Maryland Insurance Section 15-810

Article - Insurance

§ 15-810.

      (a)      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 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.

           

      (b)      (1)      An entity subject to this section that provides pregnancy-related benefits may not exclude benefits for all outpatient expenses arising from in vitro fertilization procedures performed on the policyholder or subscriber or dependent spouse of the policyholder or subscriber.

            (2)      The benefits under this subsection shall be provided:

                  (i)      for insurers and nonprofit health service plans, to the same extent as the benefits provided for other pregnancy-related procedures; and

                  (ii)      for health maintenance organizations, to the same extent as the benefits provided for other infertility services.

      (c)      Subsection (b) of this section applies if:

            (1)      the patient is the policyholder or subscriber or a covered dependent of the policyholder or subscriber;

            (2)      the patient's oocytes are fertilized with the patient's spouse's sperm;

            (3)      (i)      the patient and the patient's spouse have a history of infertility of at least 2 years' duration; or

                  (ii)      the infertility is associated with any of the following medical conditions:

                        1.      endometriosis;

                        2.      exposure in utero to diethylstilbestrol, commonly known as DES;

                        3.      blockage of, or surgical removal of, one or both fallopian tubes (lateral or bilateral salpingectomy); or

                        4.      abnormal male factors, including oligospermia, contributing to the infertility;

            (4)      the patient has been unable to attain a successful pregnancy through a less costly infertility treatment for which coverage is available under the policy or contract; and

            (5)      the in vitro fertilization procedures are performed at medical facilities that conform to the American College of Obstetricians and Gynecologists guidelines for in vitro fertilization clinics or to the American Fertility Society minimal standards for programs of in vitro fertilization.

      (d)      An entity subject to this section may limit coverage of the benefits required under this section to three in vitro fertilization attempts per live birth, not to exceed a maximum lifetime benefit of $100,000.

      (e)      Notwithstanding any other provision of this section, if the coverage required under this section conflicts with the bona fide religious beliefs and practices of a religious organization, on request of the religious organization, an entity subject to this section shall exclude the coverage otherwise required under this section in a policy or contract with the religious organization.