<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-854.1" 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>“Active course of treatment” means a course of treatment for which an insured is actively seeing a health care provider and following the course of treatment.</text>
    </level>
    <level label="3">
      <text>“Course of treatment” means treatment that:</text>
      <level label="i">
        <text>is prescribed to treat or ordered for the treatment of an insured with a specific condition;</text>
      </level>
      <level label="ii">
        <text>is outlined and agreed to by the insured and the health care provider before the treatment begins; and</text>
      </level>
      <level label="iii">
        <text>may be part of a treatment plan.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>This section applies to:</text>
      <level label="i">
        <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="ii">
        <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="2">
      <text>An insurer, a nonprofit health service plan, or a health maintenance organization that contracts with a private review agent under Subtitle 10B of this title is subject to the requirements of this section.</text>
    </level>
    <level label="3">
      <text>An insurer, a nonprofit health service plan, or a health maintenance organization that contracts with a third party to dispense medical devices, medical appliances, or medical goods for the treatment of a human disease or dysfunction is subject to the requirements of this section.</text>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <text>Notwithstanding § 15–854 of this subtitle as it applies to coverage for prescription drugs, an entity subject to this section shall approve a request for the prior authorization of a course of treatment, including for chronic conditions, rehabilitative services, substance use disorders, and mental health conditions, that is:</text>
      <level label="i">
        <text>for a period of time that is as long as necessary to avoid disruptions in care; and</text>
      </level>
      <level label="ii">
        <text>determined in accordance with applicable coverage criteria, the insured’s medical history, and the health care provider’s recommendation.</text>
      </level>
    </level>
    <level label="2">
      <text>For new enrollees, an entity subject to this section may not disrupt or require reauthorization for an active course of treatment for covered services for at least 90 days after the date of enrollment.</text>
    </level>
  </level>
</section>
