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2000 SESSION

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HB 165 Health insurance; coverage for dental procedures.

Introduced by: James M. Shuler | all patrons    ...    notes | add to my profiles | history

SUMMARY AS PASSED:

Accident and sickness insurance; coverage for hospitalization and anesthesia for dental procedures. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for general anesthesia and hospitalization or facilities charges of a licensed outpatient surgery facility for dental care provided to a covered person who is determined by a licensed dentist in consultation with the covered person's treating physician to require general anesthesia and admission to a hospital or outpatient surgery facility to effectively and safely provide dental care and (i) is under the age of five, (ii) is severely disabled, or (iii) has a medical condition and requires admission to a hospital or outpatient surgery facility and general anesthesia for dental care treatment. Such insurers, corporations or organizations (i) may require prior authorization for this benefit in the same manner as is required for other covered benefits and (ii) shall restrict coverage for general anesthesia expenses and for facility charges to the appropriate licensed providers.

SUMMARY AS INTRODUCED:

Accident and sickness insurance; coverage for hospitalization and anesthesia for dental procedures. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for general anesthesia and hospitalization or facilities charges of a licensed outpatient surgery facility for dental care provided to a covered person who is determined by a licensed dentist in consultation with the covered person's treating physician to require general anesthesia and admission to a hospital or outpatient surgery facility to effectively and safely provide dental care and (i) is under the age of five, (ii) is severely disabled, or (iii) has a medical condition and requires admission to a hospital or outpatient surgery facility and general anesthesia for dental care treatment. Such insurers, corporations or organizations (i) may require prior authorization for this benefit in the same manner as is required for other covered benefits and (ii) shall restrict coverage for general anesthesia expenses and for facility charges to the appropriate licensed providers. The bill’s provisions are applicable to policies, plans and contracts delivered, issued for delivery or renewed on and after July 1, 2000. They are not applicable to short-term travel, accident-only, limited or specified disease policies, or to policies or contracts designed for persons eligible for Medicare or similar coverage under state or federal governmental plans.