[ First paragraph effective until July 1, 2009. For text effective July 1, 2009, see below.]
Section 4. Any health maintenance contract shall provide coverage for those health services relating to the treatment of alcoholism as required by subdivision (H) of section 110 of chapter 175. Such health maintenance contract shall also provide coverage for pregnant women, infants and children as set forth in section forty-seven C of chapter one hundred and seventy-five. Such health maintenance contract shall also provide coverage for cardiac rehabilitation as set forth in section forty-seven D of chapter one hundred and seventy-five. Such health maintenance contract shall also provide coverage for prenatal care, childbirth and postpartum care as set forth in section forty-seven F of chapter one hundred and seventy-five. Such health maintenance contract shall also provide coverage for cytologic screening and mammographic examination as set forth in section forty-seven G of chapter one hundred and seventy-five. Such health maintenance contract shall also provide coverage for diagnosis and treatment of infertility as set forth in section forty-seven H of chapter one hundred and seventy-five. Such health maintenance contract shall also provide coverage for services rendered by a certified registered nurse anesthetist or nurse practitioner, as set forth in section forty-seven Q of chapter one hundred and seventy-five, subject to the terms of a negotiated agreement between the health maintenance organization and the provider of health care services. Coverage for services as set forth in clause (4) of paragraph (c) of section forty-seven B of chapter one hundred and seventy-five rendered by a mental health counselor licensed under the provisions of chapter one hundred and twelve shall be subject to the terms of a negotiated agreement between a health maintenance organization and a mental health counselor.
[ First paragraph as amended by 2008, 256, Sec. 13 effective July 1, 2009. See 2008, 256, Sec. 17. For text effective until July 1, 2009, see above.]
A health maintenance contract shall provide coverage for:
(a) pregnant women, infants and children as set forth in section 47C of chapter 175;
(b) cardiac rehabilitation as set forth in section 47D of chapter 175;
(c) prenatal care, childbirth and postpartum care as set forth in section 47F of chapter 175;
(d) cytologic screening and mammographic examination as set forth in section 47G of chapter 175;
(e) diagnosis and treatment of infertility as set forth in section 47H of chapter 175; and
(f) services rendered by a certified registered nurse anesthetist or nurse practitioner as set forth in section 47Q of chapter 175, subject to the terms of a negotiated agreement between the health maintenance organization and the provider of health care services.
The dependent coverage of any such policy shall also provide coverage for medically necessary early intervention services delivered by certified early intervention specialists, as defined in the early intervention operational standards by the department of public health and in accordance with applicable certification requirements. Such medically necessary services shall be provided by early intervention specialists who are working in early intervention programs certified by the department of public health, as provided in sections 1 and 2 of chapter 111G, for children from birth until their third birthday. Reimbursement of costs for such services shall be part of a basic benefits package offered by the insurer or a third party, with a maximum benefit of $5,200 per year per child and an aggregate benefit of $15,600 over the total enrollment period.