverage is required under this section.