MISSISSIPPI LEGISLATURE

1998 Regular Session

To: Insurance; Public Health and Welfare

By: Senator(s) Dearing

AN ACT TO REQUIRE HEALTH INSURANCE COVERAGE WHEN DENTAL CARE IS PROVIDED UNDER GENERAL ANESTHESIA; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. Every hospital, health or medical expenses insurance policy, hospital or medical service contract, employee welfare benefit plan, health or accident insurance policy, or any policy of group, family group, or blanket or franchise, health and accident insurance or self-insurance plan, health maintenance organization, and preferred provider organization which is delivered or issued for delivery in this state shall provide benefits for anesthesia and for associated facility charges when the mental or physical condition of the insured requires dental treatment to be rendered under general anesthesia in a hospital setting, surgical center or dental office. The requirements of this section shall be fully applicable to the State Employees Health Insurance Plan and the Public School Employees Health Insurance Plan. Excluded herefrom are limited benefit or supplemental health insurance policies.

An insurer may require prior authorization for the anesthesia and associated facility charges for dental care procedures in the same manner that prior authorization is required for treatment of other medical conditions under general anesthesia. The benefit provided by this coverage shall be subject to the same annual deductibles or co-insurance established for all other covered benefits within a given policy, plan or contract. Private third party payers may not reduce or eliminate coverage due to these requirements.

A dentist shall consider the Indications for General Anesthesia as published in the reference manual of the American Academy of Pediatric Dentistry as utilization standards for determining whether performing dental procedures necessary to treat the particular condition or conditions of the patient under general anesthesia constitutes appropriate treatment.

The provisions of this legislation shall not apply to treatment rendered for temporal mandibular joint (TMJ) disorders.

An insurer under this legislation may restrict coverage to include only procedures performed by a fully accredited specialist in pediatric dentistry or other dentists fully accredited in a recognized dental specialty for which hospital privileges are granted or a dentist who is certified by virtue of completion of an accredited program of post-graduate hospital training to be granted hospital privileges.

SECTION 2. This act shall take effect and be in force from and after July 1, 1998.