Text: SF02407 Text: SF02409 Text: SF02400 - SF02499 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. NEW SECTION. 514C.19 MANDATED COVERAGE FOR 1 2 DENTAL CARE ANESTHESIA AND CERTAIN HOSPITAL CHARGES. 1 3 1. Notwithstanding section 514C.6, and subject to the 1 4 terms and conditions of the policy or contract, a policy or 1 5 contract providing for third-party payment or prepayment of 1 6 health or medical expenses shall provide coverage for the 1 7 administration of general anesthesia and hospital or 1 8 ambulatory surgical center charges related to the provision of 1 9 dental care services provided to any of the following covered 1 10 individuals: 1 11 a. A child under five years of age upon a determination by 1 12 a licensed dentist and the child's treating physician licensed 1 13 pursuant to chapter 148, 150, or 150A, that such child 1 14 requires necessary dental treatment in a hospital or 1 15 ambulatory surgical center due to a dental condition or a 1 16 developmental disability for which patient management in the 1 17 dental office has proved to be ineffective. 1 18 b. Any individual upon a determination by a licensed 1 19 dentist and the individual's treating physician licensed 1 20 pursuant to chapter 148, 150, or 150A, that such individual 1 21 has one or more medical conditions that would create 1 22 significant or undue medical risk for the individual in the 1 23 course of delivery of any necessary dental treatment or 1 24 surgery if not rendered in a hospital or ambulatory surgical 1 25 center. 1 26 2. Prior authorization of hospitalization or ambulatory 1 27 surgical center for dental care procedures may be required in 1 28 the same manner that prior authorization is required for 1 29 hospitalization for other coverages under the contract or 1 30 policy. 1 31 3. This section applies to the following classes of third- 1 32 party payment provider contracts or policies delivered, issued 1 33 for delivery, continued, or renewed in this state on or after 1 34 July 1, 2000: 1 35 a. Individual or group accident and sickness insurance 2 1 providing coverage on an expense-incurred basis. 2 2 b. An individual or group hospital or medical service 2 3 contract issued pursuant to chapter 509, 514, or 514A. 2 4 c. An individual or group health maintenance organization 2 5 contract regulated under chapter 514B. 2 6 d. Any other entity engaged in the business of insurance, 2 7 risk transfer, or risk retention, which is subject to the 2 8 jurisdiction of the commissioner. 2 9 e. A plan established pursuant to chapter 509A for public 2 10 employees. 2 11 f. An organized delivery system licensed by the director 2 12 of public health. 2 13 4. This section shall not apply to accident only, 2 14 specified disease, short-term hospital or medical, hospital 2 15 confinement indemnity, credit, dental, vision, Medicare 2 16 supplement, long-term care, basic hospital and medical- 2 17 surgical expense coverage as defined by the commissioner, 2 18 disability income insurance coverage, coverage issued as a 2 19 supplement to liability insurance, workers' compensation or 2 20 similar insurance, or automobile medical payment insurance. 2 21 EXPLANATION 2 22 This bill establishes a new Code section 514C.19 which 2 23 provides that a policy or contract providing for third-party 2 24 payment or prepayment of health or medical expenses must 2 25 provide coverage for the administration of general anesthesia 2 26 and hospital or ambulatory surgical center charges related to 2 27 providing dental care services for certain covered 2 28 individuals. The covered individuals include a child under 2 29 five years of age, upon a determination by a licensed dentist 2 30 and the child's treating physician that the child requires 2 31 necessary dental treatment in a hospital or ambulatory 2 32 surgical center due to a dental condition or a developmental 2 33 disability for which patient management in the dental office 2 34 has proved to be ineffective, and any other individual upon a 2 35 determination by a licensed dentist and the individual's 3 1 treating physician that the individual has one or more medical 3 2 conditions that would create significant or undue medical risk 3 3 for the individual in the course of providing the necessary 3 4 dental treatment or surgery if such treatment or surgery were 3 5 not performed in a hospital or ambulatory surgical center. 3 6 The bill provides that prior authorization for such dental 3 7 care procedures may be required in the same manner as required 3 8 for hospitalization for other coverages under the contract or 3 9 policy. The bill applies to third-party payment contracts or 3 10 policies delivered, issued for delivery, continued, or renewed 3 11 in this state on or after July 1, 2000. 3 12 LSB 5093SV 78 3 13 mj/cf/24
Text: SF02407 Text: SF02409 Text: SF02400 - SF02499 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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