2013 Maryland Code
INSURANCE
§ 15-815 - Coverage for reconstructive breast surgery

§15-815.

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

(2) “Mastectomy” means the surgical removal of all or part of a breast.

(3) (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.