<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-808" title_number="15" title_name="Health Insurance" subtitle_number="8" subtitle_name="Required Health Insurance Benefits">
  <level label="a">
    <text>In this section, “home health care” means the continued care and treatment of a covered individual if:</text>
    <level label="1">
      <text>institutionalization of the individual would have been required if home health care was not provided; and</text>
    </level>
    <level label="2">
      <text>the individual’s physician establishes and approves in writing the plan of treatment covering the home health care service.</text>
    </level>
  </level>
  <level label="b">
    <text>This section applies to each individual, group, or blanket health insurance policy that is issued or delivered in the State by an insurer or nonprofit health service plan.</text>
  </level>
  <level label="c">
    <text>A policy subject to this section that provides coverage for inpatient hospital care on an expense-incurred basis shall provide benefits for the expenses of home health care that is provided by a person licensed under the Health Occupations Article.</text>
  </level>
  <level label="d">
    <text>Home health care shall be provided by:</text>
    <level label="1">
      <text>a hospital that has a valid operating certificate and is certified to provide home health care services; or</text>
    </level>
    <level label="2">
      <text>a public or private health service or agency that is licensed as a home health agency under Title 19, Subtitle 4 of the Health - General Article to provide coordinated home health care.</text>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>A contract may limit the number of home health care visits, but not to fewer than 40 visits in a calendar year or in a continuous 12-month period for each individual covered under the contract.</text>
    </level>
    <level label="2">
      <text>In determining the benefits for home health care available to a covered individual:</text>
      <level label="i">
        <text>each visit by a member of a home health care team is considered one home health care visit; and</text>
      </level>
      <level label="ii">
        <text>up to 4 hours of home health care service is considered one home health care visit.</text>
      </level>
    </level>
  </level>
</section>
