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PAG LIN
1 1 Section 1. NEW SECTION. 514C.13 DENTAL CARE TREATMEMT
1 2 ANESTHESIA COVERAGE.
1 3 1. a. Notwithstanding the uniformity of treatment
1 4 requirements of section 514C.6, a policy or contract providing
1 5 for third-party payment or prepayment of health or medical
1 6 expenses shall provide coverage benefits for anesthesia and
1 7 hospital charges associated with dental care provided to a
1 8 covered insured or enrollee who is one of the following:
1 9 (1) A child under the age of five.
1 10 (2) A severely disabled person.
1 11 (3) A person who has a medical condition which requires
1 12 hospitalization or general anesthesia for dental care
1 13 treatment.
1 14 A third-party payor shall not require prior authorization
1 15 of hospitalization for dental care procedures which is
1 16 different than that required for hospitalization for other
1 17 covered diseases and conditions.
1 18 b. Notwithstanding the uniformity of treatment
1 19 requirements of section 514C.6, a policy or contract providing
1 20 for third-party payment or prepayment of health or medical
1 21 expenses shall provide coverage benefits for general
1 22 anesthesia and treatment provided by a dentist for a medical
1 23 condition covered by a policy or contract, regardless of
1 24 whether such services are provided in a hospital or dental
1 25 office.
1 26 2. This section applies to the following classes of third-
1 27 party payment provider contracts or policies delivered, issued
1 28 for delivery, continued, or renewed in this state on or after
1 29 July 1, 1997:
1 30 a. Individual or group accident and sickness insurance
1 31 providing coverage on an expense-incurred basis.
1 32 b. An individual or group hospital or medical service
1 33 contract issued pursuant to chapter 509, 514, or 514A.
1 34 c. An individual or group health maintenance organization
1 35 contract regulated under chapter 514B.
2 1 d. An individual or group Medicare supplemental policy,
2 2 unless coverage pursuant to such policy is preempted by
2 3 federal law.
2 4 e. An organized delivery system licensed by the director
2 5 of public health.
2 6 EXPLANATION
2 7 This bill provides that a third-party payor of health or
2 8 medical expenses shall provide coverage benefits to an insured
2 9 or enrollee for anesthesia and hospital charges associated
2 10 with dental care services received by an insured or enrollee
2 11 who is a child under the age of five, a severely disabled
2 12 person, a person who has a medical condition which requires
2 13 hospitalization or general anesthesia for dental care
2 14 treatment. The bill also provides that such contracts must
2 15 provide coverage benefits for general anesthesia and treatment
2 16 provided by a dentist for a medical condition covered by a
2 17 policy or contract, regardless of whether such services are
2 18 provided in a hospital or dental office.
2 19 This bill provides that the section applies to third-party
2 20 payor contracts or policies delivered, issued for delivery,
2 21 continued, or renewed in this state on or after July 1, 1997,
2 22 by an individual or group accident and sickness insurance
2 23 providing coverage on an expense-incurred basis; an individual
2 24 or group hospital or medical service contract issued pursuant
2 25 to chapter 509, 514, or 514A; an individual or group health
2 26 maintenance organization contract regulated under chapter
2 27 514B; an individual or group Medicare supplemental policy,
2 28 unless coverage pursuant to such policy is preempted by
2 29 federal law; and an organized delivery system licensed by the
2 30 director of public health.
2 31 LSB 2476SS 77
2 32 mj/jj/8
Text: SF00325 Text: SF00327 Text: SF00300 - SF00399 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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