376.1225. Mandated coverage for general anesthesia and hospital charges for dental care, when--prior authorization required, when--exceptions.
Mandated coverage for general anesthesia and hospital charges fordental care, when--prior authorization required, when--exceptions.
376.1225. 1. All individual and group health insurance policiesproviding coverage on an expense-incurred basis, individual and groupservice or indemnity type contracts issued by a nonprofit corporation,individual and group service contracts issued by a health maintenanceorganization, all self-insured group arrangements to the extent notpreempted by federal law and all managed health care delivery entities ofany type or description, that are delivered, issued for delivery, continuedor renewed on or after August 28, 1998, shall provide coverage foradministration of general anesthesia and hospital charges for dental careprovided to the following covered persons:
(1) A child under the age of five;
(2) A person who is severely disabled; or
(3) A person who has a medical or behavioral condition which requireshospitalization or general anesthesia when dental care is provided.
2. Each plan as described in this section must provide coverage foradministration of general anesthesia and hospital or office charges fortreatment rendered by a dentist, regardless of whether the services areprovided in a participating hospital or surgical center or office.
3. Nothing in this section shall prevent a health carrier fromrequiring prior authorization for hospitalization for dental careprocedures in the same manner that prior authorization is required forhospitalization for other covered diseases or conditions.
4. Nothing in this section shall apply to accident-only, dental-onlyplans or other specified disease, hospital indemnity, Medicare supplementor long-term care policies, or short-term major medical policies of sixmonths or less in duration.
(L. 1998 H.B. 1302 § 8)