ENROLLED
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 326
(Senator Stollings, original sponsor)
____________
[Passed April 11, 2009; in effect ninety days from passage.]
____________
AN ACT to amend and reenact §5-16-7 and §5-16-9 of the Code of West
Virginia, 1931, as amended; to amend said code by adding
thereto a new section, designated §33-15-4j; to amend said
code by adding thereto a new section, designated §33-16-3t; to
amend said code by adding thereto a new section, designated
§33-24-7j; to amend said code by adding thereto a new section,
designated §33-25-8h; and to amend said code by adding thereto
a new section, designated §33-25A-8i, all relating to
mandating insurance coverage of dental anesthesia in certain
circumstances.
Be it enacted by the Legislature of West Virginia:
That §5-16-7 and §5-16-9 of the Code of West Virginia, 1931,
as amended, be amended and reenacted; that said code be amended by
adding thereto a new section, designated §33-15-4j; that said code
be amended by adding thereto a new section, designated §33-16-3t; that said code be amended by adding thereto a new section,
designated §33-24-7j; that said code be amended by adding thereto
a new section, designated §33-25-8h; and that said code be amended
by adding thereto a new section, designated §33-25A-8i, all to read
as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,
SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD OF PUBLIC WORKS;
MISCELLANEOUS AGENCIES, COMMISSIONS, OFFICES, PROGRAMS, ETC.
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7. Authorization to establish group hospital and surgical
insurance plan, group major medical insurance plan, group
prescription drug plan and group life and accidental death
insurance plan; rules for administration of plans; mandated
benefits; what plans may provide; optional plans; separate
rating for claims experience purposes.
(a) The agency shall establish a group hospital and surgical
insurance plan or plans, a group prescription drug insurance plan
or plans, a group major medical insurance plan or plans and a group
life and accidental death insurance plan or plans for those
employees herein made eligible, and to establish and promulgate
rules for the administration of these plans, subject to the
limitations contained in this article. Those plans shall include:
(1) Coverages and benefits for X ray and laboratory services
in connection with mammograms when medically appropriate and
consistent with current guidelines from the United States Preventive Services Task Force; pap smears, either conventional or
liquid-based cytology, whichever is medically appropriate and
consistent with the current guidelines from either the United
States Preventive Services Task Force or The American College of
Obstetricians and Gynecologists; and a test for the human papilloma
virus (HPV) when medically appropriate and consistent with current
guidelines from either the United States Preventive Services Task
Force or The American College of Obstetricians and Gynecologists,
when performed for cancer screening or diagnostic services on a
woman age eighteen or over;
(2) Annual checkups for prostate cancer in men age fifty and
over;
(3) Annual screening for kidney disease as determined to be
medically necessary by a physician using any combination of blood
pressure testing, urine albumin or urine protein testing and serum
creatinine testing as recommended by the National Kidney
Foundation;
(4) For plans that include maternity benefits, coverage for
inpatient care in a duly licensed health care facility for a mother
and her newly born infant for the length of time which the
attending physician considers medically necessary for the mother or
her newly born child:
Provided, That no plan may deny payment for
a mother or her newborn child prior to forty-eight hours following
a vaginal delivery, or prior to ninety-six hours following a
caesarean section delivery, if the attending physician considers
discharge medically inappropriate;
(5) For plans which provide coverages for post-delivery care
to a mother and her newly born child in the home, coverage for
inpatient care following childbirth as provided in subdivision (4)
of this subsection if inpatient care is determined to be medically
necessary by the attending physician. Those plans may also
include, among other things, medicines, medical equipment,
prosthetic appliances and any other inpatient and outpatient
services and expenses considered appropriate and desirable by the
agency; and
(6) Coverage for treatment of serious mental illness.
(A) The coverage does not include custodial care, residential
care or schooling. For purposes of this section, "serious mental
illness" means an illness included in the American Psychiatric
Association's diagnostic and statistical manual of mental
disorders, as periodically revised, under the diagnostic categories
or subclassifications of: (i) Schizophrenia and other psychotic
disorders; (ii) bipolar disorders; (iii) depressive disorders; (iv)
substance-related disorders with the exception of caffeine-related
disorders and nicotine-related disorders; (v) anxiety disorders;
and (vi) anorexia and bulimia. With regard to any covered
individual who has not yet attained the age of nineteen years,
"serious mental illness" also includes attention deficit
hyperactivity disorder, separation anxiety disorder and conduct
disorder.
(B) Notwithstanding any other provision in this section to the
contrary, in the event that the agency can demonstrate actuarially that its total anticipated costs for the treatment of mental
illness for any plan will exceed or have exceeded two percent of
the total costs for such plan in any experience period, then the
agency may apply whatever cost-containment measures may be
necessary, including, but not limited to, limitations on inpatient
and outpatient benefits, to maintain costs below two percent of the
total costs for the plan.
(C) The agency shall not discriminate between medical-surgical
benefits and mental health benefits in the administration of its
plan. With regard to both medical-surgical and mental health
benefits, it may make determinations of medical necessity and
appropriateness, and it may use recognized health care quality and
cost management tools, including, but not limited to, limitations
on inpatient and outpatient benefits, utilization review,
implementation of cost-containment measures, preauthorization for
certain treatments, setting coverage levels, setting maximum number
of visits within certain time periods, using capitated benefit
arrangements, using fee-for-service arrangements, using third-party
administrators, using provider networks and using patient cost
sharing in the form of copayments, deductibles and coinsurance.
(7) Coverage for general anesthesia for dental procedures and
associated outpatient hospital or ambulatory facility charges
provided by appropriately licensed health care individuals in
conjunction with dental care if the covered person is:
(A) Seven years of age or younger or is developmentally
disabled, and is an individual for whom a successful result cannot be expected from dental care provided under local anesthesia
because of a physical, intellectual or other medically compromising
condition of the individual and for whom a superior result can be
expected from dental care provided under general anesthesia;
(B) A child who is twelve years of age or younger with
documented phobias, or with documented mental illness, and with
dental needs of such magnitude that treatment should not be delayed
or deferred and for whom lack of treatment can be expected to
result in infection, loss of teeth or other increased oral or
dental morbidity and for whom a successful result cannot be
expected from dental care provided under local anesthesia because
of such condition and for whom a superior result can be expected
from dental care provided under general anesthesia.
(b) The agency shall make available to each eligible employee,
at full cost to the employee, the opportunity to purchase optional
group life and accidental death insurance as established under the
rules of the agency. In addition, each employee is entitled to
have his or her spouse and dependents, as defined by the rules of
the agency, included in the optional coverage, at full cost to the
employee, for each eligible dependent; and with full authorization
to the agency to make the optional coverage available and provide
an opportunity of purchase to each employee.
(c) The finance board may cause to be separately rated for
claims experience purposes:
(1) All employees of the State of West Virginia;
(2) All teaching and professional employees of state public institutions of higher education and county boards of education;
(3) All nonteaching employees of the Higher Education Policy
Commission, West Virginia Council for Community and Technical
College Education and county boards of education; or
(4) Any other categorization which would ensure the stability
of the overall program.
(d) The agency shall maintain the medical and prescription
drug coverage for Medicare-eligible retirees by providing coverage
through one of the existing plans or by enrolling the
Medicare-eligible retired employees into a Medicare-specific plan,
including, but not limited to, the Medicare/Advantage Prescription
Drug Plan. In the event that a Medicare-specific plan would no
longer be available or advantageous for the agency and the
retirees, the retirees shall remain eligible for coverage through
the agency.
§5-16-9. Authorization to execute contracts for group hospital and
surgical insurance, group major medical insurance, group
prescription drug insurance, group life and accidental death
insurance and other accidental death insurance; mandated
benefits; limitations; awarding of contracts; reinsurance;
certificates for covered employees; discontinuance of
contracts.
(a) The director is hereby given exclusive authorization to
execute such contract or contracts as are necessary to carry out
the provisions of this article and to provide the plan or plans of group hospital and surgical insurance coverage, group major medical
insurance coverage, group prescription drug insurance coverage and
group life and accidental death insurance coverage selected in
accordance with the provisions of this article, such contract or
contracts to be executed with one or more agencies, corporations,
insurance companies or service organizations licensed to sell group
hospital and surgical insurance, group major medical insurance,
group prescription drug insurance and group life and accidental
death insurance in this state.
(b) The group hospital or surgical insurance coverage and
group major medical insurance coverage herein provided shall
include coverages and benefits for X ray and laboratory services in
connection with mammogram and pap smears when performed for cancer
screening or diagnostic services and annual checkups for prostate
cancer in men age fifty and over. Such benefits shall include, but
not be limited to, the following:
(1) Mammograms when medically appropriate and consistent with
the current guidelines from the United States Preventive Services
Task Force;
(2) A pap smear, either conventional or liquid-based cytology,
whichever is medically appropriate and consistent with the current
guidelines from the United States Preventive Services Task Force or
The American College of Obstetricians and Gynecologists, for women
age eighteen and over;
(3) A test for the human papilloma virus (HPV) for women age
eighteen or over, when medically appropriate and consistent with the current guidelines from either the United States Preventive
Services Task Force or The American College of Obstetricians and
Gynecologists for women age eighteen and over;
(4) A checkup for prostate cancer annually for men age fifty
or over; and
(5) Annual screening for kidney disease as determined to be
medically necessary by a physician using any combination of blood
pressure testing, urine albumin or urine protein testing and serum
creatinine testing as recommended by the National Kidney
Foundation.
(6) Coverage for general anesthesia for dental procedures and
associated outpatient hospital or ambulatory facility charges
provided by appropriately licensed healthcare individuals in
conjunction with dental care if the covered person is:
(A) Seven years of age or younger or is developmentally
disabled and is either an individual for whom a successful result
cannot be expected from dental care provided under local anesthesia
because of a physical, intellectual or other medically compromising
condition of the individual and for whom a superior result can be
expected from dental care provided under general anesthesia; or
(B) A child who is twelve years of age or younger with
documented phobias, or with documented mental illness, and with
dental needs of such magnitude that treatment should not be delayed
or deferred and for whom lack of treatment can be expected to
result in infection, loss of teeth or other increased oral or
dental morbidity and for whom a successful result cannot be expected from dental care provided under local anesthesia because
of such condition and for whom a superior result can be expected
from dental care provided under general anesthesia.
(c) The group life and accidental death insurance herein
provided shall be in the amount of $10,000 for every employee. The
amount of the group life and accidental death insurance to which an
employee would otherwise be entitled shall be reduced to $5,000
upon such employee attaining age sixty-five.
(d) All of the insurance coverage to be provided for under
this article may be included in one or more similar contracts
issued by the same or different carriers.
(e) The provisions of article three, chapter five-a of this
code, relating to the Division of Purchasing of the Department of
Finance and Administration, shall not apply to any contracts for
any insurance coverage or professional services authorized to be
executed under the provisions of this article. Before entering
into any contract for any insurance coverage, as authorized in this
article, the director shall invite competent bids from all
qualified and licensed insurance companies or carriers, who may
wish to offer plans for the insurance coverage desired:
Provided,
That the director shall negotiate and contract directly with health
care providers and other entities, organizations and vendors in
order to secure competitive premiums, prices and other financial
advantages. The director shall deal directly with insurers or
health care providers and other entities, organizations and vendors
in presenting specifications and receiving quotations for bid purposes. No commission or finder's fee, or any combination
thereof, shall be paid to any individual or agent; but this shall
not preclude an underwriting insurance company or companies, at
their own expense, from appointing a licensed resident agent,
within this state, to service the companies' contracts awarded
under the provisions of this article. Commissions reasonably
related to actual service rendered for the agent or agents may be
paid by the underwriting company or companies
: Provided, however,
That in no event shall payment be made to any agent or agents when
no actual services are rendered or performed. The director shall
award the contract or contracts on a competitive basis. In
awarding the contract or contracts the director shall take into
account the experience of the offering agency, corporation,
insurance company or service organization in the group hospital and
surgical insurance field, group major medical insurance field,
group prescription drug field and group life and accidental death
insurance field, and its facilities for the handling of claims. In
evaluating these factors, the director may employ the services of
impartial, professional insurance analysts or actuaries or both.
Any contract executed by the director with a selected carrier shall
be a contract to govern all eligible employees subject to the
provisions of this article. Nothing contained in this article
shall prohibit any insurance carrier from soliciting employees
covered hereunder to purchase additional hospital and surgical,
major medical or life and accidental death insurance coverage.
(f) The director may authorize the carrier with whom a primary contract is executed to reinsure portions of the contract with
other carriers which elect to be a reinsurer and who are legally
qualified to enter into a reinsurance agreement under the laws of
this state.
(g) Each employee who is covered under any contract or
contracts shall receive a statement of benefits to which the
employee, his or her spouse and his or her dependents are entitled
under the contract, setting forth the information as to whom the
benefits are payable, to whom claims shall be submitted and a
summary of the provisions of the contract or contracts as they
affect the employee, his or her spouse and his or her dependents.
(h) The director may at the end of any contract period
discontinue any contract or contracts it has executed with any
carrier and replace the same with a contract or contracts with any
other carrier or carriers meeting the requirements of this article.
(i) The director shall provide by contract or contracts
entered into under the provisions of this article the cost for
coverage of children's immunization services from birth through age
sixteen years to provide immunization against the following
illnesses: Diphtheria, polio, mumps, measles, rubella, tetanus,
hepatitis-b, haemophilus influenzae-b and whooping cough.
Additional immunizations may be required by the Commissioner of the
Bureau for Public Health for public health purposes. Any contract
entered into to cover these services shall require that all costs
associated with immunization, including the cost of the vaccine, if
incurred by the health care provider, and all costs of vaccine administration be exempt from any deductible, per visit charge
and/or copayment provisions which may be in force in these policies
or contracts. This section does not require that other health care
services provided at the time of immunization be exempt from any
deductible and/or copayment provisions.
CHAPTER 33. INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4j. Required coverage for dental anesthesia services.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after July 1, 2009,
provide as benefits to all subscribers and members coverage for
dental anesthesia services as hereinafter set forth.
(b) For purposes of this article and section, "dental
anesthesia services" means general anesthesia for dental procedures
and associated outpatient hospital or ambulatory facility charges
provided by appropriately licensed health care individuals in
conjunction with dental care provided to an enrollee or insured if
the enrollee or insured is:
(A) Seven years of age or younger or is developmentally
disabled and is an individual for whom a successful result cannot
be expected from dental care provided under local anesthesia
because of a physical, intellectual or other medically compromising
condition of the enrollee or insured and for whom a superior result
can be expected from dental care provided under general anesthesia; or
(B) A child who is twelve years of age or younger with
documented phobias, or with documented mental illness, and with
dental needs of such magnitude that treatment should not be delayed
or deferred and for whom lack of treatment can be expected to
result in infection, loss of teeth or other increased oral or
dental morbidity and for whom a successful result cannot be
expected from dental care provided under local anesthesia because
of such condition and for whom a superior result can be expected
from dental care provided under general anesthesia.
(c)
Prior authorization. -- An entity subject to this section
may require prior authorization for general anesthesia and
associated outpatient hospital or ambulatory facility charges for
dental care in the same manner that prior authorization is required
for these benefits in connection with other covered medical care.
(d) An entity subject to this section may restrict coverage
for general anesthesia and associated outpatient hospital or
ambulatory facility charges unless the dental care is provided by:
(1) A fully accredited specialist in pediatric dentistry;
(2) A fully accredited specialist in oral and maxillofacial
surgery; and
(3) A dentist to whom hospital privileges have been granted.
(e)
Dental care coverage not required. -- The provisions of
this section may not be construed to require coverage for the
dental care for which the general anesthesia is provided.
(f)
Temporal mandibular joint disorders. -- The provisions of this section do not apply to dental care rendered for temporal
mandibular joint disorders.
(g) A policy, provision, contract, plan or agreement may apply
to dental anesthesia services the same deductibles, coinsurance and
other limitations as apply to other covered services.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3t. Required coverage for dental anesthesia services.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after July 1, 2009,
provide as benefits to all subscribers and members coverage for
dental anesthesia services as hereinafter set forth.
(b) For purposes of this article and section, "dental
anesthesia services" means general anesthesia for dental procedures
and associated outpatient hospital or ambulatory facility charges
provided by appropriately licensed health care individuals in
conjunction with dental care provided to an enrollee or insured if
the enrollee or insured is:
(1) Seven years of age or younger or is developmentally
disabled and is an individual for whom a successful result cannot
be expected from dental care provided under local anesthesia
because of a physical, intellectual or other medically compromising
condition of the enrollee or insured and for whom a superior result
can be expected from dental care provided under general anesthesia;
or
(2) A child who is twelve years of age or younger with documented phobias, or with documented mental illness, and with
dental needs of such magnitude that treatment should not be delayed
or deferred and for whom lack of treatment can be expected to
result in infection, loss of teeth or other increased oral or
dental morbidity and for whom a successful result cannot be
expected from dental care provided under local anesthesia because
of such condition and for whom a superior result can be expected
from dental care provided under general anesthesia.
(c)
Prior authorization. -- An entity subject to this section
may require prior authorization for general anesthesia and
associated outpatient hospital or ambulatory facility charges for
dental care in the same manner that prior authorization is required
for these benefits in connection with other covered medical care.
(d) An entity subject to this section may restrict coverage
for general anesthesia and associated outpatient hospital or
ambulatory facility charges unless the dental care is provided by:
(1) A fully accredited specialist in pediatric dentistry;
(2) A fully accredited specialist in oral and maxillofacial
surgery; and
(3) A dentist to whom hospital privileges have been granted.
(e)
Dental care coverage not required. -- The provisions of
this section may not be construed to require coverage for the
dental care for which the general anesthesia is provided.
(f)
Temporal mandibular joint disorders. -- The provisions of
this section do not apply to dental care rendered for temporal
mandibular joint disorders.
(g) A policy, provision, contract, plan or agreement may apply
to dental anesthesia services the same deductibles, coinsurance and
other limitations as apply to other covered services.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE
CORPORATIONS, DENTAL SERVICE CORPORATIONS AND
HEALTH SERVICE CORPORATIONS.
§33-24-7j. Required coverage for dental anesthesia services.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after July 1, 2009,
provide as benefits to all subscribers and members coverage for
dental anesthesia services as hereinafter set forth.
(b) For purposes of this article and section, "dental
anesthesia services" means general anesthesia for dental procedures
and associated outpatient hospital or ambulatory facility charges
provided by appropriately licensed health care individuals in
conjunction with dental care provided to an enrollee or insured if
the enrollee or insured is:
(1) Seven years of age or younger or is developmentally
disabled and is an individual for whom a successful result cannot
be expected from dental care provided under local anesthesia
because of a physical, intellectual or other medically compromising
condition of the enrollee or insured and for whom a superior result
can be expected from dental care provided under general anesthesia;
or
(2)A child who is twelve years of age or younger with
documented phobias, or with documented mental illness, and with
dental needs of such magnitude that treatment should not be delayed
or deferred and for whom lack of treatment can be expected to
result in infection, loss of teeth or other increased oral or
dental morbidity and for whom a successful result cannot be
expected from dental care provided under local anesthesia because
of such condition and for whom a superior result can be expected
from dental care provided under general anesthesia.
(c)
Prior authorization. -- An entity subject to this section
may require prior authorization for general anesthesia and
associated outpatient hospital or ambulatory facility charges for
dental care in the same manner that prior authorization is required
for these benefits in connection with other covered medical care.
(d) An entity subject to this section may restrict coverage
for general anesthesia and associated outpatient hospital or
ambulatory facility charges unless the dental care is provided by:
(1) A fully accredited specialist in pediatric dentistry;
(2) A fully accredited specialist in oral and maxillofacial
surgery; and
(3) A dentist to whom hospital privileges have been granted.
(e)
Dental care coverage not required. -- The provisions of
this section may not be construed to require coverage for the
dental care for which the general anesthesia is provided.
(f)
Temporal mandibular joint disorders. -- The provisions of
this section do not apply to dental care rendered for temporal mandibular joint disorders.
(g) A policy, provision, contract, plan or agreement may apply
to dental anesthesia services the same deductibles, coinsurance and
other limitations as apply to other covered services.
ARTICLE 25. HEALTH CARE CORPORATIONS.
§33-25-8h. Required coverage for dental anesthesia services.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after July 1, 2009,
provide as benefits to all subscribers and members coverage for
dental anesthesia services as hereinafter set forth.
(b) For purposes of this article and section, "dental
anesthesia services" means general anesthesia for dental procedures
and associated outpatient hospital or ambulatory facility charges
provided by appropriately licensed health care individuals in
conjunction with dental care provided to an enrollee or insured if
the enrollee or insured is:
(1) Seven years of age or younger or is developmentally
disabled and is an individual for whom a successful result cannot
be expected from dental care provided under local anesthesia
because of a physical, intellectual or other medically compromising
condition of the enrollee or insured and for whom a superior result
can be expected from dental care provided under general anesthesia;
or
(2)A child who is twelve years of age or younger with
documented phobias, or with documented mental illness, and with dental needs of such magnitude that treatment should not be delayed
or deferred and for whom lack of treatment can be expected to
result in infection, loss of teeth or other increased oral or
dental morbidity and for whom a successful result cannot be
expected from dental care provided under local anesthesia because
of such condition and for whom a superior result can be expected
from dental care provided under general anesthesia.
(c)
Prior authorization. -- An entity subject to this section
may require prior authorization for general anesthesia and
associated outpatient hospital or ambulatory facility charges for
dental care in the same manner that prior authorization is required
for these benefits in connection with other covered medical care.
(d) An entity subject to this section may restrict coverage
for general anesthesia and associated outpatient hospital or
ambulatory facility charges unless the dental care is provided by:
(1) A fully accredited specialist in pediatric dentistry;
(2) A fully accredited specialist in oral and maxillofacial
surgery; and
(3) A dentist to whom hospital privileges have been granted.
(e)
Dental care coverage not required. -- The provisions of
this section may not be construed to require coverage for the
dental care for which the general anesthesia is provided.
(f)
Temporal mandibular joint disorders. -- The provisions of
this section do not apply to dental care rendered for temporal
mandibular joint disorders.
(g) A policy, provision, contract, plan or agreement may apply to dental anesthesia services the same deductibles, coinsurance and
other limitations as apply to other covered services.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8i. Third-party reimbursement for dental anesthesia
services.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after July 1, 2009,
provide as benefits to all subscribers and members coverage for
dental anesthesia services as hereinafter set forth.
(b) For purposes of this section, "dental anesthesia services"
means general anesthesia for dental procedures and associated
outpatient hospital or ambulatory facility charges provided by
appropriately licensed health care individuals in conjunction with
dental care provided to a subscriber or member if the subscriber or
member is:
(1) Seven years of age or younger or is developmentally
disabled and is an individual for whom a successful result cannot
be expected from dental care provided under local anesthesia
because of a physical, intellectual or other medically compromising
condition of the subscriber or member and for whom a superior
result can be expected from dental care provided under general
anesthesia; or
(2)A child who is twelve years of age or younger with
documented phobias, or with documented mental illness, and with dental needs of such magnitude that treatment should not be delayed
or deferred and for whom lack of treatment can be expected to
result in infection, loss of teeth, or other increased oral or
dental morbidity and for whom a successful result cannot be
expected from dental care provided under local anesthesia because
of such condition and for whom a superior result can be expected
from dental care provided under general anesthesia.
(c)
Prior authorization. -- An entity subject to this section
may require prior authorization for general anesthesia and
associated outpatient hospital, ambulatory facility or similar
charges for dental care in the same manner that prior authorization
is required for these benefits in connection with other covered
medical care.
(d) An entity subject to this section may restrict coverage
for general anesthesia and associated outpatient hospital or
ambulatory facility charges unless the dental care is provided by:
(1) A fully accredited specialist in pediatric dentistry;
(2) A fully accredited specialist in oral and maxillofacial
surgery; and
(3) A dentist to whom hospital privileges have been granted.
(e)
Dental care coverage not required. -- The provisions of
this section may not be construed to require coverage for the
dental care for which the general anesthesia is provided.
(f)
Temporal mandibular joint disorders. -- The provisions of
this section do not apply to dental care rendered for temporal
mandibular joint disorders.
(g) A policy, provision, contract, plan or agreement may apply
to dental anesthesia services the same deductibles, coinsurance and
other limitations as apply to other covered services.