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
© 2000 Cornell College and League of Women Voters of Iowa
Comments about this site or page?
webmaster@legis.iowa.gov.
Please remember that the person listed above does not vote on bills. Direct all comments concerning legislation to State Legislators.
Last update: Tue Apr 18 03:35:00 CDT 2000
URL: /DOCS/GA/78GA/Legislation/SF/02400/SF02408/000229.html
jhf