514C.20 - MANDATED COVERAGE FOR DENTAL CARE -- ANESTHESIA AND CERTAIN HOSPITAL CHARGES.

        514C.20  MANDATED COVERAGE FOR DENTAL CARE --      ANESTHESIA AND CERTAIN HOSPITAL CHARGES.         1.  Notwithstanding section 514C.6, and subject to the terms and      conditions of the policy or contract, a policy or contract providing      for third-party payment or prepayment of health or medical expenses      shall provide coverage for the administration of general anesthesia      and hospital or ambulatory surgical center charges related to the      provision of dental care services provided to any of the following      covered individuals:         a.  A child under five years of age upon a determination by a      licensed dentist and the child's treating physician licensed pursuant      to chapter 148, that such child requires necessary dental treatment      in a hospital or ambulatory surgical center due to a dental condition      or a developmental disability for which patient management in the      dental office has proved to be ineffective.         b.  Any individual upon a determination by a licensed dentist      and the individual's treating physician licensed pursuant to chapter      148, that such individual has one or more medical conditions that      would create significant or undue medical risk for the individual in      the course of delivery of any necessary dental treatment or surgery      if not rendered in a hospital or ambulatory surgical center.         2.  Prior authorization of hospitalization or ambulatory surgical      center for dental care procedures may be required in the same manner      that prior authorization is required for hospitalization for other      coverages under the contract or policy.         3.  This section applies to the following classes of third-party      payment provider contracts or policies delivered, issued for      delivery, continued, or renewed in this state on or after July 1,      2000:         a.  Individual or group accident and sickness insurance      providing coverage on an expense-incurred basis.         b.  An individual or group hospital or medical service      contract issued pursuant to chapter 509, 514, or 514A.         c.  An individual or group health maintenance organization      contract regulated under chapter 514B.         d.  Any other entity engaged in the business of insurance,      risk transfer, or risk retention, which is subject to the      jurisdiction of the commissioner.         e.  A plan established pursuant to chapter 509A for public      employees.         f.  An organized delivery system licensed by the director of      public health.         4.  This section shall not apply to accident-only, specified      disease, short-term hospital or medical, hospital confinement      indemnity, credit, dental, vision, Medicare supplement, long-term      care, basic hospital and medical-surgical expense coverage as defined      by the commissioner, disability income insurance coverage, coverage      issued as a supplement to liability insurance, workers' compensation      or similar insurance, or automobile medical payment insurance.  
         Section History: Recent Form
         2000 Acts, ch 1193, §1; 2008 Acts, ch 1088, §134