§ 15-825
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/md/insurance/15-825A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–825.
(a)This section applies to:
(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 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)Subject to federal guidance on the preventive care safe harbor for the absence of a preventive care deductible provided for under 26 U.S.C. § 223(c)(2)(C), an entity subject to this section may not apply a deductible, a copayment, or coinsurance to coverage for preventive care screening services for prostate cancer, which shall include a digital rectal exam and a blood test called the prostate–specific antigen
(PSA)test in accordance with subsection
(b)of this section.