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<section article="gin" article_name="Insurance" number="15-835" title_number="15" title_name="Health Insurance" subtitle_number="8" subtitle_name="Required Health Insurance Benefits">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“Habilitative services” means services and devices, including occupational therapy, physical therapy, and speech therapy, that help a child keep, learn, or improve skills and functioning for daily living.</text>
    </level>
    <level label="3">
      <text>“Managed care system” means a method that an insurer, a nonprofit health service plan, or a health maintenance organization uses to review and preauthorize a treatment plan that a health care practitioner develops for a covered person using a variety of cost containment methods to control utilization, quality, and claims.</text>
    </level>
  </level>
  <level label="b">
    <text>This section applies to:</text>
    <level label="1">
      <text>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</text>
    </level>
    <level label="2">
      <text>health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.</text>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <text>An entity subject to this section:</text>
      <level label="i">
        <text>shall provide coverage of habilitative services for insureds and enrollees who are children until at least the end of the month in which the insured or enrollee turns 19 years old; and</text>
      </level>
      <level label="ii">
        <text>may do so through a managed care system.</text>
      </level>
    </level>
    <level label="2">
      <text>An entity subject to this section is not required to provide reimbursement for habilitative services delivered through early intervention or school services.</text>
    </level>
  </level>
  <level label="d">
    <text>An entity subject to this section shall provide notice annually to its insureds and enrollees about the coverage required under this section:</text>
    <level label="1">
      <text>in print; and</text>
    </level>
    <level label="2">
      <text>on its Web site.</text>
    </level>
  </level>
  <level label="e">
    <text>Beginning November 1, 2013, a determination by an entity subject to this section of whether habilitative services covered under this section are medically necessary and appropriate to treat autism and autism spectrum disorders shall be made in accordance with regulations adopted by the Commissioner.</text>
  </level>
</section>
