2013 Maryland Code
INSURANCE
§ 15-135 - Covered benefits for annual preventive care

§15-135.

(a) (1) In this section, “annual preventive care” means an annual preventive visit, screening, or examination that is a covered benefit under a policy or contract issued or delivered by an entity subject to this section.

(2) “Annual preventive care” includes, if the service is a covered benefit:

(i) an annual child wellness visit;

(ii) a routine gynecological visit;

(iii) a screening test or examination for colorectal cancer, chlamydia, human papillomavirus, prostate cancer, or breast cancer; and

(iv) an annual vision visit that includes a vision examination.

(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.

(c) An entity subject to this section that provides covered benefits for annual preventive care shall provide coverage for the annual preventive care if:

(1) the annual preventive care is provided no more than once at any time during the plan year established in the policy or contract; and

(2) any other requirements for coverage of the annual preventive care are met.

(d) This section may not be construed to require coverage for a service not otherwise required by law.

§ 15-135 - 1. Dental preventive care coverage

(a) Definitions. --

(1) In this section the following words have the meanings indicated.

(2) "Carrier" means an insurer, nonprofit health service plan, health maintenance organization, or dental plan organization that provides dental benefits on an expense-incurred basis under policies or contracts issued or delivered in the State.

(3) "Dental preventive care" means a preventive dental visit, screening, oral examination, teeth cleaning (prophylaxis), fluoride treatment, or routine preventive service that is a covered benefit under a policy or contract issued or delivered by a carrier.

(b) Coverage. -- If benefits for dental preventive care are available and all other requirements for the coverage of dental preventive care are met, a carrier shall provide coverage for dental preventive care:

(1) at any time during the plan year for a policy or contract that provides coverage for dental preventive care once during the plan year; or

(2) subject to subsection (c) of this section, in accordance with any frequency limitation for a policy or contract that provides coverage for dental preventive care more than once during the plan year.

(c) Frequency limitation prohibited. -- A carrier may not impose a frequency limitation on dental preventive care that requires the dental preventive care to be provided at an interval greater than 120 days during a plan year.

(d) Construction. -- This section may not be construed to require coverage for a service not otherwise required by law.