Effective on
and after July 1, 2009 for renewals and new sales, the following
changes will be implemented in the Maryland Small Group market:
Dependent
children who meet the definition of a dependent child, as defined
in the Eligibility Provisions of the Group’s Contract will
now be covered to age 25.
o
What specifically is the definition of a Dependent Child?
To
qualify as a dependent under a CareFirst health plan, the individual
must
be:
•
The natural child, stepchild, adopted child, or grandchild of
the Subscriber
or the Subscriber’s covered spouse;
•
A child (including a grandchild) placed with the Subscriber or
the
Subscriber’s covered spouse for legal adoption;
•
A child under testamentary or court appointed guardianship,
other
than temporary guardianship for less than 12 months duration,
of the Subscriber or the Subscriber’s covered
spouse;
or
•
A child who is the subject of a Medical Child Support Order or
a Qualified
Medical Support Order (“QMSO”) that creates or recognizes
the right of the child to receive benefits under the health
insurance coverage of the Subscriber or the Subscriber’s
covered
spouse.
•
The individual must have the same place of residence as the Subscriber
for more than one-half of the previous calendar year; and
not have provided over one-half of his or her own support for
the
previous calendar year and be unmarried.
• Foster children are not eligible to enroll as dependents.
The surgical
treatment of morbid obesity as defined in Insurance Article 15-839,
Annotated Code of Maryland is now a covered service. The exclusion
for the medical or surgical treatment for morbid obesity is deleted.
o What
procedures are considered medically necessary for the treatment
of morbid obesity? Please refer to Medical Policy
7.01.036,
Obesity and Morbid Obesity in the Providers and Physicians section
of www.carefirst.com
for a full description of what procedures
are
considered medically necessary. Examples of covered services include:
adjustable gastric banding, gastric bypass and
gastric
stapling.
o What
are the eligibility requirements for morbid obesity surgery?
Morbid
obesity is defined as a body mass index that
is greater than
40
kilograms per meter squared; or equal to or greater than 35 kilograms
per meter squared with a co-morbid medical condition, including
hypertension, a cardiopulmonary condition, sleep apnea, or diabetes.
Members should seek the care of their physician to
determine
if they are eligible for surgery.
