§ 15-823
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/md/insurance/15-823A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–823.
(1)In this section the following words have the meanings indicated.
(2)“Bone mass measurement” means a radiologic or radioisotopic procedure or other scientifically proven technology performed on a qualified individual for the purpose of identifying bone mass or detecting bone loss.
(3)“Qualified individual” means:
(i)an estrogen deficient individual at clinical risk for osteoporosis;
(ii)an individual with a specific sign suggestive of spinal osteoporosis, including roentgenographic osteopenia or roentgenographic evidence suggestive of collapse, wedging, or ballooning of one or more thoracic or lumbar vertebral bodies, who is a candidate for therapeutic intervention or for an extensive diagnostic evaluation for metabolic bone disease;
(iii)an individual receiving long–term glucocorticoid (steroid) therapy;
(iv)an individual with primary hyperparathyroidism; or
(v)an individual being monitored to assess the response to or efficacy of an approved osteoporosis drug therapy.
(b)This section applies to:
(1)each individual hospital or major medical insurance policy of an insurer that is delivered or issued for delivery in the State and is written on an expense–incurred basis;
(2)each group or blanket health insurance policy of an insurer that is issued or delivered in the State and is written on an expense–incurred basis;
(3)each individual or group medical or major medical contract or certificate of a nonprofit health service plan that is issued or delivered in the State and is written on an expense–incurred basis; and
(4)each individual or group contract of a health maintenance organization that is issued or delivered in the State.
(c)A policy, contract, or certificate subject to this section shall include coverage for qualified individuals for reimbursement for bone mass measurement for the prevention, diagnosis, and treatment of osteoporosis when the bone mass measurement is requested by a health care provider for the qualified individual.