§ 15-815
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/md/insurance/15-815A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–815.
(1)In this section the following words have the meanings indicated.
(2)“Mastectomy” means the surgical removal of all or part of a breast.
(i)“Reconstructive breast surgery” means surgery performed as a result of a mastectomy to reestablish symmetry between the two breasts.
(ii)“Reconstructive breast surgery” includes augmentation mammoplasty, reduction mammoplasty, and mastopexy.
(b)This section applies to contracts issued by:
(1)insurers and nonprofit health service plans that provide medical and surgical benefits to individuals or groups on an expense–incurred basis under health insurance contracts that are issued or delivered in the State; and
(2)health maintenance organizations that provide medical and surgical benefits to individuals or groups under contracts that are issued or delivered in the State.
(c)A contract subject to this section shall provide coverage for:
(1)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; and
(2)physical complications of all stages of mastectomy, including lymphedemas, in a manner determined in consultation with the attending physician and the patient.